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Home My WebLink About0026 MEADOWLARK LANE - Health 26 MEADOW LARK LANE, OSTERVILLE 01AA - 0 a ' 0 �r u a O ^ TOWN OF BARNSTABLE O {� LOCATION (P M tA)OWlkk /AAA SEWAGE# r VILLAGE J SrN. L ASSESSOR'S MAP&PARCEL /'l 0 INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY CQ SAP6D I LEACHING FACILITY:(type) (�)CG 1_iT (size) (1� NO. OF BEDROOMS3 OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply.Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge.of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet .--- FURNISHED BY 1nS�at� �w, �Q/ W r 1 1 , ill t�0 C A ION S E t! A G E PE RIAIT NO. ��. ��Lf2U" � �uZ� n VILLAGE - i�IIII INrSTA LER' ' " A ,E & AODAESS S U-[LDE R OR , OINNE D-ATE PERMIT ISS-U E D DATE COMPLIANCE ISSUED-' ca d �,. 1 ��. �,��'_�/� ...tit T� a .� i � � ,�� ,�� K<�'- --- J 25.1, No................. Fx$....:4.._............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ......................_.........-----....O F.....................-.................----------------•---.....----•- Appliration for Uhipati al Work,5 Corm rtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System at .... .�'._- -- ................... ........................................................... Loc on-Address i o Lot N eP wner Addr - a . L----------------------------------------- --. 1_.. � --�--•-•- .-------- Installer Address Type of Building Size Lot.. Lf.?t�,c. feet Dwellingl�f_No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 'k Other—T e of Building No. of,persons............................ Showers — Cafeteria Q' Other fixtures -----------------•-•-•-•-••-•--•---•-----••... W Design Flow............................................gallons per person per day. Total daily flow.................. ...........................gallons. WSeptic Tank—Liquid capacity.............gallons Length................ Width-------......... Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length-.... Total leaching area....................sq. ft. Seepage Pit No----_-------------- Diameter.--................. Depth below inlet.--................. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.....................- _ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...--------.----__-----. ODescription of Soil ---------------------------•-•---------•--------------------------------------. ............................................................. ----------------•-------------------------------------------------------------------------•---•••------•------•-- --- ---- - U Nature of Rep •r -76-1-e--------------------------- or Altera'ti�oLs—Answer whe app 'cable- .: �� -� --- ••••.---••--•-• ..-• •. ./ l i¢�--- ------ -----------------------------------------------•--------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIThE 5 of the State Sanitary Code-The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of llealth. Signed---- --- ........................... -�--�-........g.... . Date Application Approved By.-•-•-----•----•--•--- = Z-X!!4..)=-•----•- -Date Application Disapproved for the following reasons----------------------------•-----------------•---------•-----------------------------•--•-. -•-------•--..... .............••--•-•........-•-••----••-••-----•••-••••••--••...•••-•••••••----------••••-•••-•-----•--•--••••--••--••-•----••------••-•-••----•••-----•------------•-----------••----------•-----•----- Date PermitNo........................................................• Issued_....................................................... Date Z No.........c�..._.... FE$.....''�................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ ...... ................OF....................---------•--....... Appliration for Uhipoiial Works Tomitrnrtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal System�at: �� ` Loca on-Address o Lot N� c ... .. ....... ......••` . .-- .--.•--- �owner , Add re y .. -------------------------------•-----•--- t --c,� /- (�...4 !` `"7� :----...... . a 1 ... . Installer Address UType of Building Size Lot.......... q. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building .. No. of persons............................ Showers P.1 YP g -------------------------= P ( ) — Cafeteria ( ) 114 Other 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 Llength.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit------.............. Depth to ground water........................ [T Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.__.-_.................. 0 tJ ------ -- -----------------------------------------------------------•------•-----.----.----.------.------------------•------•-••--------------•--------. Description of Soil........................................................................................................................................................................ ...............•--.....................-•-----•----------------------------------------------------------------------------------•------•----. V ---••-•-----•--------•-•-••------------------•--•--••••--•-•---•------•--•--•--•---•-•--.......---------•-•-----•---------•----------•---•---- ......................................................... ------------------------------------•-------------------------------------------------------------•---------------•. •-- --•-..... ----••----- - U Nature of Repair or Alteratio s—Answer whe app 'cable__________ __ _":__�.-- L�� ' 1 -_ «2 ? ---_---------_------------------------------------------- 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 of Compliance has been issued by he board of 11palth. Signed.. ...... ........ -- I__��_.---- ----------------------- .........................._.... Date Application Approved By---•-•--•-•--•-•--•--.: #------...... =��--r• -y-'-"j--jL......... Date.................. ............._ Application Disapproved for the following reasons___________________________________________ -----...--•---•.....................•-------•-------•-_._......----•-••-•-••----....••---•--••------•••-------------------•--------------•-•-----•---•-•-••----•----------------...•--••--•-----•---•--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............................OF......................................I.............................................. (Irrtifiratr of Tuntphattrr : TI�I S TO CE ZIFI� hat the Individual Sewage Disposal System constructed ( ) or Repaired by....... -- .... _........:c�"` - - ....... ...... .. �f t loe.Installer. at. °4......-•-----------•-•---------•-•---•---•-------••-••--•••-•..............•-•...-•---••..--... has been installed in accordance with the provisions of TIT I,r 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit .......... dated-............................................... THE,ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....................................611slf2....................... Inspector....---.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH y` ' ...........................................OF.................................................................................... . ✓ � FEE........................ Disposal Works - ntrnrtiott rrmit Permission is hereby grante .---•-•--- .... --------------------------------------------•--..............................-•--..... to Construct ) or Repair, ( ) an Individual ewage Dis sal System / atNo........... ..... �" � :....... ........ ----------!•'�-�--..��"...-----------------------•---•-----------••---•....--••-- Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... �,,,� `°'=v='-`�w -�- - --'-•-•........................................................... � � � DATE........................... .. d .......................... Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL'SYSTEM FORM PART A CERTIFICATION Property Address: 26 Meadowlark Lane _Ga Osterville. MA 02655 / Owner's Name: Phillis Cole .5�Owner's Address: Date of Inspection: April 4. 2006 _ Name.of Inspector:(Please Print) Janes M. Ford �w Company Name: James M. Ford `a Mailing Address:. P.O.Box 49 Osterville.MA 02655-0049 - W Telephone Number: (508)862-9400 CERTIFICATION STATEMENT 0 I certify that I have personally inspected the sewage disposal system at this address and that the mformati�n reported below is true,accurate and complete as of the time of the inspection. The inspection was performed base 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 Nee Further Evaluation by the Local Approving Authority Fail Inspector's Signature: Date: April S. 2006 The system inspector shal\suba 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 r ""This.report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not:address how the system will perform in the future under the same or different conditions of use. Title.5,Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 26 Meadowlark Lane Osterville, MA Owner: Phillis&David Cole Date of Inspection: April 4. 2006 Inspection Summary: Check A,B,C,D.or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as.approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance . indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4.times_a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 26 Meadowlark Lane Osterville, MA Owner: Phillis&David Cole Date of Inspection: April 4. 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: 3 r r Page 4 of 11. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 26 Meadowlark Lane Osterville, MA Owner: Phillis&David Cole Date of Inspection: April 4. 2006 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge.or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water . supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility,and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area.(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section,E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the.appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 26 Meadowlark Lane Osterville, NM Owner: Phillis&David Cole Date of Inspection: April 4. 2006 Check if the following have been done: You must indicate"yes"or"no"as to.each of the following: Yes No ✓ Pumping information was,provided by the owner,occupant,or Board of Health.. ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two weekperiod? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? n/a 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 backup? ✓ 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(arid occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 26 Meadowlark Lane Osterville,MA Owner: Phillis&David Cole Date of Inspection: April 4, 2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 " Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 1.10 gpd x#of bedrooms): 330 Number of current residents: 3 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no) Wa [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow.(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available:. Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: The cesspool was pumped approximately 3months aQo for maintenance Was system pumped as part of the inspection(yes or no): If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any). Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval . Other(describe): Approximate age of all components,date installed(if known)and source of information: Date of installation unknown Were sewage.odors detected when arriving at the site(yes or no): No 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: 26 Meadowlark Lane Osterville, AM Owner: Phillis&David Cole Date of Inspection: April 4. 2006 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on,condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) (Cesspool acting as a septic tank) Depth below grade: Material of construction: concrete _metal _fiberglass _polyethylene ✓ other(explain) Cesspool block If tank is metal list age:. Is age confirmed by.a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 5'W x 7'T x 9'bottom to Qrade Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: -- Scum thickness: I Distance from top of scum to top of outlet tee or baffle: -- Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): The liquid level was up to the outlet pipe. The cover was too grade. A outlet tee was present. The cesspool was punped approximately 3 months ago for maintenance. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top.of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(ori pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related.to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 26 Meadowlark Lane Osterville, MA Owner: Phillis&David Cole Date of Inspection: April 4. 2006 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth.below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow:. gallons/day 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:. None (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:. None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_ 26 Meadowlark Lane OSterville-MA Owner: Phillis&David Cole Date of Inspection: April 4. 2006 SOIL ABSORPTION SYSTEM.(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I 6'x6' 1000 gal. leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: ✓ overflow cesspool,number: 2 Innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): The Pit had Y ofwater on the bottom. The scum line was Y up from the bottom There did not appear to be any signs of allure The owner installed a cement pad on ton of pit(steel re-bar with 6"of cement plus a riser) it to make it heavy duty loading Per engineers sped ications. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yds or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: 26 Meadowlark Lane Osterville. MA Owner: Phillis&David Cole Date of Inspection: April 4. 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. i A (SA`AS` B 1 6 a 31 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 26 Meadowlark Lane Osterville, MA Owner: Phillis&David Cole Date of Inspection: April 4, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 18+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the snaps were showing gpproximate.1y 18'+1-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or,implied,relating to the system, the inspection and/or this report. 11 03-2 7—200CI 12 1 1 = 40 DEED RESTRICTION WHEREAS, Phyllis W. Cole and David B. Cole of 114 Bay Street, Osterville,MA are the owners of Lot A located at 26 Meadowlark Lane, Barnstable, (Osterville)MA(hereinafter referred to as the lot and being shown on a plan entitled"Land in Osterville as surveyed for Daniel Bros., Inc." dated September 1932 and duly recorded in Barnstable County Registry of Deeds in Plan Book 87,Page 123; WHEREAS, Phyllis W. Cole and David B. Cole as the owners of said lot have agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a variance from the 310 CMR 15.214 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and to obtaining a building permit for this lot; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting the variance from 310 CMR 15.214, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this lot is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, NOW THEREFORE, Phyllis W. Cole and David B. Cole do hereby place the following restriction of their above-referenced land in accordance with their agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 1. Lot A at 26 Meadowlark Lane, Osterville, Massachusetts may have constructed upon the lot a house containing no more than three (3)bedrooms. Phyllis W. Cole and David B. Cole agree that this shall be a permanent deed restriction affecting Lot A shown on the plan recorded in Plan Book 87, Page 123. For our title, see the following deed: Book 3480, Page 257. Executed as a sealed instrument this Z ? day of March, 2000. �6/, Phylli W. Cole DaA B. Cole COMMONWEALTH OF MASSACHUSETTS Barnstable, ss March Z , 2000 Then personally appeared the above named David B. Cole and acknowledged the foregoing instrument to be his free act and deed, BEFORE ME, Not y Public expires:My commission exp � t( v G' u UASP5 BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE BARNSTABLE, MASSACHUSETTS 02630 PHONE:382-2511 EXT. 330 LAB 337 CLINIC 340 i .Dear Mrs. Cole, On 1/17/95 an inspecticn . wls held at the address below for the detection of lead-lased Faint . 1n accordance with Massachusetts ce;leral Law Chapter 111 , . Sec . 190-199 , any lead paint detected ill a , residence where a child under six years of age resides must be . removed . Based on the inspection , the. jfollowiny apply : l-he premises are lead- free t/ lead-based pairrl- was detected , however , nu children under six years of aye presently reside in this .dwelling lead-lased Faint Was clntect,?(.l ;illd 1,u!;es a health hazard to the children res idiny. Lhl3rei n lead-lased paint was de* Lected all(I I,(,r,-s ;I hn,n I th hazard to children attendirry - (Ia}•care/I)reschuol therein irrspectiun required for sate inspection required for permit filial inspectiun - violations nuted have been corrected Locatioir of Prauerty under >r rare Phyllis Cole Osterville, MA 02655 11 4 $ay Street - Osterville, MA 02655 Please contact tlri. ; of Ci ce sllculd S I�u I -till i r e on► - further i11formatiorI reyardi►iy this rllatter . l'•es�� _ t f u I 1 , PuL c Health Sanitaria _ iYr I • i 1� Cor�nmonwealth of Massachusetts Pg � Of Ith an •Il��t�r��'I� CHILDHOOD LEAD POISONING METHOD USED ,�,•Ian I UeEartment Erournnlr " PREVENTION PROGRAM C'i�NA ZS ��a0/9 S h Superior Court House 305 SOUTH ST., JAMAICA PLAIN, MA 1� 02630 INSPECTION FORM Expiration date—.--.----._— ;Barnstabie, XRAY istration _- M/NORESCENCE Reg �-�� Model x K-3 Serial A _u� APT/ � CITY " ' e / _.- I�I l�1 I.-C k�l ..ILI 1 �t. .�.�al �. :I _L 1_ -�—L- 1 Rde,1,.,. Df� Y I A'SI NAME Ot C1IIL II .. - FIRS NAME Se, Li Parent•Guardian's Last Namr. Par'enll Guardian s First Name --�-7 _ _ _ �j (� 1.DWELL OWNER OWNS I' II 18 2.DAY CARE OCC -L 5 SCHOOL Y OR N ��jj UNITS 3.OTHER Y OR N SINGLE. OF ROOMS .2 2.4 APTS INC 8. INCLUDE BATHROOMS 3.5 OR MORE BUT NOT HALLS OWNER'S NAME: A/s. L't/ OWNER'S ADDRESS: REMARKS: sase✓n$/-)' /?� Book No. >U C� .UU d Page �! _ �QCaly OW/I2/' �°P�U�°,8 f Pe /O _ r r. Date recorded -_----- / -- --- - - --- — - - -- x �— --- ---------- ----- ... . — -_ D.D O./ D.l. d.L L 0.v — --- - INSP.DATE 1.VICTIM 4.REPAIR 7.OTHER _ `—/ VIOLATION L 2.PAR.REG. 5.VACANCY - O ! / •7 Cr -�. Y OR N J 3.HIGH INC. G.INSTITUTION -- -- -- FLOOR If_.._.�-___ FLOOR/--_-- j C - Q0 r► B 3 I�oc1M 1�00� 1 E - A (STREET SIDE) A (STREET SIDE) ,I �-- ----— ----_- __ --------- ---------- -------- - ILLEGAL.-___....._ Pb MORE THAN 1.2 mg/cm 2 with x-ray fluorescence or positive with Na2S Is INSPECTOR REINSP.DATE 1.IN COMPLIANCE REINSP.DATE - I.IN COMPLIANCE _ —REINSP.DATE —_ 1.IN COMPI IAN(A --�—T 2.WORK IN PROGRESS r r 1 2.WORK PROGRESS WORK IN PROGRESS 2. - 3 NO WORK '. 3.NO WORK 3.NO WORK I.IN COMPLIANCE REINSP DATE. ( i.IN COMPLIANCE "REINSP.DATE 1.IN COMPLIANCE REINSP.DATE— J( 2.WORK IN PROGRESS (� 2.WORN IN PROGRESS 2.WORK IN PROGRESS I I I ��- 7= 3.NO WORK I�— I 3.No WORK 3.NO WORK --__. COMPI LANCE DATE — --- INSPECTOR ;I Pb = lead cov = covered Neg = Negative scr = scraped I IPos = Positive rep = replaced 11;1 - not nevessihle rev = reversed Ve nth°"dCommonwealth of Massachusetts lot tILDHOOD LEAD POISONING PREVENTION PROGRAM or Court N us 305 South St., Jamaica Plain, MA 02130 �+leCL y " -- "INSPECTION FORM O f — b Barnstable, 1hA 630 ration♦1 - AP;_I %/4- S OF INSPECTION ]' ---- 1—.1�--.J 111..��--��----------��------ sly Come M N Comp SOURCE Pb loose Dom =110d Pb loose Comp° nn_ u_°d SIDE SOURCE �- Window Sill/Apron - Upper Walls - Window C_ asIng/FleaderlStops J �:_Walls Window Sash/Mullions 2 - Chair rail Exterior Sill/Parting bead area Baseboard Windo Sill/Apron -- _- Windo Casing/Header/Stops -Door __ - - --- ----- Uoor CrisinlJ Jamb _- ----- Windo Sash/MUlllons Deer - Cl �n Exter_ for ill/Parting bead area poor Casino—jamb -- - Exterior Side Sashes r,n Closet s ___------ Uoor Casing Jambb- -T Closet or-Interior_ - Window SiIllApron Closet sing-Jamb Y seboards I Window CasinglHeader, /Stops Closet_ Window Sash/Mullions Closet.. selves Exterior Sill/Parting bead area Qs Floor' l 0 I .P Window S_fU/Apror-► h I" Calling - 13- Window Casing/Header/Stops N Window Sath/Mullions Exterior Si III patting bead area Q Wlnd w Sill/Apron Wind w Casing/Header/Stops Wind wSash- /Mullion°ns-- ROOM N 2 - Exteri r Sill/Parting bead area Wind w Sill/Apron Upper Walls Wind w Casing/Hoader/Stops -_ -- Lovvjr - w Sash/Mullions Citak-rall Wind ___---- Exter r Sill/Parting bead area --- Baseboard Extor Side Sashes 3•$� S - C Door C eri r closet Walls _ =-� Door Ca b -_- ') 1 Closet Dour interior -__ -- Door A Closet Casing Jamb _+ !°' _� Door Casing=Jamb Closet Baseboards -. - Do r - --.------— -- Closet Shelves Jamb _-_____- Do r�g_- Window Sill/Apron ne' Floor , 1 ----- _ -- `- �' - Window Casing/Header/Stops l� Ceiling f .. Window Sash/Mullions _ ' _-------- A Exterior Sill/Parting bead area --- - -_-._ Q Window Sill/Apron. / [ __------ -d- Window Casing/Header/Stops __ --•- Window Sash/Mullions-- )C`- Exterior Sili/Parting bead area Ji - ROOM a o�L Wind w Sill/Apron Upper Walls Al Wind Casing/Header/Stops - --zw -Walls Wind Sesh/Mullion____ Chair ail - Exteri Sill/Parting bead area - Baseboard 0 r Wind Sill/Apron Door _ - - _Wind v CasinglHeadar/Stops Door Cesiny-Jainb Wind Sash/Mullions _ Door Exteri Sill/Parting bead area - C 0 Door Casing Jainb r -= Exterior Side Sashes. ec Door Closet Walls e �' Closet Door-Interior Door Casurg•Jamb��,�..- . -� `-- cd D• Closet Casing-Jamb Sill/Apro Window _ n =f u:�'"/ `' - ___------- (� Window Casing/Fleade�Ps ttr (� ' --- - �- Closet Baseboa-r-ds Closet elveWindow Sash/Mullion_s s �n bead area '' / Floor i Exterior Sill/Peru g _ Windo Apron _,; Ceiling Window Casi no/Header tops t1 Window SaslilmUllions r Exterior Sill/Pepin bead area S is ILLEGAL. rT>I /crn with x-ray fluorescence or positive.with Na, PU MORE TFIAN 1.2 g REMARKS 0 10 INSPECTOR l �. Pecllo'l Dale T7-1 GI k' I wealth of Massachusetts SPE�TOR/AGENCY Common � �tIM&HOOD LEAD POISIOmI�NcGa pRainEMA 02130 NTION PROGRAM Fnvironmemui De pa men, 305 South St.. •INSPECTION.FORM pR_ Of__l- SUpert.,l �_ourt Ho se ---- _. ....�. arnsr 630 All Cit !tiS OF iNSPECf10N _ +` U I J r� Y - Comp Comp yy PI) Loose •Dote Moll— Om R Comp Comp SIpE SOURCE - Pb Loose Dote M=1'°° ------- DE SOURCE Wind Sill/Apron Upper Walls --` Wind w Casing/I leader/Stops o >A/alls Wind w Sash/Mullions L --- CI)air Exted r Sill/Parting bead area Baseboard Wind wSIII/Apron - - Wind w Casing/Header/Stop9 -- Door -=-- - Doorpoor C amb Wind w Sash/Mulllons - - Door C D9 ��-�-- - Exteri r Sill/Parting basil area Door Casing•Jantb l� y Exterior Side Sashes Door S �p_ Closet Walls e --- Closet Door-Interior Door Casing-Jamb ® _ WindWind—oar Sill/Apron Closet Casing Jamb _ Window g/Header/Stops —"- Closet BBase_boards-„�-- Window Sash/Mullion__ Closet Shelves -- Floor Z T� I Exterior Sill/Parting bead area D/)S �- Window Sill/Apron - - _ Calling Window Casing/Header/Stops - Window SashlMullions ---- Exterior bead area - Wind w Sill/Apron Wind w CasinglHeader/SIOPS Wind:)w Sash/Mulllons - ROOM r Extol or Sill/Parting bead area - Win(ow Sill/Apron -- Up er Wells_ Winc- Casing/Header/-_Stops Lo or Walls Winc ow Sash/Mullions Ch it rail Extol or Sill/Paiting bead area Be eboard 8 Exterior Side Sashes D r Clos to Walls D r Casin(0811) Closet Door-Interior . - -- D r -- - D or Casing'Jam1) - Closet Casing_Jam- b __ �- _ _ . Closet Baseboards -"- D or - Closet Shelves- �1 D or Casing-Jiunh Floor __-=-= W ndow Sill/Apron - Ceiling ndow Casing/1le_ader/stops - ndow Sash/Mullion - - -- E erlor Sill/Parting bead araa _-- - _ ----- ndow Sill/Apron Indow Casing/Headerlops Indow Sash/Mullions E tailor SIII/Purtl_g bead area ROOM a Indow Sill/Apron Upper Walls indow Casing leader/Stops - Low'r Walls indow Sash/Mullions Cha r rail E tailor Sill/ParZ bead area _ Baseboard d indow Sill/Apron - Door -- indow Casing/Pleader/Stops - �_ Door f_asiJ ng'Jamb V indow. Sash/Mullions - Door - tailor SIII/Parting bead area ---- Door Cashtg-Jamb - - tailor Side Sashes - I oset Walls Da r Casing"Jamb "' loset Door-lntutlor_ -- P Window Sill/Apron _ nC ---- loset Casing Jambi Window Casing/Raeder/Slops /) - lose,Baseboards Window Sash/Mullions loset Shelves Exterior SIII/Parting bead area loor C . Window Sill/Aprons__ Ceiling C Window Casing/Header/Slops- Window Sash/Mullions - Exlerior Sill/Partin bead area Pb MORE THAN 1.2 mg/ cm� with x-ray fluorescence.or,positive with NazS is ILLEGAL. REMARKS INSPECIUR '; Inspection Dam LINS ' oR/AGENCY Commonwealth of Massachusetts It�t11�DHOOD LEAD POISONING PREVENTION PROGRAM � 1,.j jAe4XU Pent 305 South St., Jamaica Plain, MA 02130 *INSPECTION FORM •�/ of_ - erior l.ourt Ho se h9_ —_ n-- � _— -- iegistratpar/ 5t�7b11ir 30- APT.i / ADDRESS OF INSPECTION I-Pj:ctgal ��. ��f e/ y �,/=—�-- e.. city PANTRY _ Corp Camp _ _ Pb Loose -Date ITCHEN Method OURCE comp Comp SIDE S _Pb Loose Dete Method SOURCE - Up r Walls -- i-- - UPPer Wells __ - - Lo r Walls -- Lower Walls _-_ —( - - Char rail — 6paiF-rei4 __�---- Bas board Baseboard -- - Do Door— __--- Do Casing-Jamb Door Casing-Jamb 0•-.�,Z'- Do r / Door -I-p I?C 0 f/i -CLA - Do r Casing-Jamb Door Casing-Jamb Wi ow Sill/Apron Door n Q K ¢ P/'I 6s' Wi ow Casing/Header/Stops Door Casing•Jamb WI dow Sash/Mullions A3 Door Ext rior Sill/Parting bead area Door Casing-Jamb !0om 'E Ext rior Side Sashes Z Door Of e 3t. Up er Cabinets 'It ' 2 Door Casing-Jamb Up er Cabinets Walls Dd or Up er Cabinets Shelves — D or Casing-Jamb Lo er-Cabinets Window Sill/Apron t Lo er.Cabinets Walls - (J Window Casingi Header/S�oPs Q - Lo or Cabinets Shelves __ — Window Sash/Mullions _ �e. — - Sh Ives _ ---- Q Exterior Sill/Parting bead area -C - r Dr ers Windovq Sill/Apron - Flo r - Windov�,Casing/Header/Stops Cal ing Windo Sash/Mullions - Exterior Sill/Parting bead area Wind w Sill/Apron Win w Casing/Header/Stops Win w Sash/Mullions Exter r at in bead area BATHROOM Exterior Side Sashes Upper Cabinets -- Upper Walls 0' --- Upper Cabinets Wall /� Lower Walls 4 Upper Cabinets Shelves _ C►taic Fail -- Lower Cabinets Baseboard Lower Cabinets Walls Door (� Lower Cabinets Shelves Z. Door Casing-Jamb - Shelves Drawers - �� Closet Window Sill/Apron -- �} Closet Door Interior - f.);I --- - Window Casing/Headed Steps _ Closet Casing Jamb / Window Sash/Mullions C Closet Baseboards Exterior Sill/Parting bead area Closet Shelves Exterior Side Sashes Floor �� }pp Cabinets - Ceiling -'t-EA Lower Cabinets - (' �SGI.< Lower Cabinets Shelves I ---•----.----H�t}-- -- — -- .�'-- -fit- Shelves" ---- __ _ CI set Walls S` r Cl set Door Interior —' v'- C-C� CI set Casing-Jamb --- CI set Baseboards Cl set Shelves --- Floor -------.-- Ceiling m /cm2 with x-ray fluorescence or positive with Na,S is ILLEGALPb`MORE THAN 1.2 g h� REMARKS 'IPt;` 60 1 INSPECTOR Inspection 0ale ... ;'• �•.:.�... ::J.alM+etsupcl1W�X.wlwfYlwS�Nttn!f 1�0�ti'wiglw�w�w+.w.�•.�...�.•�...••-.. "h�SQt'nStZIDiAl.ourliy tie ommonwealth of Massachusetts ItCHHalncF OOD LEAD POISONING PREVENTION PROGRAM nvironfuel',t,ai i�epa 'tI7It1iT 305 South St., Jamaica Plain, MA 02130 --Superwr Lourtffc use "INSPECTION FORM , b30 — ---pg of --s : _ - - -- Registration I APT i - ADOIIISS(If INSI'kC11nN - - - - t� l(a l HALL HALL cnml, Cn:;;p Conn, cnn'1' SIDE SOURCE Pb Loose oern - M�twnJ SOURCE Pb Loose Dare Muduul l SIDE __. ._ - Up er Walls -- --- - - - Upper Walls ------- Or ----- --- ------ ---- -- - .:_ .. -- —-- - - Lo r Wall is- L•owerVdat .---- ------ ------ Ch it rail - --...- - - - ----'------- -- Ba ieboaid —-' -- -- Baseboard �_=— - D r - --- Door p r Casing Jamb r Door Casing-Jamb _ -1 D r -- Dr� per/ D r Casing-Jamb Door Casing-Jamb - D in ---- Door _ - Do r Casing-Jamb. Door Casing-Jamb -- D r ---- -_ Door -- --- -- D r Casing Jamb -' ---- C Door Casing Jamb - --J ._ --.—-- . ..._. _._ ......._...—.--- - Wi)(low Sill/Apron Wind(, Sill/Apron -- ------_.---- 4 --- ---- Wi(dow Casing/Header/Slops -- _---- —.----- Windo Casing t Header/Sto)s - - - — 1 ._�_....---------.---- -- _- ------. --- ----- Wi Tdow Sash/Mullions Wind(, Sash/Mullions -.- -- - — i Ex rior Sill/Parting bead area Exterior Sill/Parting bead area _ .-------- --- -- ------ -.--- - --- __ - -- - ----" Ex rior Side Sash Exteri(, Side Sash - - '-- " -- - - - --- ---- _.._ /_ _ - CI set Walls 0 Closet Walls - - '- - ---- - --- - ------- ..... I - CI et Door-Interior (� Closset Door Interior ---- ------ ------- - ---._...... --- --- --- ------- Cl( et Casing-Jamb d Closet Casin Jamb - t_._. .._. _.__-.----- -- -- - Cl( et Baseboards _ Closet Baseboards --- ------ — --- CI at Shelves Closet Shelves - - -._.._.. ._ C�� CO✓ Flo r -- ------ - .. floor -, - - - -- Ce my Ceiling - Q.. g— - —----- - ---- -- - —--- Do .._A D r.CO- STAIRCASE. STAIRCASE - --- -- U pper Walls r. ... UI)peI' Walls -_ --- - --- - ------ -- --- i Lo er Walls -- i Lowe Walls - - --...._. --•-- '-'------ - - W I Casing Wall acing _- -_- Ch it rail ---- - -- Chair rail - Tread I _...._ ' - is Is i Riser __... _ ... Ra Ruilin I Cap i in Ca) _._.. .. .. .. - fl - . He drails Hand ails -.......-'---' -•-------------- --- ----- -------- . _. . Bal stors - -- -•� --- Balus els — Ne el Posts Newe Posts �.-- --- ---------•.. ..... _ - - ' ----- ------ - -- --- Sir tger -- j Ba boards - Basel ards - - -- i-_..__ ...- - - -------- ---- Wit dow Sill/Apron - -'-- - Wind w Sill/Apron - _- - r---- - Wi dow Casing/Header/Stops Wind w CasingiI leader/Stops_ Wind wSash/Mullions _ Wi dow Sash/Mullions -- Ext riot Sill/Parting bead area - -___- ---- Exteri r Sill/Patting bead area = -- Exteri r Side Sash --- Ext rior Side Sash -- -'--- ------ - - Do r -- ---'-- Door __ {— Do r Casing Jamb Door acing-Jamb ---- I Door ----- — Do r -- Door asing-Jamb - Do r Casing-Jamb ------- -- Ceiling --- Ceil nfl -- ----._ Pb MORE THAN 1.2 mg/Cm 2 with x-ray fluorescence or positive with Na2S is ILLEGAL. .� REMARKS �OOrS � lE'�f' v INSPECTOR Inspeclion Oslo Y Commonwealth of Massachusetts PE&OR/AGENC ' fly a le nun � jIjTIjf&"OOD LEAD POISONING PREVENTION PROGRAM �► 305 South St., Jamaica'plait, MA 02130 : �{ trrienf "INSPECTION FORM use --- 1,�l MA APT strati Ca _ ... titi UI N. IlilU - Cily GARAGE_• ��—d-�- -- - ;- TERIOIi - — SOURCE Pb Loose Dete Method SIDE ---- — — E i,� PbLoose nets Mothod SOURCE Siding_ +` Siding Dtipboacd. --- ptif►board I - Skirl-, gam- Cornerboards C>unet!)q 1tS1s - — Dooc-: Doo- r r DoerE�mb Door Casing/Jamb . 1 Threshold — _ Threshold Door l L 0 ! /1 f' Door Casing Jamb --_�) `-•. asiugiJnmb 1 1) f 1 Threshold tt ----- ;l .Sc,.+" �°u- `a Pindow Sill Tluesl.tdd _ Window Sill d �11indow Casing Window CasingWindow Sash/Mullions Window Sash/Mullin— ns _ - Windo `Sill - - — Window Sill _ 1F� Win do Casing - Window Casing --_—__—� —— Windo, SaSITIMUlllo118 —_—---=— Window Sash/Mullions - __—- Window Sill - -- 2 Window Sill ('uSC,nc n u n I C. Window asillg — Window Casing i 1 � — Window ash/Mullions -- —_ tl — - Window Sash/Mullions _ Window ill -- --- --- 1.� --- -- � Window Sill Window sing _ . Window T------- --_-- -- Window Casing-- ---- --- - Window S sh/Mullions r i -� --- ---- Upper Trim — ----- Window Sash/Mullion- sue— Upper Tnm Cellar Window Units Cellar VAucdow Units _ — — Cellar indow Units Geller Nilndow UnN—s — Cellar }Indow.Unit_s —____,— — Ceiiar indvw Units ----- Collar-W nd—ow t.blits— — — Iudouu-Units pulkhe-a --- -- —-- ---- Bulkhwad Fences 1. — Fettees --- - Foundation - Foaudation — A _ = Pb MORE THAN 1.2 mg/cm: with x-ray fluorescerice or positive vvith Na,S is ILLEGAL. ---- 75 REMARKS 1 INSPECTOR �^ /^/t Fes"d l.� / Ind,,00lfon De_Ie AOL a M t ${SECT R/ GEN �� II sand COmmonwealth of Massachusetts 0lon0m,P ��NntY �,�III.DHOOD LEAD POISONING PREVENTION Environntc,�l�,l �� utl II 305 South St., Jamaica Plairi, MA 02130 "INSPECTION FORM of_L uperlur 3ri _ _ -- Pg • pllrt"�'-'� "" � .. .. .�._ ... —_ -=_='-�_� ._—._ .API I tgistration I C - --.. - C7�/ 2/�l1i11e.. p1U tiff p1 IN:�I'l l'l1UN I �I Ae I� I�Iv awl I I ,t GARAGE _ ---- Coma• Comp Method XTERIOR __=' 'T. �"=�- — SOURCE Pb- Loose Dale Comp Comp SIDE �— _ -- ---- Method SOURCE Pb Loose —Dale — Siding -=' IDE - - : ' _ Siding — Dripboard Dttplsoaid - —- Skirt SkiN-,__-------"-- Cotgencoards Gwnethowds _ Door ------ yTc n Door Door Casing/Jamb---- -- -2i` Threshold (, Door Casing/Jamb — threshold Do r - ' - --- Do r Casing/Jamb ---- - -- Door-Easing/Jamb — Th shold Threshold - Window Sill GI Window Sill __ _ ) Window Casing (mac - ; I Window Casing_ r1 - �.) Window Sash/Mullions J !s Window Sill 1� `- Winduw Sash/Mullions �l/ —__ L Window Sill Window Casing — Winduw Casing —_ _ j Window Sash/Mullions Window Sash/Mullions- --_ )��s �� — Windo Sill Casin _ — --- --- -- Window Sill - - Windo 9 Window Casing..— 11 -= - Windo Sash/Mullions _ Window Sash/Mullions —.. Windo Sill �}--'-- ---'— -- --__ _- ��_—. — Windo Casing Window SIII — Window Casing _ Window Sash/Mullions 2 Window Sash/Mullions Upper Trim tipper Trim Cellar Wi ow Units ,..---- .. .... fit) Cellal Wi.,dow Unite ' Cellar Win ow Units - Cellar Window Units -' ' - - -- ---- Cellar Win ow Units _ Cellar Window Units e — n Cliac'Win ow Units ,. _ — — Cellai Window Units Bulkhead L __ -liul�lead Fences — _ /1 ——'—-- ----- - -- -— nces _ Foundation Fe --- /1 �� %l`)/�R,/ l r` Imo_ )1 --- -- M - /Cm 2 with x-ray fluorescence or positive with Na2S is ILLEGAL. Pb MORE THAN 1.2 g REMARKS /xl "'• J - INSPE1101 Inspection Dew