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Home My WebLink About2412 MEETINGHOUSE WAY/RTE 149 - Health (2) • v 2402 Meetinghouse Way W. Barnstable F f Town of Barnstable Regulatory Services Public Heath Division �K Thomas McKean, Director 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 October 10, 2014 Mr. Don Cox 2412 Meetinghouse Way West Barnstable, MA Dear Mr. Cox, On Thursday October 8, 2014, the Health Division received a complaint regarding the sale of chestnuts from your farm stand located at 2412 Meetinghouse Way, West Barnstable, MA. On October 8, 2014, Health4rispector David Stanton R.S. went to your farm stand and when you were asked about the;chestnuts, you denied that you sold any chestnuts. After some discussion, you later stated to Mr. Stanton that you recently stopped selling chestnuts. On October 9, 2014, Mr. Bill Clark of the Cape Cod Cooperative Extension Service communicated.to'Health Inspector David Stanton that the chestnuts purchased by the complainant were identified at the Cape Cod Extension Service Office as horse chestnuts, which are poisonous and can cause death. In accordance with Section 3 of the 1999 Federal Food Code,you are ordered to immediately cease and desist selling horse chestnuts from the farm stand owned and operated by you located at 2412 Meetinghouse Way West Barnstable. A sign shall also be immediately posted requesting the return of any chestnuts purchased from this farm stand in the past You are also scheduled to appear before the Board of Health at a show-cause hearing scheduled to be held on Tuesday November 18, 2014 at 3:00 p.m. The hearing will be held at the Town Hall, 367 Main Street Hyannis, Massachusetts, within the second floor Hearing Room. The reason for this hearing is to show-cause what penalties, if any, will be imposed and whether permission for you to operate a farm stand should not be suspended or revoked. During the hearing, you.will have the opportunity to present documentation, witnesses, and any documentary evidence pertinent to this case. PER ORDER HE BOARD OF HEALTH Thomas McKean, CHO, Health Agent Order received by: Date: COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, ss: SUPERIOR COURT C.A. No. BACV2014- Board of Health of the Town of ) Barnstable, ) Plaintiff, ) VERIFIED COMPLAINT V. ) Don Cox and ) Lindsay J. Hopkins, Defendants 1. The Town of Barnstable is a Massachusetts Municipal Corporation having a usual place of business at Barnstable Town Hall, 367 Main Street, Hyannis, MA 02601. 2. The Barnstable Board of Health is the appointed and duly constituted body charged by § 241-21 of the Town of Barnstable Administrative Code with preserving federal, state, and local health standards and with the responsibility to strictly enforce various regulations, health codes, and particularly all applicable provisions of G.L. c. 111, and especially §§ 122 — 125A thereof. 3. The Defendant Lindsay J. Hopkins is the assessed owner of real estate located at 2412 Meetinghouse Way (Route 149), West Barnstable, MA 02668. 4. The.Defendant Don Cox is the operator of a farm stand located at 2412 Meetinghouse Way (Route 149), West Barnstable, MA 02668. The relationship between the Defendant Hopkins and the Defendant Cox is unknown. 5. On Wednesday, October 8, 2014 the Barnstable Health Department received a complaint from a woman regarding the sale of chestnuts to her at Cox's farm stand. Health Inspector David Stanton, R.S., went to the stand and spoke to Defendant Cox. 6. When asked about the sale of chestnuts, Cox denied to Stanton that he had in fact sold or delivered any chestnuts to the public. After further discussion, Cox told Stanton the he "recently stopped selling chestnuts." 7. Cox was uncooperative with Mr. Stanton and would not allow Stanton to bring some of the chestnuts to the Barnstable County Extension Service for examination. 8. As a result, Stanton retrieved the chestnuts purchased by the private complainant and delivered those chestnuts to the Barnstable County Cooperative Extension Service located at the Barnstable County Complex. 9. On Thursday, October 9, 2014, Mr. William Clark, an employee of the Barnstable County Cooperative Extension Service, called Mr. Stanton and told Stanton that he (Clark) had examined the subject chestnuts and determined that they were so- called "horse chestnuts." Clark also informed Stanton that horse chestnuts are known to be poisonous and that ingestion of them can be fatal. Upon information and belief, the Plaintiff believes this conclusion to be true. 10. The sale of food products not grown on premises but imported from elsewhere is a violation of the zoning ordinances of the Town of Barnstable, §240-8(A)(4)(a). The source of the horse chestnuts is, however, unknown. 11. The sale of poisonous food products poses a clear and imminent danger to public health and constitutes a public nuisance. 12. On information and belief, the sale or delivery of such a product for consumption also violates the spirit and intent of Section 3 of the Federal Food Code, a joint advisory publication of the U.S. Department of Health and Human Services, the U.S.Public Health Service, and the U.S. Food and Drug Administration and any Federal or State regulations adopted pursuant to such advisory. Wherefore, the Plaintiff respectfully seeks the following emergency relief. 13. A temporary restraining order prohibiting the defendants and their agents, servants, or employees from selling or dispensing any food products including, without limitation any chestnuts or horse chestnuts, from any site under their control until further order of the Court. 14. An order allowing an agent of the Plaintiff to place a sign on the subject property until further order of the Court in essence warning the public who may have purchased or taken possession of any chestnuts from the farm stand not to consume them and to immediately deliver them to the Barnstable Board of Health and further to immediately call 911 or their medical provider in the event that any chestnuts have been,consumed. 15. A Short Order of Notice ordering the Defendants to appear before the Court to be heard on a request of the Plaintiff for a Preliminary Injunction granting such further relief as the Court deems appropriate. 16. After hearing, issue a Permanent Injunction granting such further r 1'� g ge ief as the Court deems appropriate. Board of Health of the Town of Barnstable, Charles S. McLaughlin, Jr. BBO # 336880 Barnstable Town Hall 367 Main Street Hyannis, MA 02601 508-862-4620 COMMONWEALTH OF MASSACHUSETTS i BARNSTABLE, ss: SUPERIOR COURT . C.A. No. BACV2014- Board of Health of the Town of ) Barnstable, ) Plaintiff, ) AFFIDAVIT OF THOMAS McKEAN IN V. ) SUPPORT OF VERIFIED COMPLAINT ) Don Cox and ) Lindsay J. Hopkins, Defendants 1. My name is Thomas McKean and I am the full-time Director and Agent of the Town of Barnstable Board of Health. 2. I have reviewed the Complaint filed today with the Court. 3. I hereby attest that all of the allegations contained in the Complaint are made of my own knowledge except where stated to be on information and belief and as to which I believe them to be true. Signed under the pains and penalties of perjury at Barnstable this loth day of October 2014. Thomas McKean COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, ss: SUPERIOR COURT C.A.No. BACV2014- Board of Health of the Town of Barnstable, ) Plaintiff, ) V. ) TEMPORARY RESTRAINING ORDER AND Don Cox and ) ORDER OF NOTICE Lindsay J. Hopkins, ) Defendants This matter having come before the Court and after hearing, it is ordered that: 1. That the Defendants and their agents, servants, or employees are temporarily restrained from selling or dispensing any food products including, without limitation any chestnuts or horse chestnuts, from any site in the Commonwealth under their control until further order of the Court. 2. An agent of the Plaintiff's Board of Health shall be permitted to enter upon the premises at 2412 Meetinghouse Way (Route 149), West Barnstable, MA 02668 in order to place a sign on the subject property until further order of the Court in essence warning the public who may have purchased or taken possession of any chestnuts from the farm stand not to consume them and to immediately deliver them to the Barnstable Board of Health and further to immediately call 911 or their medical provider in the event that any chestnuts have been consumed. The Defendants shall not tamper with, remove, deface, or block visibility of the sign until further order of the Court. 3. The Defendants are ordered to appear before the Court to be heard on a request of the Plaintiff for a Preliminary Injunction granting such further relief as the Court deems appropriate. Such hearing will take place on October , 2014 at So ordered at Barnstable this 10 Day of October 2014. Justice of the Superior Court P�pFTHETp�y Town of Barnstable Barnstable Board of Health "'�"'e1C8C"" + RARNSTAULE, Y MASS. Q D r $plF0 MAt Aim 200 Main Street, Hyannis MA 02601 2007 OFFICE: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi CANCELLATION OF BOARD HEARING REQUEST: November 12, 2014 TO: Donald Cox and Lyndsay jfc pkins 2412 Meetinghouse Way Nest Barnstable, MA 02668 RE: 2412 .Meetinghouse Way, Nest Barnstable — Chestnut sales at your farm stand. This is to not you that the Board of Yfealth has determined that you do X-OTneed to appear before the Board of Mealth. They are canceling their request which, was stated in their letter to you dated October 10, 2014. Thankyou. Sharon Crocker Administrative Assistant 508-862-4644 Q:\AGENDAS BOH\let Receipt CANCEL BOH Request Nov2014 D.Cox 2412 MtghseWayWB Chestnut.doc V 1 Oil .:5 86 z- Z1,6 The Commonwealth of Massachusetts Please remit to: DEPUTY SHERIFF FRANCIS M. WELBY P.O.'Box 1043 Centerville, MA 02632 Barnstable County Off. 508-362-9578/Res. 508-428-5328 1 ,Q0 # 4Q007541- I File No. OCTOBER .10 , 2014 Tc�� TOWN OF BARNSTABLEBOARD OF HEALTH For Service of Writ LETTER TOWN OF BARNSTABLE BOARD OF HEALTH vs. DON COX Service 45 . 00 Paid Witness Fee Travel Poundage Conveyance Special Service Postage, etc. Postal Search Copies D/S Office Fee Capias Hourly Mass. Fee CALL `BACK 25 . 00 TOTAL DUE: $ 70 . 00 ORIGINAL WRIT RETURNED ❑TO COURT ❑ HEREWITH New address of defendant: PLEASE RETURN YELLOW COPY WITH PAYMENT.......THANK YOU. The Commonwealth of Massachusetts Please remit to: DEPUTY SHERIFF FRANCIS M. WELBY P.O. Box 1043 Centerville, MA 02632 Barnstable County Off. 508-362-9578/Res. 508-428-5328 File No. f 4 R LV Z 1 667S y3 (,(1 o, zojy To Law Offices of , rt? N—eTown Mome For Service of Write 'Eilii I' Service Paid Witness Fee bc+fka-�A fl) .. Travel Poundage Conveyance Special Service Postage, etc. Postal Search Copies D/S Office Fee Capias Hourly Mass. Fee d(J I I ' TOTAL DUE: $ t� ORIGINAL WRIT RETURNED TO COURT HEREWITH New address of defendant-. PLEASE RETURN YELLOW COPY WITH PAYMENT.......THANK YOU. The Commonwealth of Massachusetts Please remit to: AdMbL DEPUTY SHERIFF FRANCIS M. WELBY P.O. Box 1043 Yff Centerville, MA 02632 Barnstable County Off. 508-362-9578/Res.508-428-5328 #14B007542 (ID 441 File No. OSTOBER 14 , 2014 To Law Offices of TOWN OF BARNSTABLE-OFFICE OF TOWN For Service of Writ SUBPOENA DUCES TECUYI ATTORNEY BARNSTABLE BOARD OF HEALTH V DON COX vs. DONALD COX aka DON COX & LINDSAY J- HnPKTNS s t Service 45 . 00 2 Paid Witness Fee 16. 0 0 nd Service 20. 00 @ $8. 00 Travel Poundage Conveyance Postage, etc. D Pola4elh Copies D/S @TFe'fep 2014 .Capias Hourly TOWN ATTORNEY Mass. Fee 5 .00 TOWN OF BARNSTABLE KNITIM10111'7 TOTAL DUE: $ 86. 00 ORIGINAL WRIT RETURNED ❑TO COURT ❑ HEREWITH New address of defendant: PLEASE RETURN YELLOW COP:Y.WITH PAYMENT.......THANK.YOU. Town of Barnstable OFIME Tp� Barnstable OFFICE OF TOWN ATTORNEY A*Anmdca My BAMSTABLE, * 367. Main Street , s� `bAr16 9. A Hyannis MA 02601-3907 8D MA't 2007 RUTH J.WEIL,Town Attorney Tel.#: 508-862-4620 T. DAVID HOUGHTON, 1st Assistant Town Attorney Fax#: 508-862-4724 CHARLES S. McLAUGHLIN, Jr.,Assistant Town Attorney CLAIRE R. GRIFFEN, Paralegal/Legal Assistant Inter-office Memorandum To: Thomas McKean, Director Public Health From: Ruth J. Weil, Town Attorney Date: November 3, 2014 Subject: Bill for Subpoena re: Board of Health v. Don Cox Enclosed you will find a bill from the Barnstable County Sheriff's office for service of writ Subpoena Barnstable Board of Health v. Don Cox. Please confirm that you will be processing this bill. Thank you. Sincerely, RJW/AEP Ruth J. Weil, Town Attorney Town of Barnstable pFE Tqk� Barnstable OFFICE OF TOWN ATTORNEY BARNSTABLE, ' 367 Main Street I ' 9` Hyannis MA 02601-3907 FD MA'S 2007 RUTH J.WEIL,Town Attorney Tel.#: 508-862-4620 T. DAVID HOUGHTON, 151 Assistant Town Attorney Fax#: 508-862-4724 CHARLES S. McLAUGHLIN,Jr.,Assistant Town Attorney CLAIRE R. GRIFFEN, Paralegal/Legal Assistant Inter-office Memorandum To: Tom McKean, Director, Public Health Division From: Charles S. McLaughlin, Jr., Assistant Town Attorney Date: October 21, 2014 Subject: Town of Barnstable Board of Health v. Lindsay J. Hopkins and Don Cox Docket No.: BACV2014-00498 Our File No.: 2014-0234 Enclosed please find two (2) invoices from Deputy Sheriff Francis M. Welby relative to the above-entitled matter. Please pay these bills in the . amounts of$70.00 and.$82.50 respectively. Should you f ave any questions, please do not hesitate to contact me. Thank you. r 5 OMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS JD d DEPARTMENT OF ENVIRONMENTAL PROTECTION r FAILED INSPECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A 1 Z- CERTIFICATION t Prop y Address: 2402 MEETING HOUSE WAY WEST BARNSTABLE,MA 02668 _--Owner's Name: LOUISE WALKER C.O REMAX Owner's Address: 3860 RT.28 MARSTONS MILLS ATT.JULIE RECEIVED Date of Inspection: 1/24/01 � FEB 0 7 2001 Name of Inspector: (please print) JOHN GRACI TOWN OF BARNSTABLE Company Name: "`�SEPTIC INSPECTIONS p y HEALTH DEPT. s r� � Mailing Address: 3P.0. BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-680'FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340'of Title 5(310 CMR 15.000). The system: .; 3. _ Passes _ Conditionally`Passes _ Needs Furth Evaluation by the Local Approving Authority X Fails Inspector's Signature: is 1 Date: 1/24/01 0 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 THE SYSTEM FAILS TITLE V INSPECTION.THE OVERFLOW CESSPOOL IS FULL OVER PIPE,THE CESSPOOL HAS NO EFFECTIVE LEACHINGiLEFT AND IS IN HYDRAULIC FAILURE. ****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. r: 'ins Title 5 IncnPcfinn Rnrm(,/15000n �y{S Page 2 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A = CERTIFICATION (continued) Property Address: 2402 MEETING HOUSE WAY WEST BARNSTABLE,MA 02668 Owner: LOUISE WALKER C.O REMAX Date of Inspection: 1/24/01 Inspection Summary: Check A,B,C,D or E'/ALWAYS complete all of Section D f. 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 FAILS TITLE V INSPECTION.THE OVERFLOW CESSPOOL IS FULL OVER PIPE,THE CESSPOOL HAS NO EFFECTIVE LEACHING LEFT AND IS IN HYDRAULIC FAILURE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. n/a 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 i with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the.distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board'of Health): _broken pipe,(s)are replaced _obstruction.is removed ' •a ND explain: n/a Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 2402 MEETING HOUSE WAY WEST BARNSTABLE,MA 02668 Owner: LOUISE WALKER C10 REMAX Date of Inspection: 1/24/01 C. Further Evaluation is Required by the Board of Health: - F 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 wkh 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 f 14 11.1 " � 2. System will fail unless the Board 6f 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 tar`ik'and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic taa1and 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 n/a tY. - S "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 m provided that no other failure criteria are triggered.A co g g q PP ,P gg PY of the analysis must be attached to this form. 3. Other: n/a 1� mil 6; Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 2402 MEETING HOUSE WAY WEST BARNSTABLE,MA 02668 Owner: LOUISE WALKER C.O REMAX ; Date of Inspection: 1/24/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No ' X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ X Liquid depth in cesspool is less than 6"below invert or available volume is less than''/2 day flow _ X Required pumping more than 4 times in the last year N ff due to clogged or obstructed pipe(s).Number of times pumped nLa. _ X Any portion of the SAS,cesspool or privy is below high ground water elevation. _ X Any portion of cesspool'or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a cesspool'or privy is within a Zone I of a public well. _ X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool orr privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] X _ (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The,system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems.in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet}of a tributary to a surface drinking water supply _ X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well T. 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. a Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B ` CHECKLIST Property Address: 2402 MEETING HOUSE WAY WEST BARNSTABLE,MA 02668 Owner: LOUISE WALKER C.O REMAX Date of Inspection: 1/24/01 Check if the following have been done.You must indicate"yes"or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health : X Were any of the system components pumped out in the previous two weeks X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of slu-4e and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no X Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] ,. 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE;SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 2402 MEETINGHOUSE WAY WEST BARNSTABLE,MA 02668 Owner: LOUISE WALKER C.O REMAX Date of Inspection: 1/24/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number,of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203.(for example: 110 gpd x#of bedrooms):330 Number of current residents: 0 Does residence have a garbage grinder(yes,or no): NO Is laundry on a separate sewage system(yes or ho): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: 1/3/01 COMMERCIALANDUSTRIAL Type of establishment: n/a �. Design flow(based on 310 CMR 15;203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a a t GENERAL INFORMATION Pumping Records 4 Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,}attach previous inspection records, if any) _Innovative/Alternative technology:;Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the'DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1850 Were sewage odors detected when arriving at the site(yes or no): NO r Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2402 MEETING HOUSE WAY WEST BARNSTABLE,MA 02668 Owner: LOUISE WALKER C.O REMAX Date of Inspection: 1/24/01 BUILDING SEWER(locate on site.plan) v•. Depth below grade: 8" Materials of construction: Xcast iron,40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 2" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a t If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 5' X 5' BLOCK CESSPOOL", Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle:32" Scum thickness: 2" I Distance from top of scum to top of outlet tee,or baffle: 0" Distance from bottom of scum to bottom of outlet tee or baffle: 0" How were dimensions determined: MEASURED Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SYSTEM FAILS-THE OVERFLOW CESSPOOL IS FULL AND IS PAST THE EFFECTIVE DEPTH OF LEACHING. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a I , Comments(on pumping recommendations' , inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc');'`': n/a 0 �r r1P , ` 7 � F Page 8 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2402 MEETING HOUSE WAY WEST BARNSTABLE,MA 02668 Owner: LOUISE WALKER C.O REMAX Date of Inspection: 1/24/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a'gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no):NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): n/a d PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a s � R f Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2402 MEETING HOUSE WAY WEST BARNSTABLE,MA 02668 Owner: LOUISE WALKER C.O REMAX Date of Inspection: 1/24/01 t SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS"not located explain why: n/a Type n/a leaching pits, number: n/a n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a 5' X 5' BLOCK CESSPOOL overflow cesspool, number: n/a ,,innovative/alternative system -iType/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE SYSTEM FAILS TITLE V INSPECTION.THE OVERFLOW CESSPOOL IS FULL OVER PIPE,THE PIT HAS NO EFFECTIVE LEACHING LEFT: THE LIQUID LEVEL IN THE MAIN CESSPOOL IS OVER THE PIPE. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or. no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a a x I Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2402 MEETING HOUSE WAY WEST BARNSTABLE,MA 02668 Owner: LOUISE WALKER C.O REMAX Date of Inspection: 1/24/01 SKETCH OF SEWAGE DISPOSAL'SYSTEM Provide a sketch of the sewage disposal`system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. I �l� V Pam 4.z O e` 5�e� F. .1, to Page 11 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2402 MEETING HOUSE WAY WEST BARNSTABLE,MA 02668 Owner: LOUISE WALKER C.O REMAX Date of Inspection: 1/24/01 SITE EXAM t: _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established'the high ground water elevation: USGS MAPS AND CHARTS 12+FEET t }. r 3 S Y R