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0052 OLD MILL ROAD - Health
52 OLD MILL . MARSTONS MILD _V A= 064 078 ` TOWN OF BARNSTABLE BAR-W 5988 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender '5�- ( KJLL 1�4 MV/MB Reg.# Village/State/Zip 1 4AM � !'T 01 6LO L-^ 1 Business Name " 1 Q'/pm, on(�)A-.J Y 20 Al Business Address Signatureg"of Enforcing Officer Village/State/Zip Location of Offense {�•"''� '� Enforcing Dept/Division ,ry Of f e ns e IAt)Y%- Facts T�� - V � " This will serve only as a warning. At this Gtime no legal action 41as been taken. It is the Cgoal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W 5983 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager , + Address of Offender? �► �� MV/MB Reg.# Village/State/Zip �� � 1 � 1 ?-- Business Name - OW glpm, on 3 "� 2001 Business Address "" " / 3-t Sign atur$j of Enforcing Officer Village/State/Zip Location of Offense ' � � � Enforcing Dept/Division Offense A Facts Jh This will serve only as a warning. At thisGtime no legal action has been taken.. It is the t§oal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in ►appropriate legal action by the Town. .WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. Certified Mail#7008.3230 0002 5177 8865 Town of Barnstable F� ro Regulatory Services w Thomas F. Geiler, Director � { maRNN_ 131E. " Public Health Division y� ytns;;. a/�x43q�� Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Joel Fish January 4, 2010 lk52 Old Mill Raad A Marstons Mills, MA 02648 —� 1 NOTICE TO ABATE VIOLATIONS-OF SECTION 353 TOWN OF BARNSTABLE CODE. The property occupied by you located at 52 Old Mill Road, Marstons Mills was observed on December 28, 2009 by Timothy B. O'Connell, RS, Health Inspector for the Town of Barnstable because of a complaint. The following violation of Section 353-2 of the Town of Barnstable Code was observed: • Garbage bags were observed in a pick-up truck that were not being stored in watertight receptacles with tight-fitting covers. Also observed was a large amount of painting supplies. Such as paint cans, paint thinner's and other types of hazardous materials. These items must be stored in a location which is protected from weather and other easy sources of damage so it does not cause a hazardous material release on the property you occupy. You are ordered to comply with these Codes by: • Storing all garbage, or mixed and garbage rubbish in watertight receptacles with tight-fitting covers that are constructed of metal or other durable, roedentproof material within twenty-four (24) hours of your receipt of this order letter; by storing all hazardous material within a location that is protected from the weather and other easy sources of damage so it does not cause a hazardous material release on the property you occupy within twenty-four (24) hours of your receipt of this order letter. You,may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the.order is served. Please be advised that failure to comply with an order will result in a fine of$100.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER., F THE BOARD OF HEALTH Thomas McKean,RS, CHO Director of Public Health QA Order letters\Refuse\52 oid mill rd marstons mills.doc Citizen Web Request Page 1 of 2 9 � 1�qn; i 4 Citizen Request Management - Internal Use z sir" Request ID: 28159 Created: 12/17/2009 11:21:04 q AM i Status: Assigned To Staff Assigned To: O'Connell,Timothy �ol Health Office Anonymous: No Category: Section 353-1 GarbagE and Rubbish 6 E.C. Date: 1/4/2010 u - $ Created By: Parvin, Lindsay Citations: Health Office . .........._.............._ ___---- -.... Time Worked: 0 Response Time: 0 Requestor Details: . Request Location: 52 OLD MILL ROAD- Marstons Mills, Ma 02648' ;Parcel Number: Map: 064 Block. 078 Lot: 000 j _._......._................._.....___..._..................:........_._.... .....__..........__.............._._.............._...... Request: Requestor reports that trash, including several paint cans and plastic buckets filled with painting materials are scattered about the yard. Requestor reports that the property is a rental. �r Z Request Work History: Internal Note History: System entry on 12/17/2009 11:21:04 AM: Assigned to O'Connell, Timothy 173 http://issgl2/IntemalWRS/WRequestPrint.aspx?ID=28159 12/17/2009 Health Master Detail Page 1 of 1 I...og ed In As: _f0,villa, n 1_,l 1 h Master Detail r Application Center Parcel Lao cup Selection Iterns Parcel Septic PC � 'F=ul Tank k Parcel: 064-076 Location: 52 OLD MILL ROAD, MARSTONS MILLS Owner: THOMPSON, JUL.IE G & J FFREY Business name: Business phone Rental property: Deed restricted: Number of bedrooms 3? .._ Contaminant released: Fuel storage tank permit: %Save Parcel Changes Return to Lookup _ .. Parcel Info Parcel ID: 064-078 Developer lot: I.OT 8 Location:52 OLD MILL ROAD Primary frontage: 121 Secondary road:ELMWOOD DRIVE Secondary frontage: 171 Village:MARSTONS MILLS Fire district:C-O-MM Sewer acct: Road index: 1.1.57 Asbuilt Septic Scan: 064078 1 Interactive map , ftaN Town zone of contribution:WP (Wellhead Protection Overlay District) State zone of contribution:IN Owner Info Owner: THOMPSON, ULIE C & JEF REY D Co-Owner: Streetl:52 Oi...D MTI...L ROAD Street2: City:MARSTONS NI ..i..S State: MA Zip: 02648 C_ Deed date: 1.0,19/2007 Deed reference:C184297 Land Info Acres: 0,51 Use: Single Fam MDL-01 Zoning: ill" Neighborhood: C Topography:Above Street. Road: Pl ved Utilities:Septic,Gas,PUblic Water Location: Construction Info B;—1d�n lojy r-Bw' . ective,Af -caB ..rou. n_ 1~athroo' ls, 1 11983 11190 2 Bedrooms2 Full Buildings value:5128,900.00 Extra features: $2,500.00 Land value: $147,800.00 6 IV http://lssgl/Intranet/healthMaster/HealthMasterDetail.aspx?ID=064078 12/18/2009 DOC21s032s917 45-04-2006 3254 Tax Parcel#: 064-078 ) C t f*a 179967 This Document Prepared by: ) BARNSTABLE LAND COURT REGISTRY Julie G. Thompson ) 17702 Leonard Street Dumfries VA 22026 } After Recording Return to: ) Julie G.Thompson ) 17702 Leonard Street,Dumfries,VA 22026 } Above This Line Reserved For Official Use Only 703) r� 05 QUITCLAIM DEED l.. KNOW ALL MEN BY THESE PRESENTS THAT: On OW10 Everett G. Germain and Lois E. Germain, husband and wife,and J ie G. Thompson,all of 52 Old Mill Road,Marstons Mills,MA 02648, (collectively, the "Grantor") for and in consideration of the sum of $10.00, eeneidmrtien,the receipt of which is hereby acknowledged, do hereby remise, release and quitclaim to Julie G .Thompson, married, of 52 Old Mill Road, Marston Mills, MA 02648 , (the "Grantee") all of the following lands and property,together with all improvements located thereon in the County of Barnstable,Commonwealth of Massachusetts: A certain parcel of land with the buildings thereon situated in Marstons Mills, being now numbered 52 Old Milld Road,being bounded and described as follows: NORTHEASTERLY by Elmwood Drive,one hundred forty-eight(148)feet; EASTERLY by the junction of said Drive and Old Mill Road,forty-seven and 12/100(47.12)feet; SOUTHEASTERLY by said Old Mill Road,ninety-seven(97) feet; SOUTHWESTERLY by Lot 9, one hundred seventy-three and 39/100(173.39)feet; NORTHWESTERLY by a portion of Lot 21,one hundred twenty and 59/100(120.59)feet. All of said boundaries are determined by the Court to be located as shown on subdivision plan 37712-B(Sheet 3)dated November 28, 1977,drawn by Whitney and Bassett, Surveyors,and filed in the Land Registration Office at Boston, a copy of which is filed in Barnstable County Registry of Deeds in Land Registration Book 551,Page 54, with Certificate of Title No. 68254 and said land is shown thereon as Lot 8. No portion of the FEE in Elmwood Drive is herein conveyed. Being the same property conveyed to the Grantor's by deed as recorded with the Barnstable County Registry of Deeds on June 30, 1986, in Land Registration Book 875, Page 48, as Document No. 398880-1,and Certificate of Title No. 107088. The above premises are subject to all easements,rights-of-way,protective covenants and mineral reservations of record,if any. Dacs1s032s917 05-04-2006 3s54 Tax Parcel#: 064-078 ) G t f*s 179967 This Document Prepared by: ) BARNSTABLE LAND COURT . REGISTRY Julie G.Thompson ) 17702 Leonard Street,Dumfries,VA 22026 ) After Recording Return to: ) ®� i Julie G.Thompson ) 7 _ l 17702 Leonard Street,Dumfries,VA 22026 ) Above nis Luce Reserved For Official Use Only 03 t QUITCLAIM DEED KNOW ALL MEN BY THESE PRESENTS THAT: On _ Everett G. Germain and Lois E. Germain,'-husband. ."`. and wife,and J ie G. Thompson,all of 52 Old Mill Road,Marstons Mills,MA 02648, (collectively the "Grantor") for and in consideration of the sum of $10.00, and eeaMdam ion,the receipt of which is hereby acknowledged, do hereby remise,release and quitclaim ` to Julie G .Thompson, married, of 52 Old Mill Road, Marstons Mills, MA 02648 , (the "Grantee") all of the following lands and property,together with all improvements located thereon in the County of Barnstable,Commonwealth of Massachusetts: A certain parcel of land with the buildings thereon situated in Marstons,Mills, being now numbered' 52 Old Milld Road,being bounded and described as follows: NORTHEASTERLY by Elmwood Drive,one hundred forty-eight(l48)feet; EASTERLY by the junction of said Drive and Old Mill Road,forty-seven and 12/100(47.12)'feet; SOUTHEASTERLY by.said Old Mill Road,ninety-seven(97)feet; SOUTHWESTERLY by I of 9;, ` one hundred seventy-three and 39/100(173.39)feet; NORTHWESTERLY by a portion of Lot 21,one hundred twenty and 59/100(120.59)feet. All of said boundaries are determined by the Court to be located as shown on subdivision plan .37712-B(Sheet 3)dated November 28, 1977,drawn by Whitney and Bassett, Surveyors,and filed in the Land Registration Office at Boston, a copy of which is filed in Barnstable County Registry of Deeds in Land Registration Book 551, Page 54, with Certificate of Title No. 68254 and said land is shown thereon as Lot 8.., No portion of the FEE in Elmwood Drive is herein conveyed. Being the same property conveyed to the Grantor's by deed as recorded with the Barnstable County Registry of Deeds on June 30, 1986, in Land Registration Book 875, Page 48, as Document No. 398880-1,and Certificate of Title No. 107088. The above premises are subject to all easements,rights-of-way,protective covenants and mineral reservations of record,if any. I � TO HAVE AND TO HOLD the property unto the Grantee and the Grantee's heirs and assigns forever,with all appurtenances belonging on the property. IN WITNESS WHEREOF the Grantor has executed this quitclaim deed on the day and year first above written. Signed, Sealed and Delivered In the Presence Of: Name: EvemSG.C4ermain Sign:_ Name: Oss Lois'E. Germain;By Everett G.` nt 1.-� 14 Attom in Fact 1.(T Julie G.Thompson Grantor Aknowledgment COMMONWEALTH OF VIRGINIA - County f f . - \ a Notary Public in and for the said County and State,hereby certify t Everett G. Germain, Lois E. Germain, and Julie G. Thompson, having signed this quitclaim deed, and being known to me (or whose identity has been proven on the basis of satisfactory e id nce acknowledged before me this day that, being informed of the contents of the conveyance,th t has executed this deed voluntarily and with lawful authority. Given un er my and this /�kday of <I 20 o U11 . Notary o Commonwealth of Virginia CountyjbficT ABEL MERI My commission expires: " �" Notary Public County o a iirfaz Ca Onwftm of V1r*M �b comb"Sol 1i�-�7 f Attorney's Affidavit 1, Everett Germain, hereby certify that I am the Attorney-in-Fact named in a certain Power of Attorney executed on November 4, 2005, by my wife, Lois E. Germain. The Power of Attorney is in full force and effect and Lois E. Germain is not deceased and has not partially or completely revoked,terminated or suspended this Power of Attorney. Signed under the penalties of perjury this- day ofAo—.r 1 2006. a K q Ever e f-i- G 6Qim al n, .T2. Attorney-in-Fact COMMONWEALTH OF VIRGINIA k' )ss. County of C�-krC ) . I, Ner a Notary.Public in and for the•said County and State, hereby certify that Everett nnain,having signed this Attorney's Affidavit, and being known to me (or whose identity has been proven on the basis of satisfactory evidence), acknowledged before me this:day, that the foregoing statement(s)is/are true. Given`unde d and seal,this day of f E ,2006. No is for the Commonwealth of Virginia County of My commission expires: { o - ABELM Notary Pu bbe County c Fairfax Cmasonweekbof VhVink My cmah Mn Ex*" 16-31-UV BARNSTABLE REGISTRY OF DEEDS r _ Pcs `QtEsTg4' �,F„TQwti Town of Barnstable ; °. Public Health Division BARN STARLE. I , • • E 67 e$ 200 Main Street Immommmw PITNEY BOWES �prED RIPr�` Hyannis,MA 02601 $ 05.540 i 0004606238 JUN03 2010 �� __._��+ MAILED FROM ZIP CODE 02601 7008 �3230 0002 5177 9060 � aJoel"Fish", .52'Old'1VIi11 r ° Iarstom Mi. sWA:`02648 . �J RETURN TO SENDER UNCLAIMED UNABLE To FORWA►RO BC: 025014 0.200 *1384-03409-03-43 2l.j 1 I. k` `li II y SEND OMPLETE THIS SECTION • • ON ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse ❑Addressee I I so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from Rem 1? ❑Yes 11. Article Addressed to: If YES,enter delivery address below: ❑ No i _ Joel7��`ish• I '52,old-Mill Road 3. Service Type Marstons Mills, MA 026,48 I�Certified Mail ❑Express Mail A ❑ Registered r Return Receipt forMerchandise G ❑ Insured Mail ❑C.O.D. V 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7008 3230 0002 5177 9060 0 i (Transfer from service labeq PS Form 3811,February 2004 , Domestic Return Receipt 102e95-02-M-1540, V 11 i i t L A 1.A. TOWN OF BARNSTABLE BAR-W 5991 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender 's ` MV/MB Reg.# Village/State/Zip ®�6 b Y n / Business Name 'V ,, 3c) /pm, o �v��' 3 2010 Business Address Signaturfl of Enforcing Officer Village/State/Zip Location of Offense c ^ Enforcing Dept/Division Offense 3 5 3 — Z �� TLC- '�- Fact s �v 6 — ct This will serve only as aVwarning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. i Certified Mail#7008 3230 0002 5177 9060 Town of Barnstable Regulatory Services �F tklE t�Y�� Thomas F. Geiler, Director 1 ( °�.ifAtzs7At3t � 1 Public Health Division MASS, �o Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 2, 2010 Joel Fish 52 Old Mill Road Marstons Mills, MA 02648 NOTICE TO ABATE VIOLATIONS OF SECTION 353, TOWN OF BARNSTABLE CODE. The property occupied by you located at 52 Old Mill Road, Marstons Mills was visited,on--May 21, 2010 by Timothy B. O'Connell, RS, Health Inspector for the Town of Barnstable because of i .3 a complaint. The following violation of Section 353-2 of the Town of Barnstable Code was observed: ,1t • Observed old television set, and broken furniture at end of driveway; three water soaked mattresses by home; large pile of construction debris (i.e. asphalt shingles, wood, ect.) You are ordered to comply with these Codes by: • Removing all above said items from property and disposing of them properly Within' twenty-four (24) hours of your receipt of this order letter. You may request a hearing before the Board of Health if written petition requesting same is received with to (10) days after the date the order is served. Please be advised that failure to comply with an ord r will result in a fine of$100.00. Each day's failure to comply with an order shall constitute a se arate violation. O OF HE BOARD OF HEALTH r,r •- T •_ as McKean,YRS, CHO Director. of Public Health _..t,; � $ )P2,t!:..>� �rtr ;~�.; 1V, _ `•i.. .tl, <_°� t. i ' L r^ ( F "•ty f•7 �} � -"• T L t� :, r. � l .-i . , ,a ,' a_e� ; -.. z �gl.t_:cr •.t: T'G 1.o:i, . .:l :1 �oa�Il:15II7 r' Q:\Order letters\Refuse\52 old mill rd marstons mills Il.doc TOWN OF BARNSTABLE BAR-w 5991. Ordinance or Regulation WARNING NOTICE Name of Off ender/Manager , � Address of Offender ` C"U MV/MB Reg.# Village/State/Zip �� MA oa 6 N Y Business Name A/ �/pm, on TV 2010 Business Address Signaturefof Enforcing Officer Village/State/Zip Location of Offense Enforcing Dept/Division Offense 3 3 Facts A Kv� '� � 1&0 /T�*4. 5,w- This will serve only as aVwarning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W 5991 " J- Ordinance or Regulation WARNING NOTICE Name of Offender/Manager �� Address of Offender " MV/MB Reg.# Village/State/Zip �'^'� bt� 0 f Business Name Av � "pm, one SVIV 3 20 10 Business Address Iv r'o(� Fj Signature of Enforcing Officer Village/State/Zip Location of Offense Enforcing Dept/Division / f Offense 3 5 3 Facts •v- --,,;1 v� ' �.. r 6 " 9 `.. 10 0-1- This will serve only as aVwarning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts, to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. Certified Mail#7008 3230 0002 5177 9060 Town of Barnstable : - Regulatory Services �o Thomas F. Geiler, Director 4 i�AttVSTAg ) it Public Health Division atASS. Thomas McKean, Director ��Fa MA'S 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 2, 2010 Joel Fish 52 Old Mill Road Marstons Mills, MA 02648 NOTICE TO ABATE VIOLATIONS OF SECTION 353, TOWN OF BARNSTABLE CODE. The property occupied by you located at 52 Old Mill Road, Marstons Mills was visited:on May 21, 2010 by Timothy B. O'Connell, RS, Health Inspector for the Town of Barnstable because of a complaint. The following violation of Section 353-2 of the Town of Barnstable Code was observed: • Observed old television set, and broken furniture at end of driveway; three water soaked mattresses by home; large pile of construction debris (i.e. asphalt shingles, wood, ect.) You are ordered to comply with these Codes by: • Removing all above said items from property and disposing of them properly within twenty-four (24) hours of your receipt of this order letter. You may request a hearing before the Board of Health if written petition requesting same is received with' to (10) days after the date the order is served. Please be advised that failure to comply with an ord r will result in a fine of$100.00. Each day's failure to comply with an order shall constitute a se crate violation. O OF HE BOARD OF HEALTH as McKean, RS, CHO Director of Public Health Q:\Order letters\Refuse\52 old mill rd marstons mills Il.doc ®� .-, �� i Uii izen Web Request Page 1 of 4 q" ) a , X Request USI.... Request Information .........._..._..................... ..... _.. ........... ........ . . .. Request ID: 28159 Created: 12/17/2009 11:21:04 AM _. ..._._.............__..._._...._._....................___............___............................._........_....._............___..... Status: Closed Assigned To: O'Connell, Timothy Health Office Anonymous: No Request Category: Section 353-1 Garbage and Rubbish Routine work: No Estimate: No __. ._ __._.._.. __._ .. . Date scheduled: _.... Estimated 1/4/2010 Change Estimated , Completion Completion Date: f Sun U(( V(-1 W, c Date: -z 28 29 3 <. 5 7 a 4.`P 16 31. 2 3 4 Created By:� Parvin, Lindsay Priority: Medium Health Office Citation Numbers: BARW5988 Requestor Information _ _ --.. Requestor Andrew Norton Request DETAILS: 92 OLD MILL ROAD LOCATION: 52 OLD MILL ROAD I Marstons Mills Ma 02648 Marstons Mills, Ma 02648 774-836-3931 Request -- � �---��— � Parcel Number � , Requestor reports that trash, Map �064 Block. 078 Lot0( including several paint cans and plastic buckets filled with painting ..Parcel..Lookup materials are scattered about the yard. Requestor reports that the http://issgl2/intemalwrs/WRequest.aspx?ID=28159 5/20/2010 Citizen Web Request Page 2 of 4 property is a rental. ...._- ..___.... .. i - Email ..... __........_ ....._.. .................. . ......... ......................... -- .. .............. ........ _ ......... ................... .. ......... Track Request Progress R...._............. equest Work History: Internal Note History: Entered on 12/18/2009 3:01:28 PM System entry on 12/17/2009 11:21:04 AM: by O'Connell, Timothy Last modified on 12/22/2009 2:22:48 PM Assigned to O'Connell,Timothy I I On 12-17-09 went to said property and met with Entered on 1/5/2010 11 43:03 AM a tenant who would not give his name. I told him by O'Connell, Timothy why I was at that property. I asked about paint cans and painting chemicals. He said it belonged to Joel Fish 508-776-6000 I person who he subleases from. He would not give - - - name to this person. I told him the paint must be System entry on 1/28/2010 3 38:05 PM stored in a building. Most of the other debris are riot enforcible under 353-1. I did observe some Request Closed by oconnelt household trash which person I was talking to said he would remove. I have placed a call to owner to ( make them aware of situation and to get them to register. I will follow up early next week. F Entered on 12/28/2009 10:54:15 AM i by O'Connell, Timothy i I have placed many calls to owner of said property to see if they could help Health Div gain compliance on this situation. I have not received a call back. I went to said property and nothing has changed. I have plate number' s from two vehicles in drive way. I will get names and DOB's from police and send out warnings on trash and also send a warning to owner under Chapter # 170 for failure to I register. i Entered on 1/5/2010 11:43:03 AM by O'Connell, Timothy F On 1-5-10 talked with tenant (Joel Fish). He told me he needed a week to remove painting supplies. Will push out a week and re-inspect then. An order letter an warning has been sent to said occupant. Entered on 1/28/2010 3:38:05 PM by O'Connell, Timothy On 1-28-10 I went to said property and did [ observe painting materials had been remove. The http://issgl2/internaiwrs/WRequest.aspx?ID=28159 5/20/2010 r ClUzen Web Request Page 3 of 4 l I yard still has some items that are not enforcible under trash ordinance. Will close l Enter work progress: Enter internal note: g § Baca"' .�$ C inters Hy *, i F } { 3 t � # x . 5 f S1. Check r SpelCheck Add document or image link: ' x You can 1 =. { i az 1#" ?i T x ft £' a;) hinc i! the f6der pp _.., iE( S #^wiY.f �,' �'wr` =\S.+s 7... itsi�,._. ._I `: �.7.......? P _ „�, '.f Yt xl ,,..i Time worked on request 3 50 607 Response time .1.00 I rk r, 1." ('•. Ii i +, 1,25, ,r €} -s ,.2 .4I o yo>ur est:,=t7 : e3S : `r i UP- > I 7> t : ' r = I.x: Do not 'ndu e ights, ?ve--Ikends, and ;1�,- € :' .S i' re:s`j once time fo rn:i S" ... . c:: Reopen C. Reopen and notify citizen Reopen , Public_Use: Printer_Friendly Version Internal Use Printer Friendly Version http://issgl2/intemalwrs/WRequest.aspx?ID=28159 5/20/2010 Health Master Detail Page 1 of 1 „.�.,=„wa.. aster le IParcel: 064-078 Location: 52 OLDFILL ROAD, MARSTONS MILLS Owner: TH.,OP--,PEON, JULIE O &JEFFREY Business name:l Business phone Rental property: Deed restricted: Number of bedrooms : 3f Contaminant released: l Fuel storage tank permit: Save Parcel'Changes. Return.to Lookup Parcel Info Parcel ID: 064-078 Developer lot: I._OT 8 Location: 52 OLD MILL ROAD Primary frontage: 121 Secondary road:El CRIM' Secondary frontage: :1.71 village:MARSTOi S M11...1_S Fire district:C-O-MM Sewer acct: Road index: 1.157 Asbuilt Septic Scan: 0640;�3_1 Interactive map Town zone of contribution:WP (Wellhead Protection, Overlay District) State zone of contribution:IN Owner Info Owner: TI-iOMPSON, JOLIE C & JEFFREY D Co-Owner: Streeti: 52 C31...1D V111A ROAD Street2: City:MARSTONS MRALS State: MA Zip: 02648 C Deed date: 1.0/09/2007 Deed reference:C1.84297 Land Info Acres: 0.51 Use: Single Fam MDL-01 Zoning: RF Neighborhood: Topography:Above Street: Road: Paved Utilities:Septic,Gas,PU hlic Water Location: Construction Info a>i € r ar but viou, A e �ed 1 1983 816 2 Bedrooms2 Full Buildings value:tt 109,400.00 Extra features: -3,400.00 Land value: tt 110 900.00 http://Issgl/Intranet/healthMaster/HealthMasterDetall.aspx?ID=064078 5/20/2010 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M ,. 52 Old Mill Road Property Address Jeffery&Julie Thompson Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/20/2008 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the I D computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 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 orrsite sewage disposal systems. I am a DEP approved system inspector pursuant ton-Section 15.340Yof Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fai�: ❑ Needs Further Evaluation-by the Local Approving Authority rn 11/20/2008 Inspec or'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. L4 1z11 /ob t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 2 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Old Mill Road Property Address Jeffery&Julie Thompson Owner Owner's Name information is regt.ired for Marstons Mills Ma. 02648 11/20/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. 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 es 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): t5hs•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 52 Old Mill Road Property Address Jeffery&Julie Thompson Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/20/2008 every 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Old Mill Road Property Address Jeffery&Julie Thompson Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/20/2008 every 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 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 Y2 day flow 6 ns•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 4 Commonwealth of Massachusetts H W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °SM 52 Old Mill Road Property Address Jeffery&Julie Thompson Owner Owner's Name information is requ'red for Marstons Mills Ma. 02648 11/20/2008 every 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. t5iis•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5 Commonwealth of Massachusetts . Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Old Mill Road Property Address Jeffery&Julie Thompson Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/20/2008 every 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): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5hs•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Old Mill Road Property Address Jeffery&Julie Thompson Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/20/2008 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1000 gallon septic tank,Distribution box and two 500 gallon leaching chambers. Number of current residents: unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2006:31,000 g ( y g (gpd)): 2007:36,000 Detail: 2006: 85 gpd. 2007:99 gpd. Sump pump? ❑ Yes ® No Last date of occupancy: 11/20/2008 Date Commercial/Industrial Flow Conditions: Type of Establishment: 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 i Water meter readings, if available: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 52 Old Mill Road Property Address Jeffery&Julie Thompson Owner Owner's Name requiratifo is Marstons Mills Ma. 02648 11/20/2008 required for evey 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): t5hs•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments tiM 52 Old Mill Road Property Address Jeffery&Julie Thompson Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/20/2008 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: New leaching installed in 2001 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): 2' Depth below grade: 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: 1000 gallon Sludge depth: 4" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 9 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Old Mill Road Property Address Jeffery&Julie Thompson Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/20/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" �I Scum thickness 311 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? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. 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 I Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 52 Old Mill Road Property Address Jeffery&Julie Thompson Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/20/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 52 Old Mill Road Property Address Jeffery&Julie Thompson Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/20/2008 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 No 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.): Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage into or out of box. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 52 Old MiR Road Property Address Jeffery&Julie Thompson Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/20/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2-500 gl. LC ❑ 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.): No signs of hydraulic failure.Leaching chambers water to invert was 20"at time of inspection.No stain line observed above this point. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 13 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Old Mill Road Property Address Jeffery&Julie Thompson Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/20/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 1 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 14 r Map Page I of 2 'Town of Barnstable Geographic Information System Parcel View Custom Map Abutters Map Size zoom Out J J E er �In r U 0 O 4�tCc 1 r� 11 �r t J,r �jr 0 20 Feet WE;- Set Scale 1" = 20 I I Aerial Photos I MAP DISCLAIMER (`nnvrinhf 9!1l1F_9f1l1R Tnwn of Rorne4ohin AAA All rinhM roecni. e� http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=064078&map... 12/1/2008 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Old Mill Road Property Address Jeffery&Julie Thompson Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/20/2008 i every 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: Bottom of LC 90' 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: As-Built Card ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Old Mill Road Property Address Jeffery&Julie Thompson Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/20/2008 every page. City/Town 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE %OCATION J-4 �` SEWAGE # VILLAGE ASSESSOR'S MAP & LOTG -7 d INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY - wj '4e LEACHING FACILITY: (type) (size) /07 •Y�•� NO.OF BEDROOMS j BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r tt r F- O lkS vA` X.* a.•i{�4 r,.—r, fir, •u ,K' rtf.tt+ �'i� �3'~,yuz + al''..t„Yx�3`} rcgg s s3'.5' , a y (td 2itF jj,, }• - 7T, i,TOWN OF BARNSTAR LOCATIONo�. . ;®Y !,C� 1 ' . _ SEWAGE # d®I I YII LAGS ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITD--- W1 COMPLIANCE_ DATE Separation Distance Between the (. Maximum Adjusted Groundwater Table and Bottom of:Lea-ping Facility Feet ti Pnvate'Water;Supply Well and,Leachi'ng Facility (If any wells exist F ; on site or,witlun 200 feet of leaching facility) . Feet Edge of Wetland and Leaching Facility.(If any wetlands exist wi thin.300 feet o,leaching facility) Feet Furnished by _ o # -9111�,', No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for 30isspogal bpgtem Construction Permit Application for a Permit to Construct( )Repair( a')Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ,S Z O/ Owner's Name,Address and Tel.No. Assessor's Map/Parcel ®~/ S � i9 b• so (z Installer's Name,Address,.and Tel.No.. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been' ued by this Board of Health. Sign o� - O Date 1 1 Z C Application Approved by Date v Application Disapproved for the following reasons Permit No. Date Issued No. a. ., Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes `s PUBLIC HEALTH DIVISION — TOWN OF BARNSTABLES MASSACHUSETTS 6,1 ZIpprication for Miq;paal bpgtem Congtruction Permit Application for a Permit to Construct( ' )Repair( Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. , ?_ Owner's Name,Address and Tel.No. Assessor's Map/Parcel �`�+�,,,,�� .p- p�,D S��,,, G :b Installer's Name,Address,and Tel.No.j ^11, 1 V., yr L 1 Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft., Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S A.S. Description of Soil Nature of Re/p/�'rs or Alterations(Answer when applicable) F+ del SRO 0-A. elry Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been' ued by this Board of Health. Signe c-,1L O /�a Date Z /O Application Approved by 19 Date Application Disapproved for the following reasons 9 Permit No. Date Issued aaal ----------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( /)Upgraded( ) Abandoned( )by . �����e✓ leatA %-, at S Z .� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No._Z0�'' dated —Z 7"o . Installer Designer The issuance of this.pe t shatX n t be construed as a guarantee that the syste 1 fun n� signed.r , Date 7 a Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS 'Wigpogar *pgtem/Con5truction Permit Permission is hereby granted to C nstruct(// )Re,�jaif( ✓)Upgrade( )Abandon ) System located at S2 Q/� /� 1'�G' I�'l a�rr,>"a n, _&&& and as described in the above Application for Disposal System Construction t. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special condition . Provided: Construction must be co leted ithin three years of the date of t Date: Approved by f � L 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL y WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated (. 1 concerning the. property located at Sa- e jZ J-7• IV— /`) ,(47_ meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation..[Adjust the groundwater table using the Frimptor method when applicable] • If the S.A_S.will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation (using GIS information) ® B) G.W. Elevation +the MAX. High G.W. Adjustment. _ DIFFERENCE BETWEEN A and B 0 SIGNED : DATE: L [Please Sketch proposed plan of system on back]. . iyOTIC>J Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert a , t n S �a d d/r ' THE COMMONWEALTH OF MASSACHUSETTS ®� BOAR® OF HEALTH ( 1.1 ( ................... ...................OF Appliratiou for Uh4paii tl Works Tonstrurtiuu Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: - ........•.... ....-•.....�i�l®sT�� � �L� s:..... ........__ - _ -.. .. .�. Location-Address or Lot No. ...... •... ivV.. .............. wn ^� Address J c.. .... ...... Installer Address UType of Building ; Size Lot............................Sq. feet Dwelling—No. of Bedrooms-------- .............................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building No. of persons............................ Showers YP g -----------•-•-------------- P (� ) — Cafeteria ( ) dOther fixtures --------------------------------------------------------------------------•-----------------------•---•------------------.....--------............---• W Design Flow............................................gallons per person per day. Total daily flow............................................gall o s WSeptic Tank—Liquid capacity�4P ._gallons Length....9........ Width------ ...... Diameter---------------- Depth.� . xDisposal 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 ( ) Percolation 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........................ 9 -•------------- ----------------------• . ••--..... .,,,......---------•--................................................................ O Description of SoiL..,S / � Vit 'A .............. j� ___ U ..................................................... •----------......---•--------•--••-•--------•-----...••-•------------•----•----•-•-------•-----•-------••••--••--...------•--••-•----..........--- W x -•---•-••--•••--•--•---------------•••----------•-------•---------•••-------------------I-------••---•-------------•--•----------------•---• U Nature of Repairs or Alterations—Answer when applicable...-1 _.r1... - - T.7L.._._../(,/. ..G -•---------------------------------•-----------------------•-----------------------••---•---........•-----------••------•-.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 'ssued y he bo of health. Signed.._ .. 1�....................... ...Date Application Approved BY "�'. i� -�^ =-�91 .... ---- Date Application Disapproved for the following reasons:.....................................................------•------------------•----------------••----.......... ----------------------------••--••---------...._...-------------•--------...--•--.....---•--•---------•••----------------------------• ------------••-•--•---------•---••-----------•-••----•------•---' Date Permit No........ . ®�--'�-� ---------------------- Issued_....................................................... Date No.. L J i P2 . .............. om THE COMMONWEALTH OF MASSACHUSETTS t . BOARD OF HEALTH ..........................................OF.................................................;..................................... Appliration for Dhipoiial Works Tumitrurtion Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ................0, --- ---------------------------------------------- Lea or Lot No. ................................................................................... W F /P/------------------------------- --------------... - a� L...... Installer . . ... ... Address U Type of Buildifig Size Lot............................Sq. feet Dwelling_* No. of Bedrooms.......2...............................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons._.________.____._.____.__.. Showers Cafeteria ( ) PL4Other fixtures .......................................................................................... ........................................................... Design Flow............................................gallons per person per day. Total dail flow....__._._._.____________.____._.__.__._____gallons. 04 Septic Tank—Liquid capacity/P&-..gallons-gallons Length_____ ------- Width.....V.... Diameter..._...___..._._ Depthj1T__.__. area...........Disposal Trench—No..................... Width_..._._ ............ To fal Length..__.___.______.____ Total leaching \........sq. f t. Seepage Pit No......... .......... Diameter_._._.__,..._. Depth below inlet____________________ Total leaching area..................sq. f t. Z Other Distribution box Dosing tank Percolation Test Results Performed by.......................................................................... Date.......................................Test Pit No. I................minutesperinch Depth of Test Pit_.._._.___.__._.____ Depth to ground water...__........._.__._.,._. Test Pit No. 2................minutes per inch Depth of Test Pit._.____._..._______. Depth to ground water...__-..._..__.______._. --------------------------------- 7 ........................................................................ n.4..-.A............................................................................ 0 Description of Soil.... ........................... U ..................................... ....................................................................................................................................... W ...................... ------------------------------------------------------------------------------- ....... ........ ............. . ......... �r. -- - ___ 7................U Nature of Repairs or Alterations—Answer when applicable----- �6 — ... - ---------- W ...../ .............. ............................................................................................................................... ........................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T 1 T LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in be operation until a Certificate of Compliance has ,Vby !e boar f health. Signed.. . .... ........ . ...................... ................................ Date Application Approved By............... .......... ..... Date Application Disapproved for the following reasons:................................................................................................................ ....................................................................................................................------------------------------------------------------------------------------------ Date PermitNo.._....e .......................................... IssuedL....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................OF........ .............................................. 0.1rdifiratr of ToiPffiturr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by 'I.................... ....................... ...................................................................................................... dr Installer at.........)L........................................................................................................................................................................................... has been installed in accordance with the provisions of TIT-11, 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 CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. cy DATE...................SI-Z241................................. Inspector -- ------------------------------------------....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......te-e.e411...................OF......... ................................ NOK---k3k... FEEC> --------- Raposal Workii TwOnstrurtion "amit Permission is hereby granted----.---C_zzi-.(t...... ------------------------------------------------------------------------------------------- to Construct or Repair ) an Individual Sewage Disposal SysteM .. ..........................................................------- .......... ................... Stq,et as shown on the application for Disposal Works Construction Permit NO3_[:. Dated__________________________________________ ...............................) .................................................. Board of Health DATE................................................................................ FORM 1255 HOSES & WARREN. INC.. PUBLISHERS r , L-0 CATION S G E PERMIT NO. VILLAGE INSTALLER'S NAME A ADDRESS 70&6 2 8 U I L 0 E R OR IIWNER it DATE PERMIT ISSUED F3 . DATE COMPLIANCE ISSUED �/�oT f j i � � i No. .................. THE COMMONWEALTH OF MASSACHUSETTS ;_:'fit, BOAR® OF HEALTH `}'=".gig, r ,. t XpV trttttou for Btspnaal 10orkii Tongtrnrtion ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal .. ...... ----- ------ ............ ocation- s or t No. - .... W \Ij n caner ,�{^\� AGdd�r�¢s� a ..................................� ._......------...!-�ICJ�_..-. ------------. -r ��_ ..........-. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder C� '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q, Other fixtures ------------------------ --------••-•-- ---------------------------------------------------------------------------- •--•------------------ W Design Flow............. V ...................gallons per person per day. Total daily flow_____--_�__�--•_................gallons. WSeptic Tank—Liquid'capacit� ..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 ( ) Dosingnk ~' Percolation Test Results Performed by g, _T�-_._. ._,d-�,1. ! -_... Date........................................ W U Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water•-_______-___-__---____. fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ----- O _ �f Description of Soil.------.... -•-....-•--•••l -._.. ®_GSM il b �' --- ---- V ......••••••......-•------••-----••-•-•c~' \ \ "". -----V:;-=.---......._ •iG9..<1 U c"n -`""v v\ 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 iITL LE 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 health. II Sig d q. r�l ... M_._.�"`..-----•••--•_.. �. $_! ........__.._ Application Approved By !Z .... /�{ � Application Disapprove or Date a following reasons:................................................................................................................ ....••------•-•.......................•-•••-------------•---•-•---•-----------••----•---------•--=-•----------••--•---•....-•---••----------•----•-•---•---••-•-•••••.--------------------------------- Date PermitNo......................................................... Issued....................................................... Date PIP— THE COMMONWEALTH OF MASSACHUSETTS BOARD 'O''�F HEALTH ............OF....... ...ij.CM...�. ............................................ Appliratiuu for UiipuiW lgorkg Tomitru.rtiuu Fermi# Application is hereby made for a Permit to Construct (ii o or Repair ( ) an Individual Sewage Disposal System at: .n.- .................. ..................... ems... .......................... ocation• s or t No �.� .:.. e ........ ............... • ......_._.. .... ��W .. t � � caner..... .� ..h.._.7ti ..Add > .......................... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...........3........................._....Expansion Attic ( ) Garbage Grinder tj aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ••--•--•---••-•-. .-----------------------------------...------------------------------------------•--.......-----------------------........---.._... .- _0 . 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 ( ) Dosmg„Wk ( ) 1 Percolation Test Results Performed by..... ..... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--------------:......... G Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water____-_----__-__. -____. a' •--------- ---------------- 5 O Description of Soil „ t ' ..?'>- a ------------------- V ................••---------........-......-- �"'•.... ""' •-------• \+ ; > `M C t �`,�' ''` ° ` 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 TIT1Z 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 health. Ig d.._ f!fl. -�....• ----- ---------------Application Approved By.-- ------------------------------------------------------------------------ _._Vff. ........... Date ApplicationDisapprove or reasons:------•••-•--••--•-•---•---••-••--------•---•-•---------------•----------------••.---•------------.............. .................•--•----••-------------•-•--•--•-....---•-•...--••--•---:....._...................-----•---------------•---------••---------•-•--------------------••------•--------------------•------ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ;4 n?`.'t'`.................0F......�... ..V C-)�A `�k �rr#ifirtt� of f�um�li��trr THIS IS TO CERTIFY, That the Indivi al Sewage Disposal System constructed (�,,�'`'"or Repaired ( ) b ..............•---•-..�...... .#"� ` •----•......... ........... •--- ---•:..--•-••--••------------•---•-----•...........----..........------.....----....--•------••--------- y . Installer • ......&C has been installed in accordance with the provisions of TITLE ;�pf The State Sanitary Co a escribed in the .y . p application for Disposal Works Construction Permit No. .._..__ ................... dated__ _r _......_.............. TVISSNC OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS GUARANTEE THAT THE SYSTEF CTION SATISFACTORY. DATElp-�................... .....--•-------••----•------- Inspector ----------------------------•---.._....._........ .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOY.—/y ...............\ `!✓`...........OF........... j�`x'R`' ..............._................................. FEE. ................ %;Tos� Nrko Tuuu mit .. _._.... V0.15.__........._.......Permission is reby granted•........... ._to Construct (' or Repair ( ) a Individual ewage Dispo�s Sy,e 4 gat No.......................... �[' CA `"' Street as shown /thei n for Disposal `��orks Construction Permit No.......... .. :. Date ..._....____._...__........................DATE. �s!................................................... Board of Health �3 FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Z p• S 91 'I6%w(,LL- FAMILY - BEDROOM tie./ IIIJo�GAIZ.BAGE �j¢�r`1D62 i-' pAI�.� Ft'ow : 110 x 3 = a3oG.P.v, N r 3 SEPTIG 'tPuK % a3o)cl5o% =a956.P0. �• III $ ° u5 l000 GAL. o15Po5AL PIT �6E I a o0 6AL. S 1 Dw�lAt.0 AREA. a 15o S.F T.H. 42- 150 5.F X 2.5 s 3o . % gOT't'OM A too Ilo ,3 Ill. �o R6.A 1 . ._ to Q • • 0IT t, 50 S.F X I. O a �j•O G.P 0. 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LOCp.TED WlTN11J T1i'6 oaD PLA11.1 DATE gAXTE2c NYE INC• REG 1 S'T�1t6.1D'LAN P S u ICY EYoZ I "fu15 PuMEN� Sv2vgG-Y 4D NE o SETS 6NoU4'D o3TEitV11.L6• doMP,=SS• I u 5TR- WoT DC- V%r.DTGh DC:Tc.c'-M11JC l..nrt' 1. I��G � �PPLIGA►`aT_ SAM�S k•�SN���'H