Loading...
HomeMy WebLinkAbout1112 MAIN STREET (OST.) - Health 1112 MAIN ST. OSTERVILLE -AC)l 0 v ' r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF:ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION 4 TITLE:5 : OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1112 Main St.,Oak&Ivory and Units 1-4, Osterville,MA 02655 Owner's Name: Sherm Six Condominiums Trust. Owner's Address: c/o'Huntingest Management 40 IndustryRd.,Marstons"Mills;MA 02648 Date of Inspection: 11116/2009 Name of Inspector:Michael T.Bisienere Company Name:A&K Septic Systems Plus Mailing Address: 565 Carriage.Shop Road,East Falmouth,MA 02536 Telephone Number: 508-540-6706 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and thatthe 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 DEF approved system inspector pursuant to Section,15.340 of Title 5(310 CMR 15.000). The system:. �r X .. Passes - Conditionally Passes Needs,Further Evaluation by the Local Approving Authority Fails - _ Inspector's Signature: �� ,^, 'Hate.. 11/16/200! rn _ 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 tc the system owner and copies sent to the buyer,if applicable,_and the if uth _ _ - aonty. - - - Notes and Comments: System functioning fine. No evidence of failure criteria. System consists of.1000 gallon tank with d-box and a 1000 gallon leaching pit. : : ---- ------ **—**-T-his-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-systemwill perform-in-the future-under-thesameor different - - conditions of use. Title 5 Inspection Form 6/15/2000. page 1 Page 2 of l 1 - OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) . Property Address: 1112 Main St.,Oak&Ivory and Units 1-4,Osterville,MA 02655 Owner: Joseph Amaral Date of Inspection: 11/16+2009 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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".is metal and over20 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-eexplain:=-•� - - -= � _ =� --�_ —= -� .-- = -- -_-- _- =--- =_-_ 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 ,. . . 3 stz.butign=bog '�veled o ,pi,red �_ - - -- ND explain: _ The,system required-pumping more than 4 times a year due to brokewor'obstructed pipe(s)..The system will pass inspection if(with.approval of the Board of Health): -broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Ins ection Form 6/15/2000. 2 P Page 3 of 1.1 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART A CERTIFICATION(continued) Property.Address: 1112 Main St.,Oak&Ivory and Units.1-4,Osterville,MA 02655 . Owner: Joseph Amaral w Date of Inspection: 11/16/2009, 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 failingto protect public heal f . sae or the environment. P P th,, tY ..- - 1. . System.will pass unless Board of Health determines in accordance with 310 CNM 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 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 br tributary to a surface water supply.- The system has a septic.tank and SAS and the SAS is within"a Zone l of a public water supply. The system has aseptic 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 ,- rivate— - PP y water su l well**:=Method used_to;determine distance ,- - **This system passes if the well water analysis;performed at a DEP certified laboratory.,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to.or less than 5 ppm,provided that no other. . failure criteria are triggered.A copy of the analysis must be attached to this form: 3. Other: Title 5.Inspection.Form 6/15/20.00 3 Page 4 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A . CERTIFICATION(continued) Property Address: 1112 Main St.;Oak&Ivory and Units 1-4,Osterville,:MA 02655 Owner: Joseph Amaral Date of Inspection: 11/16/2009 D. _System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or-clogged SAS or cesspool- X Discharge or ponding of effluent to the surface.of the ground or surface waters due,to an overloaded or clogged.SAS.or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or. cesspool X Liquid depth in cesspool is.less than b'.'below:invert or available volume is less than'/z day flow X Required pumping more than 4 times mffie'last year NOT due to clogged or obstructed pipe(s): . Number.of times pumped X — Any Portion of the SAS,.cesspool or.privy.is below hi� �o und water elevation X Any portion of cesspool or privy is within.I00.feet of a.surface water supply or tributary to a Surface water supply. X Any portion of a cesspool'or privy is within a Zone I of a.public well. X Any portion of a cesspool or.privyis.within50 feet of a private water supply well: ; X Any portion of a cesspool or privy is less than 00 fleet 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 co py.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,lEl be necessary_to-correct--the failur-e. -=-�- .-- ---=- - - _ - — E: Large Systems: To be considered a large system the.system must serve a facility with a design 'flow of 1:0,000'gpd to 15;000 gPd• You must indicate either"yes or"no"to each of the following: (The following criteria.a to lame 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-- I WPA)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 Title 5 Inspection Form 6/15/2000 4 Page 5,of,i 1 significant threat under Section E or failed under Section D shall upgrade the system in accordance with 3 10 CMR 15.304.The system owner should contact the appropriate regional',office of the Department. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST.... Property Address: 1112 Main St.,Oak&Ivory and Units 1-4,Osterville,MA 02655 Owner:Joseph Amaral Date of Inspection: 11/16/2009 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant;or.Board of Health X Were any of the system components pumped out in the previous two weeks 7 X' Has the.system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection.? X Were as.built plans of the system obtained`and examined?(If they were not available note as N/A). X ' Was the facility or dwelling inspected for signsof sewage back up X Was the site inspected for signs of break out? X Were all system components,excluding.the SAS;located on site v X 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 7 X Was the facility owner(and:occupants if different from owner)provided with information on the -`i�-prop i d idintefi n of subsurface=sewage=d sposalTsystems'.� The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _Fxistzr -. adorn---Eor=e ample;a=p an o--Bsoadd--elI-IJealth — 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)].' Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION. Property Address: 1112 Main St.,Oak&Ivory and Units.1-4,:Osterville,MA 02655 Owner:Joseph Amaral Date of Inspection: 11/16,12009 FLOW CONDITIONS RESIDENTIAL. Number of bedrooms(design) Number of bedrooms(actual): DESIGN flow based on 310 CMR.15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no): [if yes separate inspection required] Laundry system inspected(yes or no .Seasonal use: (Yes or no),- Water meter readings;"if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occup ancy: - COMMERCIAL/INDUSTRIAL Type of establishment: Retail/Warehouse Design flow(based on 310 CMR 15.203)`. ": gpd Basis of design flow(seats/persons/sgft;etc.): Grease trap present(yes'"or no): No Industrial waste holding tank present(yes"or no):_No Non sanitary waste discharged to.the Title 5 system(yes or no)- No. . Water meter readings, if available: Last date of occupancy/use: current OTHER(describe). GENERAL.INFORMATION Pumping.Records Source of information: A&K Pumping&Inspection z .Was'-system pumped=as-part of the inspection(yes or no):?No If yes,volume pumped:,How was quantity pumped determined? Reason for.pumping:.Maintenance TYPE OF SYSTEM _2L Septic tank,distribution box,.soil absorption system Sin le cesspool Overflow cesspool. _ Privy Shared system(yes or no (if yes,'attach previous inspection records,if any)' Y ) p ion and maintenance contract(to be Innovative/Alternative technology.Attach a copy of the current o erat obtained from s stem owner Tight tank_ Attach a.copy-of-the-DEP-approval — -- ----- — --- ----- -- ,_ Approximate age of all components,date installed(if known)and source of information: Bldg.approx.20 years old system original to building Were sewage,odors detected when arriving at the site(yes or no): i.. Title 5 Inspection Form 6/15/2000 : 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM' PART C SYSTEM INFORMATION(continued) Property Address: 1112 Main St.,Oak&Ivory'and.Units 1-4,Osterville,MA.02655 Owner:Joseph Amaral Date of Inspection: 11/16/2009 BUILDING SEWER(locate on site plan) Depth below grade` 117 Materials.of construction: X 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: X (locate on site plan) Depth below grade:_2' Material of construction X concrete metal fiberglass . Uolyethylene _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: standard 1000 gallon Sludge depth: 1" Distance from top of sludge to:bottom of outlet tee or baffle:23" Scum thickness:2" Distance from top of scum to top of outlet tee or baffle: 101.' Distance.from bottom of scum.to bottom of outlet tee or baffle:20 How were dimensions`determined:field instruments Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence:of leakage,etc.):Recommend .pumping every two years. GREASE TRAP:NA(locate on site plan) Depth below grade:_r 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; -- --mate-oflasrpumping: - - Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet"invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM: PART C SYSTEM INFORMATION(continued) Property Address: 1112 Main St.,Oak&Ivory and Units 1-4,Osterville,MA 02655 ' Owner:Joseph Amaral Date of Inspection: 11/16/2009 _ TIGHT or HOLDING TANK: NA (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass__polyetliylene 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 aiaim and float switches,etc): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to.outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Liquid level is normal in D-box PUMP CHAMBER: NA (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 appurfenances,etc.): Title 5 Inspection Form 6/15/2000 8 r - Page 9 of 11 . . OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1112 Main St.,Oak&Ivory and Units 1-4,O,sterville,MA 02655 Owner: Joseph Amaral Date of,Inspection: 11/16/2009 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excav- ation not required) If SAS not located explain why: Type X leaching pits,number One` leaching chambers,number:.: . leaching galleries,number: , leaching trenches,number;length: leaching fields,number,dimensions: overflow cesspool;number: innovative/alternative system Type/name of technology:, Comments(note condition of soil;signs of hydraulic failure,level of ponding;damp soil;etc condition of vegetation, :): . . CESSPOOLS: (cesspool must be pumped as part of mspection)(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: Indicationfgroundwater'infleor- ow Comments(note condition of soil,signs of hydraulic failure,1 vel of ponding,condition of vegetation,etc.): PRIVY: NA (locate on site plan) Iola~ -Materials of constni "chon: Dimensions: Depth of solids: .Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc:): _ Title.5 Inspection Form 6/15/2000 9 Page- 0 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C SYSTEM INFORMATION(continued)'` Property Addressc 1112 Mam St.,Oak&Ivory and Units 1-4;Osterville,MA 02655 Owner:Joseph Amaral Date:of Inspection: I1/16%2009 SKETCH OF SEWAGE DISPOSAL SYSTEM - Provide a sketch`ofthe sewage disposal systemincluding,ties to at least two permanent referenceaandmarks or ben nchmarks:Locate all wells within100 feet Locate where public water supply enters the building. 1 4- A2 11'10' Vcl w v t Titles Inspection-Form 6/15/2060 _ O_ . Page 11.of 1.1 ` e OFFICIAL INSPECTION FORM-NOT FOR`VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAR TC SYSTEM INFORMATION(continued) Property Actress .1112 Main St.,Oak&Ivory and Units 14;Ostei-ville,MA 02655 Owner:. Joseph Amaral Date of Inspection: .l 1%16/2009 SITE EXAM Surface water`. Check cellar. Shallow wells, " Estimated depth to ground water 17 Plus Feet Please indicate(check)all methods used to determmeahe high ground water_elevation Obtauied from system design plans on record .If checked,date of design plan reviewed Observed site(abuttmg.Ofoperty/observation hole within 150 feet of SAS) Checked with local Board of Health-explam: Checked rth local excavators,installers .(attach.documentation) X Accessed USGS database-expl'- You'must_descri e.. ow you'established the h►gh groundnwater elevation:. Approximated from US Dept.of Interior geological survey and USGS groundwater map rt t i i 'A/L 99. 1a ��l.N ;_hCZovYJi� a; n _ Trt1e.5.Inspection Form 6/IS/2000 11 m ti M _ . to �D m N W m N IMPORTANT -01.1N7O:WEALTH OF MAS E iSACHLIS rS L b1ASS.CEP _ .. I phis ap;zoval is kst or deweyed.nol6-N=IWPCC.t±6 John St Caneil.MA 01852.it the name anWor address Ptas changed Iron the above I:sl a.cu rr�rlact NEViVPCC iWn r_ha t. insure- n op APPROVED TITLE 5 SYSTEM INSPECTOR r r rnaifing of the next rengw a al , fcat+oa Approval is suijec(to the prowisions of 3to CLIS 35.000 and rev -not be loaned or assigned to another person. L 1 Z i t� 0 Michael T."ieners x U, ¢ 624 Old 6arnsla®le Rd. Mashpee,MA 13M9 j l Z Q L5 S13938 5RGn999 613orn10 W V Y i 1= Q OD tT G m N Q I U W A COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 4 •�, TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1112 Main St.,Oak&Ivory and Units 1-4, Osterville,MA 02655 Owner's Name: Sherm Six Condominiums Trust, a�G Owner's Address: c/o Huntingest Management 40 Industry Rd.,Marstons Mills,MA 02648 Date of Inspection: 11/13/2006 Name of Inspector: Michael T.Bisienere Company Name:A&K Septic Systems Plus Mailing Address: 565 Carriage Shop Road,East Falmouth,MA 02536 Telephone Number:508-540-6706 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-am a DVI., approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The syste n' X Passes z" W Conditionally Passes � Needs Further Evaluation by the Local Approving Author c� m Fails Inspector's Signature:`2 Date: 11/13 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. Notes and Comments: System functioning fine. No evidence of failure criteria. System consists of 1000 gallon tank with d-box and a 1000 gallon leaching pit. ****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 r Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1112 Main St.,Oak&Ivory and Units 1-4,Osterville,MA 02655 Owner: Joseph Amaral Date of Inspection: 11/13/2006 Inspection Summary: Check A,B,C,D or El ALWAYS complete all of Section D A. System Passes: X 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 yearn old is available. ND explain: -- —Observation of sewage backup or break out or high static water level in the-distribution box due-to broken or -- obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced .ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1112 Main St.,Oak&Ivory and Units 1-4,Osterville,MA 02655 Owner: Joseph Amaral Date of Inspection: 11/13/2006 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 determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 . 3 Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued). Property Address: 1112 Main St.,Oak&Ivory and Units 1-4,Osterville,MA 02655 Owner: Joseph Amaral Date of Inspection: 11113/2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion.of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well.. X 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 3 10 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• 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. Title 5 Inspection Form 6/1.5/2000 4 f Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1112 Main St.,Oak&Ivory and Units 1-4,Osterville,MA 02655 Owner:Joseph Amaral Date of Inspection: 11/13/2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS,located on site? X _ 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? X _ 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 X _ 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)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1112 Main St.,Oak&Ivory and Units 1-4,Osterville,MA 02655 Owner:Joseph Amaral Date of Inspection: 11/13/2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no): [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Retail/Warehouse Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): No Industrial waste holding tank present(yes or no): No Non-sanitary waste discharged to the Title 5 system(yes or no): No Water meter readings,if available: Last date of occupancy/use: current OTHER(describe): GENERAL INFORMATION Pumping Records _Source.of information:. A&K Pumping.&Inspection.._ Was system pumped as part of the inspection(yes or no): No If yes,volume pumped:,How was quantity pumped determined? Reason for pumping:Maintenance TYPE OF SYSTEM X 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: Title 5 Inspection Form 6/15/2000 6 Page 7of11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1112 Main St.,Oak&Ivory and Units 1-4,Osterville,MA 02655 Owner:Joseph Amaral Date of Inspection: 11/13/2006 BUILDING SEWER(locate on site plan) Depth below grade: 11" Materials of construction: X 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: X (locate on site plan) Depth below grade: 2' Material of construction: X 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: standard 1000 gallon Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle:23" Scum thickness:2" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle:20" How were dimensions determined: field instruments Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.):Recommend pumping every two years. GREASE TRAP:NA(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.): Title 5 Inspection Form 6/15/2000 7 Page 8ofII OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1112 Main St.,Oak&Ivory and Units 1-4,Osterville,MA 02655 Owner:Joseph Amaral Date of Inspection: 11/13/2006 TIGHT or HOLDING TANK: NA (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: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Liquid level is normal in D-box. PUMP CHAMBER: NA (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or`no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1112 Main St.,Oak&Ivory and Units 1-4,Osterville,MA 02655 Owner: Joseph Amaral Date of Inspection: 11/13/2006 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number: One leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation;. etc.): 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 or no): Comments(note condition of soil,-signs of hydraulic-failure,level of ponding,condition of vegetation,etc.): -- PRIVY: NA (locate on site plan) Materials of construction: Dimensions: r Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): I Title 5 Inspection Form 6/15/2000 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: 1112 Main St.,Oak&Ivory and Units 1-4,Osterville,MA 02655 . Owner:Joseph Amaral Date of Inspection: 1143/2006 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. 4 NO � ntlry o/ 2 Al /4' g 1 3q'g„ "fit A2 P'I0' B2 331 C 3 14-1 -D3 2-W Oaky jvcyt C4 4s, C4 t � Title 5 Inspection Form 6/15/2000 10 r Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1112 Main St.,Oak&Ivory and Units 1-4,Osterville,MA 02655 Owner: Joseph Amaral Date of Inspection: 11/13/2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 17 Plus 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: Checked with local excavators,installers-(attach documentation) X Accessed USGS database-explain- You must describe how you established the high ground water elevation: Approximated from US Dept.of Interior geological survey and USGS groundwater map. 1 -- .Zit )` • c.N �Qovrl�> Way►: Title 5 Inspection Form 6/15/2000 I 1 Commonwealth of Massachusetts 6�3 A 01 Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1112 Main Street Units 5- 16 tC� Property Address 1112 Building III Owner Owner's Name i information is Q� required for every Osteryille Ma.' 02648 09/29/2016 ;9. page. City/Town State Zip Code Date of Inspection I►+ as Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, 15"/ use only the tab 1. Inspector: key to move your cursor-do not Mike Bisienere key the return Name of Inspector Y Cape Septic Inspections —� Company Name 624 Old Barnstable Road �C[OI Company Address Mashpee Ma. 02649 CttylTown State Zip Code 508-280-3356 S 13938 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 09/30/2016 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. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,. 1112 Main Street Units 5- 16 Property Address 1112 Building Owner Owner's Name information is required for every Ostervllle Ma. 02648 09/29/2016 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: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1112 Main Street Units 5- 16 Property Address 1112 Building Owner Owner's Name information is OSterville required for every Ma. 02648 09/29/2016 page. City Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑. N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1112 Main Street Units 5- 16 Property Address 1112 Building Owner Owner's Name information is required for every very OSterville Ma. 02648 09/29/2016 page. ekir—rown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has aseptic tank and SAS and the SAS is within 50 feet of a private water supply well., ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1112 Main Street Units 5- 16 Property Address 1112 Building Owner Owner's Name information is required for every Osterville Ma. 02648 09/29/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Z Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ❑ ® 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. r For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1112 Main Street Units 5- 16 Property Address 1112 Building Owner Owner's Name required for is every Osterville required for eve Ma. 02648 09/29/2016 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 17 I'� Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1112 Main Street Units 5- 16 Property Address 1112 Buildin Owner Owner's Name information is Osterville required for every Ma. 02648 09/29/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 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 r Seasonaluse? ❑ Yes ❑ 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: office/warehouse Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ .Yes ® No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1112 Main Street Units 5- 16 Property Address 1112 Building Owner Owners Name information is required for every Osterville Ma. 02648 09/29/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: occupied' Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy + ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1112 Main Street Units 5- 16 Property Address 1112 Building Owner Owner's Name information is required for every OSterville Ma. 02648 09/29/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 11" Depth below grade: 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.): Septic Tank(locate on site plan): Depth below grade: 2'feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: standard 1000 gallon Sludge depth: < t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '•0 1112 Main Street Units 5- 16 Property Address 1112 Building Owner Owners Name information is Osterville required for every Ma. 02648 09/29/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 38" 1 Scum thickness < 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 12" How were dimensions determined? field instruments Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1112 Main Street Units 5- 16 Property Address 1112 Building Owner Owners Name information is required for every Osterville Ma. 02648 09/29/2016 page. Citylrown State Zip Code Daespection 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): A Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene'y El other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No tl Date of last pumping: Date Comments(condition of alarm and float switches, etc.): . "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1112 Main Street Units 5- 16 Property Address 1112 Building Owner Owner's Name information is required for every Osterville Ma. 02648 09/29/2016 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Oil 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.): At the time of the inspection there were no signs of past hydraulic failure. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 1 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1112 Main Street Units 5- 16 Property Address 1112 Building Owner Owner's Name information is required for every Osterville Ma. 02648 09/29/2016 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: two ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection one of the leaching pits was dry and the other had appx. 6 inches of ponding water in it at the time of the inspection.And there were no signs of past hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "r a 1112 Main Street Units 5- 16 Property Address 1112 Building Owner Owners Name information is required for every Osterville Ma. 02648 09/29/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1112 Main Street Units 5- 16 Property Address 1112 Buildin Owner Owner's Name information is required for eve Ve q every Osterlll Ma. 02648 09/29/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t Q A2 3f li 152 2r A4 53" 84 394 Title 5 Inspections Form 6115/2000 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1112 Main Street Units 5- 16 Property Address 1112 Building Owner Owner's Name information is Osterville required for every Ma. 02648 09/29/2016 page. City/Town State Zip Code Date of Inspection D. System' Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 17 plus feet 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: Approximated from US dept. of us s grondwater maps i Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 F Commonwealth of Massachusetts Title 5 Official Inspection F p orm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,.•'r 1112 Main Street Units 5 - 16 Property Address 1112 Building Owner Owner's Name information is ` required for every Osterville Ma. 02648 09/29/2016 page. Cltylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i � I Fee v z0 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 -COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 _ OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Osterville Property Address: 1112 Main St.,Units 5-16 MA 02 v.I /l �. 655 •��� U Owner's Name: Sherm Six.Condominium Trust Owner's Address: c/o HuntingestManagement 40 Industry Rd.,Marstons Mills,MA 02648 Date of Inspection: 11/16/2009 Name of Inspector:Michael T.116ienere Company Name:A&K Septic Systems Plus Mailing Address:565 Carriage Shop Road,East Falmouth,MA 02536 Telephone Number:508-540-6706 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 15.34.0 of Title 5(MO CMR 15.000). The system: X . Passes Conditionally Passes. _ Needs Further Evaluation by the Local Approving Authority.' . Fails. ` Inspector's Signature:« /j < Date: 11/16/2009 -The system inspector shall submit a copy.of this inspection report to the Approving Authority(Board of Health or tt 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-copiec_sent to the-bummer-:i apnl cablerann Tro�±ina------____ --- -- — - - --authority.- Notes and Comments: System functioning fine. No evidence of failure criteria. System consists of 1000 gallon tank with d-box and 2-1.000.gallon:leaching pits. ****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 5Inspection Form 6/15/2000 page Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1112 Main St.,Units 5-16,Osterville;MA 02655 Owner: Joseph Amaral Date of Inspection: 11/16/2009 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D' A. System Passes: X I have not found any information which indicates that any-of the failure criteria described in 310 CMR 15.303 or in310 CMR 15.304 exist.Any failure criteria.not evaluated are indicated below. Comments: B. System Conditionally.Passesc.. 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 breakout 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 �__—�ste�,u�non-�s�x is Iey_eita or_.epfsc�d_ ._ — ND explain: The system required pumping more than 4 tunes a year due to 15roken or"obstructed pipe(s) The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction_is removed. ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT.FOR VOLUNTARYASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1112 Main St.,Units 5-16,Osterville,MA 02655 Owner: Joseph Amaral Date of Inspection:.11/16/2009 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by.the Board of Health in order to deterinine 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.coliforrn bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be.attached to this form. 3. Other:. Title 5 Inspection Form 6/15/2000 3 r Page 4.of 11 OFFICIAL INSPECTION FORM.-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1112 Main St.,Units 5-1.6;Osterville,MA 02655 Owner: Joseph Amaral Date of Inspection: 11/16/2009 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no".to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or`clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged.SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or. cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow -X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation:• X: Any portion of cesspool or privy is within.100 feet.of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well:. X 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 :DEP.certified laboratory,.for coliforin 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 in310 CMR 15303,therefore the system fails.The system owner should contact the.Board.of Health-to determme what will benecessary to`correct_the fail fre. 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• You must indicate either"yes"or"no"to each of the following: . _ _jTlie_foll.owing criteria ply to:-large systems, add,r,on_to the crie*ia.abode) :-- yes no the system is within 400 feet of:a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply - the system is located in a nitrogen sensitive-area(Interim Wellhead Protection Area=IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a Title 5 Inspection Form 6/15/2000 4 Page 5 of.1l 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. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1112 Main St.,Units 5-16,Osterville,MA 02.655 Owner:Joseph Amaral Date of Inspection: 11/16/2009 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ; X _ Pumping-information was provided by the owner,occupant,or_Board of Health X Were any of the system components pumped out in the previous two weeks`? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection X Were as built plans of the system obtained and examined. (If they were not available note as N/A) X _ Was the facility,or dwelling inspected for signs of sewage back up? . X - Was the site inspected for signs of breakout X _ Were all system components,excluding the SAS;.located on site*? X 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? X Was the facility owner(and occupants if different from owner)provided with information on the. - t proper mainfenance'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 irformation.:�or exam^le-a- ]mat the oaTd of�?eaith— 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)] Title 5 Inspection Form 6/15/2000 5 f Page 6 of 11 OFFICIAL.INSPECTION FORM-NOT FOR YOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIONYORM PART C . SYSTEM INFORMATION Property Address: 1112 Main St.,Units 5716,Osterville,MA 02655 Owner:Joseph Amaral Date of Inspection: 11/16/2009 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design)- Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system:(yes or no): [if yes separate inspection required] Laundry system inspected(yes or.no):. Seasonal use: (yes or no): ' Water meter readings,if available(last2,years usage(gpd)): Sump pump.(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment:' Office/Warehouse Design flow(based on 310 CMR 15.203):.' F gpd Basis of design flow(seats/persons/sgtetc:): Grease trap present(yes or no): No Industrial waste holding tank present(yes or no) ''No Non-sanitary waste discharged to the Title.5 system(yes or no): No - Water meter readings;if available: - Last date of occupancy/use: current ' OTHER(describe): GENERAL INFORMATION Pumping Records Source of'information:,A&K Septic and Inspection . a -Was system pumped`as parC of the inspection(yes'or no):`No If yes,volume pumped:,How was quantity pumped determined? Reason for pumping:Maintenance TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _— �.�gle_ce�sp,Q�l— - - --- _ —— _V �- -- — _ — ` _ -:Overflow cesspool" ` Privy Shared system(yes or no)(if yes,attach:previous inspection records;if any) Innovative/Alternative technology.Attach a co of the current o eration and inaui copy -operation Penance-contract(fo 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: Bldg:approx.20 years old,system original to building. Were sewage odors detected when arriving at the site(yes or no): Title 5 Inspection Form 6/15/2000. 6 Page 7.of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE_ DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1112 Main St.,Units 5-16,Osterville,MA-02655 Owner:Joseph Amaral Date of Inspection: 11/16/2009" i BUILDING SEWER(locate on site plan) . Depth below grade: 11" Materials of construction: X 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: X (locate on site plan) Depth below grade: 2' Material of construction. X 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:standard 1000 gallon. Sludge depth: 1" Distance from top of sludge to.bottom of outlet tee or baffle:23" Scum thickness:27. Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle:20" How were dimensions determined: field,instruments Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.):Recommend pumping every two years. GREASE TRAP:NA(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.bafhe: _,Distance from bottom of scum to"bottom of outlet tee^or baffle: _ Date-oflast pumping - Comments(on pumping recommendations;inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc:): Title 5 Inspection Form 6i 15/2000 7 Page.8 of 11. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1112 Main St.,Units 5-16,Osterville,MA 02655 Owner:Joseph.Amaral . Date of Inspection: 11/16/2009 TIGHT or HOLDING.TANK: NA (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: X. (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out:of box;etc.): Liquid level is normal in D-box. PUMP CHAMBER:' NA (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.): _4 Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSLRFACE SEWAGE DISPOSAL SYSTEIVhINSPECTION FORM . .PART C SYSTEM INFORMATION(continued) Property Address: 1112 Main St.,Units 5-16,Osterville,MA 02655 Owner: Joseph Amaral Date of Inspection: 11/16/2009 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan;:excavation not required) If SAS not located explain why: Type X :leaching pits,number: Two leaching chambers,number: leaching galleries;number:` leaching trenches,number;length: Teaching fields,number;dimensions: . overflow cesspool-,number: innovative/alternative system Type/name of technology: Comments(note condition of soil;signs of hydraulic failure,.level of ponding,damp soil,condition of:vegetation,. etc.): . CESSPOOLS: (cesspool must be,pumped as part of mspection)(locate on site plan) Number and configuration: Depth fop of liquid to inlet invert: Depth of solids layer: . Depth of scum layer:: Dimensions of cesspool:. Materials of construction: -Indication ofgro`undwat6f inflow(yes or:no) - -. Comments(note condition of soil,.signs of hydraulic failure,lev el. ponding,condition of vegetation;etc.): PRIVY: NA (locate on site plan) _ Materials-- ion: Materials--of construct - _ - - -- - - Dimensions: . Depth of solids: Comments(note-condition.of soil,signs of hydraulic failure., level of ponding,condition of vegetation,etc.): i i 4 Title 5 Inspection Form 6/1.5/2000 9. Page 10 of 11 OFFICIAL INSPECTION FORM" NOT FOR VOLUNTARY AS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C " SYSTEM INFORMATION'(continued) Property Address-. 1112 Main St.1 Units 5-16;Osterville,MA 02655 Owner:Joseph Amaral Date of lnspect. n:11/W2009 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal sd . ystem 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. n - 22 i - o - _ o r - A2 , 3�,6 , �2 2 9 Title 5 Inspection Form 6/15/2000 10 Page i l:of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE'DISPOSAL SYSTETWINSPECTION FORM PART C SYSTEM INFORMATION(continued) Property.:Agdress: 1112 Main St:,Units 5-16,Osterville,MA 01655 Owner: Joseph Amaral Date of Inspection: 11/16/2009 SITE.EXAM Slope. . Surface water Check cellar L Shallow wells Estimated depth to ground water: 17.Plus Feet Please indicafe:(check)all methods.used to determine the high ground water elevation Obtained from.sy`stem design plans on record-If checked;date of design plan reviewed. Observed site(abutting property/observation hole within 150 feet of SAS)` Checked with Iocal Board ofHealth-explain:. Checked with local excavators;installers-'(attach documentation) LA' .Accessed USGS:.database-explain You,must describe how you established the high groundwater elevation: Approximated from US Dept.of Interior geological survey and USGS groundwater map. 77 IL r • 17 3 - 1 Title 5 Inspection Form 6/15/2000 11 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION h Y TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM y PART A CERTIFICATION Property Address: 1112 Main St.,Units 5-16 Osterville,MA 02655 Owner's Name: Sherm Six Condominium Trust Owner's Address: c/o Huntingest Management 40 Industry Rd.,Marstons Mills,.MA 02648 Date of Inspection: 11/13/2006 Name of Inspector: Michael T.Bisienere Company Name: A&K Septic Systems Plus Mailing Address: 565 Carriage Shop Road,Ea st Falmouth,MA 02536 t r _ Telephone Number: 508-540-6706 s° CERTIFICATION STATEMENT r".3 �, I certify that I have personally inspected the sewage disposal system at this address and that the info6ation reportecP' below is true,accurate and complete as of the time of the inspection.The inspection was performed�>ased on 4ny training and experience in the proper function and maintenance of on site sewage disposal systemssI' in a DEP —i approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: co X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails � Inspector's Signature: �_. Date: 11/13/2006 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. Notes and Comments: System functioning fine. No evidence of failure criteria. System consists of 1000 gallon tank with d-box and 2-1000 gallon leaching pits. *-***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 L Phge 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1112 Main St.,Units 5-16,Osterville,MA 02655 Owner: Joseph Amaral Date of Inspection: 11/13/2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1112 Main St.,Units 5-16,Osterville,MA 02655 Owner: Joseph Amaral Date of Inspection: 11/13/2006 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 determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform g P P facility ._._ .. _ . . .._ bacteria and volatile organic compounds indicates that the well is free from pollution from that facili and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.-A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1112 Main St.,Units 5-16,Osterville,MA 02655 Owner: Joseph Amaral Date of Inspection: 11/13/2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface . water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 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• 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. Title 5 Inspection Form 6/15/2000 4 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , SYSTEM INFORMATION Property Address: 1112 Main St.,Units 5-16,Osterville,MA 02655 ' Owner:Joseph Amaral Date of Inspection: 11/13/2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no): [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: —Office/Warehouse Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): No Industrial waste holding tank present(yes or no): No Non-sanitary waste discharged to the Title 5 system(yes or no): No Water meter readings,if available: East date of occupancy/use: current OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: A&K Septic and Inspection Was system pumped as part of the inspection(yes or no): No If yes;volume pumped:,How-was quantity pumped determined? Reason for pumping:Maintenance TYPE OF SYSTEM X 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: Bldg_'approx. 17 years old,system original to building. Were sewage odors detected when arriving at the site(yes or no): Title 5 Inspection Form 6/15/2000 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1112 Main St.,Units 5-16,Osterville,MA 02655 Owner:Joseph Amaral Date of Inspection: 11/13/2006 BUILDING SEWER(locate on site plan) Depth below grade: 11" Materials of construction: X 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: X (locate on site plan) Depth below grade: 2' Material of construction: X 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: standard 1000 gallon Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle:23" Scum thickness:2" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle:20" . How were dimensions determined:field instruments Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.):Recommend pumping every two years. GREASE TRAP:NA(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.): Title 5 Inspection Form 6/15/2000 7 r Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1112 Main St.,Units 5-16,Osterville,MA 02655 Owner:Joseph Amaral Date of Inspection: 11/13/2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS,located on site? X _ 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? X _ 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 X _ 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)] M Title 5 Inspection Form 6/15/2000 5 r Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1112 Main St.,Units 5-16;Osterville,MA 02655 Owner:Joseph Amaral Date of Inspection: 11/13/2006 TIGHT or HOLDING TANK: NA (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: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Liquid level is normal in D-box. PUMP CHAMBER: NA (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 I Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1112 Main St.,Units 5-16,Osterville,MA 02655 Owner: Joseph Amaral Date of Inspection: 11/13/2006 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number: Two leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): 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 or no): Comments(note condition of soil,signs of hydraulic failure,-level of ponding;-condition of vegetation,etc.): — - PRIVY: NA (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): I Title 5 Inspection Form 6/15/2000 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: 1112 Main St.,Units 5-16,Osterville,MA 02655 Owner:Joseph Amaral Date of Inspection: 11/13/2006 . 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. Qy\ o Al 22,6 )3 i 14V A2 3q'6" 32 2T A 3 . 291 J3 3 -37 4" t44 53' 35'4 I Title 5 Inspection Form 6/15/2000 10 f Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1112 Main St.,Units 5-16,Osterville,MA 02655 Owner: Joseph Amaral Date of Inspection: 11/13/2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 17 Plus 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: Checked with local excavators,installers-(attach documentation) X Accessed USGS database-explain: You must describe how you established the high ground water elevation: Approximated from US Dept.of Interior geological survey and USGS groundwater map. - i - •' i � - !2 ! 173 7 � Title 5 Inspection Form 6/15/2000 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owners Name , information is required for every Osterville Ma. 02648 09/29/2016 page, City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in anp way. Please see completeness checklist at the end of the form. Impg out forms When fillip out f A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael T Bisienere use the return Name of Inspector key. Cape Septic Inspections �y Company Name --- 624 Old Barnstable Road Company Address Mashpee Ma. 02649 Cityrrown State Zip Code 508-280-3356 S13938 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 09/30/2016 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. t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 � Commonwealth of Massachusetts Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Units 17 - 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 09/29/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: t - B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r Commonwealth of Massachusetts j Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 09/29/2016 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ brokenpipe(s)are re laced� p ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y .❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 3 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Units 17 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 09/29/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ( r ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above-outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Units 17- 19 1112 Main St . Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 09/29/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100`feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Z Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Mzm Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,•�` Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 09/29/2016 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 09/29/2016 page. City/Town State Zip Code. Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: warehouse _ Design flow(based on 310 CMR 15.203): > 330 Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present?- ❑ Yes ® No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: t5ins-3/13 Title 5 Ofridal Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 09/29/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address' 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 09/29/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 16"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.): A Septic Tank(locate on site plan): Depth below grade: 1211 Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 6 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes 0 No Dimensions: standard 1500 gallon Sludge depth: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments " Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 09/29/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 39" Scum thickness Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? field instruments Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 i '4 Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every OSterVille Ma. 02648 09/29/2016 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No I t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts z Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name • informationis required for every Osteryille Ma. 02648 09/29/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert n/a 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* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required Osterville Ma. 02648 09/29/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: one ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system ' Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection there was appx. 2 feet of ponding water in the leaching pit and there were no signs of past hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 09/29/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner information is Owner's Name ' required for every Osterville Ma: 02648 09/29/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposals stem including at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate o where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below t i Al 93 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,•' Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 09/29/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 17 plus feet 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: I augered a hole at a lower elevation and shot it with a transit Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 7 ` Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for eve ryOsterville Ma. 02648 09/29/201 page. Cltylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 IL " Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Ostervllle Ma. 02648 09/29/2016 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately r e_ 05 tie C i /V t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osteryille Ma. 02648 10/31/2013 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab key to move your 1. Inspector: cursor-do not Michael T Bisienere (y/� use the return key. Name of Inspector Cape Septic Inspections tiiltQ Company Name 624 Old Barnstable Road Company Address Mashpee Ma. 02649 City/Town State Zip Code 508-280-3356 S13938 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 1705/2013 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 N the same or different conditions of use. lv/13M t5ins•3/13 Title 5 Official InspeVonFSubsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Units 17 - 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 10/31/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section.D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 13) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The'system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 10/31/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): .1 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 16.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts u Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w ,.•'° Units 17 - 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 10/31/2013 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,•' Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 10/31/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This, system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system-in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 3 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 10/31/2013 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 ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 10/31/2013 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes El No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ 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: warehouse Design flow(based on 310 CMR 15.203): > 330 Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ® No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every OsterVille Ma. 02648 10/31/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,• Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 10/31/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 16"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.): Septic Tank(locate on site plan): ,Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age:- years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No I Dimensions: standard 1500 gallon Sludge depth: < 1 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Units 17 - 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is Osterville required for every Ma. 02648 10/31/2013 page. City/Town State Zip Code' Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 39" Scum thickness <1" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? field instruments Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts u - Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '* Units 17 - 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name inormation is OSterVille requiredforevery Ma. 02648 10/31/2013 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert evidenc e of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑.polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑-Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 l I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •'' Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name inormation is Osteryille requiredforevery Ma. 02648 10/31/2013 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert n/a 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* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: '' t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,••'r Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every OSterVllle Ma. 02648 10/31/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: one ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name inormation is requiredforevery OSterVllle Ma. 02648 10/31/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 10/31/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately I A o I Od Al aai 6a ss� Commonwealth of Massachusetts _ Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •' Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 10/31/2013 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 17 plus feet 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: I augered a hole at a lower elevation and shot it with a transit Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonw ealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Units 17- 19 1112 Main St Property Address 1112 Condominium Trust Owner Owner's Name information is required for every Osterville Ma. 02648 10/31/2013 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file n t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts Title. 5 Official Inspection F R. orm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1112,Main St., Oak& Ivory-Units 17-18-19 Property Address Sherm Six Condominiums Trust c/o Huntingest Management Owner Owner's Name, information is required for: rY 40`Indust Rd., Marstons Mills, MA. 02648 10/15/2010 every page:- City-row n 'State, Zip.Code Date of Inspection Inspection results must be submitted on this form. Inspection forms<may not be altered in any, way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the. r n computer, use 1 Inspector:' only the tab key " to move your Michael"T. Bisienere cursor-do not. Name of Inspector use the return key.. A&K Septic Systems Plus Company Name :. 565.Carriage Shop Company Address East Falmouth MA 02536 City/Town state Zip.Code. .508 54076706 S13938 Telephone Number :. License Number B-Certification .I certify that I have personally inspected the sewage disposal system at this address and that the p information reported below is true, accurate and complete'as of the time.of the inspection The inspe'tion was performed.based on my training and experience in the properfunction and maintenanceaf on te sewage disposal systems. I am a DEP approved system inspector.pursuant Section 11.340 ao Title 5(310 CMR 15.000).The system: ®" Passes ❑ 'Conditionally Passes ❑ Falls cn ❑ Needs Further Evaluation by the Local Approving Authority li 54 10/15/2010 spector's Signature " : Date Th&system inspector shall,submita copy of his inspectlorr report to the.Approving Authority(Board of Health,,or DEP).within M 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 o: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:09/08 Title 5 Official inspection Forn.Subsurface Sewage Disposal System•Page t of 17 Commonwealth of Massachusetts W Title 5 Officinal Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary'Assessments c M 1112'Main St., Oak &`ivory-Units 17 1&19 Property Address ' Sherm Six Condominiums Trust c/o Huntingest Management Owner owner's Name information is required for 40 Industry Rd.,_Marstons Mills MA 02648. 10/15/2010 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:.. ® I have not found any information,which indicates that any of the failure:criteria.described in 310..CMR 1.5303 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 orrepaired. 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.thb septic tank (whether metal or not) is structurally.unsound,:exhibits substantial-infiltration or exfiltration or tank failure is imminent. System will pass inspection Jf.the existing tank is_,replaced.with a complying septic tank as approved by the Board of Health.. *A metal septic tank wiq`:pass inspection if1 is structurally sound,,not leaking and-if a Certificate'of Compliance indicating that the tank.is:less than*20'years old:is available.: ❑ Y ❑ N' ❑ ND (Explain below):. t5ins 09/08 Title S Official lnspection Form:Subsurface Sewage Disposal System•Page,2 of 17 Commonwealth of Massachusetts W Title: 5 Official Inspection Form Subsurface Sewage,:Disposal System form -,Not for Voluntary.,Assessments �M 1112.Main St., Oak&:Ivory-Units 17-18-19 Property Address .Sherm.Six Condominiums Trust c/o Huntingest Management Owner Owners Name information is required for 401Industry Rd.; Marstons Mills. MA`` 02648 10/1-5/2010 every page. Cityrrown: State Zip Code Date of Inspection B. Certification (cont.) B) :System Conditionally Passes (coat;): . ❑ .Observation of sewage backup or break.outor;high static water,ievel in:the distribution box due to broken or obstructed pipe(s) or due to a broken; settled.or uneven distributiont box..System will pass inspection if(with approval of.Board of Health) FT broken'pipe(s) are replaced ❑ Y " ❑ N ElND (Explain below) obstruction is removed ❑ Y ❑ N ❑ ND (Explain below). C distrbution box Is leveled or replaced '❑ Y ❑. N ❑ Nb (Explain below) ❑ The -required pumping more than 4 imes 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). ❑'y . obstructlon.isremoved ❑ Y ❑ N "`-❑ Nb (Explain below) C) Further Evaluation is;Required,bythe 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. 4 1: System wai pass Unless.Board.of Health determines in accordance.with 310 CMR 1:.5 303(1)(b)that the.system is not functioning'in a manner which will protect public health, safety and the environment: El Cesspool or privy is-within 50 feet of a surface water ❑ Cesspool or privy"is within 50 feet of a bordering vegetated wetland or a salt marsh.." t5ins.09/08 V1 5 Official Inspection Form:Subsurface Sewage Disposal System.•;Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection .Form Subsurface Sewage.Disposal System Form - Not for Voluntary Assessments °M 1112 M.ain,St, Oak & Ivory=Units 17-18-19 Property.Address. Sherm Six Condominiums Trust c/o Huntin est Mana ement Owner Owner's Name information is required for. 40 Industry Rd., Marston- Mills MA 02648 10/.15/2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) - 2. System will.fail unless the Board of Health (and Public Water Supplier, if any i determines that.the system is functioning in a manner that protects;the public health, : safety and:environment El 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 watersupply. El The system has aseptic tank and SAS and the SAS is.within`a Zone 1 of a public.wster supply., ❑ The system has a septic tank-and SAS and the SAS is withm 50 feet of a private water supply well ❑ The system has a septic tank and SAS'and,the' SAS.is less than .100 feet but 50 feet or more from a private water,supply well**. Method used to' 'determine.:distance:_ **This system passes if the well water.analysis,-performed at,a DEP,certified laboratory, for coliform bacteria indicates absent and the presence.of ammonia nitrogen and-nitrate.nitrogen is equal to-or less:than 5 ppm, provided that no other faiIure.criteria:are triggered. A copy;%of the analysis must be . attached tothis 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 El Static liquid level in the.distribution box above outlet invert due to an overloaded or clogged SAS or.cesspool ET ® Liquid depth in cesspool is'less than 6" below,invert or available volume is less than %day flow: t5ins-09/08 Title 5 O,ffc al Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface $ewage.DisposaL.Syst6m Form- Not for Voluntary Assessments ^M 1112 Main St., Oak& Ivory-Units 17-18-19 Property Address r Sherm Six Condominiums Trust c/o Huntingest Management:* Owner. Owner's:Name information is required for . 40 Industry Rd., Marstons Mills MA . -.02648 10/15/2010 every page. Cityfrown - state Zip Code " : Date of Inspection ` B. Certification (cont.) ,, Yes No ❑ ® Required pumping more than 4 times'in the last year NOT due to clogged or, obstructed.`pipe(s)::Number of.times pumped: :® Any portion of the SAS, cesspool:or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply:or ® tributary to a`surface Watersupply. ® Any portion'of a cesspool or privy,ls within a Zone 1,of a public well. 7. ® Any portion:of a cesspool or,privy is within 50.feet of'a:private water supplywell. ❑; _ ® Any;portio'rrof 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 otherfailure 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 l`have determined that one;or more of the above failure' criteria exist as described in-310:CMR 15.303,.therefore the system falls. The system"owner.shou Id,contact the Board of Health to determine what will be necessary to correct the failure E) Large Systems: To be.considered a largeaystem the system must serve a facility with a design flow of 10,000.gpd to 15;000 god. 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: f a'surface drinking water supply El FTthe system;is within 200 feet of a'tributary toga:.surface drinking water supply _ the s ystem`.is located in a nitrogen sensitive area (Interim Wellhead'Protection El El Area—IWPA) or a mapped Zone.H 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 orfailed under Section D.shall upgrade the system in accordance=.with 310 CMR 15.304. The system owner should:contact the appropriate regional office of the Department: t5ins-09/08 Title.5 Official Inspection Form:Subsurface_Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts')a Title 5 Official Inspection' Form Subsurface Sewaci6 Disposal System Form,-Not:for Vo.luntary`.Assessments'; ^� 1112 Main St.,'Oak& Ivory-Units 17=18 19 ,Property Address . Sherm Six Condominiums Trust c/o"Hunfingest'Management. Owner Owner's Name it information is 40 Indust Rd.,.Marstons Mills MA` 02648 10/1.5/2010 required for ry every page. Citylrown State Zip Code Date'.ofinspection' C.:Checklist - Check if the.following have,been done. You must indicate yes or"no' as to each`of,the following Yes "No Pumping information:was provided:by the.owner occupant, or:Board of Health ❑' Were any of"the system components pumped.out in the;previous"two week's?. ® ` ',Has the"system received normal,flows in;the previous.two week period Have"large volumes of water been:introduced to he 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) 0 .Was the facility"or dwelling inspected for signs of sewage backup ®'w Was the site,inspected for signs,of break but? ,. w 0 Were,all system components "excluding the SAS';located on sites ` Were;the septic tank_manholes uncovered opened and the infenor: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. ® nformation'on the properrmaintenance of subsurface sewage"disposal systems? The size and.`locatiori of the Soil.Absocption Systern:(SAS)on'"thesite'has been:determined:based on:: El `Existing Anformation..For example°a planat the Board of Health Determined"in the field (if any of the failure criteria related to Part C is at issue °approximation"of distance is unacceptable) [310 CMR 15.302(5)] . D: System Informat:ion Residential Flow Conditions: Number of kedrooms (design). Number of bedrooms`(actual) DESIGN flow base on 310 CMR 15:203'(for example;;110 gpd x#of bedrooms): i4 l5ins•09/08_ Title 5 Offiaai Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts u Title 5 Official In pecton Formf Subsurface Sewage'Disposal System Form - Not`for.Voluntary Assessments, wM 1.112 Main St., Oak& Ivor`y-Units 17-18 19 Property Address Sherm Six Condominiums Trust c/o.H;untingest Management Owner. Owner's Name information is 401ndust Rd.;Marstons Mills WA 02648 10/1'5/2010 required for, Industry every page. City/Town` State Zip Code Date.of Inspection, D. ,System: Information Description: System consists of a Septic Tank, Distribution'BOX,soil.absorption system " r Number of current.residents. , Does residence;have a garbage'gnnder? ❑ Yes ❑ = No Is laundry on`a separatersewage system? [if yes separate inspection required] ❑1 Y.es ❑'>No Laundry system.inspected? ❑.Yes ❑ No Seasonal use.. ❑ 'Yes.❑ No Water meter readings if available,(lastY2 years usage:(gpd)) Detail: Sump pump? ❑ :Yes ❑' No Last date of'occupancy: . Date' ..C.ommercial/Industrial Flow Conditions. Type of Esfabhshment Warehouse%office Space Design flow(based on 310 CMR`15 203)' Gallons per day(gpd) • Basis of design' low(seats/persons/sq:ft, etc.): Grease trap,present� 0, ®; No, Industrial waste holdrng fank'present? ❑ Yes ® No 1 Non`sanitary.waste dlscharged_to the Title 5 system? ❑ 'Yes ® No _ Water meter readings, if available t5ms' 09/0S a Title 5,Official Inspection FormS:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for.:Voluntary Assessments 1112 Main St:, Oak& Ivory-Units 1`7-.18-19 - Property Address Sherm Six Condominiums Trust"c/o Huntingest Management Owner Owner's Name. - information is 40 Industry Rd:; Marstons Mills , MA. 02648. 10/15/2010 required for Y every page. City/ -rown . State Zip Code Date of;Inspection D. System Information (Pont.).':,' Last date of occupancy/use. currently Date. Other(describe below):. General.Information Pumping.Records: Source of information. Was system pumped as part'of'the inspection4 '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 Q Single cesspool Overflow cesspool Privy 0 Shared system`(yes or;no)(if:yes,:attach previous inspection records, if any) Innovative/Alternativetechnology: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.systeni operator:under contract 0 Tight tank: Attach a copy of the.DEP"approval -`Other(describe) t5ins,•09/08; Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora; _ Subsurface Sewage Disposal.System,Form - Not for Voluntary Assessments 1112 Main St—Oak & Ivory-Units 17-.18=19. ':' . Property Address Sherm Six Condominiums Trust c/o HuntingestManagement Owner Owner's Name information is required f or 40 Industry Rd: Marstons Mills MA 02648. 10/15/2010: every page. City/Town State 'Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if-known)and source of information Were sewage odors detected when arriving at.the site? El. Yes ® No Building'Sewer_(locate on`site-plan): Depth below grade: 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"of1eakage etc.): Septic,Tank-(locate on site plan): Depth below grade: feet Material of construction:, ®concrete ❑metal ❑.fiberglass ❑ polyethylene ❑ other(explain) i If tank is metal, Iistage: years Is age confirmed,by a Certificate,.of Compliance? (attach a copy of ce rtificate) ❑ Yes ❑ No 1500tGallon Standard-ST` Dimensions: Sludge de th.. t5ins•09108 Title 5 Utticiai inspection Form -Suosuriace sewage>uisposaiSysiern•rage a or i i . `"ComI.monwealth of Massachusetts 4 Title 5,Official ,Insp.ect on' Form Subsurface Sewage-Disposal System Form Not+fdr..Voluntary Assessments_." °,M ' 11'12 Main St., Oak&;Ivory-lJnits:17-1:8 19." Property.Address ' ` Sherm six.Condominiums Trust c/o Huntin es - an' em' - '.Owner Owner s Name information Is`•,. required for _ 40 Industry Rd_;Marstons Mills` MA ': 02648` . 10/15/2010 every page. _ City/Town State Zip,Code Date of Inspection D. System Infoemationjcont.) - , . Septic Tank:(cont.) Distanc1.e from top`of sludge-to bottom of�outlet tee be,baffle ` 39" Scurn:'thickness 1 8� Distance from top of,scurri to top of outlet tee or,baffle. DistancI.e from bottom of scum to bottom:of outlet tee"o[baffle.: 11 +" I. .,w How were dimension's dete`rrnined?. ..; Field Instruments " Comments (on pumping`recommII endations inlet.and outlet tee`or baffle contlition, structural integrity liquid levels as related to outlet invert evidence*of leakage, etc.) Recommend pumpin eve - two years ,. .- ,,.. a . ... ,. r. . , W .1; Grease Trap(locate on site plan). Depth below grade feet , terial uct of con Ma strion ;, . . - ❑ concrete metal ❑ fiberglass`: ❑ polyethylene ❑ other(explain) ' . ;•: Dimensions , Scurn thickness Distance,from top;of`scum to top of outlet tee,or baffle - ; .... ,:; :Distance.from.bottorn of scum to bottom.of outlet tee or baffle Date of last pumping: Date tIr 5ins•0Ir 9106 s• ` ;Title 5 Official Inspection Form Subsurface Sewage Disposal 1.System•P rr age 10 of 17 r. re Commonwealth of Massachusetts: Title 5 Official Inspection -Form _ Subsurface Sewage:Disposal System Form ..Not for Voluntary Assessments: o 1112,Main St., Oak&"Ivory.Units 17-18-19 Property Address Sherm Six Condominiums Trust c/o Huntin Best Management Owner Owner's Name information is 4. required for 40 Industry Rd., Marstons Mills MA-' 02648 10/15/2010 every page: City/Town State Zip Code Date.of Inspection D. System Information (conf.) Comments (on pumping recommendations, inlet and.outlet tee or baffle condition, Structural,integrity, liquid levels as related to outlet invert, evidence of leakage, etc). :' Tight or Holding Tank(tank must.be pumped at time of Inspection) (locate,on site plan):. Depth below.grade:, Material of construction. ❑ concrete' ❑.metal_ ❑ fiberglass ❑ polyethylene.. . .. ❑ other(explain):. -Dimensions: Capacity: gallons t Design Flow: gallons per day Alarm present. Yes:,- ❑:'No Alarm level: Alarm in working,order: ❑;Y es. ❑ 'N"o 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- t5ms•09/08 Title 5 Official Inspection Formf Subsurface Sewage Disposal System Page 1.1 of 17 " Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form.- Not for Voluntary Assessri ents �. 1112 Main St., Oak&Ivor s=Units 17'18 19 . Property-Address . Sherm Six Condominiums Trust c/o'Huntiri est Management `v Owner Owner's Name information is . 40 Indust Rd. Marstons Mills required for Industry MA 02648 10/15/2010, every page. City/Town:: State Zip.Code: Date of Inspection ' D. System Information (cont.) Distribution Box(if present must be opened) (locate on.site plan): Depth of liquid level above outlet invert .."_ 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 wo9 rkrn older ❑ es ❑ 'N;o Alarms in working order. El Yes ❑ No Comments(note condition of pump chamber; condition of pumps and appurtenances, etc.0. Soil Absorption System.(SAS){locate on site plan, excavation hot;reaui red ) ? . If SAS snot aocated;°explain'why. t5ms 09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page.12 of 17 Commonwealth of Massachusetts .` Title 5. Official Inspection Form a Subsurface Sewage Disposal System Form - Notfor Voluntary Assessments:' c,M 1112,Main.St.,.Oak& Ivory-Units 17-18 19 : _. Property Address Sherm Six Condominiums Trust c/o Huntingest.Managerrieri Owner Owner's Name , information is. 40 Indust Rd. Marstons Mills ,, MA 02648 10/15/2010'` required for Industry every page. Cityrrown State,' Zip Code -Date of Inspection D. System:Information (cont:.) Type. ® leaching pits,', number: leaching chambers,, number: ❑ -. leaching gallenes:.` number Y El leaching trenches numberength:.' k ❑ leaching fields number, dimensions: . ❑ overflow cesspool number. ❑: innovative/alternative system .,.Type/name of technology: Comments(note conditionof soil,,,signs;of hydraulic failure level of ponding;dampsoil condition of vegetation, etc.): wj 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.r„ Dimensions•of cesspool Materials of construction Indication of groundwater inflow`.. ❑ Yes .:' ❑ No . t5ins•09108 Title;5 Official Inspection For Subsurface Sewage Disposal System•Page,''13 of.17 Commonwealth of Massachusetts . Title. 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments: + 1112,Main St., Oak & Ivory-UnitsVA849' :` Property Address Sherm Six Condominiums Trust c/o Huntin est Mena ement g 9 Owner" Owner's Name information is 40 Indust Rd., Marstons Mills MA 02648 10/15/2010 required for Industry _ every page. CityJTown State Zip Code Date:of. nspection D. System information '(cont.) a 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; sign_s'of hydraulic Iailure, level of ponding, condition of vegetation' etc.). t5ins•-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal.System Page.14 of 17 Commonweanh or massacnusens.:^ W . , ;I_�.,­....j.1,.:�._�,:��..III­..-7�..,,_��.-_:...,..I 1.:1.-..._1.�,:..:II...I.I. I. Title: 5 Official Inspection; Form Subsurface Sewage Disposal`System Form.- Notfor Voluntary Assessments:: ��M , ". 1112 Main St., Oak&.ivory-Units.17-18 19 .> . . PropeRy:`Address Sherm Six_Condominiums Trust c/o Huntingest Management Owner' Owner's Name r6gyiration is -40 lndustr Rd.,,Marstons Mills .. MA. . ' 02648. 1 011 5/201 0; .required for every page: -... Cityrrown ... , State Zip Code Date..of Inspection D. System Information (cost ) Sketch Of Sewage.Disposal System Provide„a view of-the sewage.disposel sys- including ties to •' at least two permanent reference landr arks.or benchmarks: Locate all wells within.100 feet: Locate where public:water.supply enters:the building.Check one of the boxes below :: ® Band=sketch ii�the area below drawing attached separately - ,: -. . . - . ... 4.. - .. .. - -, . :- ... ' . .:.: - :. ... .r , VI. A " - , aai o 0 � 1 a qs7 . 6a . TH SKETCH OF THIS SEWAGE DISPOSAL SYSTEM (AS BUII D)AS;SHOWN ON THIS-, ;;PAGE.IS'APPROXIMATE ONLY,NOT TO . '.SCALE IT;MUST NOT BE USED FOR . ... . VARIENCE:OR Bi7II;DING:PLAN PURPOSES , I. .. 1,- .. . `',t5ins-09/08. Title 5 Official Inspection Form:,Subsurface Sewage Disposal System.•Page 15 of 17 .... r Commonwealth of Massachusetts` = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for'Voluntary Assessments °M 1112 Main St, Oak & Ivory-Units 17=18-1.9 Property Address Sherm Six Condominiums Trust c/o Huntin' est Management.-..' Owner Owners Name information is required for 40 Industry Rd.; Marstons.Mills- MA 02648 10/15/2010• every page. City/Town state- Zip.Code Date of.lnspection D. System Information-,(cont ) Site Exam: ❑. Check Slope :Surface,water [I.:,Check cellar ❑ Shallow wells..<.: Estimated depth to{high ground water. 17 Plus'; feet Please indicate all methods used to determine th atere high;ground w elevation ❑ 'Obtained from systern 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-(attache documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation .. .f .. Approximated'from:US Dept. of Interior eological survey and USGS rouhdwater map Before filing this Inspection Report, please see Report Completeness Checklist on next page. loins UYINO ,Title 5 Official Inspection Form Subsurface Sewage Disposal System Page 16 of-17 Commonwealth.of`Massachusetts Title 5 .Official Inspection Form Subsurface Sewage Disposal System,Form - Not for Voluntary Assessments:. 1112 Main St., Oak&.Ivory-Units 17=18 19 Property.Address Sherm Six Condominiums Trust c/o Huntin est Ma na ement Owner Owners Name information is.required for 40 Industry Rd. 'Marstons Mills MA - 02648 10/15/20.10 • every page. City/Town State Zip Code Date of Inspection E. Report.Completeness Checklist- ® Inspection Summary;A, B, C.D, or checked �. Inspection Summary D.(System Failure Criteria Applicable to All"Systems) completed System Information=.Estimated depth to:high groundwater ®;Sketch,'of Sewage Disposal System either drawn on page 15.or attached in separate file : • t5ins•09l08 Title 5 of Inspection Form Subsurface Sewage Disposal System•Page 17 of 17 � 13 hO 1 / / 9 - 0/ 3 - V21 Sullivan Engineering Inc. 7 Parker Road, Box 659,0sterville MA 02655 508-428-3344 e-mail:psullpeAlaol.com fax 508428-3115 November 21, 2006 Thomas McKean Town of Barnstable Board of Health 200 Main Street Hyannis, MA 02601 RE: 1112 Main Street, Osterville—Unit B07/Map 118 Parcel 0131307 Dear Mr,McKean, We have a client who is in negotiations to purchase the above referenced condominium. The client is concerned that the second floor,.which is used as an office associated with storage/warehouse space below, was not shown on the original septic design plan. It is our understanding that it has been the Board's policy to grandfather an area and/or use that has been in existence for over twenty years. We have attached an affidavit from the original unit owner, which confirms this. We trust this meets your present policy. Please feel free to call if you have any further questions. Very truly yours, J hn O'Dea - Sullivan Engineering Inc. I Members of The American Society of Civil Engineers and The Boston Society of Civil Engineers. FPOM FAX NO. Nov. 20 2006 12:49PM PS . Ran+ tft E. t#"is 290 Flint Street r.a. Dox 511 Marstons Mills,MA 02648-' November 20,2006 Mr. Scott Cro y Fax: 508-428-9080 To Whom-11 May Concern:-, In thc-falt-oft984,as ownerof the condo;located-ar1-112 Main Sue et Ostervik 1 added a second story floor to it. If any other information•is-needed;'gleaSezall'tne at the above phone numD�r. Si ly, _ Randolpl";1ois - . x No...... .�...1..� p: Fa .........5....' s .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................O F...............................................---.......................... ......-....... Appliration for Dispoottl Vorkii Tonstrnrtion Vamit Application is hereby made for a Permit to Construct (x ) or Repair ( ) an Individual Sewage Disposal System at: 1112 Main Streert, Osterville _Building "A"......................................................... ----...... •..................................•--•-•--•......... ............-...... o tion-Ad ress or Lot No. Carl s. Riedetll & C arles D. Rogers ..••• •-•-•---------------•--•----••-----••-------....•-•••.................--- Owner Address W Alfred A. Fuller Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building Office.....____. No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ................................. . W Design Flow........5...............................gallons per person per day. Total daily flow....-..6 0�'6 o gallons. WSeptic Tank—Liquid capacit?0 0 0 .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 ( ) 4 Percolation Test Results Performed by..BaitP_r....&...FIB? ...A.,,7C�Yl�.S...1' .... Date...!/IL 4-------------------- Test Pit No. I..........'.2.....minutes per inch Depth of Test Pit.l. ./�'......... Depth to ground water..--...:=-:......---. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ ................................ ---•.......................................................................... ........................................................................... 0 Description of Soil.......... d.? L]A]` 11�5 .....................•----.....----....---------------------------•--------.... V ........................•-•••--••........_....-----------------•...••-•--•--•••...............--•--........--•--•••--------.....•--•-------•-•--•-••-----•----------.....•------•-•-•-•-••---•-•-------•. W UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed. Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code he undersign u ther agrees not to place the system in operation until a Certificate mpliance has bee s by Meof6lth. ' Signed �.... ...�...�(..!..Dat Application Approved BY e...._ .......... ' `[ "'df ..... Date Application Disapproved for the following reasons:................. ---------------------•-----•-------•-----------------------..................----------•-..._.......-----•--•-•------=-•-------------•-----•---•-----•••---••••......••...--•-••--•---••-••••-•--•---••- Date PermitNo......................................................... Issued•....................................................... Date ................................................................................................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (Irdif irab of Tompliatnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by....................................................................................................--••._................ .......:.......--••--............_..._.....--•-••---•-•-•••..._......-- tall at = �ll. �.���••� ......�-J..:�--------------------------------------------------- has been install in accordance with the provisions of TIT F 5.�.of he State SanitaryCode as described in the application for Disposal Works Construction Permit No..... y_ .Z............. dated .....---..................----......,:r;` F-.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ 'Inspector..................................................................................... i r No......................... Z, Fxs......... .°.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ _ ...................OF.......................I..................... ............ ............._..._ Appliratijau for Biiipvii al Works Tontrnrtion prratit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal 'System at: j Location-Address or Lot No. ......................_.......................................................................... -•---------........_...------•••------........._..------•••-•----•••.............._...._..._...... Owner Address W Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ..................................•-------------------................................................................................................ w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P -----------------------------------•----••-•----...------------......----------.....................---•-•••----•-•---------..................•--...---.--•-- 0 Description of Soil......................................................................................................................................................................... x w ------------------------------------------------------------------------------•-----------------------------------------------------------------------------------...................... ------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ........................................-....................................................................................................................................... .........._.......:..... Agreement: The undersigned agrees to install the aforedescribed. Individual Sewage Disposal System in accordance with the provisions of TITL- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate mpliance has been issued by the board of Health. Signed............................. Date Appl cation Approved By.............. .��---,,'� ..._../r:.� _�_ �'�:,�y Date Application Disapproved for the following reasons: .-----•--------------------------------=-.- ...................................................................- ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (9rrtifiratr of T-amplianr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by..-....,......... .....-•----•--•-;-1---•................... --•-•-•---•----- -----••---------- ........... ...... .--•-- .... ................................................. l W Installer A- at /I...-....... �i'' _ ✓ ` -- - ......�ij ._....._.... _ has been installefi in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.....e�.7�K"..Lt/;.............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..........................7.--7••-------••.....---•---•-••--•-•-----•••.••-•-- Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF..................................................................................... of No......� f - FEE._.. P.......... Disposal &9 notrnrt' n rrntit Permission is h eby granted................. .................................................................... to Construct or Repair ( ) an Individual Sewage Disposal System atNo............ .............. ...----. ---------•->J. - Street as shown on the application for Disposal Works Construction Permit�No.........._-..... Dated.................:........................ � ...................................... DATE. and of Health FORM 1255 A. M. SULKIN, INC., BOSTON I No.........5-.i'._i FRs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Diopoottl Workii Tontrnr#inn Vamit Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at: .............111,2 Main Street;.._�. x�1t.1.1 •.... .........._ laa..lda.>� ..... .... .... ........................................... Location-Address or Lot No ...._... Carl S. Riede 11 O Charles D. Rogers.............................................. Ownez ddress W Alfred A. Fuller •.............................•---•--•- ... .....---........-•-•-----•--•-----............... .....................---..............---........-•-•-•----..............._._.................---- Installer Address Q Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of-Building Wa......hbu_se .. No. of persons...... ................. Showers ( ) — Cafeteria ( ) Other fixtures ---------------------------••-•.....--- . W Design Flow....2 0..................................gallons per person per day. Total daily flow----6 0 0 _, gallons. WSeptic Tank—Liquid capacity-:15 Q.0gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..2_________________ Diameter-10.0 0_..ga'bepth below inlet:_.................. Total leaching area..................sq. ft. Z Other Distribution box ( X) Dosing tank ( ) Percolation Test Results Performed b}Baxter_. & Nye, Atones PE Date........................................ aTest Pit No. I....2..........minutes per inch Depth of Test Pit....12........... Depth to ground water...... .............. f% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P ----------------------------------•-------••------------•....-•--•-•-----•-•----•-------•-••••-•....-•--•••-----•--•••...............................•. O Description of Soil..............M d Cum :S 9_nd ...........................•----••--•-•-----------------------------•-------------------------------------........-•-•---- x V W UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.i; 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate f Compliance has bee •s b he ar of alth. Signed.... .... .... ....... . //1 . . D to Application Approved By................. ,..... ..................... -_.....v2:..'. .�...... Date Application Disapproved for the following reasons---------------•----•-•--------•----.....------------..........---------------._..------._...--------...•--•_.._ .................................•--•---------------------...............-•--------...---.....------......--•---•-•-•---•---------------------------------------•------- •----•-•-•-••---••-••---. Date PermitNo....................................................... Issued....................•---•--------...._................... Date •.•�.���.s•�..�.�������.-...a�...•sH.s��...�•������.•�oa.••a•������.��.�.•ash.•�.•s.•��.�������►�����.���..������..�.�..��� THE COMMONWEALTH OF MASSACHUSETTS , BOARD OF HEALTH ..........................................OF..................................................................................... (Irdifiratr of Tomplittnrr THIS IS TO CERTIFY, Thatrtlle,Ir}c�iviidd'uaal,Sewage Disposal System constructed ( ) or Repaired ( ) // , • Installer � at...... .F.............1/.� ------ .�, ......... .......�J _......_.....---••----------....------..........--------- has been ins�n accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....-ie--5� n f,)................ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................................................................•--...... Inspector.................................................................................... - - - --- -- -- - - -- ---_= -- - - _ ... --------------------------------- .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................- ...................O F......................................... Appliration for Disposal Works Cfuustrurtiurt Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .....---•..............................................••--...............--••--•---•-•---•--••--- -----•--------.........-•----•-•--•-••---•-•-----••••-----.....-•---------••--••-----••---........ Location-Address or Lot No. ......................—.......................................................................... .............•••-••----•••-•----•--...------••--•-.........--•-•-------........................... Owner Address W Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons........_................... Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------.......--------------------------------.............----•-----.................--......_.__..... w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length.........:...... Width................ Diameter................ Depth................ 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.......----............. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----•-•----------------------------------------------------•----•-.........-•---••--•--••--••---•-------.......---••-•---....-----......_..........-••---•- 0 Description of Soil........................................................................................................................................................................ U •---•--•-•-----•----•--•••--------•--••--•••-•-••••--••---------••••••--••--•......-----•-----••---•--•-•--••-•••---•---•-....---••••-----•-••...-----••••--••---••--...-•-•--......--•---•-•...._..•--- -------------------------------------------------------------- U Nature of Repairs or Alterations—Answer.when applicable............................................................................................... --------••-•-----------•-------••--•-•-•------•-•--•-•-•••-•---•-•-•-----•-•----------•.............•---.......•-•--••--•••••-------•--••----•-•------•-•-••-----------------•------•----............... Agreement: The undersigned agrees to install .the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate gf Compliance has been issued by the board of health. Signed....................................... ......... ---------------------------------- -------------------•------------ • �4 `ate 4 Apphcation Approved BY-------------------�...,.�-.r-- =!- -•-=t==•--------•-----.... Date Application Disapproved for the following reasons:............................................................................................................... ••------••-•-----•...............•--•---•---•---------------•---...------••---•-••-•-----................................-•-•----•---------------......-------------------•••-••••••---------•-....•-•--- Date PermitNo......................................................... Issued........................................................ Date < J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................:...............OF..................................................................................... (9rdif iratr of ToutplitUtrr THIS IS TO CERTIFY, That h Iu�}}'vidual Sewage Disposal System constructed ( ) or Repaired ( ) bY-••--•--••--••-••--•----•---•-- •....................... .�,7`.tl. t._........ .. ........ ...........------------------------ -............ ........................------- .. s�� i /// Installer at.....---r��2N = � �.. '• ........ 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................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE .SYSTEM WILL FUNCTION SATISFACTORY. DATE...................................................I........................... Inspector.........-.......................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................O F..................................................................................... No..vsj.%............. FEE.....A............ Disposal Wor ��u rani# Permission is ereby granted.......................... -•-•• -•--•••-•...--•••••-••---•-••.......-•••-•••................---...... to Construct ( or Repair,,,( ) an Individual Sewage Disposal System atNo... = . '. f.- --..--•..............................•- Street as shown on the application for Disposal Works Construction Permit No...�.............. Dated.......................................... 1 0�of Health DATE.................... -�? ••-•-------•----••-•---- FORM 1255 A. M. SULKIN, INC., BOSTON i pp o qq � No......o. '..1...� FEs.............................. w THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF......................................................................................... d L Appliration for Millooal Works Tonotrnrtion ramit Application is hereby made for a Permit to Construct ( x) or Repair ( ) an Individual Sewage Disposal System at: 1112 Main Street......0sterville ___....Building C�� ... .. ........... Location-Address or Lot No. Carl S. riedel.. & Char.les.--D=---Rogers --------------------------•----......------•-••-•----....-•---•--......---.....--•-----------.-_.. Owner Address W Alfred r.... A Ful ler 11 er .-..._...... ................................ .................••....••-•-...................---.........._.........._.._._..._.............-•-- W ..... ............................... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building .WarebQUS.e.. No. of persons.12..'................. Showers ( ) — Cafeteria ( ) Q' Other fixtures ............... ..••--•--•----• -... ..._..... .. W Design Flow....3.0...........v......................gallons per person"per day. Total daily flow-A.0 0.____.....____________..____.__ gallons. WSeptic Tank—Liquid capacity.1�0_Q.Qgallons Length................ Width--............-- Diameter.---............ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----- -------------- Diameter l_M'0?_.__.__ Depth below inlet.................... Total leaching area...................sq. ft. Z Other Distribution box (X) Dosing tank ( ) Date................`-' Percolation Test Results Performed by.aaxter.._&._Nve..__A_ Janes PE �j Test Pit No. 1....... .......minutes per inch Depth of Test Pit.................... Depth to ground water..................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------------------•----....................-----••......------......_..................-•-••-•-----.........-----•-•••--....--.•..-- 0 Description of Soil...Medi um...Sand.. . ....------•-•--...-•----•--•----•------------------------------------------------•-----------------................................. ..... .. .... . x W UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIS 5 of the State Sanitary Code The undersi rther agrees not to place the system in operation until a Certificate Compliance has be ed th d o ealth. Signed.. ........................................ ..13e� l.. Date. Appli ation Approved BY ..` .•--------•-•....... Z. B .,Q�1 .�% J .._.._.. Date Application Disapproved for the following reasons:................................................................................................................. .....................................................--------------------------......._--•--•------....... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtif iratr of Toutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) bY-••----...-•••-•---••................yy..............------------------••-------•----•------•---••----•-•••-••-------------------•-------....._._......-----•.....------•-••----------..........._ Installer at••••••-••-� �l XA...........�------- 1�-�------------------------------------•---•------------ 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........fY=..fJ............... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. - DATE....................•-•---•-----•---•--•-•-•-•----...-•-.........-•----......... Inspector.................................................................................... .._.._ .-....................---------------------- i_ d No........................ Fxs........ ? .................... THE COMMONWEALTH OF MASSACHUSETTS { BOARD OF HEALTH ....... ............. .............. ....OF....................................._... ..... _..... ............. Appliration for NiVaiial Works Tomitrurtiun rxntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..........--••---••-•-•--•--•-•-•--•--...--•--.......---•---•-•-•...........................•--•-• -•----•-•-......................-•---------•-•---•....-•---.......-•••••••--•-............---••-•. Location-Address or Lot No. --•-----------— ............................................................... ----- -•--•---•--------•--•---------••------.........--••...s.............•.............................. Addres ----------------------•----.....----..............--••--------------.........................•.... ............--------------....._.......•-•-....._............._.............._................... Installer Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building -------------•-------------- No. of persons.....................--.---. Showers ( ) — Cafeteria ( ) dOther fixtures ----------------------------------------------•--..........---------------------...-----............................................................. 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........................ �14 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water....................---. Ix •-•-•----•-••----------•....••-•-•..........-••.............•-••-•--...............---•---••.........-•-•---•--•-------••••------•.....--------•••...--...... Description of Soil......................... W ------------•--- ----------------•--•-•----------------------------------------------------------•----•---------------------------------------------••-------------•----•--•-•------...--••----•--...... V Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate 'Compliance has been issued by the board of health. Signed...................................................................................... ................................ Appli ation Approved By....... �. - �/�-� '- •• Z Ce�•1--•------ Date "Application Disapproved for the following reasons-----------------------------•-•-----•-------•---------------...-------------•----------.......-------------•--••. ......----••...................•--•-•----.....---------------•---•----------...---------........---------•-------------••-•--••-••---•-•----•••-----•---•-•--•---------•••-••••--•-•...•-•------••-•-•-- Date PermitNo......................:.................•--•-------...... Issued...................•.................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtif iratr of Toutplianrle THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.................• ••. ------------.......--•-----........-----......--•--.....-----••. ---.......-•-•---.....•-•-•--•••-•-••-•---•-•-•---•--•----.....---••--•-•-•.....--••.......---- / Installer t �% Y .......................................................... has been installed accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.........f1.---.1`j.............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL-FUNCTION SATISFACTORY. DATE...........................................................--•-••---- Inspector...............................................................:. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t; ...........O F.......................... No.......f�l.. f%� FEE..... ................ Biliva1gat Works &ns!rurulon ramit Permission is h eb ranted.............. Y g ------•---------•---•------............................................. to Construct ( or Repair ( ) an Individual Sewage Disposal System atNo. Z. G• a/lxz......_ ----------� ------------- Street as shown on the application for Disposal Works.Construction Permit No..................... Dated.......................................... �I- - : rd of Health DATE. ---------------•-••--. ,.;...._. . FORM 1255 A. M.. SULKIN, INC., BOSTON .. Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: CkRST V 10-1 ON _r CO PP" BUSINESS LOCATION: `112 AAfr)IV Uu- j, INVENTORY MAILING ADDRESS: �I12,I�AiNSr Sf1�Tg L& 03M\)114L , & 0453- TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: V� EMERGENCY CONTACT TELEPHONE NUMBER: LA- 9wq—% MSDS ON SITE? TYPE OF BUSINESS: OA)ki-t III fy0:19mP-i. 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 f p , h o the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluidk(including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Photochemicals (Fixers) Gasoline, Jet fuel,Aviation gas 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) Any other products with "poison" labels Lla'(VEW ❑ USED (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 3 64 j*5 M 1 L 07bNl \"a"UCU Laundry soil &stain removers (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 Sign t e Staff's Initials Date �z /Z�1�� TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: C:'kitMI VT" �ft CJJJK co BUSINESS LOCATION: SotT?_ [� INVENTORY MAILING ADDRESS: N' Sr- 50\YL der TOTAL AMOUNT: TELEPHONE NUMBER: -- u�G-31(S CONTACT PERSON: STTW IDV �/S#apklC EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: CIfi�)/1'rET 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 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 6D Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, t6 Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents 4 Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Sig ture Staff's Initials (508)428-7727 FAX(508)420-5336 WRICO INC. Residential&Commercial Heat-Air Conditioning&Refrigeration Coolers-Freezers-Ice Makers-Sheet Metal Sales&Service ADAM MACHADO 1112 MAIN STREET-UNIT 10 Sales Engineer OSTERVILLE,MASSACHUSETTS 02655 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH O 3.Auto Body Shops unsatisfactory- 4.Manufacturers - COMPANY 6V- C® (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Id 2 41p,,<4- (jt A3 (c)+(e Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Vnwl IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: 6u 6,60or 9 K waste motor oil (C) wl feEe new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers l� Miscellaneous: 7-9 �wkz-�, of j te; C 0-4.. yC q 5(( DC ett DISPOSAURECLAMATI0N REMARKS: 1. Sanitary Sewage 2. Water Supply AyTD k ®,Y Yam' O Town Sewer CXublic �n-site O Private 3. Indoor Floor Drains YES NO O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES— _LNO ORDERS: n O Holding tank: MDC ��j K a If/ ,Q0 O Catch basin/Dry well ` , )Rton-site system rr 9 0 5. Waste Transporter Name of Hauler Destination Waste Product 1 YES NO 2. OE ol� -7 Person (s) Interviewed Inspector ate TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH 10 satisfactory 2.Printers 3.Auto Body Shops 0 unsatisfactory- 4.Manufacturers COMPANY �/�, aMd, � iMa�ibvJ (see"Orders") 5.Retail Stores / 6.Fuel Suppliers ADDRESS (;jgSS; 7..Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT-outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN . OUT IN OUT #&gallons Age st Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers i Miscellaneous: DISPOSAIJRE(;LAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply b V L S O Town Sewer Public 5� L/4a„.) ad-� J 00n-site OPrivate 3. Indoor Floor Drains YES NO—IS O Holding tank: MDC �+ O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES-,K-NO ORDERS: Q Holding tank:MDC O Catch basin/Dry well On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. Person (s) Interviewed Inspedfor Date Hazardous Materials Inventory Sheet Checklist e� Date . ! Physical Street Address-Check database to ensure it exists Working Phone Number j__ Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials-no blanks) ) Storage Information - location of storage, how long is storage for? If none, note that. Disposal Information -where and who? If none, note that. 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? For Your Information: Business certificates (cost $40.00 for 4 years]. A business certificate ONLY REGISTERS YOUR, NAME in town (which you must do by M.G.L. - it does not give you permission to operate.] You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: DL V b V Fill in please: APPLICANT'S YOUR NAME/S: -I?- BUSINESS p YOUR HOME ADDRESS: �� c1zy�.BL r_ Q�� A, C9 oZ AwTELEPHONE # Home Telephone Number NAME OF CORPORATION: c v , --e l-eC'2 NAME OF NEW.BUSINESS Sciw�-c TYPE OF BUSINESS .► W �L e�7 IS THIS A HOME OCCUPATION? . YES NOS_ ADDRESS OF BUSINESS r5LU-e /V-C( MAP/PARCEL NUMBER L`P, �-o l3 — D,) p [Assessing] ©1 C. 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 t: GO TO 200 Main St. - (corner of Yarmouth Ad. & Main Street) .t❑ make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business.. Authorized Signature** . COMMENTS: 2. BOARD OF HEALTH This individual he :been inf r f th errnr/-e uirements that pertain to this type of business, Authoriz Signature* COMMENTS: lrnl -OMP LY vVIT' ALL 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of.the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: TOWN OF BARNSTABLE Date: Yl Z TOXIC AND HAZARDOUS MATERIA SON-SITE INVENTORY r NAME OF BUSINESS: BUSINESS LOCATION: m QL M- �fka t , Ca INVEE NTO TO RY MAILING ADDRESS: 00 Qa Y 3 0 V— TOTAL AMOUNT: TELEPHONE NUMBER: d 4-a 2 a— 612 CONTACT PERSON: I��C-4c��LQ _ S'tC�� EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: �f i—= uo �e—t, z 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 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 Laundry soil &stain removers (including bleach) J 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 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: Ikm,CC) 1#-j C_ . Mail To: BUSINESS LOCATION:_ t+ f a M A-c k j— QAr i—, Board of Health Town of Barnstable MAILING ADDRESS: �d i��-' li (� G r55 P.O. Box 534 TELEPHONE NUMBER: Sor — p Hyannis, MA 02601 .` CONTACT PERSON: tunr-eiir EMERGENCY CONTACT TELEPHONE NUMBER: vim, Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES _Z NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants ,5'c- imotor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel T r_� Refrigerants�3e �� M��7xoS 9 Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) ,' Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business L2L� ixtit ,--011:1 0STERVALL . , , � 4F Fy>' i BOX, 159 1112� MAIN ST E , GNAT � ;5� DSTERvILLE, MASSAGHUSETiTSfJi - ? NOTICE OF NONCOMPLIANCE K � ; NONCOMPLIANCE •StJNIIKARY 'tx t(508) 48 �� r , x 71, y xc � ter: 4 - NAME OF ENTITY IN NONCOMPLIANCE: Ostervlle Mower Service g.>ti '- 's ` x LOCATION WHERE NONCOMPLIANCE .00CURRED OR` 'WAS OBSERVED: ` ' ` } ✓✓ ° ;,,. 1112 Main Street, Unit #13; Osterville, Massachusetts F u < `�. DATE WHEN NONCOMPLIANCE OCCURRED OR WAS OBSERVED:. April 25'; ,`19-91 i DESCRIPTION' OF NONCOMPLIANCE, REQUIREMENTS NOT COMPLIED WITH f7' ' ACTION TO BE TAKEN AND THE DEADLINE FOR TAKING SUCH ACTION: �. k • f try r Osterville Mower Service is. a Very Small Quantity`Generator 43...; q u(VSQG) ,.-_of..waste oil i.e. one who is allowed to generate up kilograms .(27 gallons) of waste oil a month. =Also, beadvis.ed"thata°° +M,a. 7 fas a Very .Small Quantity Generator, , yt are Wtioh � alowedto .y f PF R�, e accumulate up to 600" kilograms (three.: (3) 55 gallon rums : >Once . . you have achieved. 600 kilograms you must iiinediatel shi the wastes t Y g Y Y P , ::. off site`using, a proper log 'or manifest. A he Department conducted k<.an inspection on `the above, date" (April 25a r.1991) , during which .th&'Wrfw y y �j F following violations were observe , ; >k �"i'F�& rf.i% 1. Osterville Mower Service is storing one '(1)" 55 container located Vinside the garage area-used -for z accumulation of waste oil. This container was not-marked :' with the .required information, in violation- of '310 CMR M{ 30.253 (5) (c) which references 3�0.353 (6),(g) -and �30.682: ' "all containers in which o Therefore, .effective immediately y ,'. waste oil is being accumulatedS hall be markedF with the � tiY rHs { following: SW , yy , rt5 r, a) The words Waste'oil '+,,� fk:• ' %�.;. t''.r:. _ - I s a- .>`' ;• :s. sxr£r, �: �'i; f b) The typeof hazard.(s), associated with the waste'- . ` ` (toxic) • .. 4 rYS. X 1 P w+} ti,- -'r4 6� i�x :?¢ y . .' L':t -. K . n •'11N. t•' k`1 G 4j 1 y +( •' r x '4� s- Hereafte'r,..' ..Oste`rville ' MowereFr ervice`�'`shall maintaiw' " _ compliance- with the regulationx.:governing thek �� labeling4Fs ' t , , t ,[•,,"f �ti z& as of waste oil accumulation containers. 2 Ostervi�l-le Mower Service Manifest +records also:revealed � ;a• ���� ��. that copy.seven (7) ' of manifest1MAF107997- (dated 9/5/90)r , K=..• sue for the shipment of waste oil off the site of generation �fr e t x n was observed in the fifes, in violation of'31:0,CMW30.313 - Fss+.. � {� tg (2) which "proviges'thaPy ithin ten (10) daysgof the, dateµ} y , �'�* the shipment be ins co seven {R7;) shall be forwarded'�by 6 ' � Fh ��� x the generator to the 'Department, at' the address ,noted at the `op of -the manifest Elf f&-tive immediately;` You shall come into and stay lYl_, compliance with this t k regulation. T , � _ i y � • ��' )fix TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: / Board of Health MAILING ADDRESS: i/f Z- /71A ti -5y Town of Barnstable TELEPHONE NUMBER: P.O. Box 534 CONTACT PERSON: ,� Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES &-*" NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners iZ Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants V" Motor oils/waste oils Road Salt (Halite) c:./' Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, _( Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine �vl' Car Wash*detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 0 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY n� - �, (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 1113 hA aa),,. SIC Class: �z 7.Miscellaneous ® QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) ,CV new motor oil (C) �0 transmission/hydraulic Q Synthetic Organics: degreasers Miscellaneous: Lea Is.aA 10 L= L ENNNNEI� DISPOSALIRECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply O Town Sewer OPublic xOn-site OPrivate 3. Indoor Floor Drains YES NO_.�L O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES_V_NO ORDERS: O Holding tank:MDC O Catch basin/Dry well 1$1On-site system 5.Waste Transporter DestinationName of Hauler 1 YES INO . 2. son (s) Interviewed V J Inspector Date N `�----FxiSt caA-)c,. FC06r- /4J TS w d -X ZX 3= %SD`�'�� M.,x. 5/JT i iiCQrZO `Jo �CNMe ---- = C. F C,►'X7,`/� = Vol, iti 5�1�o..�S ��.-Cvtic rem w�a,sovcJy y r fry.r-ed I _ AIS1 Founder �N USA [ I oco 00 f '. PLAN August 13, 1991 TO: Torn McKean FROM: Ed Barry RE: Hazardous �,Ihaste at commercial condos at 1112 Main St.Osterville,1A. UNIT 01.1NER OCCUPANT HAZARDOUS WASTE in EXCESS OF 50g l or 25lb: 7 Randy Harnois same Motor oil and waste oil . Grease 9 Joseph Amaral same Lawn Weed Contro_l,Turf Food,Insectides,Rock salt, paint,22 lawn mowers 13. CI-jar lesRogers Pahl Weatherbee (Oti t.Mower) Motor oil and Waste oil, About a dozen mowers Units 18 (Robert. Keston) has a combination of toxic substances that would total_ more than 25 lbs .This vrould. include :Chlorine conditioner, denetured alcol-.Lol ,lacquer thinner, spray paint cans ,Round U.P,acetone and reg paint -Ln gal. Units 12 6nd. 17. have one or tvio gallons of paint and thinner. �I J4'I V /� d ' ' �. e ' i ' I <, / '� ,/ . , I �� l � - f i I I _ � __.���____.z TO: Tom rlckeoii 1R" Toxic and Hazardous Waste stored at businens condo units at 1112 Main Street, Ostervil.letMA, y " The following units Ore i.n vi.olr�ti.or►s of conditions set up by letter y. dated F,nb. 201C01: from The Commonwrhlth of Massachusetts Dept of Environmental Otinllt.l End i.►iecri►ig(I)V,()E) now Tho Deportment of Enviro►►me►ital F'rotech ion(DVT)TI ion o conditions were further stated iri ,a letter dnt cd Fet)-3, 1994 from John Kelly,former director of health fov the Town of Barnstable to the developers Chales Rogers and Carl. Riedell of OsterviLle. The violations are of Sec tio►t 3b Article )LUIX f Control of Toxic and Hazardous, Materidls UNIT OVIIJ01 OCCUPANT VIOLATION 7 Randolph ll.Harnois Sm►►e Storage of new and used lad Lumbei't Mill Rd oil,paints and thinners MorstorisM:[LLs,MA.026).18 �9' Joseph F.&Maria Amar4l Same Storage of Pesticides 16 Wintergreen Circle oil and gesoline(mowers) Ostervilld,MA. 02655 12. Thomas. A.0elson Same Storage of paints P.O.LIox 7h 9 and thinners Osterville.MA. 02655 13. Charles XSl)irlpy Rogers/Osterville Mower Storage of new and used P-0-Box 310 (Peter Weatherbee) oilpaerosol degreasers Osterville,MA. 02655 gasoline in mowers 1'j. Theodore R.Turner E.R.O'Connell Storage of Paints and 55. ' Brirnrard Rd. Builder thinners 9 Ostervil.le,MA. 02655 18. Robert C.Keston Some S� torge of paints thinners East Bay Rd ; . pesticides. Osterville.,MA. 02655 i j TOWN OF BARNSTABLE CLASS: 1.Marine,Gas Stations,Repair 2.Printers BOARD OF HEALTH )(OMPLIAN;CE: satisfactor 3.Auto Body Shops unsatisfac 4.Manufacturers COMPANY O 0 (see"Orde 5.Retail Stores �� 6.Fuel Suppliers ADDRESS a• l a Class: 7.Miscellaneous (W QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN (JUT1#&gallons Age Test Fue asoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) eavy Oils: 0(/ 96t,0 w&ste motor oil (C) y mawmotor oil (C) transmission/hydraulic Synthetic Organics: degreasers a 45'6 o Miscellaneous: DISPOSAURECLAMATION REMARKS: V7 Gr 1. Sanitary Sewage 2.34ter Supply ie Or�_ O Town Sewer XPublic AOn-site Q rivate n 3. Indoor Floor Drains YES NO k O Holding tank: MDC Q Catch basin/Dry well O On-site system r' 4. Outdoor Surface drains:YESNO Oft DERS: Q Holding tank:MDC r� C� O Catch basin/Dry well O On-site system 5:Waste Transporter fA8 i Name of Hauler Destination Waste Product LicensedT, YE NO 2. eR :DOYVA 10 �6PS��-8 gQq3B/- Person (s) Interviewed Inspector ate THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR ORIGINAL (S)QUALITY IM ^�Cc� C DATA + ,_ A Rd ������� , PLACEMENT,FORM k T7 _Big Timber Road DUNS NO os106 tiO4UO kt�" ,. ':f ,h.,,.,y�S -. .• .. ` Yr r 'S' • . '. �E 6b909 #FED D NO39 01 � ®L,/ R as s r%S t -3t,�srtt'r f ,v " ,n.� ..C>r, 34 �7 L .M IYlr171r1IYT it �� � "< d � s i GENERATOR/LOCATION x n x ' ILav�9 Iz- K NFORMA( Eh {,, ,r`{ c ,• -3+ Jt. ll AY. R {Dt$St+4n DEL1V R•YAD RE9s • - T r '! '.,* 2 '°!t?Y. •as .f...'. »;eti° c,�.-c.'+r?.'; t Ml '- t { tpI'r•r�x � '` '' �� � � � �,�;". f � 'S , yY�. r •. r ��,sty � ait r O.ZIP r;-21 rU v. .;sT T.0o NO.,,,' I �F,f F i u ft tV, MANIFEST NUMBER s � �{{A 1L , SIGN-UP,'DATEr},-,,'[';,SALESMAN'S NO. .:'I-BUSINESS CAPACITY' TERRITORY CUSTOMERJELEPHONE NO. SALES TAX EXEMPTION NO. CUSTOMER:P.O.NUMBERti�3 «-s . 3`,;,4t CHAIN r "SVC P/S' PROD P/S HANDLING CREDIT NEXT SVC SERVICE TERMS BRANCH NO. 's T x� #' CODE CODE x 7f COMMENTS A r�..te ��F •'P� ,fsa + '" .-.. •[?. ° as s +.. a rx A k h 1 1 S k y=-x nub d ' s . This Into certify that the above-named materials are properly classified,described,packaged,marked and labeled�an'd are in proper condition for transportation according to the applicable t�, regulations of.the Department of Transportation.`' � * ,, 1 t. r ram,; -`- •'.` d a�=Y :1-,1%ftvy t at m total waste streams ere: rtnm or•e ' r� NO TYPE QTY UNIT US DOT Descri tion Includin Pro er Shi in Name Hazard Cf ss and ID Number' otmelonowinYcat ones Y tskr3 ` i .l v- a 2 5 •&' y ,k5-a s -. - 0to220lbslmonth t'P` LJ 1 $ "1 t';ti.'Y$ 5�'3 4 �Y"'•,�>f f• d )& 'k "'E n+c r= -�" 220 Ibs t0 2 200 lba lmomh . s s -Ey ay r $ 3 , w, e x Greater then 2 200 Ibs/monthA 4 3: DESI,33GNATED FACILITY)NAME AND ADDRESS: m 113`�-`V� w+ '.USA;EPA ID,NO ,r ..7}.ram s ✓^ +$ °k4,r,,!.z '.' ,� r."ti s�,.�•� _ "�" 1 �/�l"{".�.� �l`:J) ` �.M- � # •STATE ID NO:`:1 xaSERVICEi` ra DESCRIPTION GROSS t NET UNIT OF SERVICE:' x' r{rr"LIIJE r o� NutneER >--,z- � - '-QUANTITY •QUANTITY `MEASURE ,,PRICE::: >:.CHARGE .",,.TOTAL -:.„ ' r .,`..+�/ rw•u�...:y",✓X-ysl,.,., ,. aF w r ,... `•.> -v. i.-..:. .. (40.; SEDOILPICK3UP IhrsY+ - r 'y%'�� .7F F s, '" r ma's •�-:-�z :s ",xr,.x .. , :. i: a .-.� kr � a '" ;r.�• s OILY.,WATER DISPOSALK s �L e � rf'� g� �' f„g•s <Vr+s„ .ks +'<k�'�f < <Za x A ~�i� �, c" � / � e ;. yw P^4 +fit a8 .>m�6 c t �, c�,�;� �.�,`+ s�'^`x , �, •� � � �.., 8 ,rru �aw ,� t e 140050 A DEMURRAGE tx YT .$b dmr✓ ✓ .f a,- a 005 r UNIpIfG1IME §e5.t� k �s� Y £�f r .�t ra 10052 MILEAGE I . " 4 }ram µa ,r }a r C: y ..� t } ,: pyr - -.M " 4l '34'd10054` "a 5.9,y,.. x1,5N #'•in.'3kzr0 t < L' .'_ r .� n , • A oc `4.*_+N. ` '^ ", �. YY k,y''y �`3''.. � (E L•{'r' , �'� U t i�� T ax a � a.3,, �, ��C�cr' Y•r r�`,}�r.y �'x' ys j �.12.`' � r 5� z e. � w s1 E I E • TOTAL RECEIVED as, a 4<.• z ✓ 'k;'�- e r `r' t�.z:'y'z. •CHARGE MY ACCOUNT FOR.THIS TRANSACTION UNLESS OTHERWISE.INDICATED�IN THE"" �- s ar C-HECK NUMBER•% -r'"Y '` .PAYMENT.RECEIVED SECTION ,a '-�'+' '�''a,e rt. _"cj �'�"°` iK r :r`: • INVOICES REFLECTING'CHARGES TO,CUSTOMER ARE SUBJECTTO,AN.INTEREST_FU1 OF`t {`r - sa. ifi .yc+ss : i4 THE LESSER OF I/a%PER MONTH(190;PER ANNUM)OR THE MAXIMUM RATE ALLOWED BY Tn- s a. ® LAW ON ANY INVOICES THAT ARE NOPAID WITHIN 30 DAYS xIN THE EVENT OF DEFAULT SAFETY KLEENSLL BE4 „ .r{ f,; ENTITLED TO RECOVER COSTS OF CO�L�LECTION;INCLUDINO.REASONABLE ATTORNEY S FEESt £4, {;s . PAYMENT t�tETHOD� r PAYMENT AMOUNT'. ' t ' GENERATOR WARR4N S AND REPRESENTS THAT THE MATERIALS PROVIDED SAFETYKLEEN'CORP'.HEREP DER`: - :-V,VE NOT BEEN 1,4 ,ED,C;0MB NFU ON OTHERWISE BLENDED W-ANY,OUANTITY WITH MATERIALS?RN LNJIhG,f rH 3�x ❑CHECK.` U�. _ �. '*I P� vCl lu n7r,� BIPN,�^ltl c t.,.2,-+ 5 Yf.,.rt R ,dA'� IAL'DEFiNED AS--i�'-HA US WASTE,UNr,,;f' r r� a c T i — n `" P CFiV_n F!'"` � r F'LICJ EL t AN,S,CJCJJUN.9U r OTTLIM,7E3:040 CFR P..i , 6t:GENERATOR AGReES T0INDEMNIFY-AND HOLD 'CORP.HARMLESS ut+AN�DAMAGES,COST&-ATr RNEY S FEES ETC ARISING�LSAFETY KLt i F OR, dt T WAY RELP.TE D TO A BPEACH CI The '60VE WARRANTY BY THE GENERATOR G3 � yfjF" K L_ LUSTOMER's SIGNATURE URE I ) a RIN�. k _ PT i � �(� ,�d. + f NAME l� 'x GENERATOR/CUSTOMER SIGNATURE IBM_ �gy.,-x"a��.'s•'�(' «i v�:! r• '* r �r x � z � s t� r?S�r'4�x,�., er_*K',,,p b ..y w�•� ���}:�- t ,ter' �: `` cf.7 s'S, .' x�nv.�+k:+�'���t��,q+,; ,��z6.�r�� «' �- 1F2�� ffnz_PZW 1r [[4•? 111{�`��� # > }raRhi 'r.�S F✓i ®S T E:OV1����h1 ` } �l �'.. j � � ; r�•, -2_ P BOX 159 1112 MAIN STREET UfIF�3� , OSTERI/ILLE;MASSACHUSETTSx�0w6�5 � The Department requires a written' response within fifte �i8�( 8 >' b id#>=h4days: of receipt of this Notice, addressin each of :the 'items above and indicating the actions taken in ordei2ll to achieve and maintain . s� <y s compliance with the Regulations. �, Should you have any questions :relative to hazardous waste's � h management at your company, 'please, contact Edward.' Burke ;of thiwj r ; k F office at (508) 946-2826 .it *° DATE: J ( 9 BY: z Gerald A : Monte; Chief RA Section; € � b is �t { S fi, !ry "i; �' t;�" ✓fYAr_, z+fjJ >-F a'4 mx i' a uit�r: ryti He` d zFs arz''� ✓ � .F x:". 'ter �✓�s� ��. �t�'������st�r^�. F.if {i$.«"Wr�" Yy� t v s riJ�ahr � `y} ,ty 1 x., i ,♦+. rr.- r 5„ r"� ,, rr r.,„ ?;- ``-;.%,.,t`' 4x'v �,,r.'�c*q Sri 1; $ - ,. � i. a L rx�- .ty. .�. + t �j #� ��•%ti _. 1 i f rvh-k�e c.X�..� „z�r r ,...,Y,r , ♦ r �., 3 ._ � .�y,�� € 1�.�.,r", :.�,� i,y *" i, rc r �,a �' X�,i ;x, L g:: R3 ,. a`� $ ✓ i 4y ray sLi ry'3t - z �� . e .,v x'g� it✓ F. F3'i^�n°'�<' `�' Tki �X3 - ` y: •` .r :. !�* �"ld �e^e. i'ti,�� ,�� «y'r,�-,". � ;.. �k ,'S, k�, d " f " '� •,�`'y,t" `T^ a it" Y.-. r •„f t ' :a h AVzI- �cyy�`y�j,�+£.;efs ,�.� Y #. 3 � 's 9 �G `i� sF✓;�t�? r g'�l' r x ;f girth a r rh �, s �;'S€'e2„"�.�rr`� ,ty .� �,,� �-� .5. i :r. r 3�+,-y'Sc _ .•f,4 i 4:'e+^ y t' t aX'�.x uc� �x�t�R:� ����{'a�.. i+: e�✓�� .a„'. ,a .r�°�g„F f. 3 � .r a:�`S`'r ti ?`:,S r,esv.s✓ �, �"„r�.a S �. p r• y - N'.. •i y, -�r„c� �•� �' .�`i{.'.a"N'4w,J.S. s `"x^ "'f' t+Lc�",� ,F t v"' < �, dt:,r 4aq.;_r•,, x �:'" ,rs"' ,,�} �' 0/`0 �ory" ay} 3�t �. Y r �;°{ r r r 4. n ,?'�y fa `# *... ,adS`+. +ti, . .•4,*:k W 0 egCi`s +g Y r�t,�*dfi '�a%:-' - .. ._-- I 'v`1� ' d •� � i Y t r x 7� 1-+#s � :c .�,�� .,�,,� � ,�,. • Je�� $OX 159 1� '"IN Sl'REET 11Nl,T,��3 CHUSET'TS Now �'"`%1..`h.'ars :- 5 �.ES&,�'�-tee s ,e?�' •��J. _ , / /. _••//// .,, ''ft a /q/ rn' �td �'� r;.•�,-e:.y;�� �/ �' ' Uzi �r, ' �r� d f;t• ' � DANIELS.GREENBAUM x { Commissioner rki✓�," y`-t'"+i•.- .T ` r r {x5 k'�a y`^t w•°�,w �. L< GILBERT T.JOLY '* „� � . r Regional Director 3 1, May 3, ,�.19 9 ti� � .' - y+��r j .".t bra.� vvo:• - - . - a�. - h ,�; ��;,� d yam. s��S���..�� Osterville Mower Service RE: OSTERVILLE--Hazardous Waster' s ` ' _ Wyk..• t arty` w�P:O: Box •.159. Unit #13 y0stervlle Mower t Service Osterville,� assachusetts 02655 =1112 Main .'Street F M tir 310ydi 30 000 r fi. SiteD#MAV0000:08820Ar � �� 3 k Status. f VSQU R '� , 1 ,},xATTENTION Paul WetherBee' x �c �. ��# Owner F . t x.� e. i f •kXxll �xaP". z ' NOTICE OF •NONCOMPLIANCE " x�4r`'t d. ` THIS IS AN IMPORTANT. NOTICE. FAILURE T0 'TAKE ADEQUATE�.ACTION rIN . �N RESPONSE TO THIS NOTICE COULD RESULT IN SERIOUS LEGAL CONSEQUENCES. kt' ' }�r.?F' .q- } 4 .c Department ersonnel have observed that on A ril ='25 ' L� ' �.,; r���: s P P �,�� p , ,19 91; .„ �,� � 4 °activity occurred at Osterville Mower Service, located atM'1112 A'n04`. s r s Main Street, Osterville, Massachusetts, 4h noncompliance with one ra more laws, regulations, i orders, licens, permits or approvalsn ,4�, set41 enforced by the Department. {."N �� , ,ryf �:"z 1T X .3 t ".'C'�. .3 'i� ,- { A ( r { e s -D1 Fw` �,J .{^s'"^ `*2' A. `. w 7 ' ':The purpose of this 'inspection was tW;determine the.,statusff of vt"Ar , •d k 4+bra t� ky �Ea.A your facility relative to compliance.'wit .;the" Massachusetts, .' k ,, y= . 'r ;Hazardous Waste Regulations .as contained n 310 CMR 30.000<<which �. 00t 11 were adopted, under the`provisions of ::Sec ;ion-`4,6 `'and 9 of� Chapters," .; `f 10 of the_Massachusetts General Laws. as applicable. zf, � Nq, a r ... .,._ j a� � t� '�?, Attached hereto is a writtendesription of. 1�. each � t � activity referred to above, 2, the _requirements violated, ,3y. tY �+action the Department now wants you .to,�take, ;and 4. the deadline ';` for taking such action. £ y�'k n . w4n, W, X,*3 ._ If you ,fail_ to take any .action heMepartment now wants` your take' by the prescribed deadline, ' or if you otherwise; fail <�remain in compliance in the future .with requirements, applicable```-to ou ou could be subject to' legal' action, includin =but note y /ia� ,# p sdsd' ..y y, .. . g_. %> g� limited to,'' criminal prosecution,, court.imposed civil..£penalties o a ri' ' � `e3 civil administrative penalties assessed ,for. ,every. c�ay ,,from: now onti' Yfi r .�," y 3 A r i R VIN t z Recycled Paper '. t ` 9-..>`q. Yet'at, h �� � bra � v• .. ,. - � + t W� � #:�, �'�� s;y�+ ,�� . F t ��-•�K3��+5'� ���fi � � z a ,�� e,f�'`'tea ���x�xAr� �� y % %fx� yx i �a�vYs-, � a;�t J �M +�'�'3"��' ���' �,; �"t'c��� t.+•,t R��/■J/� ' in �i'n{,I Ij1E t Nn " ,Y.N-^L y"/sti',.{XYJV,T LF�'q� •:0�T��Y'Y _ 1�1 5, ,��.' �� D 7 i v L�J1 5 M1yi�1p'F"'y pY a + .. BOX 159 1112�IVIAIN ST EET� sIiNlTil_ � .. Q$TERVILLE M'ASSA,-HUSETTSr0265M5 '�Y rc —2 , 21 ;that``you are in 'noncompliance with .the ' equirements" ;referred Rto , ; ' + 4 1.. s t :Wabove. IFS• r3' t` _ "•yam ii .:.' r ; very truly ,:yours, `ate��€: {� s t�} y < Gerald A. -Monte Chief . ��� } <- { ." , RCRA Section: s • , CERTIFIED MAIL #P622 584 330 •,;:_RETURN RECEIPT REQUESTED ' � - � �t ���47. w Ma . + � „u Attachment .�� ff i' s, au fir^. r4 _' cc: Board of Health x X - ' Barnstable County. Health Dept... F Superior Court House •�" .t4 a a Barnstable, MA 02630 DEP - BWP - Boston ATTN: Compliance ,4 h,; dr Y wG kr SiY %I.. '!'t,."45"yy''.'a .try - i 4 '•"4,.# ;''r +t - •� ..�,{se a <f .� s., .,.a- •��f„r,s�#t,o,a5w.✓-•. .. -.�,.„ - ,...... -'-- .�`-a�.a..,._•,u+.k ---s s.c.c«�-�3 '.sm---'��-- -•t.ria- w-. ,5�`�:.�ri.6:e:; tk g3 �t.', b x �t✓�'bgb'+z�. - .. ,. - ti - `��- s� `' � '.+ .a'"��+..��s. _ h "P j §x�r • a+r;� .a r,. 4 =,x s K�.s r :hk Y`'�"s�•Vr`` ' TNFV f r`t at7 �� '�' ` ,. �.r - ... tty..r M•. .� :'t7'�' `��r r tx- y Ate air �a� at y rn • ' .s _ •,r�," �t-�.• ��t' -� t( 3 i�' ^w r • ... M ., ,� ,� tea._>�.¢�,i is a. �� i;��5 � r ; _ „� •+ s � �� � : � 4, �~ � � �_ ���� t:'-`fit xw�a"er' .. �.,f ....,�� 4y'�,A•„eF,l.f�r �•..E. •..,- .. i,5r•i•.:v ,<ti ', 4' 0 c •"t „. Qmk 9ae ?a2 c /5Vo r i• ° '-l�lo�!4L'✓•. d«.la/C4'%. C(/J ` Il. �.G4 ��1tiRfY�'+i�Js�/,. .., �,r`>€t Daniel S. GreenbaumA. Commissioner A2Czssi! etfB� Gilbert T.JoPy r Regional Director July 1, r 1991 x: Yr x '> r rs 'Osterville Mower Service ' ;RE: OSTERVILLE--Hazardous Waste P.0 Box 159 i Ostervil le Mower Service' r Osterville, ; Massachusettsr 02655 • 1112 Main Street i '" Notice Hof Inspection` ; Zfi � r;. 310 Cif'30. 000' r1 ,1� r rt >,< ar; Site I64MAV000008820 Statust: : VSQG a. . 1 "ATTENTION.{ Paul Wetherbee $'t a Owner. Gentlemen: 3 ; � x a. . .: ° •"�" . e - 'e ;. r� L ..,x,Wg The Department of. Environmental Protection, on Jurie 7„ 1991, � s �« 'conducted.,a; follow-up; inspection. of, Osterv111e Mower aocated at 11.12-,•.Main .S.treet; ,Osterville, Massachusetts',,. .,Their *K purpose of the inspection- was -to verify. that': Ostervi 11 e:"Mowern, Service, has complied with the� deficiencies°outl n:ined.°,i the ` `� r,r % $Department s Notice of Noncompliance dated May 3', ,. 1991,,E relative to Massachusetts Hazardous Waste Regulations as y F �_contained in 310 CMR 30. 000. }+ x�,#�, i. - •e c +� ,' K k S, x 'H"t' `-'-,.r� ,Ti`r fir ".htt' `t i".F W+Pi SSk .5,--�'T. _ a"i .."4"'i' 'P r e.t•J:. •h �ate ,-'6S 4 a, - The •follow-up inspection confirmed that"'corre'ctive° action y x has',been satisfactorily implemented regarding the , :)wing{ K`` ;•.�<{,, {P deficiencies: ,Y iv 1. - All 'drums and ,conta'iners of ,,waste oil are properl labelled, , and are, inspected weekly. P p'S 4 2 All manifest records were in,proper order, in that copy ? 'of manifest'MAF107997 (dated` 9/5/90) was sent ' ,the' proper address. ifi. iY". : y.• , 'As a re$ult. of this -corrective actionand ,in, view. of yo�ar , � 3 T "S " r :current .operational. status,. the Departments-,has ,determined:.:that Osterville Mower. Service,; has; complied with the Notice of: r � R Noncompliance -issued on May 3 , 1990 ;�arf.s�•t".s.R.��+A.i ig d'�- . +cy7° c 'T •' ,`t `` •5,.�.aj.r r 4 ,*LC} Y ark ' » . ' Original Printed on Recycled-aver d kx x °4 "- x +N. •rr aifi''•'� • {jy � OWEN S R."I.-III MOVERi P } BOX,:159 1112 MAIN STREET t 9 —2— 2 .( • OSTERI/ILLE, IVIASSArCkUSETTS,426,,5 � Should you have any questions relative to hazardous war ,� ­''management at your company, please contact Edward Burke: of this f -office at (508) 946-2826. 4 k � .Very truly (yours, { xP a! k •" Y R T `}f P ra d A. Chief CRA Sect101f<_a � a, - M/EB/lm - ,� '"• 9 :1 a,M1 x xFYp.. T.Y M1 A r'c: Hazar'dous; Waste Coordinator'. of Health rt 4 z ; 1 day ,+w Barnstable County Health •Dept ` � Superior Court House ;�� 3 .: € Barnstable, MA 02630 , DEP - BWP- - Boston ATTN: . Compliance '� s'£ , ri, t r - • • a. fi'- w l �.* 4 it a.i,- ti r t k+..�+ �4- x" ° 3, .*, .n•4 P+ »•r .• Y 1 w t-4 .� '.`x y r�,k 1 �•' ... x T +• ��' �'' 9 �.ei ��. s SST' '�°"�°"~w`��� '•Y"'C'��,` 4 y {� �yy:: s".el ]�.ijs�Ax'" t r ',' +4W, •?�s,'F �'r ' '"1' i� "°f r�7 k 5 � • .. ,� A w 1 � � � J \ � � �,Si'i`�`t,����J r ,�i "�"va-F4",�+n�r � - - y � 7' t� •k �� �h} �hc��r.d+:rj;��t�?r`� 1� --��,���', ' �^•4�-•.`r 2`fin"�ry#.:?kit �G �� f "'� t r 7r r' � � v a e�s �Ca '?.�'�'FY 'y��� T�n y�<+. ��`-nl,� r' �`'� .�-: s _ Y ,�f.,� k is t ^4?� ]�� t,�.r't` '� k-•', ���' �'�'�+i,"� y'ra- ; '+ „«� �•vrhr k at t" ^h'- 3 '5'u x�g,{L� jar $ .� ; �aKy�" �'� 3 r.•.. •.- ,. ,. _ •. i #- X - ii+iA...,wK^�•..a� :+-k+Yciantl'D�i.inhw.. �w3�}'}- � x,Wkydf r i'''�ee k .t ,. r �' ! 3f' r��+r en'"�• ,�„,. ,, x✓L � r- 4�,.,r', � F � � �i j .K•' X�L`vs'�yr f .3e sG+: 'bbc r Fy,�syxt� �� J "S fi tih•'3� r�- . _ - �y ,,r,d. •] Crt�F � ,w+a• .,r i- �rr+e. .i+ { 40 r C'� .S ar .}. a'+ ;'f -k, ysyl M1S .• �x � ``�f ^✓rF�s�''�'j �T ,�- � k- -�i fir. g k r y -is ���s-�{� �r, '� R-y` t- � �. � -•r. +°.fit. z� 'k�a'r �.��� � ' ^` +" �, �x;�sT'^• .*F k_p .. -slj,F „irc�_5 tv `..z" ,,.•,'aa VA q i'�s,k�t��C x p �"3�'ti•�r��. r '� +� ,s�. x�� �.a �.,� � s- x x i4`� ��}fiy J�.... �3 d3''tz „W •t r R7 s .e3 .5, �'''�t• ,rs ,+.. s, ten• °` ,. -, y {sh,�, �" - •.r `-.�F r 'L 4 i' 4 ap -krr .wr _ �',�-"�,'' <�,•'�c. ,,}F ?'r`4. 1.5' �M s'� A �Ta�.* _ ''t r a. ; �. • 'w L .� ft7j�, ,,t •yyl5`y, S � zu � ''tr ✓� x i ra �f i-5 /. - c, F C.FX 7,y� = von CvwC f-c.f e rk4.S��JCJ` i cc 00 �V PL A w 1 d1 T7L-T Cc;.,jC . FCoor— n �,�r S = C, F. ki C.FX 7,yg = Vol ��Cvticr�te w�cL�a��cJy r . 0 _ �'biCCi� �MJr�zcr�d I � cc 00 FL A Au A i-fr- i 1 ' i I_ C 4.77-- ------------- ? yXIS r caA) 1 �!!TS ..� C, F C.FX 7 Vo CiOL l T C C PO 0 00 J„ PAGE NO. DATE: Lc�S ASSESSOR'S MAP& PARCEL: 7- 1 COMPLAINT LOCATION: f I f Z COMPLAINT DESCRIPTION: Af- - • -DATE: INSPECTOR'S ACT,ONS/COMMENTS: 60s" Al LIL5 v A r h O l W Ij i 1,�5 s6A' Lra iz ; ULAS IRJ426 9UHG. �Zlrl W69C klAvV OE��j 0 U5 AD 010 5� ii r 'r c,Fi 511ri -�`l 5Fi F� •: I�ii..l'i_I 09/ tD4, �-'fi --1.7= rib 5115 14: r TOWN OF BARNSTABLE COMPUA C ,: CLASS' 1.Marine,Gas Stmtloma,Repair BOARS QF HEALTH satisfactory 2 Printers y hops 9.Auto god 4 ,, ,•;.,- . p unsatisfacto 4.Manufacturers COMPANY _ (see"Orders') S.Retail Stores G.Fuel 8uppliets ADDRESS .. ; `,las5. ! 7.Mlscvilnneous QUANTITIES AND STORAGE (IN=indoors:OUTaoutdoore) AWOR MATERIALS IN OUT IN OUT I OUT N&gallons Age Test Fuels: Gasoline Jet Fuel(A Diesel,Kerosene,12(8) Heavy Oils: ) waste motor oil(C) new motor oil(C) tran sm ission/hydreulic Synthetic Organics: degreasers 7 sir � •sj7d � [ ��: � T Miscellaneous: f n. -..a7 1 �T DISPOSALRECLANATION 1.Sanitary Sewage 2.Water Supply fI', 0 Town Sewer bP.blic OOn-site bPrivate 3.Indoor Floor Drains YES,,,__NO ✓ � � O Bolding tank:HOC— C)Catch basin/Dry well N O On-sits system-- 4.Outdoor Surface drains;YES NO ORDERS: O Holding tank:MDC •'' O Catch basin/Dry well O On-site system 5.Waste Transporter NO Person(a) nterviewed Inspector Date 09%05%95 14:55 5Ct8778555r INPJfd=� rrtCi4, r'1 i'�ac �31 Giarnno d Freida Certified Public Accountants Date: TO: cY� Recipi4nt 1tga - b3o Fax Al FROM: Semler Phone # (508) 778-5555 Fax# (508) 778-5556 # of pages including this cover Federal Building, 78 North Street, Hyannis, MA 02801 (506) 7 7 6-0 515 5 263 Medford Street, Suite 401, Somerville, MA 02143 (617) 623-6100 Printed on recycled paper manufactured in Meseechuaoatw 09 05/95 14:55 50:8-7 785556 :S: 0 Campbell The Campbell Co's., P.O. Box 71, Marstons Mills, MA 02648, Tel. 778.5555 August 3, 1995 Mr. Andy Witter First Property Management $32 Main Street, Suite F Osterville, MA 02655 Re: Unit 16, 1112 Main Street Condo Assoc. Dear Andy: It has come to the attention of the Board of Directors that the tenants in Unit 16, a unit we believe to be under your management, are doing automobile repair and maintenance in the unit. Please be advised that this unit is in a zone of water contribution and, therefore, is limited in its usage. Specifically, any use that would at all endanger the existing water resources is barred by law. Please advise me as soon as possible as to either the termination of such use or a representation from you that this property is not currently used for this purpose. Once I receive your response, I will forward it to the Board of Directors. Thank you for your prompt attention to this matter. Please do not hesitate to contact me if you have any questions or comments. Very truly,yours, MG:jc cc. D. James Wright Lawrence Madden Joseph Butera 09:'I1 5%j5 14:55 50,0, .rj FiFF, '.7THI .,_� _. _.��l;i, _! _�t I_I.; .FIRST PROPERTY MANAGEMENT COMMERCIAL•RESIDENTIAL •OFFICE•RETAIL $32 MAIN STRXIrr SUITE F OSTERVII,LS,MASSACIiusm,s 02655 (508)420.0299 FAX(505)42"759 August A, 1995 Mr, Mark Gianno The Campbell Co. P.O. Box 71 Osterville, Ma.02655 Dear Mark., Enclosed please find a copy of the business certificate issued by the Town of Barnstable to Bolduc Auto Repair allowing them to conduct the busuness of auto repair at Unit# 16 1112 Main St. in Osterville. In addition I have enclosed a copy of a recent Board of Health Inspection which shows that all hazardous materials are being properly handled, recycled or disposed of by liscenced hazardous materials disposal companies. I am aware of the restrictions imposed on certain overlay districts by the 1988 Ground Water Protection Ordinance, However, due to the existence of a previous auto repair use in this unit ,prior to 1986,this use is grandfathered for this unit according the The Town of Barnstable's Building Inspector, Ralph Crossen. If you should have any further questions or requests please do not hesitate to call me at the number above. in rely, /0 Andy Wi r enc. AJW/dc 09/05f 95 1 4:55 til I..7 7 H,555 TOWN QE BARNSTABLE MASSACHUSETTS BUSINESS CERTIFICATE i DATE ISSUED: 814/95 DATE RENEWED: BOOK: 178 RENEWAL BOOK: PAGE: 95-209 RBNEWALPAGE- CERTIFICATE EXPIRES: 814/99 In conformity with the provisions of Chapter One Hundred and Ten(110), Section'Five (5)o4e tYtheraAaP a;;Tended, the undersigned hereby declare(&) that a business is conducted under the title of BOLDUC AUTO REPAIR INC D/B/A AUTO DIAGNOS.OF OST. I located at 1112 MAIN ST#16 OS'I'ERVILLE,MA 02655 by the following name person,persons,or corporation: BOLDUC AUTO REPAIR WC AMY BOLDUC 723 RACE LANE MARSTONS MILLS MA : 02648. Signs A ►r,u wJ: r AI4�T ON August 4, 1995 THE ABOVE NAMED PERSON(S) PERS)DNALLY-APPEARED BEFORE ME AND'MADE OAMMUr THE FOREGOING STATEMENT 18 TRUE. TI;E Identification Presented: In accordance with the provisions of Chapter 337 of the Acts of 1985 and Chapter 11,0,Section 5 of the Mass General Laws,Business Certificates shall be in effect for four years'from the date of issue and shall be renewal each four years thereafter. A statement under oath must be filed with the city clerk upon discontinuing,retiring or withdrawing from such business or partnership. Copies of such certificates shall be available at the address at which such business is conducted and shall be furnished on request during regular business hours to any person who has purchased goods or servicos from such business. Violations are subject to a fine of not more than three bwUlred dollars($300)fbr each month during which such violation continues, ...................................... ...,.....------------- - -------------------------------------- CERTIFICATION CLAUSE i certify under the penalties of perjury that 1,to the best of my knowledge and belief,have filed all state tax returns and paid all state taxes required under law, J • y1g ture of lquidusil or Corporate Name(Mandatory) By: Corporate Officer(Mandatory if applicable) "* or Federal ID Number * This license will not be issued unless this cettiflcadoo clause is signed by the appiwant, •• Your social security number will be furnished to the Massachusetts Department o!'Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license sus enp sii�n Q�reyggatian. This request is made under the authority of Mass.G.L. Chit 62C,S.49A. I ftet sow 00 n?tve A� cw^ I i i 'I i , THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) IM ^ACC DATA �"'�°M"��`#e �f....r5.rw«':ha..f.. • _ . ,+� ! i ..��, i ��/Mt.- F •,�� .!* fix..... h... *a€ � t -get{ y +E . F€;;�Y F`6 4 t ._ 1 .. , +p :4 . Y ?' 4.,. .2 ' ♦` , ttt y t,+F h .�. tom. €'i 9s.a� . t _ „s - • �+ ., • - ..rti. - b;�,� �,Z€ x �Z•�Sah�.��,.i��x3 4 } A i f . _ � :a+v.u.row.•___ r .. ..., -- ,t i..� -- .. j t I e r r 'TOWN OF BAR.tNST ABLT � f MASSACOUSETTS ' r BUSINESS CERTIFICATE r . s< t+€q� DATE RENEWED: l t„ pATI .s.�iJk i): 8€ RENEWAL BOOK: BOOK 173 RENEWAL PAGE: bA '; ` PAGE'.95-209 CERTIFICATE EXPIRES: 8/4/99 '0. � 41 i, — a In cin]:`vred tile n;it ' .Fitt] tl]e provisions of Chapter One hundred and Teri 010), Section Five (5)ot't$]c.GSttter3l�aN �C s amendAUTO y undersigned hereby declare(s) that a business is conducted under the title of BOLDUv AUTO RE r r r)iitC 2aOS. Ol'OST. p' persons,or cor oration: " located ai 1112 lvtA1N ST 916 OSTERV�LL s,,IVIA 02655 by the following named person,p t J BOLL3UC AUTO REPAIR INC t AMY BOLDUC 723 RACE LANE, MARSTONS MILLS MA 0264$ ; Y �}'*, '_-fix--- �"- V,�`y',r,,✓ ... _ ��> ^� � '. � �. ` . ~Oiu At gE;fst , 1995 TI{£ AF>OVE NAMED PERSON(S) PER S�ALLY`APPEAftI D BEFORE ME �NTS.��I,�bE �.`�1'l� l flA1" c I11 1rRFC�OIlO STATEMENT IS TRUE. . TITLE , � Identification Presented: r la`:accordance with the provisions of Chapter 33'of the Acts of 1985 and Chapter 11,0,Section 5-of the Mass Gencral I_aj�S, Buscr;cs 3 . _ Ccrtifscaltes shalt be in effect for four years from the date of issue and shall be renewed each four years thereafter; A sta#iric`t order` oath r'ausi be iileil with the city clerk upon discontinuing,rLt.iring orwith It°awing fiom such business or partnership. t Copiers of such certificates shall be Fvaitable at the address at which such business is conducted and shall be furnished on request 1. S during regular business}]ours io any person \vl]o has purchased floods or services from such business. Violations are subject to a fine-of not more than three t,.rr?rlrei.d o„i,.s �.!N.3) .or e.acih morn]t.u.ing which such v]ola,ion continues ?Y g .. i f i Wit., Sa I ^S• —.—_ .... — -` - ,_ - r Lt CI✓R'I47 ;Il?TCATION•GLAUSE� r �I1"4 certify under the penalties of penury that 1,to the best of my knowvledge and belief,have filed all state tax'returns and paid al[,, €z state taxes required under law =t x ' * Signature of lrojiduual or Corporate Name(Mandatory) By: Corporate Officer(Mandatory if applicable) tt #* or Federal ID Number' A! t This license will not be issued unless this certification clause'is signed by the applicants µ. . ** Your social security number will be furnished to the Massachusetts Department of,Revenue to defermine'whether you hay Trie �A"} tax'filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency willbe subject to license r•+, t } ' t se,sision or revocation, This reqwuest is made under the authority of Mass.G.L. Cha 62C, S. 49A. - ----- -------- ----- „' T ����i � � i�� Y��S'�A,,f(:�,�':e+•r =�f;�,•.-...a F ". 1 t 6 F'•'°e"_`� ��---^�-: �. �—_ '-<�` �..-�yqc'^.'-.z•� '�� t� �y.�;��`�e ��i •aP';14�` `w.k M �.� a'NN � 3 YlaF 3' 7 t�`g"� y A. i i51 � g .du✓ C!RY.y%- � 9 '$E°F`�y Y'� "#M3.w��Sak,3ifAF'!.. '� +�� '� � ,�:. 9 9 •+�F j 9 xr.}' ;t!a 1 '1� r z ,.�r ; ..a � � / '� MIT �sy. yoAr ►� 1. F Cwt U..'�'..�.--•--Y ram-_ �r � A � 1 ; f•Yl �. • t iR .S- 4 i � TO ALL NEW BUSINESS OWNERS: Y nw. Fill in below.> �iJii.`•t.`fiin` `�M zm _ E OF NEW BUSINESS: �' / lit"'u b S��S. NAM O5 1`9, TYPE OF BUSINESS�'�)4L'-mr ADDRESS OF BUSINESS 1 I In (P) S4_ MAP/PARCEL NUMBER If you are starting a new business there are quite a few things you need to do in order ° to be in compliance with all rules and retulations of the Town of Barnstable. Once you have been checked off on this sheet you may apply for a business certificate at the Town Clerk's a office(Ist floor-Town Hall). 1. GO TO BUIPNG INSPECTOR'S OFFICE(4TH FLOOR TOWN HALL) This in ' ' co i nce and has b�aeexplained the procedures needed to•start �/j.W a businessy Building Ins ctoes*;_ 2. GO TO BOARD OF HEALTH(3RD FLOOR TOWN HALL) This individual has informed of.a pe it requirements that pertain to this type ,ppriof business. • r ° Health Inspector's Signature 3. GO TO CONSUMER AFFAIRS(LICENSING AUTHORITY)-(3RD FL SCHOOL ADMINISTRATION BUILDING This individual has been irdo of any licensing requirements that will pertain to this type of business c • Lice"sing A ority Signature After being checked off by all of the above-remember to return to the Town Clerk's office to I actually obtain your business`certificate. { ��- � �� �� ,�g ��- G'0 The Town of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner September 7, 1995 Mr.Ronald Bolduc Auto Diagnostics of Osterville 1112 Main Street Unit 16 Osterville,MA 02655 Y Re: 1112 Main Street,Osterville Unit#16 _ 7 Dear Mr. Bolduc: You are hereby ordered to CEASE AND DESIST the use of Unit#16 as Auto Diagnostics of Osterville. The reason for this order is that,despite your assurance to my department that you were replacing a like use within the five-year grandfathered period,we now find that the use prior to yours was a much less ; intense use that,essentially,worked on the one owner's cars only. Your operation does work on cars for customers which is a much greater intensity. It is our opinion that you have a grandfathered right to work on your own cars in that unit up to two(2) cars,the number of cars the last owner worked on only. You have no right to expand that use as the use is non-conforming according to Barnstable Zoning Ordinances, Section 3-5.2(6)(B)(m). You have the right to appeal this decision to the Zoning Board of Appeals. If you so choose,we will be happy to assist you. Sincerely, I Ralph M. Crossen Building Commissioner RMC/km CERTIFIED MAIL P 015 496 714 R.R.R. Q950907A f - Th e Town of Barnstable ib� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 E Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner September 7, 1995 Mr.Ronald Bolduc Auto Diagnostics of Osterville 1112 Main Street Unit 16 Osterville,MA 02655 i Re: 1112 Main Street,Osterville Unit#16 Dear Mr.Bolduc: You are hereby ordered to CEASE AND DESIST the use of Unit#16 as Auto Diagnostics of Osterville. The reason for this order.is that,despite your assurance to my department that you were replacing a like use within the five-year grandfathered period,we now find that the use prior to yours was a much less j intense use that,essentially,worked on the one owner's cars only. Your operation does work on cars for customers which is a much greater intensity. It is our opinion that you have a grandfathered right to work on your own cars in that unit up to two(2) cars,the number of cars the last owner worked on only. You have no right to expand that use as the use is non-conforming according to Barnstable Zoning Ordinances, Section 3-5.2(6)(B)(m). You have the right to appeal this decision to the Zoning Board of Appeals. If you so choose,we will be happy to assist you. Sincerely, Ralph M. Crossen Building Commissioner RMC/km t CERTIFIED MAIL P 015 496 714 R.R.R. Q950907A TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair k satisfacto 2.Printers B ARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 11z2 AV Class' �" 7.Miscellaneous MAJ01 0 4rg� QUANTITIES AND STORAGE (IN= indoors;OUT-outdoors) Case lots Drums Above Tanks Underground Tanks IN OUT IN OUTI IN OUT #&gallons 777 Test Fuels: Gasoline,Jet Fuel (A) ie 1, Kerosene,#24JD Heavy Oils: waste motor oil (C) new motor oil (C) �. transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: Af ell DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply AA O Town Sewer Public On-site 91 Priv ate 3. Indoor Floor Drains YES NO [� O Holding tank: MDC O Catch basin/Dry well O On-site system ,/ 4. Outdoor Surface drains:YES VINO ORDERS: O Holding tank: MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES No 1. c e'2, Person (s) Interviewed Inspector Date TOWN OF BARNSTABLE F OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTHatisfactory 2.Printers - 3.Auto Body Shops i unsatisfactory- 4:Manufacturers COMPANY/Lb' , T!� -3+ see"Orders") 5.Retail Stores �.. � 6.Fuel Suppliers l �� ADDRESS f 2 1:0�_ Class: 7.Miscellaneous ,/E /�1:- QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIAL Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: w ,wO ee—�il� DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2. ater Supply O Town Sewer Xublic "qon-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES `y NO ORDERS: Holding tank:MDC Catch basin/Dry well. On-site system 5.Waste Transporter ; Name of Hauler Destination Waste Product YES NO 1. 2. --- Per �(s) erviewed Inspector Date i a � February 3, 1984 Mr. Charles Rogers 300 Baxter Neck Road Marstons hills, Ma. 02648 Dear Mr. Rogers: The Board of Health recently received a letter from the Department of Environmental Quality Engineering setting forth conditions applicable to your development on Main Street, North of Pond Street, Osterville. Activities not allowed in this development are listed in Section 3, Definitions, Paragraph (b), of Article XXXIX, Control of Toxic and Hazardous Materials, of the General By-laws, of the Town of Barnstable. Enclosed is a copy of the By-law. In addition, we are enclosing a list of toxic and hazardous materials that cannot be stored or used in development. Very truly yours, John M. Kelly Director of Public Health JMK/mm encl. 2 ccl Mr. Don Rugg, Centerville-Osterville Water Company Mr. Joseph DaLuz February 3, 1984 Mr. Carl Riedell 778 Main Street Osterville, Ma. 02655 Dear Mr. Riedelle The Board of Health recently received a letter from the Department of Environmental Quality Engineering setting forth conditions applicable to your development on Main Street, North of Pond Street, Osterville. Activities not allowed in this development are listed in Section 3, Definitions, Paragraph (b), of Article XXXIX, Control of Toxic and Hazardous Materials, of the General By-laws, of the Town of Barnstable. Enclosed is a copy of the By-law. In addition, we are enclosing a list of toxic and hazardous materials that cannot be stored or used in development. Very truly yours, John M. Kelly Director of Public Health JMK/mm encl. 2 cc, Mr. Don Rugg, Centerville-Osterville Water Company Mr. Joseph DaLut r / ���Gu iue 60" 0 r� 0/ ANTHONY D. CORTESE SC. D ✓Reyeow Commissioner o2va isc�e, 4&Mad&Jea 02.346 PAUL T. ANDERSON Regional Environmental Engineer 947 f28 f, (oaf 680-6'84 February 2, 1984 Mr. John .M. Kelly, Director RE: BARNSTABLE--Public Water Supply, Board of Health Review of Plans of Proposed Construction Barnstable Town Hall By a Private Developer on Land Adjacent 367 Main Street to the McShane Tubular Wellfield Hyannis, Massachusetts 02601 Dear Mr. Kelly: The Department of Environmental Quality. Engineering has reviewed a plan showing onsite sewage disposal systems for three proposed buildings on property of Charles Rogers and Carl Riedell adjacent to property owned by the Centerville-Osterville Water District, used for water supply purposes, on Main Street north of Pond Street. The subject plan is titled: ' TOPOGRAPHIC PLAN OF LAND IN QSTERVI:LLE. MASS. FOR CHARLES ROGERS & CARL RIEDELL SCALE 1 "=20' DEC 1983 REV. JAN 12, 1984 BAXTER & NYE INC REGISTERED LAND SURVEYORS OSTERVILLE MASS The proposed development will be located in close proximity to the McShane tubular wellfi:eld. Portions- of two of the proposed buildings and a portion of the sewage disposal system for B.ui.1di.ng "C" are. closer than .250 feet to the nearest well in the wellfield. The t6.ree proposed buildings, as indicated in the "design data" are. to be. Building "A" Office- Building, Building "B" Wareh.ouse - 10 Units and Building "C" Warehouse - 4 Units. The town should require the . following with regard to this proposed development: • I . Th.e entire sewage disposal system for Building "C" shall be located .outsi.de of the .250 foot radius. 2. No hazardous material shall be used and/or stored in the three proposed b.ui;l dings or on the si.te.. -2- If you have any further questions regarding the above please contact Mr. Joseph IX. Conley at this office at 947-1231 . Very truly yours, ' For the Commissioner R bert .P. Fagan Deputy Regional Environmental Engineer F/GH/re { cc; Centerville-Osterville. Fire District . Box 369. 11.38 Main Street Oste.rville, MA 02655 Attorney John ,R. 'A1ger 886 Main Street Oste.ryille, MA 02655 4 t i f i 'l I U�' T '� OFs',•f^' -+z+--as t,7 " .�,.a` ' . 'tl :, a-..c _ - . y-. __ 1. BOARD OF WATER 1POMM1$SIONERS,' K CENTERVILLE OSTERVILLE FIRE DISTRICT LE OSTERVIL , MASS. 02830 r /� L 'S • ' 1 ` 4 a /�li L•1 r - ' S ep. t ember 221 1982 T3.oard o.f S e l ee tmen A T'bwn, Of Barrastrabl,E Town Hall �.. Hyannis , Mass _.2601 , Ther,e s as .pr.c posaly in Manning tagc to,ybui d , a twelve . init conc3mzn :lam bra 3" .5x ' adja Brit + o and south }. of the CentfrullEvQstciville Water Dep4r,tm nt office and 4 ;d ump rig --a iw. obi Main Strreet in Ost:ervi? 1.E.. This :condo s-i'te Located on Town of Barnstable Asps ors Map ,1] 8,. r -Parc :L 13° ;cc�m� ri � �� o 2, ?� cze + f Yt, Nine`;}T fi g ;, i;ent of this Pay cr l `1.3 is locdtec • ' wi then q 400 foo,C ��dius cif one of the Water De artment P: Wtl lfielc�s crFzi:ch zs �r ,lu� Ong 1, . 2 m ,J`lon gallons of=watx� p'ex day t r oar its u� nt.s . The, Bo'd d Of 64Tat:E�r" Commissian,-a ss # Uf the Coi.itervi 11 �Qstery lc Firs . Das ri�:'t. ,� ,` r`eques'tiri ; the ���e 1p o f , al1 deip, t-t rceT�t_ wl t.�l�.rt t}ie '7011n,x .o f Barris tat�].e ` r � t o s't p at ones , ��r:°i�r aria c�,l.l 'I3n fir .1 All].ding can +. this 7 t , fi 'We � I,- ypt,r�help" far 1-he �cn+ 3n� f-uture` prot ection 3 o,f four Eryrst �i?g w�a .��r upE?ly * A copy .;,y t}� . tAssessors F c� "{..;�ti.+ ;i. -T 4,�•! ; � #„' BO`dto n L He -n` Tr2<<E �c tc n " iPI'd 14'rig Rct�-a� 3f- X`u 1+f Bca rd cif ky)pi alp q♦5 i^` ,- � ` �' .. .,,,tom r + y;4 f. ,. + �' �9+' y + �• �� iY�. n tp.,,. a x,w 7 `t -, ( .�. f rf„ K ;. r w d f iY ' #t ki 1y i, t 1�'. 'i it 5 ..�xs �.h 5._ `S°x r 1! . - '.'aa tFl t - 1 s 1 r.ti " ;p a. x r i + ­",,I'­." y r f ita + -' t' a r r ^� a t l! at r we t .+.. ! r "�,-r�t4-y • r e 9�hka^f{[-{ a '`•'E Sr d'-i i'� e 4. e r., e x 1'A - t r ry F. i 3 "T rt r >k'` f3 i�i {4Yt , 4 ^ k! f 411,; y }FC9 { x� a ! ! -M1 '. / r, 5 01 -16y ` bad .+ { Ii r 3N{ .,,,4 t —r *r'.. "r'Y �t a + t n �,,,�.,'.; �; - t, Cgt t"j i t t( s } r .t I -r, r ) �t apt >. -µ L {t.. �� nuf11� ,t. ! r ltt`'f>{-F�s t!wwo, 4 r y I s t t °_ t >• .� y 1 r -hy { iE r iti.rt�. Ky - y r ,i 7 y fr 9 ;.. - J lri; a a,(.;r ,, i}.: l c ' Y �. +[ 2 t ' ' _,p j, i.. () r r - t+ r 'q t t yr' :F .S f ! } k fi 7 4 F.AI +.. e ,. t �'1.' F '"1 1 '°'`� z- b t. S Yt xYn r:,r rt AL ; ✓; k.j1. tt r-, "tk r �r4 71 AC X '1 it^ .et e o-., , f t A t d k "3 # y. >-# x ! moor b ',, 4 e r c r,l t =r ry 4 r t 1 r z , 6,w a >t -k # t t e r # i g -, t d S! a f { W. of t� ;}, F t � ?ax t, dt,r ., I _:� # i f r �^e c �2 I �.e 7 Y t}t j e t£" r nr"§` n+� 2 !r S a `} It �' r .!' t ti• it y ! :� s '# fit_a k { �", x r " .. a .. r t - 1 f 3 A I r r c t `a 3 r th ' e N� I }. G t f t, rt `r ,` t,' F �Yv r.. s'l't t,f kl ,jnr I .!t I t .. 5 i;.. � ^F' u J S r :-�' ,, `� ( •J }, :t t a X r ! 915 J ',p i b ! r�' tIt�, ' try t - - nt, x e h 4 J AAf,� # trt t ",',,,to it r a r >P r�Fi;! *t (fier a.,. { f y ` f4v,.- M ''%V'l , F�,. t S'rt'e'a} ,a. :t ..r )i att'St t.�t r i.t, G" SSPP ta,jy ''s 3 ,• u &. z x:"r o� 1 4 'fir { M N t + j'. } sR'mayE ry 'e 4:ty � v'd Y �, t;::,yk. }.� k" ,�( r t «W 1 F LM,�, 1 , � ., rF r �N h zt J �Jr y .. y:r t a n mob ek 1.e iv �9 � �, r, � s I rx k T�ra? x rr U. E`t d'd :. �.y',+ J Jt.: 41: �:I r *, ! �'f,t a >..'. }.. a', t',t, r tt x r '`r "a ya;, � a g'�z.: t fit 1 + i Y gg r c s' 1 rfi : s < { t k�, nt t l { f a' ir; 1 9)nl[. '+ i .k:. iX/s r ' '-_. r ® � : ;t � z> i 4 t r5 x.JC t d S .M r xi 8 It •p r r'a 1).r ftt� : r, : e a, e +N a. x , 4 F y. 1 r., } t ow f t � T 1 x d '� J " r,- : J t, 1,1 "n r t`ir h{�. x*3F a � '. a t b7 Mn r 'F rr cgv S', r � 'r t q N>A y ' a a�tr^I �,y r fy ',.3f .; tY r i�I '+. f t_,,( }.t ry t r n > /� Y S g.ti v f 1 t,7 p s i .^ 6� t a ' r ' + l a- '�� i t ,C x d X t E �Qv ¢�'a t G 1 yA art t x # �� r A ., ✓ ;z + . �a`iv t t` ,,1 V �" r> e> . tr ,, t �� 7A A��. ` .'`�I z . J v° " c'4 r t Ala 4 9 t _ •V(l// + Ycl} " 'r �� tt r} a.. 5' M .t .Q t �. ii ! s.A., +� X + ti _ + � i t 7I e;.' + r E #�' �"`t x 4 n ta'' 0i x" -�.+. - P i J -0-14'e Fr ^ t�x y . t •'rt e, �4: i '�- 1'y�. +' 2 r�r+-a 7 L t" Or ! t fit.. ?„ r - 7 `k t `' i t 4 !.. _ 'At. , Grt#+ k y j }r��t r t�' d ate} /}/t rf f7F r .. f q, 1. t r 1.to f „r 3 �^ry F' , ylv.,, � t t , '..r � •, P. 1i ;�'r'- !P 0r/ -> r 7. ` `; `fl,� !'y_- , ,y"z "+�. s: ` ; i1. 1 'f; -' 1 r ly .6{ d-.C Y 3 ¢.. 1 U._V Y1 / ?.- i,°* Al f 1 i k j'k.4 P i 11 of a ! x s �' 0!' r !�"'_} v zr : . j i r" t f r n %�t". r a ., e' ' •fls! �: � ®j d s' rcf t ?P i t ?� (�+ t f�4} , t 1 -i 1 — l��r t o.,-O`O l } ' A r';1 t ry9 . P ,t n t[1 1 twr.-: {e_ ! �' , r _,, ° ! ,/1 s4* rri N { iF�r !a i�I• If .1 O i 061 !k 1.#>'` ,cjr rFt t �� b? r a r. t P i� �!Va w t YGylt,� h' g �Ws Y `{ -, t°,{t +� .t e3 r, .J �s �c 1`� to e. pa d f;s ,,% t.}S . tt '71, r I vr1�t " r � s` � L �,i r��' t - t. kai rc,°;l ','-�a " p i . ":I '" .r }. ! r a f m kr`` 3y J S 4 n'i' S,a�.,ct Fd`I t a kt + i.,a�t •, €t 1 jT t'�-,St +�'� tr^ r a ' t s�� '"' z s F ' i t 7 ' k -rib ja 1.1 wfi, ° O yr " f � v �� r_ 1 s r r A t > s 2 "'! _ 11 .Fa x 4 1 t 1 t ,, I i.:;a „{.,. { tl:,a '" e taa d,. V :t !gy p rt 1 - �� t t ,is4 a .P 1 1. ( t 7 iW f '+ ✓ "- i ��•+ S r r 'j 4 t i�, _ 7 V 1. 1 i '�rY 1 'Cyd'j .+� �.,{ 5 e vt et 9 " „d.. - '' E, F� Z '°I tlli Y- i). t} 3 Y No ' f! Ili7.l,eF �: ..1 pp 4 f '� I Y:11r 0 k.74 � ST.,k, . fig,.• r i g�T AC•, •�A x 1^ y�2Pe,�r aa.{ � �A r1 t& I y1 +sr �: "-r' ' # >? C r tc� # ,kD �. .t � t{ v ;��r t. � �� ;` .. yat >7t L x t tY r l /LQ j q }'a t 1i d� X t �F1.d. ,t t�'+a -. N _ a g( .ryk + r r rF 1y. 1� 1. F...... Rixvf_ uer #y.x V 'f j t z i r r ih of: f r S ''f 1 _• tt 9 t✓k'��1 I s r ti r+ � A' � ! r is f 1 ,t: -rr a: r;i#�:� �tC7 f. } a i• btu ' , k t # t {t 1 S/,. y q3 � ���t+ Y t -1 'e 't e t �t f ° t a A �' A`', Y f -0,j40' S tM � '� o f n5 ?�' # �f yJ 1F+r l "qC t f'_ A !' P y ' a+">` ti { M 9' 4w tef n air t Pe 'x- l 'xp { + - 1 4:51 :t S fjp) ,t '. #;-f? `' w at mra 't` ' , t" F V s' , t y : t ,� fXar ++ s.-r a O :t ;.";T f r' t `?`� # F W��Y a# A i f -.t t rr :i. G t r + .: .1 # r r �aa,� * E to E i .r y . .« 0V, ; AM t + a or " r f 4 <k {Y '�t A .t 4'fr 4 ' St`rE(:h ` ! J" > S\�x 4! 5{''+7,' ; /�'.. ° Y,. pr.i !, 3' p {ri f W v �r, �a ! " ", t . :r r r 1"J i 1 � 1 # a d > '.i a t a 1 s` 3 Y ', r f' v r �, ut3: " s^ .� �' �>y,<V to 1.. pp ! i , a 1 J.k } 5 t c y y j.r '-`- i j 'j a a 4` 11 m Ar e r�4. + '4 ti i�. s f �t r 70 r :.r` `l`;,' ,�,- eQWQ b , a _ X , b Y ,., �=My, t . e r IN,',, , #,.4_5 r a1, # 4'-,�x <�of-A It ` s'� ��X #o "Y � t,rt r aft ,..1 x t ,4 4r.S k t r 4.. �r 4 v r� `s t St t,.#:'" `v 'ta(d ,-M.*'' 1'. ; ra _, h _w. .xt ; -,.lw.�,-...e.,'. ._e''` $ x : s F. . I �► + �Y t I . A(.i. y. f tta3'a y #f't '� ,;,, r ` -..} r@. r r4 y W'+t:CT1 ,-"r n Ua r ,r.P,..Y 7 s'{'r #ie t� kNs 9`f`� i r• pr o -. -. k E } z r .. r .fit �e AMCt , .A F,ko r K ' >�,'°.. , YhIk" ��n , S t +.' ,45. S <:.`. ,:,tr,y J x A _r ,r `".1 a? 1'�, pn, [. .sx., r ."t r G. yl}3 !• i"� f ��l a Y�O R,Ii� 1 '� t rF4 -- "'9r l-K+'„' i =0. t. {;81�tr'e;� test .1. P ,*g'a•`� ,� ^f �.,. t H tT.� 1 : ¢�:,'� S r✓� ; -'•4 f5r`x i ! 1 y ��,' t ! 3 t k Y1 kit e , + f i y s `r'. 9 I. r Y 's`r,{, I . # s it V+£}I _ 3,� Ea•' ;' rr - Y '� ; '�, - F I i 5, t %' E a. q t z.t. ti. + 7.i z i2 A o - 4 h n f `r9 .. r p..: P- 1 n' d +`I j r*,�. Y {&. y f '¢ r��1111`�J .`r { ZY" 'K-- g L{ 1t, j a "+ 1.� - > E s r f i .-. r r #�6 x 5 sb 4 + , } T r -vi ,f� ol u r c < :t ! .,, :: t��t� S111 ,14 i th hM $ E'h dv." ,`. c �r'. k�'c f ' t_._. ,t ..fiath yr ":'I i ? ,41T* ri iy+r3 " -s� 4 y :`es irk i,.ti#:; 1�' a g k �r p TF g,kr�t�j at^Tri4 a x .Ac j �'r":If: x t `+ t x�yr 3 t}. ''✓ t =J i k "mum{ $Y}}_i f c a e ita, Cw S .11�" ,x '� -1 +r i' i 9df r tr i�. f- J ��a!k� �>< i ' ai:`x r r x i e, , ttx t tr a O -} 7 t` r..,`' ,� a `'. s� a s t it - y Pine+� t7i ' t sw .; h + 2 00 x a'i { � � � �!Sr�'yt�,,'f tr '' �- trl r vtf ,j�P I k`-. Y i.I "iUZ+ �z �'��r a O op -Tr - G. t kY - w, + A"x�t a i f a .p r p a R t ' , :, -- � Q�y V V oil kt riff ' , 1r ,r .Pt a 71, ����stt qz'q i I i t t,� ^-'r t 9 !gF '}S a� x:'C', xr, �tlr Y'u, n ? ++ r y f . Jet `'` t i 1 r ?M11' 1 1K t �z x r. •1% a i �, tt 1 i 't E N ! 'k .`,: t �t w r JINX tk t`.., r t -r yf y. y 1 i. I. P z w� i� � qR'�t. t3 t 'aa t g,td r! 4 s i qt (:. S s. "} _ ..e~P,1 Y } yL t , 4 5 f p F?? _�y�yy f - e r '`j.1w Nt4 -.s y t -'{ .v } r e!t �`A, s +4 9E {g,$1Y rt i # r " t1 i'#l .S_ �i Ya .I A r jj'!Y1 .d J 4r`, ,a k t`t7,QM r -- kµ' '3� ,r # t'� 4*'. y tt qq { _ >: 3 r ? 1�'s' a_F@, w{tV1 Mgt fir 4111,1' S � t,,' .+ } ' � 5 s': r { �,"it: fr s t �S� a a t� t ..f� T110n ,t rt r t rc { 1 f : s a* F•t.p ° { n;� .,+J°' t " n 'D r r r r i ¢ t y 'X IIN�� GN dY. �.: G + t r a a r e e, ,pia �:. ', �.. o to �$yta!.'j 'S " -':v ' - fs if i r) °k t w ;`r s .., r a 2 x } a t d s ii �� , ,fi r!! rI 4 I jr," j� W d" s I � p— _ a,."y ..1 , ,.r, t I. e t c �! �K ,ah ' §'W2> "�x�. S Ludt f:S srt t,-t Srtl f&.. t ON.+t�, e� , v. rr - gs z t { ys-: t ) ; r. 9f:.a. ox �),c' - R'l: v t S . ,� t i a �`.}j 't t @ y,, ,.'x b� �yi - *1 s� a fa ! -a a �f�: ' ",I, €� ,,,, :" 7 JraSx t. .-..V J "`✓4i {`', 4�n;.�.,xYs t,. tj t` `iz'• !r r1 �# +. i „// , ,.;ti, p.14, rr_ +",�. sI. r.,. r r' ✓ �' �, i ' ..*.'p. J� Ns# V, yr;"J 1,r+eF, i[,F. ',v Yf r.:tk AF( i r`a s5 r :-'c} ;a'N',2 r �, :4 e, 2 ti'k .r ¢r.':z"''Y,>•g 31. �.% - E:. ':r. d ,j y c,?y tt !ti �: t S;f1 1}� k;,+ I f! :,ri , '; k�y �'lh i' ! �' r,��lr 7`r'i{, h,.r =r'd d' r F. )q},, o a�.t+4 a K! t t t ai ;. a r ,# t c ,r s e t rat , p; + r 1 . i<!rm:rat4 ,�I rK - F .o :tit t>j !' ' F z f i '�' 1 ,;i; ." k" {. ! `+r .§--g {' r � Ara �. 9 r ;";4+ _s ! z .rN^ 1.. t_: .,..y 1> 4 r.--.# t >i.:.;f.,.. ap �;s,:7,q �.}�f:Ys'. 5'�1r `„a•. � e^v; 'r k .r> x t" ' a r ta_ ..�>f 4.7• .{ .a. ) i �t{.,. ! {aM1 o 5 1. F[;# a 7:.i +�� {-, T { 'xr 5." " 1 :ea8,, p tf j�rlti;: 1 J{.�.1 v� a1 ,� �Cy e.y! i d`d ...�! 7 3- E �} u a!J k l�: r e o :r7 C � r�r e:sr t.4 i° ' .t x 1; t:�,t o r s. 6 �, a t v t q 6 x t.4 wt t �i k�i, �: �srt rri I'A 3 rt r J r r f; F r '"dl' t 1J z�7f 1A.f d '?#"N}I..H fy,.'.. X L .,i.ra4rt. 7,�9��3r i,„3.,-, t �G Strr� I ,J. 2 � a rT. .,;v!(I sr,'F; E1vYe t sr...t3,3, }Fl. . 1 !s', 1. { # �:,1,- ti t i ,'�i f 1 !i{., +;D r `�{&;>} Jr ¢ ;.A� `� ' fi� i.. '1>i �r ,��1' �tg.!t i� tl � g h€!`+tcit� :!t�". 77?<�� �� ?���r y, s � 3 :r' ss Yet Y� t J+i a ,{ ` ,', r � a y. al Q,. >ti. x S F t.d^ F.x s:;�' `" }a. t 5.t r a ? G'.r k :. y ,p:� �.�. ��`, k P 1�. ',�ff,"! t t y tq r ) T}#:,',C a:.� >r '! J t ���--A '4 •s 's' t., S i 3 r_ i rx r. a;; a tt, 1 {4 anti fr ,t} �J r ? a r7 ICU, ,�+J> ;t t. r 1 .k a 3 S d t Ayr XS3t�t u p;, .y,p ! i Y rz 1 a1ti -,r y ;,fix �I art t t �r t - t,' ,l�k;i t ,•3:. Sd1 3. w`"� .r �P-Vo M fie" �'i t#. t r :' a�`tt e sro r-d xt x„-�c rt�i,`J 1-f, xJ',' °e f}4 p ), 1. ,:a te •4�� '^' a g i^,}y�+ie�r e,. r1 +��r, t r 1- _.¢� !ra'17 y.: n t :.F `, ' ,7., ^a,,o�, �'t,,z (Kb °4,1t; 2 Tt � - f x�7 E'st. i �t $�7�rJ< S i! I ...t +t2.(p: r7 r. ti:. d 'M t. F1' ... �, w a a x +4yu t v..+ r t t1. A '. r " 5#J+5,V�, f,'i�f kSCZkafr r3rari In Q n,, ',.' 1 r��t�,.} i � v F ,,rft?� �� 7 �r �' �1 �. :d r r 'T'r „LF },jrr Id' fr�� 1.err �p yt g"r:� M' i.V e LY J a .t d { J`:_r t! r a, e r 'd r 3. f t �'.� 1£ ttJzf- PI n''L%ft r Y F.::, a f,;: a k':s' rl srq, z; .! 1 z- rX .„�.h,'if.` It,".a'i, K�F B�ytirg tl �'a Fa`4 lilr, y?r �,, ? '; i iar t.., } r '!� 'fti{ t- h� i` '.f.r. - t f_ ! ,. .m �,�t,#t 3"'t Y � '.frppft t x, �a�"rr ,S�`,tom.t r �+pq°k s'!,t A�'lf# e +. j t ,f t( �� t y'tY P t ti4 s ,+ 3 ,S xS.L k i! ai...;t a�'�"„.'.'# a ,y r1 x:�J y .., t - + wi rz` tjk.& tt S -;,4t yf' 4h� t���y rt. k al r• r' y r rt t t a j, "'r t"F ;✓F• Sy.a' # k }•! !! ,F t 6 ! zF r ;' "j c �S,S rr t k d r xra�l 15 l.r111.1 re r,y,N 5 f - ' ,� t r; sy c ' v + 3 s f t # t -' y .e </�, s t 6 ,? C r I_. r s r$ r +s r A - ,n _ y e i- - 19 t§ C� r i+ Y .:' r✓ :� ! it r " :'r 'Y f .. t` T ,y s y x z*1Fyqi i _ !� I '. r r �,i� i1 r'" rl#-a+.i n jfj• r t rW fv*tr' }t- P rtt .r tf f.'.a ! s I�P-: ": �l L YY. t Jf ' '!"! k 1�. 11 ^ a IIf yi r y�` a �r \Q �tg"� Off' F . t !t t karts». �. n , x 1 , t .:: _ j tR t .maxtI aJ r ntd y tfi- -ro i '3 r a1 I s g tf i:.y�j it -t i4 {} 'x R4: s ;!.r.,' V r ,.r qd i't"( `+., ;. `t t ?EP y_ 4 r �, ' :FN °" e Z ! { 11 K a rt a ay a e r S i a •..c i'r k„°..,Za't ys 4 t +''fit X'-;:�xi ' >r:, s3. F.. '3, e Ad ,r, n_t,, ts''t 4 4 ¢ - i .4 t!xMoat. _ '�! a k ayl 3a {afi I 6Y �j"�tt,,�,n� L,r.: tM � `} xi�.,r � tyx.)f t a' 6 ' . t 4 . "t rd�� , +1 3' " `n rqS r5 J e '. r - i ,I t to tt ka I.! ¢, 1 ..`r r�..}9 i s i.. ) d ,t t"•.S 41' ,I"r & > 6.. Jt" 1 7 Y Ci•'a r , Sj b 2i':,t a q._ t fy"s y, .4 i f 'tf. r! 1, t y..t ,Fd aar�a r r, r 1 Sr�� * -'^ is t#�,�' r��:. 6 d, 4 ;' g a� '{ P, Y. «t :::# f k ' ; S< i i #" f_i .i}. rcr1 J,,k} }� `! v - f .n d: Grp - L 4p� r'k} y 3 x„ ) 9 �t{ : i Y .$ t 3 : iV.. - i N / -3 8- { (h) All reports which may be made to any board of health, or to any health office of any town, of cases of contagious or infectious disease ; occuring within the watershed of such source of water supply or tributary thereto, shall be open to inspection at •all _reasonable•ti.mes'by ,the - - $vnru--fii-rin%c -a:v,Tuui�oiGiac+�'vi-.-�.z::F>-.. :.:y`..-.�.:...�--�—=--�»_�:..._1,.•„�,�,.,:T-,:.. �-.:�__`;e-- r.---_.-....-,-------. _ of supply,by its officers or agents, and by~`the Department. (i) The supplier of water shall cause regular and thorough inspections to be made of the water shed to ascertain compliance with this Section 21. It shall be the duty of the aforesaid supplier of water to cause copies of y any rules and regulations violated to be served upon the persons violating the same together with notices of such violations. If such persons do not immediately comply with the rules and regulations, it shall be the further duty of the aforesaid supplier of water to take appropriate action to enjoin such violations and to promptly notify the Department of such violations. The { aforesaid supplier of water shall report to the Department in writing annually, prior to the 30th day of January, the results of the regular inspections made during the preceding calendar year. The report shall state the number of inspections which were made, the number of violations found, the number of notices served, the number of violations abated and the general condition of the watershed at the time of the last inspection. a ' i SECTION 22 , GROUND WATER SUPPLIES To protect ground waters used as sources of drinking water supply from contamination the following requirements shall be applied: (a) Where a community water supply is derived entirely from ground water sources, standby-wells and pumping. equipment, or their equivalent, k shall be provided except where 0 it (1) An interconnection with another approved public water supply can be provided or (2) The standby requirement is exempted by the express written order of the Department. (b) Suppliers of water shall acquire sufficient land around wells, infiltration galleries, springs, and similar sources of ground water used as sources for drinking water to protect the water from contamination. This rea_uirement shall be deemed to have been met if all -land within 400 feet of 'a gravel packed well or 250 feet of a tubular well with a diameter of 2 1/2 inches or less is under the ownership or control of the supplier of water. The Department may order greater distances or. permit lesser distances than the distances required herein if the Department deems such order or permission necessary or sufficient to protect the public health. (c) -No .sewers or manholes shall be construced within 400 feet of a gravel packed well or 250 feet of a tubular well with a.diameter of 2 1/2 `f inches or less, except in accordance with plans and specifications approved by the Department. F I January 17, 1984 I Mr. Joseph Connelly Water Supply Section D. E. Q. E. - Southeast Regional Office Lakeville Hospsital Middleboro, Ma. 02346 Dear Mr. Connelly: Enclosed is a copy of onsite site sewage disposal systems in Osterville, Mass. , for Charles Rogers and Carl Riedell that you requested in our telephone conversation Tuesday, January 17, 1984. Building C is within 250 feet of a public water supply as well as por- tions of Building B. The septic tank for building C is within the 250 foot radius. Mr. Rogers informed us that his attorney, Mr. John Alger, had contacted D.E.Q.E. about this proposal recently. Please advise. Very truly yours, John M. Kelly Director of Public Health JMK/mm encl. 2 cc: Mr. Charles Rogers -{- . . ., .��' . 11.:. : � I ' '. ,. . . — 1 . . , ' // . ;.. ` t . .. . . . . I . �, • j1 , 21 I Yl' - E. l .71 AC. - - ,. _ r i� '. . ". I � — ," , ,I . I / ; � I '. - � .""i I , I � - � I I ­ r�} ra y. t �. F a _ ". I!� .. ri . " f X y ' '1. r ' 3 ,r o • i y! . . j : fp .. 0 o e � ' y ,ZQ {J a s .j c�,0 - ��� �1F.. . �� o °e ° I 'r, 7�AC: t O O' dr a 1„ • .p c ... -�..,., -11"-.I,�-".[- I...- .�- A..I1..!.�� � ",.�,".: �,, �"�iI;l�-,I 6F _ , _ 0, B 6'` :. i `t 'i f b ' 4 /":,.i m r. s . l `. 2 1,.,,• Y ", r ' i .la <__r r _ .4 4 s `F iri ..'f`I. -:,,,,1.-,­.�,4-,7i-;.-I..,,-e-,._,".�,1�;-­_'--,;-.e.�,";.;­� :,�I 1�I.,-�1I'-t-,._�-_.,--.-,.,­,�.,,�;,.-.1 1,.,.,,.,�-;.`�,"�;1"��.�_­",,;1.�,,1,.-�-.,-.%1��'_...�i,-�,,I1.l I,,,i..-1.`I;�,'-�',.—,.��.,.,,,,.",..;,...I,1 I�,,,..,,�,-��.�..,'.-\I--.�1�1:����I-�,..�',,"1I;\.".1- _ , t t t r t t 'f ^ram . I^ t x 3 r rz !, _ Y - 1 Y ,� ,; q � "_.A ffR �� ff. 94AC t _ D yP 1 t. i 1,' . r ; , t,. 4, /�/� r� P 5 t, f�. i '+- ` ; -' is r t a t lam�^. :4 f •yn t k� is , dy - t •1 ,. iF Ar W r f 'd'^f pi `il� ". - t4. i '�• ' ♦ IY �',t A f .. j 1Z. 3 s t '� .4 ,�_ i _ .l .x Y -'.i'l,, ' r 4 f .J I r : t�.t Y .+z 1. .y =a,,t , (J�=. h r.t '' s �, _ a-r , s �..' F` vtis v 3 X.: 7 . k -'t _ r c, J.. i`s a-_ .� .. x ;g a r :1 " F _ .",Y 9 "''r .;,y iPt 5 .- r } W r - { tj�*'T - t 1 t Y ,, l i a"} r }d 'tr'' i, t { s_ }a i sy + i s a s ya i, _ . _' t ' ' .. - E � 1 4 R i} f Y } x A ` j l ty $�. !. - 4. 5\ . 1 r t i ,t t r y \. ,A AG � r�.,'T 7' _,•. .x r _ ., • . - r t ? ~ "R* t, •x t - .� F ^,' S °a 3, /n ba -' t - - I - , Fv e'. ` ULt !.r ,r ` . -.'. , !'.."' J }: t s , i..+; FMB } i K PFF p M - . Ow,;� r l5�` ' -� Y �t .. - L -�"{. 3 p, , It,,rr' �` __P ��� T. ". O �'.D j rvN9 up1,G14 �; �;- .. N h 1 ~" S I. ...., u- q r x! .ry s - A SnH ` l S„` pj r 'a - ,j M T. I. 1 a 4a ' `r' { 3; r t o Y w a ' ti + h i r l 1tc+ { 4 - tins s �s i 4 r L `S � fi jai . ." �} M ,d .' {{_ i Y1 ;.r M .. !� r ki r. �y(.5 r V r1! 'i. j y , rr a ,,1 F —}! d - r _, .� � s. +'- + L..4 l INK K ' YZ<:f}^}.J ,]'t y.I } A r�i i 4 l t r:•.. } �F t .,.„y.' '} -�.,t .t. s . + { I3t' 7.!.i.., -1:jfy 1'F _ - ,, -N,�. 1 frn f RH. r -, er t if / _zfi`S � Ir4, f j-, rz zU. .- vt, Y¢��, .* i 5 1 �,9 i 4 a a t. t F .A' ''t t k d _ b y $ 5 g tr. .}.1t s j( t�Fti7?uylf� 'l3xi�i ,A � y9fk Ac•' r .xr a, lt7tYn r �- s . A s t" A,_ y„a,' r\Tj..t 'e a ,�`ji_ �,. t lt(x. 5 i i ,: �'Ntj}'j•jr }? i•.c _ss.,...; d .. 1 j T f f , '° 4 4.cvb ..a1?. P..} y ,- �.`!n r i .� - {� 1 -,i . , N�, � f r t i 1:j9 1 i,t1.'Y i F X`Y f S f 2 $, . I a;;,.` r d�k�,' t r, st t: 4 }A " f •, .. ;. 4 +r3,yy. ,.' y " jb is_-_vf�:;w }��'a-{i�A v.(Ol �tr:..s; - tr ,1 i_. , r��•:�'-'- y$A­4� r ,s;! s.# as'h et -4 1n�. i }-I. '' tidal }r ia ' �.x ra'sY..' �. 1I`.'�3 a t. s .> r j� L ! j!j It4 • �r tir t 7j !r , i r{d r: 9 $ �,T xa y't j �, t t z G , j ?t ! .,.}Xir}� , s. t�g'� y ✓ .,?,`3�,.�e;r'A tt <.,,- ff66 t`*'Sr r j y- »t Y Pt { T N t: `£ P ''i oP7 � . .�l JJ� •.o IT ��,13-'S. {{�.7 k' i ` 5� r• z 1 v-. v 5J H : v y s .a r M. . ! f- v ! ! ,ssii, .i } a t J :`9b es �` i 1 r .5 r l4xt t , i t s 1�.: T y ' a °�ry�.j 1 r•dy y lr'x c r T"i✓ fi b M e13 t s T 4• t j. J ? ,'t °Y+,l,j 4 4 i A, } a ti3 fk�•y �4g.��. tt 4 l ♦ i " f.; t ;t } r i ,_.t s;? .•,� 'z �O' �i 4r •�.•^ !E r ra �:t� �{ ta,4 - iii J .+.v..:^Fv t t ti 't! rY �5.ctt , i 5 I; ',> t•C: .-i Y`a• �,rs� •',./r�: 7 r 1 l r ,'fr} 't 't '. j 3� .-•, '• ,+ s" r.. t4. t y) * rj. 'D': i rt _ �, r{. , J r a ; i;^-n� t �,' �r �.,,i 1 ;t q .sjY ail ,/'?� T x` s, t '.". s•�-ta` ,t ." 4r"t y •a' " kx y If I 2g PG hA ti II r ;. ti O Na 1 V, , r It ` .M „ .� y{ 1 gg ° ,.- x' R tf � .. „� ara�..�-'t N ""w^Y3' �;i �.- ..4 ','tiM,; • fn­ ::9w��r�Z,e , .... gl r ,j ` --- Y`° _ .e.'e>t"11 Wit. ,,.,..o-•,,..,.,, . .... .. ARTICLE 27: To see if the Town will vote to amend its .......................................... ..................... .............................................. .......... . .... .. ......... bylaws by adding at the end of Chapter 111, the following new... ... ...................... .......... ......................................................................... ................................... Article numbered in appropriate sequence: .................................................. ............................. .................................... Article Control of Toxic and Hazardous Material. .. .........­­...................... .... ..... .................................. ....................................... . .......................................... ........................... Section 1. Findings 1_7................................................................................. ....................... ................................. The Town of Barnstable finds that - . ........................................ ............................................ ................................. (1) The groundwater underlying this town is the sole .................... ....................................... ...................................... .......................................... ........................................... source of its existing and future water supply, including drink ' ................... ....... .. ...................................... ......................................................................... ................................................................................... ..............*............. ter*'mg wa ................................................................................. ............. ................................................................................... .................. �2) e groundwatei aquifet is integra y connected with ......................................... .................................... ....................................... and flows into, th�'sdrface waters, streams and coastal ..................................... .................................... ......................................... i i I .................................................................................. ... .......... giilfi 'recreational and ................ ........................................... - I estauries- which -con`s�6�uite,-�'i ............................................................. ........... NY significant jc�nt cr ...................... . . ......... ........................ economic resources-of the used for bathing and other -----------............................................................... ........... ............................................................................:...............................................a.. ..................... water-related r;creafion, shellfi3shing and fishing; ........................................................................... ....................... ....................... .................................................................... ...................................... ....... . . ....... ........................ 1 ..... .................... .... ..... .. ...... .... ..... ............ ....................... ......... ........................................ ................................................................................ ..................................... .... ............. . ................. ........................................ .............. . ........ ................... . .. .......... ....................... ....................... ............... ...................................... . .. ..... .......... .................... . ............................ . ... ........ . ............................ ................................... ........................ ..................... ..................... .................. ............................... ............. ............ ....................................... I............. .............. .................................. (3) Accidental spills and discharges of petroleum pro- ............ ........................................... 7..................................... .............. ducts and other toxic and hazardous materials have repeatedly ................ threatened the quality of such groundwater supplies and *.:::::i:..:::::7:................................ ............................................................................... .......... ......................................................... ................ ................................ Cod and in other ...... .. related water resources On Cape ....................................... and safe- ................ .......... ................... Massachusetts towns, posing potential public health ............................................................................. ............................................................................... .................................... ty hazards and threatenihg economic losses to the affected .................................... communities; ..... ............ ............... (4) Unless preventive measures are adopted to prohibit ............. discharge of toxic and hazardous materials and to control their .............. 7.............................. ........................ ......... ............................................................................ storage within the town, further spills and discharges of such *................... ­:::::::::::::::::::::::..................................................... ........................................................... ..............* materials will predictably occur, and with greater frequency and degree of hazard by reason of increasing construction, ............................ ............. commercial and industrial development, population, and ............ vehicular traffic in the Town of Barnstable and on Cape Cod; ................ ....... ........................... .............................. ............. (5) The foregoing conclusions are confirmed by findings ............... ......................................................... set forth in the Environmental Impact Statement and Water- .. .................................................. ..................................... ............. Quality Management Plan for Cape Cod (September, 1978), .......................................... ..... prepared by the Cape Cod Planning and Economic Develop- ................................ .. .. .................. ........... ........................... ment Commission pursuant to Section 208 of the Federal .............. ........................................... ............... .......... Clean Waters Act;by tuc report enfitlod Chemical Con:amina- ............................................... .. ............................................................. ............................... ............ ......... ............................................................................. tion (September, '1979), prepared by the Special Legislative ................................ ............ assachu- ............................................ ............................ Commission on Water Supply, Commonwealth of M ........................... Chemical Quality of Ground Water, setts; and by the report. Ch . ................. ..... ................. Cape Cod, Massachusetts (1979), prepared by the U.S. ..........I.................... ... ............................ Geological Survey. Section 2. Authority ................ ............................................ .......... ...................................................................... ...................................... The Town of Barnstable adopts the following measures veers, its police powers to protect the .................................... ............................. under its home rule pow ........................................... ......................... public health and welfare, and its authorization under Chapter . ....................... .. ....... ........ 40, M.G.L. S. 21. ............................. Section 3. Definitions ................................ ... ....... ................................... .................................. (a) The term, "discharge," means the accidental or in- .................................................. ............ tentional spUling, leaking, pumping, pouring, emitting, emp- ................................................................ a tying or dumping of toxic or hazardous material upon or into ............................................... .......... ..... .................................................................... ............ - ............................ any land or waters of the Town of Barnstable. Discharge in _V.� I.....". ......................................... ......................................... .. .........I ......... il -.......................... eludes, without limitation, leakage of such materials from fa 7, ......I....... ...... ed or discarded containers or storage systems, and disposal of ................................................ ...... such materials. into any on-site sewage disposal system, .............................. ------------- ...........I—-........ ......................... drywell, catch basin or unapproved landfill. . . ... ....... ....... "discharge," as used and applied in this bylaw, .................................. The term, . .. ........ ................................. .............. .... ................. .............. .. ................. does not include the following: .................................. . ..... . ........... ...: (1) proper disposal of any material in a sanitary or in- .................. . .. ............. ........... received and maintained all necessary ... ............................ dustrial landfill that has . ......... .... ....... legal approvals for that purpose; . ................... ............. ........... 14 ... ..... . ... ............. ............. ...................................................... �.....I..................................... ............................. ........�..................................... .........�............................................................*.,.,...........�......... ­ .-:.: ...L...... .1......................­­.. ..............�............�........................................ .............I.......... -..,::::,;.!.:::::,.�:::::::::.:,::............................. ................................................­­........**""**.......... *.........* ..........*.............­...............­­­­.........*......... -.---- - -:::::::::::..:::::..m.:;...::...-.-.....-.-...-...-.-..-.-.-.-...-...-..-... ...............i.....................:::�::::::::::::::;::::::::::::::::::.:::::::::::::::::::::::::::::::::::::::::::::::::;::::::::::::::::::::::::::::::::::::::::::::::::::::::::::�:�:::::::::::::::::::::::::::::::::::::::::::::;:::::��:::�:�:��.�....�.1:�::::::::.::::::::::::::� �................................it ..,..............................................................I...:.::...........­::�:.............................I....:::.......!... ..�...........................................................................................:...................I—........ . .................... .:. ...............................!.................................... ..........�................�... ....�......... ... , - ......_,W.................W......................................................................................................... .............. ................................... ......... .................................................... ** :.,.,.*.,.,.,.,.,.'.'.'.'.'.'.'.*.'.".'.*.'.'.'.".'...............�...... • .... . ............ -�... ........�....-.......-.-...-.................-.-.-.-.............-...�..1�.�.,............-.:...-.-.-.-.-.-.:::::::::::�::::::::::::.,:::::::::::::,.::,.�"1,.:,.,.,.,.,.*.'.*.*.'.'.*.*.".,..,, ............................................................... ...............................................................................................�.........................................::...................:::.:...................................�.....................:............................�..........�.............. ...�...............................�....................................................................................�.............. .................. .................................................................I......­............................................I...........I..........................�........�....... - - ---::_.::.%................................. ............... .I... ........................::::::.::::.!:::::::::::.:. ...................=...............�.. .............�.... _......................................... _::.:�:::::::::::::::.::::;::::;1 1��:::�:���_-,�.���::1::::::::::::::::q.:::::::... ...... ......................::.-.-.-.-.-.-.-.-.-.-.-.'.'..'.-.'.-.-.'.-.'.-..'.'.'.'.'.'.'.'.'.'.*.'.'.'.'.'.'.'.'.'.'.*:. ... ...... ..................*.......... ­...*................. ....­­............**...­............**........................*.........._." , . .. : , t::!::.: : ,::: : :::::::::::::::.::::::................................................................................... .....................................................­�........... .::..........I...�........... ...................................... .....................* .... .....­*............................ ..............­­................*.......*............*......*......­­.......*........*........**............*......*"*"** .............. .................... ..... .....................................................................................�...............�.............................I...............................I........I....�........�................:....................................................................�..........�........................::..:.......::: ...................................�.................................................................................................�...........................................................................................................................................................I.........�..... ......... ...�.........- .............................................................�...............................�....... �.����:::::�.::::::::::�::::�-.-.-.-...�::!!:- :::::::::::::::::::::::::::;::::::::::::::::::::::::�::;:::::::;::;:::::::::::;::::::::::.::::::::::::::::::::::::::::::::::::::::::::::::.,.,.,.,.,:::.*.,::�1.1:::::::::::::::::::.,.*:::..-.-.,.,.,::.....................�...........,...'.".'.'.'.'.".'.'.'.'.'.'.'.'."�'.*.�'.'.'.*.'.".,.::,.::*::,.-.*.:::::::::::::::::::::::::.,: .............................................................................-.................................................................-.........................._ ........�...................�.... ................................................................. .------­­­�_-. �...........:................................................................................................................................................................ .........................� ............................................. -- — ....................................................................... . ..I'-- -- ........ -::::::::: ::::.:.:::::::::::::::::::::::...::::::::::; :.:.t . .. . � , ;.1 �,..Z�L�I " _.- * -� '- -—-1�- I �I_r .45- . .1-.1�_-, ., ..............i..:.....-.-.-..-::::-.:-.-.-.-.-.::-.:::..:�::................._, ,-,I .. ... ..........I.............................:........................... -.,�. ^- ,t- I. x- - -I.Z'� f, . .. ...................................................:..... _...... - - , , . 11 ,, , -,��,, -.��' �,.e,v.,%, .,� ft.7,, . 1 i, '. _ �, . ..............................................�............. I" ,V � ," - I � -.� .. � ::..... -...-.-..-.-.-. � . .11 . -# Z, _3,;�V,; ......::::. . :: ­.............................11......�................. ........ , -,� ,�.- � , ,,-.; ,- ',­ "� �-�� ,. , ........................................................ I ­� I .. , ........­­.............................�............................ � I n- � -_. �., Y t, ,i..­ -_-; -�,- � I , �� . 1 " . .:....�................................................. , ,t- -� � �� .�� � I 4 . 1,I!, �, � --,-! . I ... . . - X�, � . ,* �,�.�,� - . ., I-,*'',-�-,�, �i,- I" � . :*_,::::::::::::::::::::::::::::::::::::::::::::::::::::�i �-.::,.::::::::.::�::::::::::::::::::::::::::::::::::::::::::::::::::::: � .. . . ­............................. ...................... ................�....�........... . - I � ,_ ,1, ,• -*.v­, . " � . I., - �, : I , , ,- . ....................................................... ..............I...................� . . '. - ., ,I; " .�� I"- �, q ,i�_ , " � ';,-:� . , . �..................�..................... , -,:,. ., � .. . ,,, ,. . ; . - .� � ""�'� , � � .­.....................�... . -.- . . . . . 11 .- I- ." . � . I I I. --I _k ��, , .. .. ......::::.::::::::::::::::��.-.-. I ,. - - � --I I I,::::::.,.,.*.'..'.'.,.*:.,.,::::::.. ...... I t": , '..�- �� I I , . �. ', . .. .................................. ..............,.. ........................................................ . . . .1 . � , - F .. , . - I � .� .....�................� ...... - " I . - I � .......�...................................................... _. � I ,;- . �I, . I . I I �I I I."� 1� :....................... ..........�............................. � . . I I � - , ..................I.........I............................ ,:::::::::::::::::.,.*.'.":: ::�I. . . ,, . , -. - . . � ......................................... .. w::::::.,.*,*.".'.'.'.'.'.'.'.*.'.'.'.*.*.= - I , ............... ....................... -....................�......�.......� � . - ........... - . - , - I Section 7. Enforcement - ::::::::::::::::::::::;:::::::::::::::::�:::::::::::;:;:: _I_. . ' . . I .................�........................................ ................................. I .............................................-............ ....�................................................................. . o t" - (a) The provisions of this bylaw shall be enforced by the .'.'�".,.,::;::::::::::::::::::::::::::�:::::::::::::::,.::*.:: ...................................................................... � , ' *11,111,111"*....*:.*.*.'.'..,.:::::::.,.::........::::::::::::::::::::;: �.......................:................................ .................. . ...... :::* ­..........�......................................._ ................................. . Board of Health. The agent of the Board of Health may, accor- : : ::::::: : .*.,.:..,.*.,.'.'-".'.'.*.,.-.-.,.,.,.-.,:::::::.,.,.,.,.".,:. .................................:::."::....................*'.'*.............. . . :.,: .,...::-.'.* ::i:::::::::::i::�.:,:,.--..-..,..-.*-,.,.,.,-,"-*.,.,.,.,.,.,.".'.'.'.'.'."".'*.-. .....................................................�...........::..: ding to law, enter upon any premises at any reasonable time to ...�.................................. .............. ..............................I....................................... # ......�'.'.'.'.'.'.­.......................................' ..... .. . .. ......... ................ inspect for compliance. ......................................................... ...................�-. .. . . :­....*....*.....**..........­11..............................:.:: ......................................�.......................... .:. .-.��:.... ........�.......� ......................... ..........I............�...........�...�................ (b) Upon request of an agent of the Board of Health, the .......................................................... I......�.........................::�:::............................... . ................................. .......:....................... :::::::::-"::-".-.=....:::.................,...-.......-....::-...:::::::,:::: ...:. ...................................... owner or operator of any premises at which toxic or hazardous ..................*............. ... .::....... , .,.,::�7 t ::::,.:::,*,-",,,*..... .. .............I........................ . .. ............................................... ......­ -.....I.....................I.....................................- . materials are used or stored shall furnish all information re- - :�:::,.:::::::­::::::::::..::. . ..........�................::: quired to monitor compliance with this bylaw, including a ..............* - ,-::::::::::::.::::::::::: .::.,:::::::.*.,.*.,.,.,.,.,.,.,.*.*.-.,.,*.'-""'.."" *...................... ............_ : : :: � -.-..,.-..'.i�*.'.".-.-. . '"'­..............*................................*, :::: : :::::::::::.:�:.:,::: complete list of all chemicals, pesticides, fuels and other toxic -.1....................................I---I.............. ............................................................ . ....................... ....:::. . ........::.-......::.---.,.-'.'....'-'-.-.'--'.'.".�, ...................... .....................................:::: or hazardous materials used or stored on the premises, a :,::::" *........................*:.­.­­*............... ::::;::::::::::::..................................... ....... , I........... ..............................**....... ::::::-.::::::."::::::::::::::.,.. . . -- --,.-.-.-.-.-.----.-.-::=.-.-.: ...-.,.*.'.'.':.,.*.,.,.,:... .description of measures taken to protect storage containers ........................... , :::, . .. ....................................................... .........�......................:,::"*:::::::::::::::::::,�,:,::: from vandalism, corrosion and spillage, and the means of ::::::::::::::::::::::::::::::::::::::::::i*.i�����-.�.-.-.....�.. ................................... ... . .. ­ ::::::::::::::::::::::::...-::::::.::::::�::::::::::::::;:::::::::::::- I .......................................................... ......::: .......................................................... . , ..........:.... ..........*..........*...........*...*.......*...*... disposal of all toxic or hazardous wastes produced on the site. .-.-.-:::".,:::::::::::::::;::::::::::::::::::::::::::::::::::. ......................_ _...................:..... : :::: .*.,..: : ....................�..........I.......�.................. .......................................................... ...................................................................... A sample of wastewater disposed to on-site septic systems, . ...::.-......-,-,.-.-.-.-.-.-.-.�-.---�-.-.�-.-..-.-.-.-.-.-:::.-.-.-..---.:::.---.---::----I .1.............................................I......I............. . . . : ::.,.*.'.*. drywells or sewage treatment systems may be required by the,..................................... . :::::.:::.::::::.,.,.".,.*.'.'.'.'.'....I................................. . ........................ ­: ­.;.................................... ........... . - .. .::::::::::::::::: agent of the Board of Health. ...........................................�.............� ................�.......................�,.::.:::::!.:::.::::��:::::::::: .....�........ ....�............­ --.. ............. I .-...*.:.:.:.:.:... - ....................... (c) All records pertaining to storage, removal and ...........V­.............: :: :: ::::::=:.---.-..-.-.I ......... ...........I...................................................... ...........................................................I :, disposal Of tOXiC or ha7ardous wastes shall he retained for no . ........ ...........................�.....................................:. - ::::�::::::::::::::.�-.'.','-'.','.'=...*.*.-_*:::.._­_­.-:..... I :::::::::: . . � ............................._1...........................: .............................. ........�..................::. ..,...........................I......................�.... ...:::::* less than three years, and shall be made available for review by ::::::::::::::::::::::::::.......I............................. i..........................�....... .1.....I.................... ...� .............. ; I . . . the agent of the Board of Health upon request. I I t ...................................................�................. (d) The Building Commissioner of the Town of Earn- ........................................................... ..................................................................... .-.-:.......-.-.-.-.-.-.-.-.-..-.-.-.--..-.-.---..-.-.�-.: -.-.-::::.::.,..*.*..*..*...............::............:.::.:.:,:-:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:-:.:.:.:.:.:.: � , stable shall condition issuance of construction and occupancy .1.............-........................................... ....I..........................- ...............................I.......................- ............................................I.......................I...... p conformity with the requirements of this bylaw ---�................................................. .,-.-._.:,.'...'.­...!.. ..M�..��:. -....... 11........................................................ .::::�:::,::::::::::::.-::::::::::.:::::::: re .. ......................:�4 * specting any toxic or hazardous materials to be used in the .....:......�......... , - . ...................� .............. - .- ,._ . ::::::,.*....:,.:.-:..-..:..-............,...-..-.........-----.---.-..---.... .................................................................... course of such construction or occupancy. .......... ..,............................................................... . ------*.�� ........... Section 8. Violation . ..........................:..�........-.-.-.-...==...-......,.,.........: .............................. . .................... I ......................... . ---::::::::::::.::................... . ........................�....... :::::: : :: :::::: ::::: :::::::::,, . .. -- ii-.-.-.-.-.�'�'.i".'.�..�.............�:�:.�:!:::::���:::::::::::::::::::::::::::. . (a) Written notice of any violation of this bylaw shall be :,:::,:,:::::::::-:::::::::::::::::�:�::::::::::::::...... ..... ..............................I . ................. ..!'.*:­.'.*.'.'.­..::.. ........ . . ' . - - - ,; ........ :::::::::::::::::::::::::::::::::*:ii.i__..i_._.._._..._-_-.-.-.-..�! .....­........................ .:: given by the agent of the Board of Health, specifying the ...... ..........:. -:::..:..:: ..:::::: ..............�............ ................................................................. 1-1..........�-----------I.� ...........................::::::::.... - ................................................................. nature of the violation; any corrective measures that must be . �-=- ' .'...-,.'.','..-::::....: . . ............�.............................................I ............I...........�............................�...... _................................m,._....­*...........*....*.... undertaken, including containment and cleanup of discharged _--.-.-,.---.-.-,-.-.-.'�'..'.'.'.'.'--.-.-.-.,.,.,-,- ::::.*-,:. .............................. .......................... ...,...................................................... materials; any preventive measures required for avoiding .................................I........................... ...................�............................................... ..............................................I................... -::: :::::�:::.-::::::::::::::::::::::::.::::::::::::��l�.I .............. : :;:::::.;:::::::...:::::�..: : ::::::::::::::::::::::::: future violations; and a time for compliance. Requirements - . .,-.,..-.:::�:::::::-.::..-.-.-.-,.--.----.-.-...--,.-..-----.-.....-.�....�......i � ..... .. - i ::::.,:�::::.".--:.":::::::--:.,�'.'....,.::".,.::::::::::::::::::::::�*........ specified in such notice shall be reasonable in relation to the ---- .... *....�........-.-....---.-.-.'.'.-.'.'.'.*.-.".'., � ....I..........�.................................:.................. .................................................................. ::::::::::::..............................................­­ ::::::::::::::::::::::.:::.:::_:::..::::::::::.....:::.,�........... . public health hazard involved and the difficulty of compliance. . .............�........,.-............--.-.-=.--...,.=-*.'.'.*.,.,:::::----."---..�� ... ..........v � I . ... ................I...�............ ........... .1.........I....................................................... The cost of containment and cleanup shall be borne by the - ::::-:.:.:.::.:.: : :::::: :::::::.::::::-:::..:.::::::::.:.:.-: ...............................�................................... .:. owner and operator of the premises. . . , .......................:::!..::.:�,.:,-,.":::::�-:.-.--..........--...... ...... . - ... . ..................... - ....................... . .. .1.................................................................. - �.-.-.,��.�.�-.-.,.,..-.-.........-.:::::::::::::::::::::.::::::::-:::::;� -.-.-.......-.-.-.-.-.-.-.-..-..-.-.�....-.-.-.-...-...-.-.-.-.-....-.::.-.-.-.-.-.'....-.....*.::::.,:::::: Section 9. Penalty '.'.'."..-.,::::::::,::::::::::::::�:::::::::::::"-:::::::::::::. __...................... .................................... - � . . , , ............................. ..................................... . : . ::::.,...'.".'...,.,:..:.-......-...---...--.-----.......--.--.--.-....-... _ . ............................ .............�..........- .::::::::..:::::::.�::.,...*.. Penalty for failure to comply with any provisions of this ,:�::::::�::::�:::::::::::.:!::�.................. --­­ ...............**.... ...**" ....................................­_*1-11*................:. ......:........... - ....... .............................................. " �. bylaw shall be S200.00 per day of violation. � . :::::: : : ::::::...:..... ::_: :::.:_:::.:::_-:::: ::.i:. :::::::::: . I . I ::::::::::::: ::: :::::::::::: ::::::. :::i . . .. ........ ................................. ility ...:. .............�t:.­.�........... ...................�......... . � � - ­ 1.­..-.-.,.._..'.'.--_ ..:::: ::::: ::::::::. ................:---------:..'-.. .......................__ . . ..........................�........I......................... ...I.........................: ,:::�::::::�::��:..........---...-. . ...............�.....................­_................... .1.......................:_... ......... I Each provision of this 'bylaw shall be construed ........... . .... ..........I....:..:..... ..................�.............. �.............�............�........ .046-.1; ... ......... :: : ::::: :..-.-*:. . as separate, to the end that if any part of it shall be held invalid ::::::::::::::::::::A....M::�. --------* ..............�....I—- I..................................... . . .�-_-.-.=:.:_-:::.*................. .......- _1..........I.................. � ...................... ..:.::: : ....................::::::::.: . . -:.:.:------�.........I......... ..- ...............�.....: - . for any reason, the remainder shall continue in full force and ::�::�:::::: .............................,.. ..%'.'.'.'-:::.,.,...............�.�I..... ::::! ' I ........................... ............:.................... ....... . ..�....... ..I . ......................... effect. � ; . I ...- - : :::: -.*.*.�*%*!.� -_ ............... _M_ .-.-.,. '.'.'.- ... 17 .......................... - ---------- - -------W::_-:::_ -::,.::::::::::::::::::::.::: .. .­.................�..........._­............................ .............................................................. ..............I......�...... ......­.....�.................. . I ... .. -.. ..", ...........................�................. :::-:::.:::". .:::::..........�...'.'......'.'.'.'-.......-.'.'.'.'.'.....*..'., .,.::.*.:*.:::...................­_�.............. : .......­.. .1......�.. .........I...................... k ............................... ................................. . � ... "I.........�............�.....-­­­.-....'.*­*. ............................ .............. - .:::�::::.::::::::.�::.:::_:......:..�:::::::::::::::::....-.::::.:. . I . . ........................-.....�............................. ..............�.......... . : ::::::-::::::::::::::::::�.........­ .­­. - .. ­........_11__._.__.. * - - __ I. . . ­. � ­1................................�............�......... ......�.....................I . - _____.. . .---..- . _1............................ .. ....... . I.. . ..........._....... .. ....­'-...._..._.­.... ............... ......� .... - ........ .-.�..................�..........­.­.. .............I..............:::-::::::::::::::::�::�::::::,:. - - � ....... . ... _.. . ,. ........_.. . I . ..­­ ­­......... .. .. ........................ ................�........�.....I...............�........­1......................... , ..........I............... ............................. .�..:.:�::...:.�...:.-: .:.: "..W._... ....................�................i-.-.��-..'.'-'-'.'..--*.*..,.,..-.*.,.,..-.-.,.-"-,�......-..-...-".-.-.-,,.,.,�,.-",.,.--,-�'* -­ ­........... .......... .............. ...� ....... .... . ­ ­ ...... .. .......�...... ........*:. _,::*:'::,.:,:... *...�".*.�'.'..,.:,....-..,:.,..--,.,.,.-.,.,.",...,..*,.,.................................... ..... ........I I..' . ... ................­ _ - - _�'.'. .:.. � ....... . � .. .. .- _-- - ----- - ---- ...- -...----- ... .... ... ......... ... .. .. ........................:.�'.-..,---........-..---:--....-."-.-...-.-.:..-.- - .. - -:.-.- '.'.� *.��'�!'.�....wa..�..... - .. --.�.*.'."'..*.*...*.........-.-:......�.-�-.........�..:::.:.*.'...'.....I........ . . . ------ ............. ... -- . . ..........�.............. ......I...................�......�....... .... ..�....�......�....... . ....... ....... .............. ....-**_:q:::��.::.4 61_.�A-_::�: .................. �................�.........�.........................�.........................................�................� I ...�.............�. ... ... �................................ .... -.... ... ...�............I....�..........................�.....� -,*,* :......... ..................­­ -****,-*" - .-�...............:_ '.'::._._::.--. ..:,::::::::::::::::I'-. �!.. ..:.. _.-...-,,.._.:__-.. .-::.. - . .... ............ ..... ....-- ... .... ...... :........_...'.'..'...I.I .................. .. :::::�::��­�. �.::::::..................................��..............:::::::w.��'..*.'..,:.,.,.*...........................................�...................................................................�..... .�..............�.......".."._......'...'.,...%'.'.*.*_.'...:.:_::::.. . .... . ..........­1.....................................................................__­......... . ­ .... "I..........................I...................................................................... - , - �_____ -.-,--___________. ,-------__- . .____­�_.i­__. _- -------- —.----.--,---------­��—:--,;,�'ll,_,"--.--�--^"7-��-�'!_--k-.­ ______­­----..--�L_.- 0 ; ALGER & SCHILUNG ATTORNEYS AT LAW 886 MAIN STREET P. O. BOX 449 OSTERVILLE. MASS. 02655-0069 JOHN R. ALGER TELEPHoNe 428-e1394 THEODORE A. SCHILLING AREA CODE 617 March 2, 1984 r Mr. Robert P. Fagan Deputy Regional Environmental Engineer , Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Quality Engineering Lakeville Hospital Lakeville, Massachusetts 02346 Re: BARNSTABLE - Public Water Supply, Review of Plans. of Proposed Construction �. . by a Private Developer on Land Adjacent to the McShane Tubular Wellfield 3 Dear Mr. Fagan: This is in belated reply to your letter to Mr. John M. Kelly, Director of the Board of Health of the Town of Barnstable, dated February 2, 1984, a copy of which I enclose herewith. The purpose of this letter is to seek a clarification of your intent and see if. we can agree or arrange a meeting and , attempt to agree on the future of this property. To review the history of the problem, so far as the most recent chapters are concerned, in December I called your office to determine the status of the State regulations. - ) I was referred to Regulation 310 CMR 22. 21 (2) which reads: t " (2) Suppliers of water shall acquire sufficient land around wells, infiltration galleries, springs, and similar sources of ground water used as sources for drinking water to protect the water from contamination. This requirement shall generally be deemed to have been ,. : met if all land,.within 400 feet of a .gravel packed well or 250•-feet of a tubular well with a diameter of' 2 1/2 r inches or less is under the ownership or control of the supplier of water. The Department may order greater dis- tances or permit lesser distances than the distances re- quired herein if the Department deems such order or per- mission necessary or sufficient to protect the public health. " 4 Sw 2 - -Mr. Robert P . Fagan March 2, 1984 I was told that there was no provision that could. prevent a private owner from building but that the Dept. of Environmental Quality Engineering could require the Water Department to purchase the land or in the alternative could waive the regulation. Based on that, my clients purchased the property and prepared their foundation and- septic system plans. When these were filed with The Barnstable Board of Health. they. wer.e referred to your -office for determination and as a result you issued your letter of February--2, 1984, a copy of which is enclosed. Immediately the Board of Health issued a letter dated February 3 to Mr. Rogers, a copy of .which is enclosed, which enclosed the Town regulations which are encompassed in General By-Law Article 39.. which was adopted November 1, 1980 and approved by the Attorney General on February 27, 1981. Also -included was a�=-copy of the toxic and hazardous components. I enclose a copy of the entire submission. You will note that after the definitions this By-Law prohibits the discharge of toxic or hazardous material, the outdoor storage of the same except- in product type containers and limits the quantities to 50 gallons liquid or 25 lbs. dry weight unless registered with _the Board of Health. In addition, there are. various exceptions listed. The Board of Health, based on your letter, has taken the position that none of the toxic and. hazardous materials listed can be stored or used in the development. If this' is true, the buildings could not be heated by oil. There could be no amount of paint used, no house- hold cleaners, no toilet cleaners,. no disinfectant. In other 'words, it would be impossible to build or maintain a building. This would apparently -apply- to our existing building but would not apply to the repair garage maintained b g g y the Water Department in the same area. f I do. not believe this was' your intent. for several reasons. One, and perhaps most importantly, I do not believe there is any existing -state or local statute or by-law which would authorize this. Secondly, I- think the order would be so restrictive as to constitute a taking. Thirdly, 'I just do. not believe. this was your intent. Certainly .it is not the intention of the developers who are local people to pollute their own water. supply. All parties want to cooperate but. we 'do feel that we should not be asked to contribute our land for the benefit of the public good without compensation. This land has after all been offered for sale to the Water District on numerous prior occasions. I would therefore appreciate it' if you would let me know under what authority' ;your orders are issued and exactly what it is that you 'intend. I think it- could be perhaps most helpful if all parties could meet with you 'here to clarify this matter. If you have any questions, please do not hesitate to get in touch with me. /Ve trul urs, JRA/JJ Encs.cc: Mr. Charles. D. Rogers; Ml S . Riedell; Mr. John M. Kelly; and Mr. Joseph Daluz r TOWN OF BARNSTABLE BOARD OF HEALTH Toxic and Hazardous Components PRODUCT TOXIC OR HAZARDOUS COMPONENTS Antifreeze (gasiine or coolant systems)-- methanol., -ethylene glycol Automatic transmission fluid petroleum distillates, xylene Battery acid (electrolyte) sulfuric acid Degreasers for driveways and garages petroleum solvents, alcohols, glycol ethers Degreasers for engines and metal chlorinated hydrocarbons, toluene, phenols, dichloroperchloroethylene Engine and radiator flushes petroleum solvents, ketones, butanol, glycol ethers Hydraulic fluid (including brake fluid) hydrocarbons, fluorocarbons Motor oils and waste oils hydrocarbons Gasoline and Jet fuel hydrocarbons Diesel fuel, kerosene, #2 heating oil. hydrocarbons Other petroleum products: grease, lubes hydrocarbons Rustproofers phenols, heavy metals Car wash detergents alkyl benzene sulfonates . - Car waxes .and.polishes petroleum distillates, hydrocarbons Asphalt and roofing tar hydrocarbons Paints, varnishes, stains, dyes heavy metals, toluene Paint and laquer thinners acetone, benzene, toluene, butyl acetate, methyl ketones Paint and varnish removers, deglossers methylene chloride, toluene, acetone, xylene, ethanol, .benzene, methanol Paint brush cleaners hydrocarbons, toluene, acetone, methyl ethyl ketones, methanol, glycol ethers Floor and furniture strippers xylene Metal polishes petroleum distillates, petroleum naptha, i . isopropanol Laundry soil .and stain 'removers. (& bleach) petroleum distillates, . tetrachloroehtylene Spot removers and cleaning fluids hydrocarbons, benzene, trichloroethylene, C' (dry cleaners) 1,1,1 trichloroethane Other cleaning solvents pure strength benzene, acetone, trichloro Rock salt (Halite) sodium concentration Refrigerants 1,1,2 trichloro-1,2,2 trifluoroethane ` Bug and tar removers petroleum distillates, xylene Household cleansers, oven cleaners xylenols, glycol ethers, isopropanol Drain cleaners 1,1,1 trichloroethane Toilet cleaners xylene, sulfonates, chlorinated phenols Cesspool cleaners tetrachloroethylene, dichlorobenzene, i methylene chloride Disinfectants cresol, xylenols Pesticides (insects, weeds, rodents) napthalene, phosphorus, xylene, chloroform, heavy metals, chlorinated hydrocarbons Photochemicals phenols, sodium sulfite, cyanine, silver halide, potassium bromide Printing ink heavy metals, phenol=formaldehyde Wood preservatives (creosote) pentachlorophenols Swimming pool chlorine sodium hypochlorite Lye or caustic soda sodium hydroxide Jewelry cleaners sodium cyanide Leather dyes formic acid Fertilizers (if stored outdoors) arsenic, nitrates, ammonium, sulfuric acid, heavy metals, formaldehyde, phosphoric acid PCB's chlorinated hydrocarbons carbon tetrachloride chlorinated hydrocarbons 41&t TOWN OF BARNSTABLE OMPIdANCE: CLASS: 1.Marine,Gas Stations,Repair nters BOARD OF HEALTH satisfactory 3.2.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY !1��3 (see Orders ) 5.Retail Stores i 6.Fuel Suppliers ADDRESS Class: ! 7.Miscellaneous S QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR�]�ZA.Tove s s IN OUT IN OUT IN OUT #&gallons Age ITest Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers " d Miscellaneous: DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply / O Town Sewer XPublic f ,'On-site OPrivate 3. Indoor Floor Drains YES_NO_ O Holding tank: MDC O Catch basin/Dry well 6 . O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5. Waste Transporter m' of Hauler Destination Waste Product 1 YES NO 2. Fr l<,4e,,, � %'� Person(s) Interviewed Inspector Date TOXIC AND HAZARDOUS MATE RIALISTRATION FORM NAME OF BUSINESS: QA S e , Mail To: BUSINESS LOCATION:` _ it it- map l S+ a —4c'ey, de. U .),t-- ( Board of Health Town of Barnstable MAILING ADDRESS: P.O. Box 534 TELEPHONE NUMBER. ul a-d S ST / Hyannis, MA 02601 CONTACT PERSON: : S EMERGENCY CONTACT TELEPHONE NUMBER: 3(6;._-4 C) ! Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities to`tglling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO h This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers' hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) ' Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business M o —a •. • m tr ' . Postage $ p p Certified Fee p ReturnReceipt Fee • Pry (Endorsement Required) area] p Restricted Delivery Fee —D (Endorsement Required) rq r=1 Total Postage&Fees ul p Sent o V;--- - b -------------------------------- o PO B�No. �� . i ` l - . I'll---------- Guy, State,21Pr4 :1 1f (D J Certified Mail Provides: o A mailing receipt lasmey)zooz ounr use wjod Sd c A unique identifier for your maiipiece e A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. a Certified Mail is not available for any class of international mail' a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. COMPLETE • ■ Complete items 1,2,and 3.Also complete A S' ture �` item 4 if Restricted Delivery is desired, � DAAgent ■ Print your name and address on the reverse X ❑Addressee so that we Can return the card to you.. g eceived by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, J i d 1 q—/5-a7 or on the front if space permits. D. Is delivery address different from item t? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No Mr. Adam Hostetter 770A Main Street Osterville, lV1A 02655 3. Service Type 13 Certified Mall 0 Express Mail Cl Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number t s a' (Trans%r fiom rvl�lab �, 5 ,1 16°;0t�0 O p p i0191 , H6 o-- PS Form 3811,February 2004 11 ' Domestic Return Receipt ' "".102595-02-10-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Pees:Paid j USPS Permit No.G-10 • Sender: Please print your name, address,and.ZIP+4;in this box-•f ! PUBLIC HEALTH DEPARTMENT TOWN OF BARNSTABLE 200 MAIN STREET L, HYANNIS, MA 02601 s... S f.. i3t73Fl3 fSii .3ft3 4i3.f. 3.' SF I i r «. .. —DIV �bq_VIT � fl!� OLE T>'�?T ?'2ts+t`1 �-I �Xt -�t'Ii1Ge �ot.JS� ,•-c-��:"��' �"'�....�.�:... ,� � � �.1'�7► - /� � P 110PCB. Su�,vit„ �- t�tv E r T'pl-� �'` �' ►tip/ �� 0 �- N-7-I 2o X 11.4Vo tl• ©o© ►tRFt� �Lca, �� +G l i E �_ -- - ii !-`. �....__ � I _- o t E - ...�-- to 1 �Q ..r.. �I � �; i � � �' � ,. r,a}.i•a!'-` ^' � .�! � _-r, '�"��M �� � "� t ��4G� Ar ILL \ i y ��+.Aa✓`� t i:;c.,Itti-' l I °tea �... \ \ ~� Tyr �- r.,— �, _ _ — zt ,5 — �. _ _ 1 �V t e,t Wfl � •fief. {-�.Z �,'.t1 i.. � ...._I r.� _.__._.. ._ r ,�+' ..' � � $ i " � � \ � ,,c ' `+ t , •� �� ' Exits ' ��..a.©� ( __.__ ...�.. 5�•-Inc I y�4� �`'�''�"` " i q _ ... _._ _ -'�.�. •1��..� =rev � � �� ` j}.� ® 0 ID® Bc AA aw,�FlAU'tit ' i 1 ,err U�J!�� A tt ___ ... t _ . 000 .- " j - 'Lo t.! ",(,, - �1 •-tam _ _ _.___.___ r i , /,,., � ; h 'NJ�iL- 1 ,-.. "',� .,ate _.,• '' � t � r .., ,r �. i 1K Al ► � •,�,o. -- ��s � � ..:. ��: .fit � ., ... - � �t � � � < � _1_ ',,,.� PIT ` � � "'l� �F E � � qM��c�Sty , , j � `C' �►I..rAi. ,.r'P '�l "_•, �(,� -- T p i >- it A / ` � � ,.��« T{fir t- � " E � } C _..--3..y.••' � � d '1 ,/ � � ,��+,,, / t `�� _� .r' G+' '� '�' .nr ' 1 � .r. .... .. .r�r"" � ,`•�'� ': � 11 � \) f ' 41 � � � �k't� � ,,ems* � I � -� , � ► r� �^ .4 se J � �\` , �� , ,,,__ •� t,", �',`'8:..✓il 3 -"� .,,....« ' _ ,,,,. ..i .,.. `I � .``. ' ^�� �� .JV1/i.'�"7/�1.. � C� .. �1..*�+ ' .___• �+' \ , Ao pt �� _ _1 .fey w -----•jl�t7"'_. .» P 1 f''r{C —rr LL \ - A� s43 Centerville-e- c,sagCy 'rstns. F4:,—«.•-.•a - .............,....... - ".�.,. at— i 'y s ,r�s APPROVED ...,.. a .......:. ... .. y T It tt I �^ ' )d 1 5 r y� I«m .i 1' ' ,-'r" — Z 7 L)�, c-to �/U� �C~ Cis... ,,t ('� "y �, mot,J1 'C� t, '� j �,� t , . _ f \� t�A (L.�� C Mr` - 3 x'2.c x S� = `�oo ''" f �_ r"1 � ;�%';'A �� _ r \ \ �iit'�'t-'+✓"J'/�„ .,.. ,,{`�.. t ._-i.. Fi� /t IV 4 4 �"I l,�✓�i 17 j El � _'_7�t/1t�d..�ir'`����7i /1.��••( � 1 �.. '•4►'dty�..i��es"A�i � ��� 1•�^ V`� HJ• � _ '� ...,. fw� ../ �.t'ts,r.�a+r.! r e ►Y�,. ,� ,. �. � ' .:bc,.'?..•luu". 'f" I ,'1 :.. —T�o� �L �A t Lt F-Law `�c�t� fa+ i� r? ;»f w Cc:-r;1 +0 G� - ,• „" ;�T ! fie,{�. j �-c.•o .�f - � � 'L a � � !� v Gtr. ,;:y ��� c� c_ - A IA t4,. (so i �"W �.:r,C� r 1 ._�. v(���► ,~- ° - - __... �,,,�r �.f� - i �. . ,�, !► t- `• P 2�3 L.d� to ICX� 4 ►„ L.. Ja r-�3:ti,. �,t�/ d�L s �u T�"� , �: �. WQt c� �8 GI�V�Id-rg :tom -r-. �vu►T . ► V ! 1 - 'lG� ►f^�,c 2�'car '7 jai. C' .`J df � �..N'x !L.'� ��?`�; T' �� 1(i� >(�..� •}'" � � 1C.��v l�jT'E t'� �,.�� U`�,10�•rt7�,.,,•j-' �1'�..�rY�.l�t... ! l.�it1 (D©d°�" �_ �— �( iiTG7�.1p, �'• �+� � »- I K2 c • 375 �i . ... . , xr�r ►W �' ` t �rla 7`,�raf� _ x ISO '! ~�tsS t�. � 't"t-ea M. Q t,.tarA �( (•o 5v GrPf� ) �l3�-a :r•;: •z4i� Sr r v�, t ca +r� . . ,_ n w te. ._ _.._ G.; r I s l..L_r-. t ` � GLJ ',Z 1*. 1=••�1r"•-3'_,�;��*:,�,,. f=�p'�" t�gg Ic:�.`- �..• ,�4I••�. fir?' Z -S`rr�sJ�-- VG�"..�•CUf4. 1 .v .. ��i L#G"� s . �`rttiCl/RofL'.L �_ A�.IQ s f" a 3s�� `k�a <� lyL j.� x ``h • yap + ry Q fir+ �:► f.,�.� . vac 3 A :' Tor>�� a�- !w"r..�av�•r - CIO G'I'` t>• TZr:.:l,,/�it3'G ` " ►•� l2 , r Fo►Z CNQIA ! ,' g t. ,.4 _ _