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HomeMy WebLinkAbout0775 ROUTE 149 - Health 775'Route t149(Marstons Mills)f`; i+ µ; p101 005� I $S, ;jrylpl r f lit• , , 'r^'N1 yj.n Yk� (t•.pi y� A gl .`I I 1 i Ai (�i,,l �1 TOWN OF BA.RNSTABLE ° LOCATION Pl`7� �� . I�f� Cfus a'�., SEWAGE# VILLAGE i-I A�_ASSESSOR'S MAP& LOT I.o INSTALLER'S NAME 8c PHONE NO. P1AG3e L �E c,c:e��T SEPTIC TANK CAPACITY oO�!!-cJ . LEACHING FACILn Y: (type) :5 6 (size) fZ5Q6,0nN�, tee. % NO.OF BEDROOMS 4 BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: ®ve' Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) " ' Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) �� '"� Feet Furnished by [ At - at ' a 34 / c BS r ; Oct 04 2015 22:18 Jim The Inspector Man 5085349919 page 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessmentsw•,' cep.t i775 Rt 149 (Cotuit Rd_) a� Property Address t„R _Beth &Simon Greenberg Owner Owner's Name / information is Marstons Mills ✓ MA 02648 10-1-15 71 required for every page- CitylTown State Zip Code Date of Inspection �zF9 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When ng out forms A. General Information on l the computer, `\`�`0t►10F r444Ss�'�i use only the tab 1. InapeCtOr: key to move your .= •DAMES G cursor do not James D.Sears = R' use the return —+ Name of Inspector key. Capewide Enterprises LLC A o o Company Name . 'j, • f' 153 Commercial Street �.,,F$•I N Sp�G���`�� Uq-r-----:+�t Company Address Mashpee MA 02649 Cityrrown State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 10-2-15 i-Ifispectors 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. Aofta V's 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal Syslem•Page 1 of 17 Oct 04 2015 22:18 Jim The Inspector Man 5085349919 page 19 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 775 Rt 149 (Cotuit Rd.) Property Address Beth & Simon Greenberg Owner Owner's Name information is required for every Marstons Mills MA 02648 10-1-15 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,O or E I always complete all of Section 0 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 system is a 1000 Gal. Tank D Box and three chambers. Note: Outlet tee has a filter. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements, If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•W 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f Oct 04 2015 22:18 Jim The Inspector Man 5085349919 page 20 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r� 775 Rt 149 (Cotuit Rd.) Property Address Beth & Simon Greenberg Owner Owner's Name Information is MA 02648 10-1-15 required for every Marstons Mills page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 15ins•&13 Title 5 Official Inspection Forth:Subsurface sewage Disposal system•Page 3 of 17 Oct 04 2015 22:19 Jim The Inspector Man 5085349919 page 21 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 775 Rt 149 (Cotuit Rd) - Property Address Beth &Simon Greenberg Owner Owner's Name information is Marstons Mills MA 02648 10-1-15 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cant.) 2. System will fall 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 aseptic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: t 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 alw2poW is less than 6" below invert or available volume is less than %day flow-,0W Cf/1y F 15ins-V13 Ttte 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Oct 04 2015 22:19 Jim The Inspector Man 5085349919 page 22 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 775 Rt 149 (Cotuit Rd.) Property Address Beth & Simon Greenberg Owner Owner's Name information is required for every Marstons Mills MA 02648 10-1-15 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.j ❑ ® 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. One-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 or 17 Oct 04 2015 22:19 Jim The Inspector Man 5085349919 page 23 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `f 775 Rt 149 (Cotuit Rd) Property Address Beth &Simon Greenberg Owner owner's Name information is Marstons Mills MA 02648 10-1-15 required for every page. Cityfrown 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 . i ® ❑ 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): 4 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•313 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Oct 04 2015 22:19 Jim The Inspector Man 5085349919 page 24 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 775 Rt 149 (Cotuit Rd.) Property Address Beth & Simon Greenberg Owner Owners Name information is required for every Marstons Mills MA 02648 10-1-15 j page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal Tank D Box and three chambers. 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ® No Seasonal use? ❑ Yes ® No Water meter readings,'if available last 2 ears usage d 2013-38,000Gals g ( y g (gP )) 2014-36,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: D rteesent 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 Water meter readings, if available: t5ins-3113 Title 6 Ofllclal Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Oct 04 2015 22:19 Jim The Inspector Man 5085349919 page 25 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 775 Rt 149 (Cotuit Rd.) Property Address Beth &Simon Greenberg Owner Owner's Name information is required for every Marstons Mills MA 02648 10-1-15 page. citylrown 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: 08/09/10 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): 15ins•3113 Title 5 Official Inspection Form Subsurface Sewage Disposal system•Page 6 of 17 Oct 04 2015 22:20 Jim The inspector Man 5085349919 page 26 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments o-(0 775 Rt 149 Cotuit Rd. Property Address Beth & Simon Greenberg Owner Owner's Name information is Marstons Mills MA 02648 10-1-15 required for every page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1999 Permit#99 -77 i Were sewage odors detected when arriving at the site? ❑ Yes ® No I Building Sewer(locate on site plan): i 30" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on conditicn of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan): 19" 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 Gal. Precast H-10 1„ Sludge depth: t5ins•3113 Title 5 Official Inspection Form:Subsurface sewage Disposal System Page 8 of 17 Oct 04 2015 22:20 Jim The Inspector Man 5085349919 page 27 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 775 Rt 149 (Cotuit Rd.) Property Address Beth &Simon Greenberg Owner Owner's Name information is required for every Marstons Mills MA 02648 10-1-15 page. CitylTown 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 29" 1" Scum thickness 8 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 18 How were dimenslons determined? Asbuilt - Plan Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank at 19" below grade w/outlet cover at 6" and inlet cover at grade.Two inlet tees outlet tee w/filter. No sign of leakage or over loading. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Oct 04 2015 2220 Jim The Inspector Man 5085349919 page 28 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 775 Rt 149 (Cotuit Rd ) Property Address Beth&Simon Greenberg Owner owner's Name information is required for every Marstons Mills MA 02648 10-1-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) . 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 15ins•113 Title 5 Official Inspection Form SubsLrfaoe Sewage Disposal System•Page 11 of 17 Oct 04 2015 22:20 Jim The Inspector Man 5085349919 page 29 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 775 Rt 149(Cotuit Rd.) Property Address _Beth & Simon Greenberg Owner Owner's Name information is required for every Marstons Mills MA 02648 10-1-15 page. CitylTown 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 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-2' below grade. Box is clean and solid w/three lines out. No sign of over loading or solid carry over. 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.): I If pumps or alarms are not in working order; system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 12 of 17 II Oct 04 2015 22:20 Jim The Inspector Man 5085349919 page 30 Ll Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 775 Rt 149 (Cotuit Rd.) Properly Address Beth & Simon Greenberg Owner Owner's Name information is Marstons Mills MA 02648 10-1-15 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ 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,): Leaching is three 500 Gal. dry well's w/4'stone. Chamber's are 38" below grade. 2"water in chambers,wall's are clean Like new. No sign of over loading or solid carry over. 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•3113 Title 5 Official Inspectlon Form:Subsurface Sewage Disposal System•Page 13 of U Oct 04 2015 22:20 Jim The Inspector Man 5085349919 page 31 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 775 Rt 149 (Cotuit Rd.) Property Address _Beth &Simon Greenberg Owner Owner's Name required for is Marstons Mills MA 02648 10-1-15 required for every page. City/Town state Zip Code Date of Inspection D. System Information (cunt.) 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.): i i i 151ns-3113 Title 5 Official Inspection Form:Subsurface Sewage.Disposal System•Page 14 of 17 Oct 04 2015 2220 Jim The Inspector Man 5085349919 page 32 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Y 775 Rt 149 (Cotuit Rd.) Property Address Beth & Simon Greenberg Owner Owner's Name information is required for every Marstons Mills MA 02W 10-1-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately /3 r f,3 3 -�' 30 l ii5.4= 31, -.5-c 38 3 ,q U d O t5ins-3113 Title 5 Offidal Inspection Form:Suhsurace Sewage Disposal Sys*.em•Page 15 or 17 Oct 04 2015 22:21 Jim The Inspector Man 5085349919 page 33 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 775 Rt 149 (Cotuit Rd.) Property Address Beth & Simon Greenberg _ Owner Owner's Name information is required for every Marstons Mills MA 02648 10-1-15 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 'N 10'+ Estimated depth t high ground water: feet Please vindicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: 2-10-98 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) i I ❑ Checked with local Board of Health -explain.- Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: T.H. on Design plan 2-10-98 no G,W. at 10'+. Bottom of chambers at 5' below grade. Bottom of chambers at 5'above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins-3113 TWO 5 official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 , Oct 04 2015 22:21 Jim The Inspector Man 5085349919 page 34 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 775 Rt 149 (Cotuit Rd.) Property Address Beth & Simon Greenberg Owner Owner's Name information is required for every Marstons Mills MA 02648 10-1-15 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 inseparate file I E 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION —I`76— � Iwq fit' , t SEWAGE # VILLAGE 1 ASSESSOR'S MAP& LOT � INSTALLER'S NAME&PHONE NO. C-• SEPTIC TANK CAPACITY i j LEACHING FACILITY: (type) u o t ,wl(� (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) ' Z Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Furnished by �7& Af S 4 , le - Itf ; °PIKE Town of Barnstable '"R"' AB'E Board of Health. ArF P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Ralph A.Murphy,M.D. Sumner Kaufman,M.S.P.H. To: GRAINGER,DOUGLAS H 3R&ANN MAR Date Monday,March 05,2001 775 COTUIT RD MARSTONS MILLS M 02648 RE: Underground Storage Tank at 775 ROUTE 149 Map Parcel: 101005 Tank NO: 01 Tag NO: 00000 Our records indicate that your underground fuel(or chemical)storage tank is over 30 years old,and has not been removed as required by section 03: subsection 2 of the Town of Barnstable Health Regulation regarding fuel and chemical storage systems. You are directed to remove this tank sixty(60)days from the date of this notice. After your tank is removed, please furnish this office evidence in the form of a permit from your local Fire Department within ninety(90)days of the receipt of this notice. You may request a hearing provided a written petition requesting same is received by the Board of Health within ten(10) days after this order is served. Per Order of the Board of Health Thomas A.McKean,RS,CHO Health Agent ~ No. � -� -••-•--. ... --- Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Mizpoal *p.5tem Curs.5truction Permit Application for a Permit to Construct( )Repair( - Lj4grade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.,,/o -7-75 ea0i., / Owner's None,Address and Tel.No. �J��/.�ai�S/)�/`ram �f/ •.d�/''� C�•o'2'-c/c/L�j[f Assessor's Map/Parcel o (� Installer's Name,Addres ,and Tel No. Designer's Name,Address and Tel.No. 0 cO ;Q `f�77 d``lG� r� C /;"//cam. �igpeg> Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixture''s Design Flow � ) gallons per day. Calculated daily flow gallons. Plan Date L �� f G Number of sheets Revision Date Title Size of Septic Tank Z Type of S.Alr c 4 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 iss alth. Signe Date Application Approved by Date Application Disapproved for the following reasons n c � Permit No. Date Issued — No. / - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION- TOWN OF BARNSTABLES MASSACHU. ETTS 2pprication for ;Digpogar *pstem Cow5tructiou Permit Application for a Permit to Construct( )Repair(�Tpgrade( )Abandon( ) O Complete.System O Individual Components Location Address or Lot No�of 7—7�' Owner's Name,Address and Tel.No. !�/� (� Assessor's Map/Parcel 7 �1 ',L�1 D . O c-�l� T c! ,, Installer's Name,Addre ,and Tel.No. Desi�is Name,`ddZgs�d Tel.No. -7 7 15— G) —7()CD 3S 0. � Type of Building: Dwelling No.of Bedrooms4_1 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures R Design Flow 4� gallons per day. Calculated daily flow gallons. Plan Date 4� /G Number of sheets Revision Date Title Size of Septic Tank Type of S.AT a Description..'of Soil Nature of Repairs or Alterations(Answer when applicable) . . 1 Date last inspected: Agreement: r, , The undersigned agree-s-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 iss alth. .10 ! Sig ne5 Date Application Approved by Date Application Disapproved for the,following reasons Permit No. Date Issued ` ——— 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 �/ If at l / has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated 4W-- Installer Designer , it The issuance of this dermit s all not be construed as a guarantee that the ftwill function as)�deigne41 Date \ '�/ Inspector /� f/� a --------------------------------------- No. ` < Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migoar *pztem Construction Permit Permission is hereby granted to onstructt Repair( Upgrade )Abando n System located at / �Y/ ..w and as described in 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 thhii dihnit. r. 1 Date: ^ '' Approved b ." • II Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I 775 Route 149 Property Address Clinton Perry Owner Owner's Name information is required for Marstons Mills Ma. 02648 12/16/2010 every page. City/Town State Zip Code Date of Inspection I 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. i Important: A. General Information c� When filling out \ \I forms the computeto r,use 1. Inspector'. only the tab key to move your Robert Paolini cursor-do not Name of Inspector I use the return key. Capewide Enterprises,LL'C. Company Name I � P.O.Box 763 Company Address Centerville Ma. 02632 sewn City/Town State Zip Code (508)428-4028 S14454 Telephone Number j License Number I - I B. Certification I I 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-in'speetion was performed based on my training and experience in the proper function and maintenance of on situ sewage disposal systems. I am a DEP approved system inspector pursuant to-Section 15.340 of Title 5 (310 CMR 15.000).The system: . = c> ® Passes I ❑ Conditionally Passes ❑ Fails ❑ Needs Furth r Evaluation by the Local Approving Authority I � cis �J CM I Y I 12/16/2010 InspaSign Date I The system inspector shallisubmit 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. i I� t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Dispos I ystem•Page 1 of 17 L Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 775 Route 149 Property Address Clinton Perry Owner Owner's Name information is required for Marstons Mills Ma. 02648 12/16/2010 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"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal.System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 775 Route 149 Property Address Clinton Perry Owner Owner's Name information is required for Marstons Mills Ma. 02648 12/16/2010 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 I removed El ❑ N ❑ ND (Explain below): ❑ distribution bI ox is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): I i I i i i ❑ 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): I ❑ obstruction is'removed ❑ Y ❑ N ❑ ND (Explain below): I i i i i II I i C) Further Evaluation is;Required by the Board of Health: ❑ Conditions exist which'require further evaluation by the Board of Health in order to determine if the system is failing to'protect-public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within.50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 I i Commonwealth of Massachusetts , W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 775 Route 149 Property Address Clinton Perry Owner Owner's Name information is required for Marstons Mills I Ma. 02648 12/16/2010 i 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: i **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. i 3. Other: i I I i ii i i I I i D) System Failure Criteria Applicable to All Systems: I You must indicate "Yes"!or"No" to each of the following for all inspections: i I Yes No i ❑ ® 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 %day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 775 Route 149 Property Address Clinton Perry Owner Owner's Name information is required for Marstons Mills Ma. 02648 12/16/2010 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. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 775 Route 149 Property Address Clinton Perry Owner Owner's Name information is required for Marstons Mills Ma. 02648 12/16/2010 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 I ❑ ® 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 ilarge 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? I ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were Ithe 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? i ® ❑ 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: I ❑ ® Existiig 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)] I i D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 I I I i I t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I ,M 775 Route 149 Property Address Clinton Perry j Owner Owner's Name information is required for Marstons Mills Ma. 02648 12/16/2010 every page. City/Town State Zip Code Date of Inspection D. System Information Description: I I I I� Number of current residents: 2 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 2010:37,000 g ( y g (gp ))' 2010:37,000 Detail: 2009:93gpd 2010:101gpd Sump pump? ❑ Yes ® No Last date of occupancy: 12/16/2010 i 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 Water meter readings, if available: l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 • i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i ^M 775 Route 149 Property Address Clinton Perry Owner Owner's Name I information is Marstons Mills ! Ma. 02648 12/16/2010 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) . i Last date of occupancy/use: Date Other(describe below): I I i I I j General Information Pumping Records: Source of information: I Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons i How was quantity pumped determined? i Reason for pumping: I Type of System: i ® Septic tank, distribution box, soil absorption system ❑ Single cesspool .. I ❑ Overflow cesspool i ❑ Privy j I ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) i ❑ 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 lof the I/A system by system operator under contract ❑ Tight tank.)Attach a copy of the DEP approval. ❑ Other(describe): i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 775 Route 149 Property Address Clinton Perry Owner Owner's Name information is required for Marstons Mills Ma. 02648 12/16/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ 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: 10+ 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): Depth below grade: 18"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: 2" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 775 Route 149 M Property Address Clinton Perry Owner Owner's Name information is required for Marstons Mills Ma. 02648 12/16/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) i Distance from top of sludge to bottom of outlet tee or baffle 30 ' 2" Scum thickness 611 Distance from top of scum';to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 12" Measured How were dimensions determined? 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 tank every two years.Inlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. I Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): I Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 775 Route 149 Property Address Clinton Perry Owner Owner's Name information is required for Marstons Mills Ma. 02648 12/16/2010 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 775 Route 149 Property Address Clinton Perry Owner Owner's Name information is required for Marstons Mills Ma. 02648 12/16/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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 three outlet Iaterals.No evidence of solids carryouver.No evidence of leakage. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 I , Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 775 Route 149 Property Address Clinton Perry Owner Owner's Name information is required for Marstons Mills Ma. 02648 12/16/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ 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.): Sandy dry soil.No signs of hydraulic failure.Water level was 18" below invert at time of inspection.No stain line observed higher. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 775 Route 149 Property Address Clinton Perry ' Owner Owner's Name information is required for Marstons Mills Ma. 02648 12/16/2010 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.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 t Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ® ® Zoom Out J ,In n A . ...... ................... ............... . + t e - a G' 1 L ' ... ..... .. ............. r , k £ R 4 7 f d+ ij �r s MW. N MI x r O 4 Set Scale 1" = 20 I Aerial Photos I MAP DISCLAIMER (�nnvrinhf 9MFAl11(1 T--of Ror—fohle KAA All rinhtc roeenn t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 775 Route 149 Property Address Clinton Perry Owner Owner's Name information is required for Marstons Mills Ma. 02648 12/16/2010 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 40' 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 ❑ Checked with Focal 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 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 775 Route 149 Property Address Clinton Perry Owner Owner's Name information is required for Marstons Mills Ma. 02648 12/16/2010 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed E System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 h- n 08-27-2001 11:00RM CENT CST FIREDEPT 50879e,2355 P.02 Make application to local Fire Department. Fire Department retains.original application and issues duplicate as Permit. - � A APPLICATION and PERMIT Fe$: i al for storage tank removal and transportation to approved tank d spas yard in accordance with the provisions of M.G.L. Chapter 148, Section 38A,527 CMR 9.00, application is hereby made by: • Tank Owner Name(please print) Mr. Doua- Gist j ncier X • w Address 775 Cotui` Road Marst.ons Mills, MA 02648 sa..c cb st•a. Z7p • ' Company Nama E nv i r o—Safe FinCo.or lndNkkW Emlro—Saf e � •u Address P -0 "BOX 8101 E.Sandwich, MAZ. Address R- _o- .Box 810 E. S,maxandwich. SSA Slgnatu� if in pe t) Signature(it for t it) Y/l/ 18 IFCI Certified Other 0 IFC,1 Certified O LSP# Other TankLocatlon 775 Marstorts rills Sf•tllAd7Rii G+Y 1 Tank Capacity(gallons) 500 Substance Last Stored__Hea t i nci Oil } Tank Dimensions (diameter x length) ' Remarks: ...._ Firmlransportingwaste Enviro--Safe -Slate Lic.# 329 MA Hazardous waste manifest# MAM77 2690 E.P.A.# MAD985269323 Approved lank disposal yard Turner Salvage Tank yard# 002 Type of inert gas Tank yard address 235 Commercial Street Lynn, MA . . 40 City or Town Marston$ M'11rz F010#_nr n20 --.Permit* Date of issue JSAIY 9. Z001 Date of+ex mUon cio sate aoorovat number 2 0 013104 3 5.4_ e x p 8/.31 , ntg Safe Toil Free Tel. i _bet- 00-322-4844 Nfl@r rcmov att:sl yeau t-onu rr-r.'JQ�m8nev oy a vooi v.r•.w v��..��....ory -. nev.n 13to. Boston, MA 0210e-161& IV� T13TAL P.02 YOU WISH TO OPEN A BUSINESS? J. For Your Information: Business Certificates (cost $30.00 for 4 years:.) A' Business Certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.I.- it does not give you permissionAto'operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the -Town Clerk's Office, 1st FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by la, : ;a Fill in please: Date:` 0 1 s APPLICANT'S NAME: YOUR HOME ADDRESS: fR BUSINESS TELEPHONE # So836YyQ HOME TELELPHONE #:6o� YSiQ NAME OF CORPORATION: NAME OF NEW BUSINESS 4EI/ TYPE OF BUSINESS ,qi IS THIS A HOME,OCCUPATION? x YES _'+v0 ADDRESS OF. BUSINESST�s s�is/��IS D M MAP/PARCEL NUMBER` ,O r' d (Assessing) When starting a new business there are sev s you, must do to be in compliance with the rules and regulations ofA the Town of Barnstable. This form is to assist you in obtaining the;'information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any prmit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH , ' This individual ha!-b a informe f the p'.�rmit iremen't th t pertain to this type of business. Authorized Signa a** -- COMMENTS: , 3. CONSUMER AFFAIRS (LICENSING AUTHORIIY) This individual has been informed of the licer,sing requirements that pertain to this type of business. 4 Authorized Signature** ti COMMENTS: f 08-27-2001 11:00RM CENT CST FIREDEPT 5087902385 P.02 Make application to local Fire Department. Ind Fire Department retains original application and issues duplicate as Permit. APPLICATION and PERMIT for storage tank removal and transportation to approved tank disposal yard in ai;cordance with the provisions of M.G.L. Chapter 148, Section 38A,527 CMR 9.00,application is hereby made by: Tank Owner Name(please print) Mr. Doua_ Gra inger X Address 775 Cotuit Road Marstons Mills, MA 02648 .Removal Contractor. Company Name Enviro-Safe Co.or individual E=irn-Sa_fP � Address P•O:'BOX 810, E.Sandwich, MA Address _P-_Q,..Box 810 E. Sandwich, N P,eK Signatu rf n pa t) Signature(d far r it) f ® IFCI Certified other 0 IFCI Certified © LSP R Other Tank Information Tank Location 775 Marstons Mills Sf••f A�hBf• CRY Tank Capacity(gallons) 500 Substance Last Stored__Heat in q 0 i 1 Tank Dimensions(diameter x length) Remarks: Firm transporting waste Envi ro=Safe State Uc. 329 MA Hazardous waste manifestli MAM77 2690 E.P.A.q MAD985269323 Approved tank disposal yard Turner Salvage Tank yardff 002 Type of inert gas Tankyardaddmss 235 Commercial Street Lynn, MA City or Town Marston$ mills FDtD# 01920 T _PennitO Da te of Issue Jp1 X 9, Z011, Date of explratlon Dlo sate approval number. 20013104 35.4_ Dig Safe Toll Fr®e Tel. - Q0�'i2 -4W f �n@r rCR1QYaliii,yecal rvrnl re^�VVa d a4lane%ivy 6.V-1 V"—WvV-,W noon lalo.Rcpaton,MA 021084SM ' TOTAL P.02 �OFtHE raw TOWN OF BARNSTABLE 6vQ ♦� OFFICE OF 13ARISTLU i BOARD OF HEALTH NAM p°ems i639' `em 367 MAIN STREET 'FD MpY k' HYANNIS, MASS. 02601 January 29, 1999 Mr. and Mrs. Douglas H. Grainger 775 Cotuit Road Marstons Mills, MA 02648 Dear Mr. and Mrs. Grainger: You are granted an extension of time, until March 30, 1999, to remove the underground fuel storage tank at 770 Cotuit, Road, Marstons Mills, Massachusetts. The extension is granted because you testified that the removal companies you contacted were back-logged for four or five months and the cost would be considerable, approximately $2000. Thirty (30) days was not enough time to obtain bids, remove the tanks, and get an alternative source of heat in place. Sincerely yours, Actin Chairm Boas' of Health Town of Barnstable RAM/bcs grainger .. 3 rr • t Cp ✓ r s' E . r r' oll 2-y r' • 0-1 t� COS r , L0 a Z Ly -- we SCALE_ APPROVED BY DRAWN BY "Qv Ai DATE: ! 7 i DRAWING NUMBER&, �}`" ' - G�1'� �r-�-' g�Y^il'yr ;'fin' ,nrb..`i�l-'•�..3n Il,., `' ,.�.y..'.+` - ._ _ _ , _ • < _ , Y �, a ., � � - . } #, , • . -• -Y - { n + � • ...-"a-...�..32 .. ..-.,i.�r':;,"Tv"p�.--.-...-..... :Ci.py�.:+`+" '��-•. ,. ".�..,��, TM�za+-� r.,s_ ��., _ +._ .a;_'•, .r .�"�-t -Jc�_ -'_x..-.ry...'^�- _ _ ^"-.�: �,' T .. �� .w-.l..rr•.l.r.,- !�.. � .{� ' • "�-w+.,A4e.Jrsr, � a wrb'...'!tir+.s.+-..+f , - ♦ ~.. , +• a . '�..._. __r+n•rV--_-rr-�r�:.Ii-+...�rt��.•�""rr�i+w,...�-,w'a.-�•.n+wu:.+rr'�,.-.^.ay� _ �.'. �'k ,rva,�.-'�"` '�.Y'.�R�Yr�t^x'yMY•` ��.w•r.'YIM��. A • y Al • 1 . . ti t2, i�i.'•.x�ic...:�.M naaeaac..,.=�+�'ua�-�:Ra�.�-a�ou,&».aK .••-c-�raa�aos� --^^ ...3se:z �*' '�'Y'.�'��s�^�k"3fs;as.ax:.'s�JG.".�".s3ee�:.seus°,�.�_,. _ --..w r_�±�.�^�_r�7� .-000-TE-S INSTALLER NOTES: 1. LOCUS IS A.M. 101, PARCEL 5. RqC� 2. ELEVATIONS SHOWN ARE ASS GNED AND "NGVD LIKE". 3. LOCUS IS IN FLOOD ZONE C ON RPM DATED AUGLST 19, 1985- 1. EXISTING SEPTIC TANK APPEARS TO BE L j ZONE B ON FLOOD MAP IS SHOWN COINCIDENT WITH EDGE OF HAMBLIN POND_ ���E A 1000 GALLON TANK, VERIFY CAPACITY. 4. ALL PIPES TO BE 4" SCH 40, AVD PITCHED AT 1/4" PER FOOT. (UNLESS NOTED) IF LESS THAN 1000 GALLON TANK INSTALL d5. LOCUS IS ON WE_L WATER. LOCATION OF NEARBY WELL IS SHOWN. A 1500 GALLON TANK. 6. COMPONENTS TO BE AASHTO H-10. UNLESS NOTED. rn 7. INLET TEE TO PROJECT DOWN 13", OUTLET TEE DOWN 14". 2. EXISTING SEPTIC TANK FULL AT TIME OF `� 8. IF TWO OR MORE LINES, WATER TEST D-BOX FOR EQUAL FLOW SURVEY. FLUSH TEST SEWER A. IF LINE A D-BOX EXIT PIPES TO BE LEVEL FOR FIRST TWO FEET. NOT FLOWING TO SEPTIC TANK, RAISE SEWER 9- DEPTH OF COMPONENTS NOT TO EXCEED 3% OR VENTING MUST BE PROVIDED. PIPE 11 3/4" AND CONNECT AS SHOWN. I� BUILD UP COVERS TO WITHIN 1' OF GRADE. MORTOR CHIMNEYS IN PLACE. NOT TO ONE COVER OF TAN< TO BE WITHIN 6" OF GRADE. SCALE 10. STONE TO BE DOUBLE WASHED 3/4 TO 1 1/2" WITH 2" MIN. 1/8 TO 1/2" PEASTONE ON TOP. CB/DH FND & HELD N/F 11, IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL LOG ARE FOUND, ,I 43.4 CON-ACT THE BOARD OF -tEALTH, OR R.J. CADILLAC. LOCATION MAP LOUIS EGELSON 12 IF AN OVERDID IS CALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACH;NG H AEI B LI N POND l/,/ //� x IS TO BE CLEAN GRANDULAR SAND MEETING SPECIFICATIONS OF 310CMR 15.255(3). TEST HOLE 'I 13 PUMP AND FILL ANY EXISING CESSPOOLS. REMOVE ANY CLOGGED SOIL, ELOCK, AND STONE IN LEACH .AREA, AND DISPOSE OF AS DIRECTEC BY HEALTH AGENT. 14. ALL CONSTRUCTION TO MEET TITLE 5 .AND. LOCAL REGULATIONS. DEPTH (inches) ELEV..(feeti (EL. 41.7---2/'10/98) //� 1f o s6.s 61.0 BENCH MARK--PK NAIL SET IN TEST HOLE DATE: February 10, 1998 2„ 0 toyer IL I PERFORMED BY: Ron Cadillac, Soil Evaluator A layer 10yr 4/4 / / r 57.,36�/ 57� DRIVE=61.20 ASSIGNED GAD LIKE" �52f WITNESSED BY: Jerry Dunning;, Inspector silt loom / a� PE:RC RATE: inclC2 & C3 layers)ers 10 3j . / ( y ) B toyer 1Cyr 5/6 TOP FOUND 6O. 6' SOIL SURVEY(1993): Merrimac sandy loamy 2 sity cloy loom huh a �" 62. 3�6�9 9�6� Invert 53.1E GEOLOGIC MAP(19$6): Mashpee pitted plain deposits $" C1 layer 10yr 6/4 1j ,� Proposed Inert 61.69 coarse loariy sand X 4Y.7// / ` '/ �MEq E / / \ $ CQ Us$ offle 38. (30% grovel) 53.6 58.8 2 3.4 6 .5 Tp InvertProposed15 2 DRY WELLS / .: 6t.5 i C2 layer 2.5 5 60.3 .sri :::; r' / UtEL_ C9) S=1/4" fz �5=1 8" ft TOP PEA STON 64"n coarse sand /6 62.3 O /w - 57.. U 54.2 Line q Existing / / S= /8„/=t (30% grovel) �.,. / 59• ......:;:2 . 1 x 5? 8 Tank __� h / / x co 59 / W , Rnvert b1.94 f +� T n0 water \ // / 120" 46.8 f 1 55.6 �2a52. ' x F2.0 I Proposed Invert 61.32 Invert 61.06 39.08 b3.0 ,4_�) x� - x `- CP I Use 6" Stone Under Proposed Proposed 14.4' 12 ry' Bottom / /, rs: : �5 K I I I TEST HOLE 2 63.2 �OO b1.2 DRIWE �5.4 CB/DH FND HELD -59` 3n L�9' �. / / / k ;' 2 I (-� I DEFTH (inches) ELEV.(feet) 61.% W Q ' 'A 64 1 clean out 5-?-9- �` - � Bottom TH 1=46.8 v / O p / x 53.0 x J`I-7-� 14' - ---,59.C) DESIGN aATA USwS Adjlustment-Zone B Z 0layer 59.6 / x �/ `D 164 / QP 62.`_ .4 f 58.0 4 6U.6 BEDROOMS: 4 2'92'Fek. 9s=4&72 5and.253 A foyer 10yr 4/4 / / x 7 p .44 v, ?y` `�4.0 x r, / \ `\ GARBAGE GRINDER: No Pond Elev. 2 10/98=41.7 1p" silt loom O\ 0 x 6 '' . 'n i "' I-� 1 / \ B layer 10yr 5/6 i a.5 \ REQU RED CAPACITY: 440 GPD LEACH AREA silty Clay loam N ne x ¢.9 E 0.2 36" BENCH MARK--NE CORN.yFLAGSTONE 62.2 EXISTING SEPTIC TANK; 1000 GAL. n Q USE 3 SHOREY DRY WELLS WITH Cl layer 2.5y 5/E r/ r BOTFTOM LEACHING AREA: 429.8 5F coarse loam sand /// / / �14.. / WALK = 64.00 ASSIGNED "NGVD LIKE" l 4' OF STONE ALL AROUND y l �rylh -� ;k 2a j \ st ['33.5' X 12.83')] A 33'-6" X 12'-10" X 2' 42" (30% gravel) =6.1 .J,.,... I SIDE LEACHING AREA: 185.3 SF C2 layer 2.5y 5/6 V X 6 4.3 � x r DEEP LEACH AREA. 63.3d .r 49.0 sly [2((12.83'+ 33.5') X 2' DEEP)] 30%eraveld °ROr? :°: 64. x 59. �.. A PARTIAL 5' REMOVAL DOWN ( grovel) DESIGN CAPACITY: L55 GPD �r 6 °� oAD�It q. 'v 4,3 6 O O O x 4 9 / [;429.8 SF + 185.3 SF X .74 GPD SF 3.5' IS CALLED FOR BASED UPON 96" / ) / ] TEST HOLE 2. C3clayer o se2sand6/4 NC. 59.6 O / y 66. J to _ 126" nc water 49.1 �/! / x 64. x V d "� x �9 CB/DH FIND HELD 4 / �� 8 6`2�. 64.5 a TH u� x 46.5 00 x 68.E 64. `n , 6g.�8 /I 45.2 x 69. Rd N 5u 1N 1 l( 50.1 66 23''se N fi PROPOSED 26 sr8, WORK LIMIT AND SIL- FENCE x �8.8 x 57.; x f5 (.+ �ti 65.3 i I F`9S CB/QH FIND & HELD `� x Ssl s LOT A �� 7�� . LOCUS APPEARS TO BE IN AN RIF 0 �} c�J ZONING DISTRICT, AND SUBJECT TO o a 1 2 0 0 0 i S . F. CONSTRUCTION YARDS OF: - 0 FRONT YARD 30' a n SIDE YARD 15' < Sg) REAR YARD 15' ACTUAL ZONING DETERMINATIONS MUST �� Q BE MADE BY TOWN ZONING OFFICAL. N/F VINCENT COOK 0� �ry V LEGEND SITE PLAN TH 1 TEST HOLE LOCATION, NUMBER THIS P-AN IS A VALID COPY ONLY IF IT BEARS Q� ( FOR C� W WATER LINE MARKINGS AN ORIGINAL RED STAMP AND SIGNATURE. NN MARIE L74 V OU�.7LAS.J GR AI N GER G GAS LINE MARKINGS (IF SHOWN) -- OE OVERHEAD ELECTRIC WIRES (IF SHOWN) pV,\NOF�4S'S° e CB/OH FIND HELD 9.5 x 11.0 EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) �� RONAL �`� P`NO M��s9 LOT A, 775 COTUIT ROAD, MARSTONS MILLS, MA y-�"6`'•-- EXISTING CONTOUR JAME � PO�J?' °y ' r;CADt1 C JAti APRIL 3, 1998 SCALE: 1"=40' 8- PROPOSED CONTOUR � rou UTILITY POLE (17 SHOWN) 9FG,/STEP v' 35779v ---OU--- OVERHEAD UTILITIES (IF SHOWN) s'9NtTAR\�� O �r � RCNALD J. CADILLAC, PLS, RS ` + TREE (IF SHOWN, NOT ALL SHOWN) 1NDSURv�� PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN OS EXISTING SEPTIC COVER P.O. BOX 258 ❑ EXISTING DRAINAGE CATCHBASIN WEST YARMOUTH, MA 02673 REV. 2/22/99-EXTRA DRY WELL FOR HEALTH DEPT. HEALTH AGENT APPROVAL DATE (508) 775-9700 PAGE 1 OF 1