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0539 RIVER ROAD - Health
539 River Road 1%larstons Mills. . P A = 060 014003 P� Ib r I R cIII �CYo�c,�� UPC 10271 No H163Y oe HASTINGS.MN ilo 6 , '34 rotes r 5-e. , �� f Opp �� �� �t'I °Fj�Er°wy Town of Barnstable + iAFSS.LE,MA ' Board of Health 9 MASS. �. AtF0 MAC A 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayangi March 26, 2007 Maryann Barboza 130 Mitchell's Way Hyannis, MA 02601 RE: M/M Joseph, 539 River Road, Marstons Mills, MA Dear Ms. Barboza, You are granted permission to utilize the existing septic system for a five- bedroom dwelling. This permission is granted because: (a) the date of the disposal system construction permit is dated July 1987, months before the town adopted the waste water discharge ordinance in November 1987, (b) the capacity of the existing septic system was designed to handle 550 gallons per day sufficient for a five-bedroom dwelling, and (c) the town ordinance allows for alteration but in no case shall the discharge of waste water increase beyond that prior to such alternation. Sin ely, Way Miller, M.D. Chair an BOARD OF HEALTH TOWN OF BARNSTABLE Q:\WPFILES\Barboza_Joseph 539RiverRd2007.doc 003 No. U2 r Fees THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Migpogal bpgtem Cougtructiou Permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 53 9 R:P0- /474/ Owner's Name,Address and Tel.No. Assessor'sMap/Pazcel ' "� � / Gl� C?c';�/ye �rr.'5-- S-39 f>''«r/id -0 /� OB�wd11 NI4rSfflhl` ,/�iIIS t7e+G`7�� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Jotih C, Type of Building: Dwelling No.of Bedrooms ..3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 6;10D gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank__ A s>,r5 10002 Type of S.A.S. T,4 4e, rX 3D 5(,? Description of Soil Nature of Repairs or Alterations(Answer when applicable) `- ✓J e&l 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 issue y t 's Board of Health Signed ����� Date .2 3 ',?C700 Application Approved by Date -i_a 2 :�Lcvt7 Application Disapproved for the hollowin'gleasons Permit No. 2,coo - l Q Date Issued ------ —.a....---- ------ ----—_----- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE thatlthe A n-}site Sev�ge Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by at S' ''i `f' t it f �jq has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.2&,) 1( r,) dated Installer Designer The issuance of this pe t 11a11 o be c9strued as a guarantee that the system will function as1des g ed(', 1'1� Date .f Inspector �!, ,t a f / .!(,t a.------------------------------ - - . --------- No . — '),15Zno_ l fD _ Fee �S � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigpogal *pgtem Conotturtion Permit Permission is hereby granted to Construct( )Repair(,,\4 Upgrade( )Abandon( ) System located at L/ M and as describe 'n the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: Approved by _1 KE TT°`�� Town of Barnstable `SA ` Board of Health 9 T1ASS.SS. �A _ 059. Argo MPS 200 Main Street,Hyannis MA 02601 Office: 508-8624644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayangi March 26, 2007 Maryann Barboza 130 Mitchell's Way Hyannis, MA 02601 RE: M/M Joseph, 539 River Road, Marstons Mills, MA Dear Ms. Barboza, You are granted permission to utilize the existing septic system for a five- bedroom dwelling. This permission is granted because: (a) the date of the disposal system construction permit is dated July 1987, months before the town adopted the waste water discharge ordinance in November 1987, (b) the capacity of the existing septic system was designed to handle 550 gallons per day sufficient for a five-bedroom dwelling, and (c) the town ordinance allows for alteration but in no case shall the discharge of waste water increase beyond that prior to such alternation. Sin ely, Way Miller, M.D. Chair an BOARD OF HEALTH TOWN OF BARNSTABLE Q:\WPFILES\Barboza_Joseph 539RiverRd2007.doc Stanton, David From: McKean, Thomas Sent: Thursday, March 29, 2007 10:17 AM To: Stanton, David Subject: Re: 539 River road, permit on hold for now until resolved Hi Dave The Board did approve the existing system without requiring an upgrade or replacement. -----Original Message----- From: Stanton, David <David.Stanton@town.barnstable.ma.us> To: Mckechnie, Robert <Robert.McKechnie@town.barnstable.ma.us> CC: McKean, Thomas <Thomas.McKean@town.barnstable.ma.us> Sent: Thu Mar 29 10:08:47 2007 Subject: 539 River road, permit on hold for now until resolved Bob, I have put a temporary deny on the permit application (200701691) for 539 River Road until Tom returns. The current septic system (2000-110) at said location is only designed for 3 bedrooms. This location did go before the Board of Health recently and were allegedly granted permission to have 5 bedrooms at said location because the original septic system had the leaching capacity for a 5 bedroom house prior to a date in 1987 when the ZOC was approved by the Town. I'm not sure if it was addressed with the Board of Health that the existing system is only designed for 3 bedrooms. If it was, I'd assume they would have required them to put in a new septic system for 5 bedrooms if that is how many bedrooms they want at said location and what the Board approved. I was not present at the hearing, so I don't know what the Board allowed. I will check with Tom when he gets back to see what the Board wants for said location and if they OK'd it to keep the existing 5 bedrooms with only a 3 'bedroom septic system. If the Board OK'd them to have an undersized septic to remain at said location and keep the 5 bedrooms, I will re-open the building permit. If not, they will need to pull a septic permit application to accommodate the 5 bedroom house and then we can re-open the permit and sign off on the new septic permit number. Thanks, David 1 531 TOWN ++ OFBARNSTABLE � LOCATION SEWAGE # "\\D VILLAGE MarCtb`%-% ASSESSOR'S MAP &LOT INSTALLER'S NAME.&PHONE NO._J�C P��k' ry CA0'� `/ " I 555 Q SEPTIC TANK CAPACITY > LEACHING FACILITY: (type) '°'� << ��ocS ��lX(siz) NO.OF BEDROOMS BUILDER OR OWNER �'e4 of lr"'S PERMITDATE: "a COMPLIANCE DATE: 00 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 C> f 36 yg 361 y :3 ' TOW OF BARNSTABLE S LOCATION ® ti P P �®r,} SEWAGE # _ S _ VILLAGE II?AF.Ci ow c'4 Mites° ASSESSOR'S MAP & LOT y� INSTALLER'S NAME & PHONE SEPTIC TANK CAPACITY LEACHING FACILITY:(type) -- (size) NO. OF BEDROOMS tij PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER�f¢ �J DATE PERMIT ISSUED: 7-- ZQ — 7 s DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No °l �y. I a 2- V�37 Fimic THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TowN................OF...... ---------------------------------- Appliration for Dhipaiial Works Cfnnstrnrtion Prrutit Application is herreebb made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal System at: ..,.o..T...__. ._.. loll . .�a'o- ------------------------• -•--.........--------------------•--------- --------.............----............----- ------------ Location-Address or Lot No. -L� P 12 �.t l .................. � - ---- ....................................... Owner Address W Installer Address d Type of Building Size Lot..4-6+.930...Sq. feet V 5. Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) U Other—Type of Building No. of persons........G,.............. Showers — Cafeteria Q' Other fixtures .................................. W Design Flow...............J-.5...................gallons per person per day. Total daily flow--......... Q........._._._..gallons. WSeptic Tank—Liquid capacitylCM.gallons Length$'.?*... WidthA.-A07- Diameter--------.--_-- Depth.Vn__ x Disposal Trench—No..................... Width........ ..--.. Total Length------.................... Total leaching area....................sq. ft. Seepage Pit No.--.I................ Diameter.10."0.-- Depth below inlet.....0....._.._... Total leaching area.2a.1.....sq. ft. Z Other Distribution box (✓) Dosin tank ( '-' Percolation Test Results Performed b .G.AM---. 1eLWE?5.4EXAZMC.6.-. .... Date..KkX_ T0 19451--. Test Pit No. I.......Z.....minutes per inch Depth of Test Pit....1 ..... Depth to ground water.......-��"..-- Test Pit No. 2................minutes per inch Depth of Test Pit------.--.---------. Depth to ground water........................ O Description of Soil ..1..l. � �"� Al,�l �--------------------...................................................... x U -•----------------••-- ..................................................--...--------........------------------------------••---------•---•-•--------•••-------...-------------•--•--•--------.••---- W ••••-----------------------------------------------------•----------------------------------•-------------------------•--------------•---------•-----••---•-•---------................................. U Nature of Repairs or Alterations—Answer when applicable.-.............................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL% 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by t e board of health. Signed........ ... � Application Approved BY............�""�}----�- ................ ...................... ....................Date.............. Date Application Disapproved for the following reasons------------------•-----•--------------------•-----------------•-----------------•--------------•------•---•••-- --------------------•-----•------•--•-------------------------------------•---------.........---------.....------------------------------------------------------------------........................... Date e PermitNo....... 7._ -. ` .................... Issued....................................................... Date ' 1 FEs.... .1..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TQw ...............OF....... ".................................. Appliration for Disposal Works Tonotrurtion Prrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal ` System at: r.. 22Aj .--•--•................ .........•••-----•-.••------•----...----_... - -- ------------- .--------.................__...........__ Location-Address •--or. ............................................... Lot No. Owner Address W Installer Address g _ Sq. feet U Type of Building Size Lot____...��...�..Q--.._�__�__.__ Dwelling—No. of Bedrooms..................✓._.......................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons___..__.�A••--•••.---.-. Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------------------------------------------------•-•-•.....-•--•--•-•-------•------•-•--•-._...- d w Design Flow................_�� ...........................gallons per person per day. Total daily flow........... _. ._.________._____gallons. 04 W Septic Tank—Liquid capacity.l�_gallons Length_r�_"_�_ _q"_�Q_ _r-a__'"_�_._ Width . Diameter________________ Depth._ — x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.....I Diameter_0.'®__. Depth below inlet... __.......... Total leaching area__. l.....sq. ft. Z Other Distribution box (✓) Dosm tank ( )` aPercolation Test Results Performed by. _. ..�SLNJ05��. rzVEY Cj._... Date.__ ,,.a Test Pit No. 1....... -----minutes per inch Depth of Test Pit.___�___�..-__Z_____ Depth to ground water........—........ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----- --- :: �........ O Description of Soil ..ev) �A'(.......l.P l C�------ ELC7,r./ �pQ----------------------------------------•----------------..........------ x w U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------------------------------------------------------------------------------------------------••----•---•---------------------------............................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIZ- 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. Signed...................................................................................... .........................._.... Date Application Approved By-••--••••--• � j ................... .................... Date.............. Application Disapproved for the following reasons:-----•---------•-----------=---------------------------------------------------•----------------.......--••••.-- --•-••-•-•-•----•-•-•-•-••••-•-•-••••--•••-••-•-•--••--------....•---•--•-------••••-•••--••-•-•••--....--•.............••------....----••-••---...•-----•-----••-....------•-----_ -----•-••-•-•- Date Permit No........!.._?------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ ---.�........OF...............( �tr..s.,:ac�� ............................. (Inrtifiratr of Tontpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by......................... ... .......... --------------------Installer----------------------------------------------------------------•-------------•---•------------ ,� {� •- at �-Fs `'�v ---------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......5f-_7_.__.. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................ ........................ Inspector............ 0------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH �- ^-- ................. .........OF.-..............1!=��: ��'o- '��a"......._....................... No...�b..l..:.. �,j FEE............ .......... Disposal Works TOnstrttrtion Uprrutit Permission is hereby granted..........� ...... �1� ______________________ to Construct (, or Repair ( ) anQ Individual Sewage Disposal System at No......../-� .......��_ _..... ...�1eli. ' ' '�/ _.1r� (_..... Street ] as shown on the application for Disposal Works Construction Permit No._.�_y5_5.6.7.y5.57Dated.......................................... Board of Health DATE....................... t a ............................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - -31 TOWN OF BARNSTABL,E 0C L(JCkf1ON SEWAGE # oao®o`"o VILLAR'JF, Mc3-�t�arnS M'11S ASSESSOR'S MAP & LOT ` 5`35 0 INST�L,LER'S NAMF,dr PHONE N0.`1 C�,_n���'�� C,ovLy"� SEPTIC TANK CAPACITY I O� ' t4� // e LEACHING FACILITY: (type) `°� ®� /"��X(siz) NO.OF BEDROOMS Z BUILDER OR OWNER G0-0 0r(-'i5 I PERMITDA.TE:' 0-" 3— 2 Z COMPLIANCE DATE: 2qA00 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 C'odsite or within 200 feet of leaching facility) Feet Edgesof Wetland and Leaching Facility(If any wetlands exist ' "within 300 feet of leaching facility) Feet Furnished by Y^t �. of J- 36, s k) 19 y� 36 y �, 3 �,, 8/ y,f0 •'_ _may No. so !_— Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Miopogal *pztem Construction 3permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 53 9 R,,P el- Re Owner's Name,Address and Tel.No. ./'7Z"=� Assessor's Map/Parcel _ IL 063 f q-,r /o.l*S 'Pad Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. jol,lh !:�. 44 �f0 P.0 lb✓331� ,,r ,Ilr Type of Building: Dwelling No.of Bedrooms e.3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ait'D gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank fi:s1 f00-2 Type of S.A.S. ���" I`f4tor3 /0 re 30 Xv? Description of Soil Nature of Repairs or Alterations(Answer when applicable)_ ../-tff-1/ h rw J',9 5 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 issue y t 's Board of Health Signed Date Application Approved by ° Date -i „ D..evwcp Application Disapproved for the ollowin easons Permit No. 26QQ Date Issued i s f _ice , 00, No. Fee— — THE COMMONWEALTWOF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION TOWN OF-BARNSTABLE., MASSACHUSETTS 2pprication for �Digool *pgtem Congtruction Permit - Application for a Permit to Construct( )Repair(-/)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No, j % �Q,r�r /Q�` Owner's Name,Address and Tel.No. PCI Assessor's Map/Parcel / �{ Installer's Name,Address,and:Tel.No. Designer's Name,Address and Tel.No. Type of Building: r Dwelling No.of Bedrooms 3 Lot Size rsq.ft. Garbage Grinder( ) Other Type of Building::_", `'" No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow'"" 3�n ��✓� gallons per day. Calculated daily flow x t s gillons. Plan Date Number of sheets - Revision Date i Title Size of Septic Tank /00� Type of S.A.S. !. f r fail la',,( 3U,X a Description of Soil: Nature of Repairs or Alterations(Answer when applicable) rl rov f S, j � 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 issue y t 's Board of Health, Signed ' Date ,2-,W 3 Application Approved by Date :_A:A Zc�ao Application Disapproved for the ollowin reasons Permit No. 10eo - l l D Date Issued t ------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS ` BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTJFY,.that/the Qn- ite/Sew ge Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by �\j r at A4 ,,44 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.2j�7a.- I(o dated Installer Designer A n The issuance of this pe t�(hhal/l do,fbeycoo-nystrued as a guarantee that the system will f�unnaction,aidesig`m"peaY Date t1=rXl /1 Inspector Mi V/ U/ : 9 11,/ I l. 1 r No n Fee 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS ligpogal 6pgtem Con d uction Permit Permission is hereby granted to Construct( )Repair(,�4 Upgrade( )Abandon( ) System located at S_td Q pllllr &I . M �. and as describedin the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: Approved by 16 �S I'1 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 WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, 4a Ifo , hereby certify that the application for disposal works construction permit signed by me dated 2-,;? 3 — a oon , concerning the property located at �-3 I? 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) 7� B) G.W.Elevation '� +the MAX.High G.W.Adjustment. _ DIFFERENCE BETWEEN A and B 3 `, SIGNED'. DATE: —a 3 [Please Ske proposed plan of system on back]. NOTICE 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 I� 10 3� 0 4 TOWN OF BARNSTABLE t ZATION'V 1� SEWAGE #AGE -n�a'�S ASSESSOR'S MAP &LOTS INSTALLER'S NAME &PHONE NO. a\ b C.Q vt t/..$_9 �3 SEPTIC TANK CAPACITY _ I QO c> LEACHING FACILITY: i .+�3 ,�`�-{A'�ucS a�X X 3d (type) (size) Trek i NO.OF BEDROOMS BUILDER OR OWNER PERmrrDATE: 0_`A 3— O COMPLIANCE DATE: 00 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leiching Facilit y (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 d . i /,4 h ` �0V .a ( COMMONWEALTH OF MASSACHUSETTS EXECUTNE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION t TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A RECEIVED CERTIFICATION Property Address:53R Y2ly&e ?,nA <L APR i 8 2002 1Rxs1 nns ll� m,� nat. � TOWN OF BHhIVJ,;;u�L Owner's Name: Ej i 7A 6eTk U 3 1' HEALTH DEPT. Owner's Address: 1Q1vp,r LZ�c�a z y,n;11 _mA a a Date of Inspection: 3-Q A: MAP PARCEL • 1mI 4- p03 Name of Inspector:(please print) R E I D C . E L L I S Company Name: ELLIS LOT 3 Mailing Address: - 23 ENTERPRISE ROAD , P.O. BOX 59 , YARMOUTH PORT, MA Telephone Number.5 0 R-3 6 2-6 2-j 7 CERTIFICATION STATEMENT I certify that i have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to tion 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails / Inspector's Signature: j,�w 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address bow the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I rage�vi ii OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:Sq U Lb �6�aks IMi1►r,irnA oaL.�itl Owner: � Date of Inspection: T 3-o a Inspection Summary: Check0AA BCD or E/ALWAYS complete all of Section D A. System Passes: ILA ko 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: 14 B. System Conditionally Passes: One or more system components as described' the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacem t 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*o r 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& approved by the Board of Health. 'A metal septic tank will pass inspection if it is structur illy sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is avail le. ND explain: Observation of sewage backup or break out or hi gh static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven istn'bution box.System will pass inspection if(with- approval of Board of Health): broken pipe(s)are i eplaced obstruction is rema ed distribution box is veled or replaced ND explain: The system required pumping more than 4 times year due to broken or obstructed pipe(s).The system will g pass inspection if(with approval of the Board of Health) broken pipe(s)are laced obstruction is remov ND explain: Y Page 3 of.11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: �;39 Ptlre= l�r<; mj►l Mo o"4g Owner:�zsa" t WEL Date of Inspection• 4-3- o a C. Further Evaluation is Required by the Board of Health: y Conditions eyist which require further evaluation by the Bo 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 a rdance 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 vegeftd wetland or a salt marsh 2. System will fail unless the Board of Health(and Public V later Supplier,if any)determines that the system is functioning in a manner that protects the public he dth,safety and environment: _ The system has a septic tank and soil absorption syste (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 m'thin a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is m ithin 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is It ss than 100 feet but 50 feet or more from a private water supply well".Method used to determine dis ice "This system passes if the well water analysis,performed a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the 11 is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is eq al to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be ittached to this form. 3. Other: page 4 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION RM PART A CERTIFICATION((continued) Property Address: eL Rd Owner• Date of Inspection: 4- - a- D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes N _ backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool \/ scharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or dogged SAS or cesspool Static liquid level in the distribution imx.above outlet invert due to an overloaded or clogged SAS or Vpooloil id depth in cesspool is less than6"below invert or available vohune is less than h day flow uired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number /61 times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. y portion of cesspool or privy is within loo feet of a surface water supply or tributary to a surface ater supply. _ y portion of a cesspool or privy is within a Zone I of a public well. y portion of a cesspool or privy is within 50 feet of a private water supply well. T 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 he attached to this form.) The system fails.1 have determined that one or rnm ofthe above faili:re criteria exist as , described in 310 CMR 15303,therefore the system fails.The system owner should contact the Board of Health to determine what will be neT/ts!e : correct the failure. E. Large Systems: To be considered a large system the system m a facility with a design flow of IQ,QQQ gpd to IS,000 gpd- You must indicate either"yes"or—no'to each of he following. (The following criteria apply to large systems in 2 Idition to the criteria above) yes no the system is within 400 feet of a drinking water supply — _ the system is within 200 feet of a tribxw ry to a surface drinking water supply d.e;,«te; ;s i�+cat in a nitrogen sensi ive area(Interim Wellhead P otectio.^.Arm-IAA)or a mapped Zone 11 of a public water supply well if you have answered"yes"to anv Question in Sv ion E the system.is considered a significant threat,or answered °yes'°in Section D above the large system has fail .The owner or operator of any large system considered a significant threat under Section E or failed under 'on D shall upgrade the system in accordance with 310 CMR i 5304.The system owner should contact the appi Dpriate regional office of the Department. 4 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENT'S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:SIT Ri v r r Rj - 44 6at.�1$ Owner: EL1 zta" I i a y,r Date of Inspection: 4 3-b a Check if the following have been done.You most indicate"yes"or"no"as to each of the following: Yes N ping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out m the previous two weeks'.' / Cthe system received normal flows in the previous two week period? e large volumes of water been introduced to the system recently or as part of this inspection? y Were as'built plans ofthe system obtained p yste 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,rWxcluding the SAS,located on site ) Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of th 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: Y no /Existing information.For example,a plan at the Board of Health. _ V Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15302(3)(b)] raY,c v us t i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . . PART C SYSTEM INFORMATION Property Address: 3`1 ktver PA-- YYl r�T�,n S h�i 1, 1 S W 02-04 g Owner: r1i zal,eT►, �- Date of Inspection• 4-3-0 2 FLOW CONDMONS RESIDENTIAL c Number of bedrooms(design): 3 Number of bedrooms(actual): J DESIGN flow based on 310 CMR 15203(for example: 110 gpd x#of bedrooms): 33 0 Number of current residents: 1 Does residence have a garbage grinder(yes or no;: 0 / Is laundry on a separate sewage system so] no): [if yes separate inspection required] Laundry system inspected s or no): 01 T �� ;9#A-J YZ f Seasonal use:(yes or no):. /, jLc.�t,tom Water meter readings,if available(last 2 years usage(gpd)): t�/`�'' �iK.� Sump pump(yes or no):W Last date of occupancy:�044 W T y2Q 6 f' C COMMERCLUANDUSTRIAL !�� )0 Qj i Type of establishment: Design flow(based on 310 CMR 15203): god 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(y or no):— Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFOR41ATION Pumping Records Source of information: r N Was system pumped as part Qf the inspection(yes or no): 1f yes,volume pumped: ti ons— o quan pumped determined? Reason for pumping: 1,'�/ itjd!}�►r�r1 JE OF SYSTEM Septic tank,distribution lox,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): Appro5druate ag;of 0 co� nents 1�(i known)an�so of info anon:. / l� S Wer sewage odors 4tected when arriving at the site(yes or no): i^-�— f ' rag,c r v► i• OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:S39 Piyer P Owner: ell-z�- 1� Date of Inspection: ��}-3-a a BUILDING SEWER(locate on site plan) De l�below lie: V40 Materials of construction: cast iron PVC other(explain): Distance from private water supply well or suction line: _:go-{—• Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:.,-ovate on site plan) Depth below glade: 17* Material of construction: Y concrete_metal_fiberglass_polyethylene other(explain) At�lf tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) gX SX,y • Dimensions: Sludge depth: 7 Distance from top of sludge to bottom of outlet tee or baffle: N. Scum thickness:J o w Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scam to bottom of o et tee or e: How were dimensions determined: A I Comments(on pumping recommenditions,inlet and outlet tee or&Me conditio ,structural integrity,liquid levels as related outle invert,evidence of leakage,etc.): • 4 ff/v i.v �tL GREASE TRAP:_(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 be: Distance from bottom of scum to bottom of outlet i ee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet m d outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc. Page 8 of 11 OFFICIAL INSPECTION FORM—NOT F-OR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: -1i ever _• %1 Vill uwa ow(0, ,9 Owner: fla2,ral,zzh li�tiC' Date of Inspection: /y TIGHT or HOLDING TANK: (tank must be p at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fibe,glass_____polyethylene other(explam): Dimensions: Capacity: aailons Design Flow: aallonslday 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:d� (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: A //V Comments(note.if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or Out of x,etc.). • . as .1 � �. !/Sm,#G �4 PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condi n of pumps and appurtenances,etc.): 0 r � OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . _ PART C SYSTEM INFORMATION(continued) Property Address•• 539 94v �hh A-% ilnillc A e�(��$ Owner: i],., �,crr T' Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: VL PG. eaching pits,number. 1 - t aoe jp leaching chambers,number. leaching galleries,number. leaching trenches,number, length: leaching fields,number,dimensions: .�f- /1A,�/i 1(ti 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.) G 46W ��rl `✓! L AAli CESSPOOLS: (cesspool must be pumped as of inspectionxlocate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic ilure,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 fa ure,level of ponding,condition of vegetation,etc.): rags iv ui i i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Al Property Address: S2)9 r Owner. fL 7wb us Date of Inspection: SKIETCH OF SEWAGE D SPOSAL SY M Provide a sketch of the sews a disposal sy m including ties to at least two permanent reference landmarks or benchmarks.Locate all weI[ within 100 fe .Locate where public water supply enters the building. a 4 600, s o OL �o ` ragc i i ui i t R OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: JS39 12tvear- RJ_ wyW96'ns Will, i3 a64% Owner: Ry7A1,Cl., LQhr. Date of Inspection: 4-3-o l SITE EXAM Slopc Surface water o4n&& ,-- Check cellar Shallow wells Estimated depth to ground water-76 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 ISO feet of SAS) pecked with local Board of Health-explain: Checked with local excavators,installers-(attach documpntation) Accessed USGS database-explain: r,+w0a 'r /Al&.%, You must describe how you established the h' h ground water elevation: !t/�✓ ,CIG�o ls�"V# 7 r • Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: -�" x4t. Lot No. r Owner: Z Address: G•+ Contractor: � — Address: i i �.--sNotes• STEP 1 Measure depth to water table t ? tonearest 1/10 ft. .............................................................................. Date month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................................... ZJ Water-level range zone..................................................... STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to water level for index well ........................... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A),current depth to water level for index well (STEP 3), and water-level zone(STEP 2B) determine water-level adjustment .......................................................................................... STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ................................. , Figure 13.—RWWIJc1b1e computation form. y DIVE DATE: G AR —5 P i 3.: 2 # FEE: O�r ja 4. BARNSfABLE, MASS. 1639. p�� REC. BY I . DATE: 3 Z 01 Towne_ -, pP;Bannstable 1�1 t SCHED. Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION ` Property Address: `> Assessor's Map and Parcel Number: C�er-,cl 1C'l q U-©.3 Size of Lot: Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME: 1�c--- - yt t -z- a 0 k Phone Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON Name: '�C f GS9—f� Name: VV(q= -- 4--L-1 8 Address:��j .� iM��'-+5 Address: Phone: Phone:� 'GF-Z Ac-5- 73 SN l VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) C � . � E NATURE OF WORK: House Addition 000000 House Renovation ❑ Repair of Failed Septic System IN Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. _ Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (forTitle V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) _ Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Paul J.Canniff,D.M.D. REASON FOR DISAPPROVAL C:\Documents and Settings\decollik\Local Settings\Temporary Internet Fi1es\0LK1\VARIREQ.D0C t Certified Mail#7003 1680 0004 5458 3879 Town of Barnstable " Regulatory Services anerrsr. . Thomas F. Geiler,Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 16, 2006 Mrs. Rosanie Joseph 539 River Road Marstons Mills, MA 02648 NOTICE TO ABATE VIOLATIONS THE TOWN OF BARNSTABLE CODE. The property owned by you located at 539 River Road, Marstons Mills was inspected on August 8, 2006 by David Stanton, RS, Health Inspector for the Town of Barnstable. The following is a violation of the Town of Barnstable Code: Chapter 232, Wastewater Discharge: 5 bedrooms were observed at said location. Said property is located within a Zone 2, Wellhead Protection Area with 1.2 Acres of land. Said property is limited to a maximum of 3 bedrooms only. The original septic system, permit number 1987-455, was issued for a 3 bedroom dwelling. Septic permit number 2000-110 was issued for the repair of a failed septic of a 3 bedroom dwelling. You are directed to correct the violation listed above within thirty (30) days of your receipt of this notice by converting said property back to a 3 bedroom dwelling. You are ordered to correct the violation by eliminating the two extra bedrooms so that a total of only three bedrooms are present at said location. The Town of Barnstable Health Department has a policy to eliminate the privacy of being considered a bedroom by installing a minimum five (5) foot cased opening with no doors, no beds and no one is allowed to sleep in the room. You must obtain the necessary Building Department permits to make the necessary alterations to restore the property back to a 3 bedroom dwelling. It is noted that two rooms were. finished off in the basement, which did not contain windows and therefore they cannot be used as bedrooms. 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. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. QAOrder letters\Sewage violations\539 River Road.doc PER ORDER OF THE BOARD OF HEALTH Dale Saad, PhD Coastal Health Resource Coordinator Town of Barnstable Cc: Paul Attea, Attorney for property owner Tom Perry, Building Commissioner Linda Edson, Apartment Enforcement Christine Palkoski,Legal COMM Fire I QA0rder leuers\Sewage violationsl539 River Road.doc i L_ COMMONWEALTH OF MASSACHtJSETTS ExECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PItOTECTION TITLE 5 .OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART RECEIVED CERTIFICATION Property Address:539 nI„ex, kaja - APR 1 8- 2002 rii si s Owner's Name: �MzA 1.dlk Li ahT r>%Is Iltta nat4� TOWN OF DE , ;LE $'IY S HEALTH Fi DEPT.. Owner's Address: 24 Y1Vp,r' � Date of Inspection: 2-3-b9� Name of insp*tor:(please print) R E I D C. E L L I S PARCEL • vl 4 003 Company Name• ELLIS 6 LOT Mailing Address:_ " 23 ENTERPRISE ROAD, P•0. BOX 59 , YARMOUTH PORT, MA Telephone Number: 5 0 R-3 6 2-f 2 3 7 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.Ile inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to on 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: L= s 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 now of 10,000 gpd or greater,the inspector And the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address conditions of 4se: how the system will perform in the future under the same or different � } 'Ile 5 Inspection Form 61,5/2000 page I OFFICL4,L INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM w PART C SYSTEM INFORMATION Property Address;5 3`I 17.ty e-r 12,A-- Owner. �r L z Tl, Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design}: 3 Nurnber of bedrooms(actual): DESIGN flow based on 310 CUR 15203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1. Does residence have a garbage grinder(yes or no) Q Is laundry on a separate.sewage system or no): [if yes separate inspection required] '1',i l�l Ps�' l A-- Laundry system inspected or no):4# Seasonal use:(yes or no):-2 Water meter readings,if available(last 2 years usage(gpd)):,-z j p k-.1,o0 Sump pump(yes or no): Last date of occupancy. COMMERCLUJIN©USTRIAL Type of establishment: Design flow(based on 310 CMR I5203): d Basis of design flow(wats/persons/sgft etc-): Grease trap present(yes or no): Industrial waste holdurg tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yv, or no):_ Water meter readings,if available: Last date of occupancy/a se: OTHER(describe): [" GENERAL INFOR1i+IATION Pumping Records Source of information: r N Was system pumped as part of the inspection(yes or fio)AAP If yes,volume pumped: . gallons— ow, qu pumped determined? V o Reason for pumping_ JEOFSYSTEM Septic tank,distribution lox,soil absorption system Sutgle 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(desert'be): Approximate a of co ems (' known)and sonrce of info ation• Wer sewage odors Led wben arriving at the site(yes or no):"� ` Page 1 of 3 Listing# DOM Listing Price St# Address BD Town Village&ZIP Yr Status Type Selling Price SP%LP Listing Office BA(FH) Lot Sz Sq Ft Tax ID 2019604 37 $399,000 539 River Rd 4 Barn Marston Mills 02648 1987 Sold(05/04/02) Single Family. $390,000 97.74 Unique Real Estate 3(3 0) 1.120ac 2201 014-003 fl N tds °ti'ipr �: 4 Bedroom Horse Property!Bring The Kids,Dogs,Horses-there Is r Room For Everyone At This Picture Perfect Cape.You Will Love Its -Cheery Atmosphere,Family Room,Living Room With Fireplace,Eat-in Kitchen And First Floor Master.Finished Walkout That Offers Seperate Living Quarters.Barn And Corral And Lots Of Trails Await. I Listing Price Selling Price Address Listin # 399,000 [$-390,000 JF5_39 River Rd, Marstons Mills 0264_1717 2019604 Agent Kristin Seeley (ID:U244)Primary:508-778-4036 x112 Office Unique Real Estate(ID:UNIR)Phone:508-778-4036,FAX:508-778-9368 Property Type Single Family Property Subtype(s) Single Family Status Sold{05/04/02) DOM 37 Town Barnstable Commission Sub Agent Comm. Buyer Agent Comm. Dual Agent Comm. Dual Var Comm 2.5% 2.5% 2.5% . No Facilitator Comm 0.00 Listing Type Excl.Right to Sell Owner Name Elizabeth A.Light County Barnstable Tax ID 014-003 Subdivision Other Beds 4 Baths (FH) 3(3 0) Structure(approx sq ft) 2201 . Lot Sq Ft(approx) 48787 Lot Acres(approx) 1.120 Year Built 1987 Publish To Internet Yes Listing Date 02/18/02 All Office Remarks The House Is Zoned For 3 Horses.The House Backs Up To Horse Trails. Directions To Property River Road Near Wakeby Fork#539 Selling Information Selling Price 390,000 Selling Date 05/04/02 Listing Price 399,000 Pending Date 03/27/02 SP%LP 97.74. Original Price 399,000 Financing Conventional Comments Selling Agent ' Nancy J Morris(U0139) Selling Office Today Real Estate(TODY3) Listing Page Showing Instructions Call Listing Office General Page Zoning Residential Year Built Desc. Actual Total Rooms 10 Total Levels 2.0 Basement Baths 1.0 Level 1 Baths 2.0 Level 2 Baths 0.0 Level 3 Baths 0.0 Basement Yes httD://ccimis.raDmis.com/scrints/mgroisni_dll?APPMAW..=ranP�ntik..Pp(7;NA'k4'P= r R 1 nn I/I)nnr. Parcel Detail Page 1 of 3 40 . � x ::- w r '1°3 Ym_ M x �� � .•.3 .a...».F�stt, `A ..... .. Logged In As: �„�� � �� Friday, Marc Parcel Lookup �► Parcel Info Parcel ID i 060-014-003 Developer Lot LOT 3 Location 15 9 RIVER ROAD Pri Frontage Sec Road ^�—- Sec Frontage Village LMARSTONS MILLS Fire District C-O-MM -� Sewer.Acct F—u-�-- Road Index 11373 Owner Info Owner ,IOSEPH, ROSANIE _ Co-owner Streetl (5 9 RIVER RD Street2 City,RSTONS MILLS State MA Zip 02648 Country Land Info _._._... ----- -----.—._..__..._...._..........._..._......_..._........._........._.........__............._........_........_.........--------------_--- ------...-- - ---........................---...._..----..._-.._..__._..------ Acres 11.12 Use:Single Fam MD Zoning Nghbd 0105 - Topography Level ._�._�.� Road[Paved Utilities IPIP b Water,Gas,Septic Location Construction Info Building I of 1 Year 1987 Roof Gable/Hi Type None �� Built P_ Struct T e —__ __. Effect; Roof Bed €i4 Bedrooms Area'2785 Cover Asph/F GIs/Cm� Rooms Style. Cape Cod IntDrywall Bath Wall Rooms Model'Residential Rooms 7 Total Rooms ......... Grade;Average a Fl000 rr I } i Bath Style(Typical for Gr� _ -- _-- � -- _ ---- - - --......... Kitchen Stories 1 Story w/Fin style ITypical for Or y Ext Heat� Bath' •"'"' Wall i WOOd Shingle Fuel ----� Split c Heat.Hot Air Found-[Gas .v... Type ation http://issql/intranet/propdata/?arcelDetail.aspx?ID=3953 3/24/2006 OF THE Tp� The Town of Barnstable • sniuvsTnsi.e, �, Growth Management Department ArFD MA'S A 367 Main Street,Hyannis,MA 02601 Office: 508-862-4678 Fax: 508-862-4782 MEMORANDUM TO: Tom McKean, Director, Health Division FROM: Christine Palkoski, Regulatory Coordinator DATE: March 20, 2007 RE: Joseph Variance Application Below is a brief summary of the above referenced matter: Approximately two years ago, Linda Edson (Amnesty Apartment Investigator for the Building Department) discovered a basement apartment located at 539 River Road in Marstons Mills. After attempting to contact the owner several times to rectify this matter, the letters went unanswered. Ms. Edson then issued a number of non-criminal citations which went unpaid and ultimately initiated a criminal action in the District Court. We later discovered that the home contains five bedrooms, only three are allowed. This is was the condition of the house at the time of sale as evidenced from the Title 5 Inspection Form completed in April of 2002. As a resolution to the matter in the District Court, Mrs. Joseph agreed to restore the residence to a three bedroom house and apply for a family apartment in the basement. However, she now seeks alternate relief which, if granted, would be acceptable to the Town as a step in resolving this matter. Both the Town Attorney's Office and I have had numerous conversations with Mrs. Mary Ann Barboza, who is acting on the Joseph's behalf to resolve this matter. During those conversations various issues have been identified beginning with the fact that the septic system was identified as "passing" the Title Five inspection at the time of closing, when, in reality, the system could not accommodate the number of bedrooms contained in the house. By the way of providing guidance, the Town Attorney's Office indicated to Mrs. Barboza that if the Joseph's hire a septic engineer to determine the current capacity of the system (which may be a 550 gallon system) town staff may be willing to support Mrs. Joseph's application for a variance to allow for either four, or five, bedrooms. Although there were representations that an inspection would be completed, to date it has not been done. Page 1 of 2 J �`I Kiwer Kvo,cl JVIu✓3-fVlf +M,'lt5 M - 660 p(�(-OD3 ��xlv�r S Y&v r 3 gediauI,f Su'l L c�� ,� I L / roa set SeAlt'17 l ' 0.+� 2 rr� SKe�d�Gue✓��' W���c�/ W,nCfaZvs ) yy h fix, ow,Hdow, aQ�-tl?1�M L"dtl ! ' �`n �✓•.q.:11 l'G!'� L�v�/i � �G�?vl� r'aac� �/ / (/ I�p�Nuv. &dlA,- Livr� ar, S�f°P_ �URIG&I .S' I , ry� 1 r(bUr by Seat r✓74- �fmM Of11 0/7(y4eC/ F�v�tr � ro v�n.t f rA ��se Aid 1 rvv Pe CO-7.—,. T". 7 mp I oZ Oi C J�J d f ( G1^`� o � �cf"/�0✓�`1 MA 1l o����°� � �C oa%((7J A �f rs�l�Q Oe�pi) �3 TOWN OF BARNSTABLE �(1. • ���110 LOCATION.,_ _ SEWAGE # T I VILLAGE a�`��°'°� '`lS ASSESSOR'S MAP & LOT � . o INSTALLER'S NAM &PHONE NO. E SEPTIC TANK CAPACITY I ��r� l LEACHING FACILITY: (type) °�.4��`�"t o� ���Jr�siz j NO.OF BEDROOMS /� 'BUII.:DER OR OWNER l}0-0 0,c {di.s PERMITDATE: ®a� COMPLIANCE DATE: 9A . 00 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 i � A ► y s36 f /3 36 y 1 to 38 - 1 1� BA ; � S T A B LE T 'R N W O LOCATION r i99rt e ASSESSOR'S MAP & LOT VILLAGE /'�'j�PCT�v� - O. /1 �w INSTALLER'S NAME & PHONE r 1 SEPTIC-TANK CAPACITy i LEACHING FACILITY:(type) � ' ►`� , aw NO. OF BEDROOMS �' PRIVATE WELL OR P.�JBLIC WATER BUILDER OR OWNERS®'_ f v daJi C DATE PERMIT ISSUED: DATE .+C0bIPLIANCE ISSUEDS VARIANCE GRANTED: Yes i �7 1 / y r OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address;5 39 Pav er 1R -- Ybt-r-Kriffn S Y1Lt_ i 1_1pY1 y�(614 r Owner. . V a ht Date of Inspection: T-3-b 2 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: I Does residence have a garbage grinder(yes or no): 4 / �A'� Is laundry on a separate sewage system s or no): [if yes separate inspection required) Laundry system or no): Seasonal use:(yn �1 �1 e_ 8,Q•/ I,v f Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):W Last date of occupancy: COMMERcLuANDUSTRIAL fk � � 10 Q_j Type of establishment: Design flow(based an 310 CMR 15203): �pd Basis of design flow(seats/persons/sgftetc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-muitary waste discharged to the Title 5 system or no):r Water meter readings,if available: Last date of occupancy/use: OTIIER(descrbe): f' GENERAL INFORi ATION Pumping Records Source of information: r i" Was system pumped as part Qf the inspection(yes or If yes,volume pumped U. gallons—&Mpan' pumped determined? t, o Reason for pumpinga J��F SYSTEM c tank,distribution box,soli absorption system. _Single cesspool Overflow cesspool —Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _InnovauvelAltelnative 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): p'ximate aEof!f;onyp9nentsdpft in I�(i known)al, of info ation:. Wer sewage odorsLected when arriving at the site(yes or no). - .lam 1.vys►i -'-� _ J � �� -s1� i �oFIMEI� Town of Barnstable Regulatory Services yB MASS. Thomas F. Geiler,Director �A 039. ♦0 TfD Mn+° Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4024 Fax: 508-790-6230 August 10, 2.006 Mrs. Rosanie Joseph 539 River Road Marstons Mills MA 02648 Re: 539 River Road, Marstons Mills, MA 02648 Dear Mrs. Joseph, As a result of the inspection of the above referenced property, the following is a guide of the steps necessary to bring said property into compliance. First, the property contains more than the maximum allowable bedrooms under the Board of Health regulations. According to Board of Health records, your current septic system has the capacity for three bedrooms.In order to restore the house to a single family home containing three bedrooms a building permit MUST be applied for and obtained after review by this office.Part of this process is to provide plans that depict how this is to be accomplished. After the residence is restored to three bedrooms, and if you choose to retain a bedroom in the basement, an application for a one bedroom family apartment must be applied for. By ordinance, the family apartment cannot exceed 800 square feet or 50% of the square. footage of the existing single-family dwelling, whichever is less. A copy of the ordinance is attached for your review.This does not mean that you can have three bedrooms and a family apartment which contain additional bedroom(s).The WHOLE house is limited to three bedrooms maximum. I All Building and Health Codes and Ordinances must be met and final approval will be made by the Building Commissioner. I am also available to meet with whoever is going to be performing the work.or to discuss plans. Thank or your prompt attention to this matter and we look forward to your anticipatedco-operation. f Sincere , FtHE 1pk The Town of Barnstable * BAPNSTAsIZ, ��$ Growth Management Department �ATED 39. A 367 Main Street,Hyannis,MA 02601 Office: 508-862-4678 Fax: 508-862-4782 MEMORANDUM TO: Paul Attea, Esq., Garnick & Scudder, P.C. FROM: Christine Palkoski DATE: August 24, 2006 RE: 539 River Road, Marstons Mills Dear Paul: Please be advised that I spoke with Tom McKean, Director of the Health Division, and he has authorized me to provide you with the memo you requested. Mr. McKean is aware of the agreement reached in the District Court and has a copy of the letter sent to your client from Tom Perry, Building Commissioner. In accordance with that agreement, the Health Division will stay any action until February 2007. 1 trust that either myself or Tom Perry will be kept apprised of the plans, as they progress, to restore the above referenced property to a three bedroom residence. Sincerely, Christine PalkoskC/ cc: Tom McKean Tom Perry i Mrs. Mary Ann Barboza 130 Mitchell's Way Hyannis, MA 02601 Re: Joseph Property 539 River Road, Marstons Mills Dear Mrs. Barboza, It was good to speak with you earlier this week. I am writing to you to follow up on our meeting and to tell you what our research has shown. I need to start by reminding you and Mrs. Joseph that ultimately we in this office represent the Town and therefore we can not and do not provide legal advice to private individuals. I would urge you to have your own counsel as you consider how to proceed in light of our comments below. At the heart of the problem, of course, is the fact the septic system was designed to service three bedrooms whereas the house actually has five bedrooms. As such,the building inspector and his staff were required to take action on this mater and they would have been remiss if they did not. That is not the end of the analysis,however. You have brought to our attention the fact that before Mrs. Joseph purchased the property,the seller had the septic system inspected as required by an independent, state- licensed septic inspector. The inspection showed that the system"passed", or at least the "pass"box was checked off by the inspector.The state regulations require that a copy of the inspection report be delivered to the buyer before the closing and I assume,but do not know, that this was done. Both Mrs. Joseph AND the town were entitled to rely on the certification that the system was reported to have "passed". And obviously,if the inspector reported that the system had failed,Ms. Joseph and the board of health staff would have been alerted and would have taken action accordingly. In truth,the septic system did not pass. The fact the inspector found five bedrooms in the structure should have caused the inspector to mark the system as"failed". Had he done so, everyone would have been on notice. Unfortunately,he only made note in the body of his inspection report that the building contained five bedrooms and that the system was only designed to support three. His inspection and findings should have caused the inspector to fail the system and, had he chosen to comment on his findings (he was not required to do so other that to mark the"failed"box),he arguably should have made his comments boldly on the first page of the report. You should also be aware that the state regulations require that the report be delivered to the town's board of health within thirty days of the inspection. It appears that at least one of the reasons for the filing requirement is to have a central place where these inspection reports can be found. Interestingly,the thirty-day time frame for delivery of the inspection report to the town creates the possibility that the town might actually receive a report after a closing although, in Mrs. Joseph's case,the report was actually received before the sale to her. With this background, and particularly with the"pass"box checked off,the board of health personnel were not required read the report page by page. They acted properly then and all officials have been acting properly since then. However,that does not mean that Mrs. Joseph is without options or that any of us wish to see an innocent buyer hurt. (I do have to caution you,however, that the board of health's first obligation is to protect the public health and Mrs. Joseph's good faith and innocence.alone will not mandate that the board allow Mrs. Joseph's property to remain as is.)Nevertheless,this office is prepared to make some recommendations that might be of help. First,we are prepared to recommend to the District Attorney's office, and through them,to the District Court judge,that the current criminal complaint be dismissed and that Mrs. Joseph's record in this regard be sealed. This office does not control this process and the decision to follow our recommendation rests solely with the DA and the judge. Secondly,we will recommend to the Building Inspector that his order with respect to the removal of the fourth and fifth bedrooms be withdrawn for the time being. Thirdly,we will recommend to the Board of Health that they consider the nature of the error by the independent inspector. Mrs. Joseph may want to consider applying to the Board of Health for a variance to allow her to expand her septic system to accommodate five bedrooms. Mrs. Joseph may also want to consider applying in the alternative for an extension of time on any potential enforcement order to eliminate the extra bedrooms. Should she chose this latter route,this office would urge the board to seriously consider an extension of five years or until the property is sold or transferred,whichever occurs first. (If the property isn't transferred in that period, or if Mrs. Joseph still owns the property after five years,we would want an agreement in writing that the extra bedrooms be removed by the five-year anniversary on a date-certain that would be spelled out in such an agreement.) Fourth, as to the apartment issue,we would recommend that Mrs. Joseph process a request with the Building Commissioner who will guide Mrs. Joseph on the procedure for a family apartment permit. If the application is approved,that alone will not increase the number of bedrooms in the home. Ultimately,the number of bedrooms will be governed by the decision of the board of health as per the discussion above. Please keep in mind that the relevant officials have the authority and discretion to adopt or reject our recommendations. We would hope that the equities of the situation and 2 ti Y D/i zl 6 r � 2006-0159 G �� S Mrs. Mary Ann Barboza 130 Mitchell's Way Hyannis, MA 02601 Re: Joseph Property 539 River Road, Marstons Mills Dear Mrs. Barboza, It was good to speak with you earlier this week. I am writing to you to follow up on our meeting and to tell you what our research has shown. I need to start by reminding you and Mrs. Joseph that ultimately we in this office represent the Town and therefore we can not and do not provide legal advice to private individuals. I would urge you to have your own counsel as you consider how to proceed in light of our comments below. At the heart of the problem, of course, is the fact the septic system was designed to service three bedrooms whereas the house actually has five bedrooms. As such,the building inspector and his staff were.required to take action on this mater and they would have been remiss if they did not. That is not the end of the analysis,however. You have brought to our attention the fact that before Mrs. Joseph purchased the property,the seller had the septic system inspected as required by an independent, state- licensed septic inspector.The inspection showed that the system"passed", or at least the "pass"box was checked off by the inspector. The state regulations require that a copy of the inspection report be delivered to the buyer before the closing and I assume,but do not know, that this was done. Both Mrs. Joseph AND the town were entitled to rely on the certification that the system was reported to have "passed". And obviously,if the inspector reported that the system had failed, Ms. Joseph and the board of health staff would have been alerted and would have taken action accordingly. In truth,the septic system did not pass. The fact the inspector found five bedrooms in the structure should have caused the inspector to mark the system as"failed".Had he done so, everyone would have been on notice. Unfortunately,he only made note in the body of his inspection report that the building contained five bedrooms and that the system was only designed to support three.His inspection and findings should have caused the inspector to fail the system and,had he chosen to comment on his findings (he was not required to do so Mrs. Joseph's good faith will weigh in her favor but the decision ultimately rests with each official. If the relief asked for and/or the time for compliance is not granted,Mrs. Joseph will have to comply with the Building Commissioner's directions and this office will be prepared to insure that his orders are carried out in a timely manner. There may be other options that might be developed that I haven't mentioned here. Given the importance of these issues, I would again strongly urge Mrs. Joseph to consult with counsel as she weighs these comments and perhaps develops other options that might be available. I also need to remind Mrs. Joseph through you that zoning absolutely prohibits her renting rooms or apartments to non-family members.We will be recommending that any relief that the board/s might chose to grant would be conditioned on compliance with this requirement and that a violation of this provision could result in revocation of such relief. Certainly, any such violation would be reason for this office to reconsider its recommendations contained in this letter. Finally, Mrs. Joseph needs to follow through on these matters without delay. Leaving the status quo is not an option and doing so will require us to advise town officials to renew efforts to enforce compliance with existing orders. I therefore must respectfully insist that Mrs. Joseph inform us how she intends to proceed not later than November 17, 2006. This should give her plenty of time to get cost estimates,consult with counsel, etc. Assuming that we can reach written agreement on how to proceed,this office will move forward with these recommendations. Mrs. Joseph is fortunate to have you as a good friend. I hope that this letter gives you the information and guidance that you have sought. Please don't hesitate to call me if you have any questions or comments. Very truly yours, Charles S. McLaughlin, Jr. cc: Robert D. Smith,Esq. T. David Houghton,Esq. Christine Palkoski, Esq. Building Commissioner Thomas Perry Thomas McKean, Board of Health Arthur Traczyk, ZBA Paul J. Attea,Esq. 3 .. �r . ++.. cf`t- :..;,iv.;, �-n..., w.r15.-s TMt�s.F?- .tirc-v`+n} r,..:e;. `rM�r� -..:•�'--dam ,1:?....!"' �x....� •---,F ., �, :l.:.e- ! TOWN, OF BARNSTABLE BAR-W O3957 Ordinance or Regulation WARNING NOTICE Name of Off.ender/ManagerA1� , `^� "� Address of Offender N.y (Z MV/MB Reg.# Village/State/Zip -1 4 } i'. �r,. W" Business Name bt)40/pm, on 20 6Z Business Address �? �C.!- �_ Si°gnature of Enforcing Office"r Village/State/Zip Location of Offense Enforcing Dept/Division Offense - �t�t� 8- C' \( ` Lk4LIE �F Facts fi^ TM� r 1..` ""�t `� a .t F ' �`' �1 This will serve only as a warning. 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. .. _ _..-..,.<.�-..cr......�++.--.".�:..•.r;rt:n,,.;.r-'�+--..r^.o:" 1�?'=:•` r'+c, ;: rtt �:r 'r-.:"�.a "'+-3. _v .k e•.e-'= *}."*'.7j".'•y. ,.,�ar�ry ,,.,.._-4...�.y -,._.,yam �.-,., -- • x - T.4WNs�OF BARNS.TABLE BAR-W Ordinance or Regulation WARNING NOTICE Name of Offender/Manager "t `: XE.. Address of Offender `,•" ; ,0/L z �� , MV/MB Reg.# Village/State/Zip `� '_. � '; tew',�, 1�._:t'- #. f ' Ots f 1 Business Name s _ tApm, on '�, 20 !,Z Business Address Signature of Enforcing Officer Village/State/Zip S Location of Offense ' -r.•s �.f.!`v', t� '�, �`-.-� �`����i�`�, i .� `��.:�.,��'��:�� '� �;,� .� �� . '?_ �i�` Enforcing Dept/Division Offense. ` . Facts s i 5"-. 1 11d , `1 �` }���a !f r� + ��` " 4 x !A•` r p i '' =ems•, t t - l ', t, � �' ; ``'�` z, This will serve only as a warning. 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. 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