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0144 GOVERNOR'S WAY - Health
144 Governor's Way Barnstable F/R A = 258 051 Commonwealth of Massachusetts ,1 Title 5 Official Inspection Four' , Subsurface Sewage Disposal System Form - Not for,Voluntary Assessments_ ( �f` t�C�✓✓1 rJ rf - x Gt Property Address ��r✓J �-�—G,q �2 Owner Owners Name information is / CI/,n S� f-e /required for every �✓ page. City/Town State Zip Code Date of Inspecton 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 , filling out forms A. General Information - on the computer, use only the tab 1. Inspector. key to move your J/ cursor not return ail✓f�' y l /S� /l� use the return .. key, Name of Inspector Company Name 7 001 Company Address ,Clty/Town State - Zip Code . _ r 4Telepho tuber License Number. B.-Certification _ f"certify that I have personally inspected the sewage disposal system at this address and thatlhe .;: 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`maintenanceiof on4si.te sewage disposal systems.I am a DEP approved system inspector pursuant°to Section 1V340 off Title 5(310 CMR 15.000). The system: L7 Passes 0' Conditionally Passes ❑ Falls 0 Needs Further Evaluation by the Local-Approving Authority r Inspector Signature 4 Date 9 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 thetime 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. 15ins 11110 Idle 5 offidal InspectionIFVrface e p l system• ge 1 of 17 Commonwealth of Massachusetts = ROOM Title 5 Official lhispection form Subsurface Sewage Disposal System Fonn= Not for Voluntary Assessments ���✓mod✓S+ �/G - , Property Address ! Owner information is Owners Name required for every Ct►ri'i G h j .�pLC 5 Lp page. City/Town' ( State Zip Code Date of Inspection B. Certification (cunt.) " Inspection Summary: Check A,O,C,D or It%atways•complete all of Section D A) System Passes: . 1 , Eik-f-have not found any information which lindicates that any of the failure criteria described in 310 CMR,15.303 or in 310 CUR 15.304 exist. Any failure criteria not'evaluated are indicated below. Comments: I ' B) System Conditionally Passes: n ❑ 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, PP as approved by the Board of Health,,will pass. Check the box for"yes","no"or Inot determined".(Y,•N, ND)for the following statements: If"not determined," please explain.f I 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�eplaced with a complying.septic tank as approved by.the Board of Health.'- a * A metal septic tank will pass in pection if it is structurally`sound, not leaking and if a Certificate of Compliance indicating that the t�nk is less than 20 years old is available. I ❑ Y ❑�.N` ❑ 1ND(Explain below): grins•11/10 + i Tine 5 Official 1 ••nspection Form:Subswfaoe Sewage Disposal System•Page 2 of 17 t r Commonwealth of'Massachu'setts U Title 5 Officilel 1'6 ec'tlon dorm Subsurface Sewage Disposal Sys4m Form-Not for Voluntary Assessments Property Address Lo /e . Owner Owner's Nameinformation is / f' required for every �7 ( `/ ., ...C�;L CIO page. CityfTwon�j 'State Zip Code Date of Inspection B. Ce Cification (cont.) B) System Conditionally Pass1les ( ont). w ❑ Observation of sewage backup or breakout or high static water level in the distribution box due to broken or obstructed pipes) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): , ❑ broken are re laced ' ' pipe(s), ,P r ❑ Y . •❑`N ❑ ND'(Explain below): , ❑ obstruction is remov ❑ Y ❑ ;N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N. ❑ ND(Explain below): I _ ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will,pass inspection (with approval of the Board of Health): r _ ❑ broken pipe(s) are'r{placed •❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed `'' ❑ Y. ❑ N ❑ ND(Explain below): n C) Further Evaluation is Required by the.Board'of Health:' ❑ Conditions exist which requir6 further evaluation by the Board of Health in order to determine if the system is failing to protec-lt 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 systelh is not functioning in a manner-which will protect public health, safety and,the environmeni: ❑ 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 (Sins-1,10 ' Title 5 Officiai Inspection Forth:Subsurface Sege Disposal Systern•Page 3 of 17 -t a Commonwealth of Massachusetts Title 5 Officinal i spectic n Form Subsurface Sewage Disposal Sys; or n Not for Voluntary Assessments, Property Address 1 , Owner Owner's Name o'le ) / information is /h S/ �� l / i Qo`b required for every (7 page. Cityfr6wn 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 syster� is functioning In a•manner that protects the public health,, safety and environment: f ❑ 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 tankand SAS and the SAS is within 50 feet of a private water supply well 1 rt ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance This system passes if the well water analysis, performed'at a DEP certified laboratory,'for fecal f coliform bacteria indicates abse6t 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. j r. 3. .Other. r f S D) System Failure Criteria Applicf ble to All Systems: A i z You must indicate "Yes" or"No"to each of the following for all inspectloris: a Yes No i ❑ Backup of sewage into facility or system component due•to overloaded or clogged SAS or cesspool ❑ �/ Dischargeor ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ r� Static liquig level in the distribution box above outlet invert due to an overoaded• ' or clogged SAS or cesspool r Liquid depth in cesspool is less than 6° below invert or available volume is less than 1h*flow t5ha-11/10 Title 5 Offidal Inspectbn Force Subsurface Sewage Disposal System-Pam 4 of 17 f Commonwealth of MassachiJisetts Title 5 Official ifispecti n orm Subsurface Sewage /Disposal System Foam -Not for Voluntary Assessments Property Address G kj /-e- Owner Owners Name information is ,(�/a r Ae required for every ► �/ OC`b-70 71—L page. City/Town I State Zip Code Y Date of Ins Dion B. Certification (cunt.) Yes' No j Required umping more than 4 times in the_ last year NOT due to clogged or obstructed�pipe(s Number of times u ) pumped: ❑. L Any portio j of the SAS, cesspool or privy is below high ground water elevation. ❑ Bell", Any portio of cesspool or privy is withinE160 feet of a surface water supply or tributary tol a surface water supply. ❑ (� Any portioh, of a cesspool or privy is within a Zone 1 of a public well. ❑ 2" ' Any portio l of a cesspool or privy is within 50 feet of a private water supply well. _ Any portior�l of a cesspool or privy is less than 100 feet but greater than 50 feet • from a private water supply well with pp y 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 lof custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd�r The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The - system owner should contact the Board of Health to determine what will be necessary P 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 inditl ate either"yes"or"no"to each of the following, in addition to the questions in Section D. a Yes No , ❑ ❑ the systeml is within 400 feet of'a surface drinking water supply ❑ ❑ the systemlis within 200'feet of a tributary to a surface drinking water supply Elthe 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 an�f 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 3109 MR 15.304. The system owner should contact the appropriate: regional office of the Departmen. , •11/10 I e I Title 5 official Inspection Forth:Subsurface Seva�ge Disposal System-Page 5 of 17 e i Commonwealth of Massachusetts ' ti Title 5 Official in ' pection Form Subsurface Sewage Disposal System!Form - Not for Voluntary.Assessments ;.gVerYlorS c, Property AddressS4__6V 1) ! Owner Owners Name J informationquire is /h required for every page. City7own State Zip Code Date of Inspecton C. Checklist i i Check if the following have been do.ke. You must indicate"yes"-or"no" as to each of the following r Yes No I ' l� ❑ Pumping information was provided by the owner, occupant,or Board of Health ❑ Were any of th�systemF 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.�s N/A) ❑ Was the facility or dwelling inspected for signs of sewage back up? f ' 1 ❑ Was the site inspected for signs of.break outs, L� ❑ Were'all system{ components, excluding the SAS, located on site? i i ❑ Were the septi�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 El information on the proper maintenance'of subsurface sewage disposal systems? ' The size and 16cation of.the Soil Absormtion Svstem(SAS)on the site has been determined based on: L� 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'f distance is unacceptable) [310 CMRI 5.302(5)] D. System Information Residential Flow Coriditions; . f y a Number of bedrooms (design): , I Number of bedrooms (actual): DESIGN flow based on 310 CMR 1�5.203(for example: 110 gpd x#of bedrooms): f ��G ✓1 O to f-/00 j t5ins 11/10 ' Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 6 of 17 1 I Commonwealth of Massach6setts Title 5 Official Ihspectl h form Subsurface Sewage Disposal Systiem Fonn Not for,Voluntary Assessments l e i?O�l 4• Property Address Owner • sT c�1Y // information is Owner'=INIame equired for evvj GAb.�2_ page. Cityfrown State Zip Code Date of Ins •on ®. System Information Description: - y � l•f T/[ �[�r TIOt�j �Q Number of current residents: 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? E,Yes EP Seasonal use? A I ,.,,: } •, ❑ Yes 'L4- o Water meter readings„if availabl�,(last 2 years usage(gpd)): , Detail: ; t Sump"pump? ❑ Yes No Last date of occupancy: x 1 Date Commercial/Industrial Fiow Conditions, r Type of Establishment: Des Yign;flow(based on 310 CM 115.203):, ` GaIlons per day(gpd) Basis of design flow (seats/persohs/sq.ft., etc.): Grease trap present? 'I El Yes ❑ No :Industrial waste holding tank present? ❑ .Yes ❑ No Non-sanitary waste discharged t�the Title 5 system?, ❑ Yes .❑ No a Water meter readings. if available: 151 •tvno. Tilt 5 Official Inspection Forth:Subsurface Sew¢ge Disposal Sy�em,Page 7 of 17 ^" y r , r i Commonwealth of Massachusetts Title 5 Official l s ection, Form, Subsurface Sewa a Disposal_ System Form iNot for Voluntary Assessments ' property Address Owner Owners Name information is / required for every GL/Nf v"" CU 630 (2 1 page- City/Town State Zip Code Date of fnspe 'on D. System Information (cnt.) Last date of occupancy/use: ' 1 i Date Other(describe below): ~ . - s General information g, .Pumping Records: � 7 �� Source of information: f Was system pumped as part of .the inspection?' _" ❑ Yes if yes, volume pumped: j gallons How was quantity pumped deterfnined? Reason for pumping: Type of Sy Septic tank; distribution box, soil absorption system_ ❑ Single cesspool ❑ Overflow cesspiliol ❑ kPrivy, I ❑ -Shared system l[yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance cXract(to be obtained from system owner)and a copy of latest inspection of the ll I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ 'Other(describe),: r , .t5fis•7AI10 �, Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Ma ssachtisietts Title 5 Office l l s ec i° ti�n Or . Subsurface Sewage Disposal System form -,Not for Voluntary'Assessments ProoerN Address /e Owner Owner's Name information e /� ; required far ever; J 7zi h/ D� �30 page. City/Town state Zip Code Date of Inspection D. System Information (c�nt.)" Approximate�age of all components, date installed (if ow )and source of information: Were sewage'odors detected when arriving.at theFsi' '? R. �LJ Yes No Building Sewer(locate on site'plad):- Depth below grade: t +: feet ' ;viatP.i^•i3! '`.�.vtist('itC'iiCrl. i z _ •• _ I t h _ cast iron 40 PVC{ ❑other(explain): - Distance from private water sup�,ly well or suction line- feet .'Comments (on condition of ioint i.eventing; evidence of leakage, etc.): ` w l/Septic Tank(locate on site plan: Depth below grade: T" iv feet a Materi construction: o Crete. ❑metal k fiberglass, D'pol thylene ❑ other(explain), ` If tank,is metal, list age: . ` years Is age confirmed by a Certificate jof Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: o) t,Sins•1Itt0 (i Title 5 Offiaal Inspedion Form Subsurrace Sewage D 1 SyS1ern page 9 of 17 f Commonwealth of Massachusetts Tithe 5 Official 16spection . 0 subsurface Sewage Disposal System Form =Not for Voluntary Assessments ••' ���{ D�edv10►�SG Property Address 1 Owner ( 4 ✓I /� Owners Name -/ / - information is Ci�Pj STD `� i !!''l r ,6 required for every V a d✓tJ, page. City/Town ? State. Zip Code Date of ins ion D. System Information (wont),,'' Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle z Distance from bottom of.scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations,,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet ittivert, evidence of leakage, etc.,: • I _ CA VI- i ✓1 r/j p , - ' � �� .. � `r { 1 Grease Trap(locate on site"plan): Depth below grade: } feet Material of construction: ,i El concrete ❑ metal El fiberglass F1 polyethylene O.other(explain): " Dimensions: Scum thickness ; Distance from top of scum to top iof outlet tee or baffle _ Distance from bottom of scum to`bottom of outlet tee or baffle Date of last pumping: ' P Date t5ins•11/10 r . ., Tdle 5 Official Inspec ion Forth:Subsurface Sewage i g Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 ®ffiic�ial o�spectinorr�n Subsurface Sewage Disposal'Syst m Fonn -'Not for Voluntary Assessments / � 0I�2�v10✓S � Property Address Owner Owner's Name information is required for every �G/dls Qo1 630 ' G page. City/Town j State Zip Code Date of lmp ction D. System Information (cbnt.) . 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.): • ,Tight or Holding Tank (tank must°be pumped at time'of inspection) (locate on site plan): Depth below grade.- Material of construction: f V ❑ concrete - ,metal 0 fiberglass- ❑polyethylene. . - . ❑ other(explain): Dimensions: S Capacity: gallons Design Flow r ,. gallons per day Alarm present° ❑ Yes ❑ No Alarm-level: I -Alarm in working order. Yes j r . ❑ No Date of last pumping: Date Comments (condition of alarm a�d float switches. etc.).- Attach copy of currentpumpinc contract(required). Is copy attached? ❑ Yes ❑ No MM•11r10 ' ` r Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official I�,spectidn Form Subsurface Sewage Disposal Sy m Form-iNot for Voluntary Assessments Property AddressS1 v` G� Owner Owner's Name information is e // /�q --� /Jo, required for every G/dls�z.,�Ie # �'/•%�Ld- (J b L page. City/Town .'State, Zip Code- Date of Inspection D. System information (cbnt.)`. ,.. Distribution Sox(if present must be opened)'(locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level arid distribution to outlets equal; any evidence of solids carryover, any evidence of leakage into or out of box, etc.)-.'-AV/ _ 0 •' h Pump Chamber(locate on site Ilan): r 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: • : . a ... . . ;' � `{ � ' ,,,� , !Sins•11np r , ` Tdle 5 Offidaf Ins - 4 pedion Forth:Subsurface Sewage Disposal System•Page 12 of 1) l . f Commonwealth of Massachdsetts Title 5 Official l pectIon Form Subsurface Sewage Disposal Sys' mForm Not for Voluntary Assessments' Property Address. I Owner G h� information is Owners Name required for every ci/10,A.Ue� Od 00 , `o/ page. City)I own i State Zip Code Date IfDate nsosppedion D. System formation (cont.) = : - s w /l x364•x ' Type: leaching pits number. ❑' leaching chambe�s number: ❑ ' leaching galleries number. ❑ leaching trenche I number, length:, N leaching fields _ number, dimensions ❑ overflow cesspool number. ❑ innovative/aiterndtive system Type/name of to fhnology: - Comments (note condition of soil, signs of Hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): �y / V7-��"�e " 4,0, /"O✓T 07 Cesspools (cesspool must be Fm ed as O art p� p p of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer a Deptl� of scum layer Dimensions of cesspool Materials of construction ' a Indication of groundwater inflow I r Yes ❑ No tiros•11/10 9 ? Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 + l r � Commonwealth of Massacti�sefts Title 5 Official 16 a t! n Form y Subsurface Sewage Disposal Sys pm Form.-'Not for Voluntary Assessments �vw � �l�ervia fS Property Address Owner Owners Name information is required for every G lei page. Clty/Tov,, ( State �;p Code } Date of i lspection a D. System Information (coot.) r Comments (note condition of soil, signs of hydraulic failure, level of pondinp, condition of vegetation. etc.): Privy(locate on site olan;: Materials of construction: Dimensions I - Depth of solids Comments (note condition of soil, signs of hydraulic failure. level of ponding, condition of vegetation.. � .t'T Title 5 Otfiaal Inspection Form Subsurface Seardge Disposal Sy slem•page 14 of 17 �Qx commonwealth of Massachusetts Title 5 Official Ifis ection . Form Subsurface Sewage /Disposal Syst�m Form -'Not for Voluntary Assessments . .� �" } . l01%P►✓✓�o ins' - W Ci Property Address 1 Owner S�- ✓1 /� information is tOwnerr7sName / / / required,for ever. G/'✓►S �� dog 6 30 page. Cityrrown ! • State_ : Zip Code Date of Inspection D. System Information (cbnt i Sketch Of Sewage Disposal SysC m: Provide a view of the sewage disposal system, including ties to at least two pe Kanent reference+landmarks or benchmarks: Locate all wells within 100 feet. Locate where pub' water supply entersl the building. Check one of the,boxes below: t nd-sketcn in the area belo'I r drawing attached separately! r ,, I , ------------------------ .. f n � • a { • � -. a `x - •} I •. t5ins•11/10 Tile 5 Official Inspection Form:Subsurface Sewage Disposal system page 15 of 17 f Commonwealth of Nlassachisetts l Title 5 Official Inspection , or p Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �Wrl- e�H Property Address �� �• _ e , Owner Owner's Name M _ ) information is G trtil S7 b�� • / (�� 3� �f required for every 1 ' page. typ'o'r, State zip f"oti Date c` rush ctic D. System Information (gpnt:) Site Exam: ❑ Check Slope j x CI Surface waterLj i Cher= cei¢af I F EJ Shallow wells k l� /l/Dkl.� Estimated depth to high ground water: { feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from systeEn design plans on record If checked,date of design plan reviewed: , j Date ❑ Observed site(abutting property/observation hole within 150-feet of SAS) Checked with loc I Board of Health-explain: , �l� �s. - :�- ,%•Psi �o%s . ❑ Checked with local�xcavators,1nstallers'-(attach documentation) ❑ Accessed USES dajabase-,explain: i You must describe how you established,the high ground water elevation: I I T /9r�a vim" i l � Before filing this Inspection R i port, please see Report Completeness Checklist on next page. T [sins•11110 i 't'` Official Inspection Form:Subsurface Sewage Disposal System•page 16 of 17 Commonwealth of Massachasett$ • Title 5 Off! 1 I s ec 'on I°®rm. Subsurface Sewage Disposal S t. m Form -trot-for Voluntary Assessments, Property Address �—�--�.� Le _ ;- • Owner Owners Name information isI �j ll reouired for every Vd 6 30 page. CltylTovm ® ® State ' -Zip Code ' Date of Inspect' n E. Report Completeness Checklist a Inspection Summary: A, B, D, or E checked - e [l Inspection Summary D (System Failure_Criteria"Applicable to All,Systems).completed Sys em Information=Estinited'depth to high groundwater Sketch of Sewage Disposal System leither drawn on page 15 or.attached in separate file At Y iO Miricial Inspection Form:Subsurface Sewage Disposal System;Page 17 of 17 . r rr; T6WN.0F.BARNSTABLE N _ LOCATIO { Co If A)Q S� �� _ SEWAGE VILLAGE ASSESSOR'S MAP & LOT -65 INSTALLER'S NAME&PHONE,I,O.__ t P M6 i2 SEPTIC- TANK CAPACITY LEACHING FACIL= (type) 9 ( %z. k (size)-ySo NO.OF BEDROOMS L I BUILDER OR OWNER i Svl L r PERMITDATE: ` = { COMPLIANCE D Separation Distance Between the: i Maximum Adjusted'Groundwa[er Tible and Bottom of Leaching Facility' Feet I Private Water Supply Well and Leaching Facility (If any'wells existµ 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 facilit ). Feet ! • Furnished by f - :.,/DO /do X 2 0 C, 6. o e rr TOWN OF BARNSTABLE LOCATIO �' (�e��� O(Z �� SEWAGE VILLAGE 'C2,/�,k it] _ASSESSOR'S MAP & LO INSTALLER'S NAME&PHONE NO. ti `� nnmcm ml SEPTIC TANK CAPACITY i S d LEACHING FACILITY: (type) 4 l z. s ,(size) Cnl fit`E�rtn �2 NO,OF BEDROOMS BUILDER OR OWNER �r re PERMITDATE: /�Id CQMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table;and Bottom of Leaching Facility, Feet Private Water Supply Well and Leaching Facility (If-any wells,exist on site or within 200 feet of leaching facility) 7 { "'"_ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by--- -'' r sae. �1 q ��?. v78 . q � (�.cj -off c�7 3_12 Soy �� Fee��� THE COMMONWEALTH OF MASSACHU$ETTS Entered in computer: Yes PUBLIC PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASS'ACHUSETTS 01ppYication for Oigozat *pgtem CowAruction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) 216mplete System O Individual Components Loc�A dre r Lot No.i� � '1 Owner's Name,Address and Tel.No. Assessor's Map/Parcel a5$ - BSI Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 272 Lot Size dOU sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gy-5— gallons per day. Calculated daily flow gallons. Plan Date '-Se e. C 66 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �� izJ S ✓� 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 provisiotks of le 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is-ued by hi Boar Signed Date l/-9-cam Application Approved by -- Date it -/o t)!Z Application Disapproved for the following reasons Permit No. Date Issued F w S y ' Fee U Ir r THE COMMONWEALTH OF MASSACHUSETTS. Entered in computer:V Yes -PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS1 ' Zlpprica/tion for Migonf *pztem Cougtruction 3permit Application for a Permit to Construct( . j Repair( )Upgrade( )Abandon( ) f Complete System ❑Individual Components Location Address or Lot No.I CFL( (SC eyb�S GUgy j2 2 jV Owner's Name,Address and Tel.No. �+- (-I— Y f Assessor's Map/Parcel g _ CIS ( Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No." Type of Building: j Dwelling No.of Bedrooms Lot Size - dUU sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures °^ ' Design Flow 1-/Y5 gallons per day. Calculated daily flow gallons.] Plan Date Sew ?.o G`� Number of sheets Revision Date Title Size of Septic Tank /5 y d Type of S.A.S. (3 X Z- ` Description of Soil Nature of Repairs or Alterations(Answer when applicable) �E SC,e Sf�N 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 issueQby thi Boar�f H its h. 4Signed =— Date Application Approved by Date /I /�—G%V Application Disapproved for the following reasons t Permit No. )u o Ll S`C! 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 —T P d A. /ru at 1 �f oU�/z/GR S �R y '��i2X/ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 Uo(4—5�X dated l l- U'u y Installer Designer The issuance of thus permit shall not be construed as a guarantee that the systeit3 willf`unction as2lesign/ed. Date lyd Inspector f )&_� l `ti'! ffJJ G x No. 1)J/ S �4 Fee D U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS x1h5pozaf *pgtem Com5truction Vermit Permission is hereby granted to Construct( )Repair(•.-)Upgrade( )Abandon( ) System located at I 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 oft ' e f. Date: I ( ' t'� Approved by � �lnJr 21 TOWN OF BARNST.ABLE LOCATION w©a S C@]� SEWAGE VILLAGE tRAk et] ASSESSOR'S MAP & LO '6 INSTALLER'S NAME&PHONE NO. `� Mo a SEPTIC TANK CAPACITY r c� • LEACHING FACILITY: (type) V- ,(size)-,�,056 �rU ire I$nA 2 NO.OF BEDROOMS 3 BUILDER OR OWNER _ E,/,d rN`P SV.-A) PERMITDATE: ? COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility. Feet Private Water Supply Well and Leaching Facility (If any wells.exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by LwSp Post rRvOLe c- /¢ 13_ (2 47 Town of BArnstabte 114E14w Regulatory Services Thomas F. Geiler,Director MASS- Public Health Division 165.9, Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: A/01/, JV ZCP04 Designer: &T WAR,D 4r• )4rUg'1/ Installer: j �1p12 VU Address: QoX .S'/ Address: `1 47- On was issued a permit to install a (date) (installer) septic system at /44 G'oV&E"04-"t W,Q1/ based on a design drawn by (address) Cw.-VAV"z) dr llt1ZGg/ dated .Se.°W C Zoo- (designer) ✓ I certify that the septic'system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 1 certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical.relocation of any component of the septic system)but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. h tiNOF , 0./" EDWARD taller's Signature) E• H o. 261.00 as'aAL LAND s (Designer's Signature (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOT191 THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PITULYC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form F THE r °rfti Town of Barnstable Regulatory Services sARNSTASLE, * Thomas F. Geiler,Director 9 MASS. �p 1 39• Public Health Division rFn nna't°` Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Elaine C. Borowick Date: September 21, 2004 P.O. Box 304 Barnstable, Ma. 02632 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. Several months have passed by since you have been ordered to repair your "failed" septic system located at 144 Governor's Way, Barnstable, Ma. 02632. You are reminded that you are ordered to hire a professional engineer to design a replacement septic system and to hire a licensed septic installer to replace the system on or before November 1, 2004. You may request a hearing before the Board of Health if petition requesting same is received within ten days. Non-compliance may result in a non-criminal ticket citation of 100 dollars. Each day's failure to comply with an order of the Health Agent shall constitute as a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health CC: Board of Health Ino_engineerplan BROWNtech Document Management Systems Page 1 of 1 Barnstable County Registry of Deeds John F. Meade All Records by Property Adr Property Addr: 144 GOVERNOR'S WAY Search Date: 01-01-1998through 04-05-2004 Town: Barnstable Document types: Deed document group Database searched: All Land records from 01-01-1998 through 04-05-2004 This may not be a complete listing of activity for the address you are searching. The Registry only began indexing street address information in 1994 and we index the address provided to us by the party recording the document. We have no way of verifying that the address given to us is correct or complete. We provide address information as a search aid only and it should not be relied upon as an accurate reflection of all activity for a given property. PROPERTY ADDRESS LIST 12363-336 Recorded: 06-25-1999 @ 12:42:00pm Inst#: 50405 Chg: Y Vfy: Y Grp: 1 Type: Deed Doc$: 1.00 Desc: 12 214/77 Town: BARNSTABLE Addr: 144 GOVERNORS WAY Gtor: BOROWICK, ELAINE C (&0) Gtor: BOROWICK,30SEPH 3 (&0) Gtee: BOROWICK, ELAINE C No (more) matches found HOW TO USE THIS PAGE To see summaries of the next sequential docuuments, click on Next>. To see the previous panel displayed, click on <Previous. To view an abstract, click on the document icon with the "A". To view an image, click on the document icon with the "V". To view an abstract of a referenced document, click it's hyperlink. Most images you will view and/or print will not have marginal reference notations on the image. If you are interested in marginal reference information for a particular instrument/document, check and optionally print the abstract for it. There is no fee for printing abstracts. To print the abstract, right click on the abstract side (not the left side) and, for Internet Explorer, select"Print". http://199.232.150.242/ALISIWW400R.HTM 5/6/2004 Town d Badttable Department of Health Safety and Environmental Services P Public Heal visio am eet Z. 273 5®2 581 s�-����$POSTAGE # JAN24 .i ox 534 00 !y� t i Hy f {R ✓8 ME 7EA •� # rY�/.11Y1 1 ✓}1 613844.3 - .�. 1st NDTICEA - K 2nd NOTICE 9 0,o�'Z A1D, JOS H J. ICK �G ° •�';;• sue° ^, °/ E C. ROW 0� °`R .a a ti 3;9rr qC/110 , •���r�01. °a9 ,J44 GOVERN . r01 'led Q'a O O; pie, c •9.�b , m N 'r0 4dr H. f O Y r �' i O � roi ,�. '';�;�Qe� �'�'U���`°� so,4ted IVY Kfu r.; reet fy9 Lam •I �,S�U — r'�_�_`---T- •r�! �.li?ili?�f�?�11?�-}:i'?}i.??�j��4?I?ii�:?i��}?!�??ll?��4?�#}{l i7if� c amen�ffw -,2^v - 0 SENDER: I also wish to receive the :o ■Complete items 1 and/or 2 for additional services. 40 ■Complete items 3,4a,and 4b. following services(for an •► ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address d Z permit d m ■Write'Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N .t. ■The Return Receipt will show to whom the article was delivered and the date a delivered. Consult postmaster for fee. f v 3.Article Addressed to: 4a.Article Number --7" 93 a 4b.Service Type m 0 ❑ Registered ® Certified N �� .�,�� ❑ Express Mail ❑ Insured .5 cc ❑ Return Receipt for Merchandise ❑ COD p 7.Date of Delivery J � p z Zft . \ H 5.Received By:(Print Name) 8.Addressee's Address(Only if requested c and fee is paid) r g 6.Signature: (Addressee or Agent) t i i t i f t i PS Form 3811, December 1994 102595-97-B-0179 Domestic Return Receipt � ,. Town of Barnstable Department of Health, Safety, and Environmental Services sAE1V8Ti►ilb, 16 9. A�� Public Health Division 367 Main Street, Hyannis MA 02601 Office: 508-862 4644 Thomas A McKean,RS,CHO FAX: 508-790-6304 Director of Public Health TO: JOSEPH J. BOROWICK DATE: JAN. 20, 2000 % ELAINE C. BOROWICK 144 GOVERNORS WAY BARNSTABLE, MA. 02630 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE-5. .. - The septic system owned by you located at 144 GOVERNORS WAY was inspected on 8/26/96 by ROBERT BORTOLOTTI a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: r� BACKUP OF SEWAGE INTO FACILITY OR SYSTEM COMPONENT DUE TO AN OVERLOADED OR CLOGGED SAS OR CESSPOOL.I) The above system, according to our records has been in a failed state for more than two years. Therefore, you are directed to hire a licensed Town of Barnstable septic system installer to sketch a proposed system that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. The septic system must be brought into compliance within (30) thirty days of your receipt of this directive. You are also directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into buildings, onto the surface of the ground, or into surface-Waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. ZE �FBOARD OF HEALTH T omas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable WONg A m ru PU Postage $ED _ 1 Er Certified Fee �Ztrwk �t Raw-Receipt ired)Fee ' c -7 5 �� Here 0 (Endorsemerrt Requ O Restrlctrei Delivery Fee p (Endorsemerrt Required) U�jPS C3 Total Postage a Fees Elaine C. Borowick P.O. Box 304 �4) o Barnstable;Mw02630 rti Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece o A signature upon delivery- lo A record of delivery kept by the Postal Service for two years Important Reminders: n Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. o Certified Mail is not available for any class of international mail. e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. p For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. •For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". n If a postmark on the Certified Mail receipt is desired,please present the arti- cle at:this post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,January 2001 (Reverse) 102595-M-01.2425 1 ti, �o�t"E'wyti Town of Barnstable Regulatory Services * BAMSTABLE, * Thomas F. Geiler,Director 9 MASS. 1639. Public Health Division Arfp�.�A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Elaine C. Borowick Date: April 28, 2004 P.O. Box 304 Barnstable, Ma 02632 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic system owned by you located at 144 Governor's Way, Barnstable was inspected on, 8/26/1996 by Robert Bortolotti, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Backup of sewage into facility or system component due to an overloaded or clogged-`SAS or: cesspool. >. Our•records show that the system has been in a failed state for more than two years. ` You are:ordered to hire a professional engineer or registered sanitarian to prepare a plan .of proposed replacement septic system component(s). This plan is to be submitted to the Town of Barnstable Public Health Division Office (Regulatory Services, 200 Main Street,Hyannis), within (90) days receipt of this letter. The plan will bring the septic system into compliance with 310 CMR 15.00,The State Environmental Code, Title V. You are also ordered to upgrade or replace the septic system within six months (180) days of your receipt of this letter. �— Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. You have the option of requesting an adjudicatory hearing pursuant to 310 CMR 15.422 i ;McKean, w' h this order will automatically result in a public hearing scheduled before the Board OARD OF HEALTH R.S., C.H.O. Agent of the Board of Health CC: Board of Health Ufai]ed_sept ic_l etters I Septic inspection Information 12/2/1997 258 ' ? t .:. 051 »f3uS36Et4F ` Elie ' 144 ' <' Barnstable »» € ?r< Robert Bortolotti >`>> IF ........................ ........................ ' i>rt Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. a ' 1/2012000 '` # Installer ........... > F(i3'; E3 4tlk' 2/20/2000 e BROWNtech Document Management Systems Page 1 of 1 Barnstable County Registry of Deeds John F. Meade All Records by Property Adr Property Addr: 144 GOVERNOR'S WAY Search Date: Town: Barnstable Document types: *ALL Database searched: All Land records This may not be a complete listing of activity for the address you are searching. The Registry only began indexing street address information in 1994 and we index the address provided to us by the party recording the document. We have no way of verifying that the address given to us is correct or complete. We provide address information as a search aid only and it should not be relied upon as an accurate reflection of all activity for a given property. INI li ij'I giJll I ti ,JI 'i�V'�iIICJ illl`I�IMIVI iI�I PROPERTY ADDRESS LIST 15741-192 ffi `° ;� Recorded: 10-15-2002 @ 2:14:24pm Inst #: 90020 Chg: N Vfy: N Grp: 1 Type: Mortgage Doc$: 25,000.00 Desc: 12 214/77 Town: BARNSTABLE Addr: 144 GOVERNORS WAY Gtor: STANLEY, ELAINE C Gtee: CAPE COD COOPERATIVE BANK No (more) matches found g HOW TO USE THIS PAGE To see summaries of the next sequential docuuments, click on Next>. To see the previous panel displayed, click on <Previous. To view an abstract, click on the document icon with the "A". To view an image, click on the document icon with the "V". To view an abstract of a referenced document, click it's hyperlink. Most images you will view and/or print will not have marginal reference notations on the image. If you are interested in marginal reference information for a particular instrument/document, check and optionally print the abstract for it. There is no fee for printing abstracts. To print the abstract, right click on the abstract side (not the left side) and, for Internet Explorer, select"Print". http://199.232.150.242/ALIS/WW400R.HTM 3/31/2004 BROWNtech Document Management Systems Page 1 of g Y g 2 Barnstable County Registry of Deeds John F. Meade All Records by Property Adr Property Addr: 144 GOVERNOR'S WAY Search Date: Town: Barnstable Document types: *ALL Database searched: All Land records This may not be a complete listing of activity r'or the address you are searching.The Registry only began indexing street address information in 1994 and we index the address provided to us by the party recording the document. We have no way of verifying that the address given to us is correct or complete. We provide address information as a search aid only and it should not be relied upon as an accurate reflection of all activity for a given property. � ^,°i+*nd a r+ aY'o1�979y r i 1�ji� r� PROPERTY ADDRESS LIST 10361-13 ' ll Recorded: 08-26-1996 @ 1:20:00pm Inst #: 48481 Chg: N Vfy: Y Grp: 1 Type: Mortgage Doc$: 100,000.00 Desc: 12 214/77 Town: BARNSTABLE Addr: 144 GOVERNORS WAY Gtor: BOROWICK,JOSEPH 3 (&O) Gtor: BOROWICK, ELAINE C (&O) Gtee: NORTH AMERICAN MORTGAGE CO Ref By: 11-07-1997 Assignment In book: 11051-106 Ref By: 11-21-2002 Discharge In book: 15950-215 10390-236 Recorded: 09-16-1996 @ 3:40:00pm Inst 4: 52761 Chg: N Vfy: Y Grp: 1 Type: Discharge Refers to Book: 5479-44 Town: BARNSTABLE Addr: 144 GOVERNORS WAY Gtor: FLEET NATIONAL BANK Gtee: BOROWICK,JOSEPH 3 (AS ID AS TR&O) Gtee: BOROWICK, ELAINE C (AS ID AS TR&O) Gtee: BOROWICK REALTY TRUST (BY TR&O) 11051-106 Recorded: 11-07-1997 @ 1:19:00pm Inst #: 65647 Chg: N Vfy: Y Grp: 1 Type: Assignment Refers to Book: 10361-13 Town: BARNSTABLE Addr. 144 GOVERNORS WAY Gtor: NORTH AMERICAN MORTGAGE CO Gtee: G M A C MORTGAGE CORP p 14 ya54*p�s+Fi°i F*919��° 'I til ii�ili9 ��liilli�p�I,V��i Vl�ii r r a r�l i y HOW TO USE THIS PAGE To see summaries of the next sequential docuuments, click on Next>. To see the previous panel displayed, click on <Previous. To view an abstract,click on the document icon with the "A". http://199.232.150.242/ALIS/WW400R.HTM 3/31/2004 BROWNtech Document Management Systems Page 1 of 2 b, Barnstable County Registry of Deeds John F. Meade ,All Records by Property Adr Property Addr: 144 GOVERNOR'S WAY Search Date: Town: Barnstable Document types: *ALL Database searched: All Land records This may not be a complete listing of activity for the address you are searching.The Registry only began indexing street address information in 1994 and we index the address provided to us by the party recording the document. We have no way of verifying that the address given to us is correct or complete. We provide address information as a search aid only and it should not be relied upon as an accurate reflection of all activity for a given property. r 11434{1(17i�?'i PAl}9ii'll'it %":W�Pi4194A i%14tt P1g���=,a�,q PROPERTY ADDRESS LIST 12363-336 N RIWA� Recorded: 06-25-1999 @ 12:42:00pm Inst #: 50405 Chg: Y Vfy: Y Grp: 1 Type: Deed Doc$: 1.00 Desc: 12 214/77 Town: BARNSTABLE Addr: 144 GOVERNORS WAY Gtor: BOROWICK, ELAINE C (&O) Gtor: BOROWICK,JOSEPH J (&O) Gtee: BOROWICK, ELAINE C Recorded: 10-15-2002 @ 2:14:24pm Inst #:.90018 Chg: N Vfy: N 15741-174 .;;»fir Grp: 1 Type: Certificate Of Municipal Lien Desc. 12363/336 Town: BARNSTABLE Addr: 144 GOVERNORS WAY Gtor: STANLEY, ELAINE C 15741-175 Recorded: 10-15-2002 @ 2:14:24pm Inst#: 90019 Chg: N Vfy: N Grp: i Type: Mortgage Doc$: 72,000.00 Desc: 12 214/77 Town: BARNSTABLE Addr: 144 GOVERNORS WAY Gtor: STANLEY, ELAINE C Gtee: CAPE COD COOPERATIVE BANK I HOW TO USE THIS PAGE To see summaries of the next sequential docuuments, click on Next>. To see the previous panel displayed, click on <Previous. To view an abstract, click on the document icon.with the "A". To view an image, click on the document icon with the "V". To view an abstract of a referenced'document, click it's hyperlink. Most images you will view and/or print will not have marginal reference notations on the image. If you are interested in http://199.232.150.242/ALIS/WW400R.HTM 3/31/2004 . C CI O Postage trI Certified Fee CEI 7 ( PostmargY Return Receipt Fee UP Here �C M (Endorsement Required)Iq �7 N Restricted Delivery Feed � (Endorsement Required) p Total Postage&Fees $ y a Si Elaine C Stanley,& E C Borowick s P.O. Box 304 ,,; o Barnstable, MA A2630.1, Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece o A signature upon delivery o A record of delivery kept by the Postal Service for two years Important Reminders. o Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this.receipt and present it when making an inquiry. PS Form 3800,May 2000(Reverse) 102595-99-M-2087 Town of Barnstable � OF1ME T� o Regulatory Services snxr«STABIU, Thomas F. Geiler,Director 9 , : `0$ Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Elaine C. Borowick Date: 8/1/02 144 Governors Way Barnstable, MA 02630 FINAL NOTICE ORDER TO COMPLY WITH 310 CMR 15.00,THE STATE ENVIRONMENTAL CODE,TITLE 5. Our records indicate the septic system owned by you located at 144 Governors Way Barnstable, Ma was inspected on 8/26/96,by Robert Bortolotti a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: Backup of sewage into facility or system component due to an overloaded SAS. According to Title V, the owner had two (2) years to repair or replace the system. More than two years has past since the date of this inspection. You were previously notified of the failed septic system. However, the system has not been repaired as required as of this date. Therefore, you are directed to hire a licensed professional engineer (PE) or Register Sanitarian (RC) to design a system that will bring the septic system in compliance with 310 CMR 15.00, The State Environmental Code,Title 5 within twenty-one(21)days of your receipt of this letter. You are also directed to hire a licensed septic system installer to install the system components within forty-five (45) days of your receipt of this order. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. Failure to comply to this order of the Board of Health, may result in court action against you the owner of this property F TH BOARD OF HEALTH o as c ean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable Town of Barnstable Assessors Division Page 1 of 3 ./' rts k'hr _-+.Y ;4�4.. L ( wq¢ 5PY x" 9 �'" _Fl. "mt trite, yk n,TMwm xefi�N �� -; Your Location : Home :Town Departments : Administrative Services :Assessors Division : Property Results <<Back-Forward>> Thursday, May 30, 2002 Assessors Division- Property Results Data is based on Fiscal Year 2002 Assessor's Fiscal Year 2002 Assessed Values database and is provided for information Tax Information purposes only.. Sales History Land and Building Description Construction Details «Search Again Out Buildings & Extra Features Building Sketch 144 GOVERNORS WAY Map/Parcel/Parcel Extension: Mailing Address: 258/051/ STANLEY, ELAINE C Owner of Record: BOROWICK, ELAINE C P O BOX 304 Property Location: BARNSTABLE, MA 02630 144 GOVERNORS WAY Parcel ID:258051 Fiscal Year 2002 Assessed ValuesA n Top Appraised Value Assessed Value Building Value: $ 135,700 $ 135,700 Extra Features: $2,500 $2,500 Outbuildings: $0 $0 Land Value: $62,000 $62,000 Totals: $200,200 $200,200 Tax Information n op Town Tax $ 1,853.85 Tax Rates(per$1,000 of valuation) BARNSTABLE FD $52252 Town 9.26 TAX . Fire District Rates Land Bank Tax $55.62 Barnstable 2.61 C.O.M.M 1.38 Cotuit 1.69 Hyannis 2.54 Total: $2,431.99 W. Barn. 1.54 http://www.town.bamstable.ma.us/ComeOnhi/Department.../resultsk02.asp?MAPPAR=25805 5/30/02 Town of Barnstable Assessors Division Page 2.of 3 utner Kates -Total does not include special assessments- Land Bank 3%of Town Tax Due to rounding differences these values are approximate. Sales History ^Top Owner: Sale Date: Book/Page: Sale Price: BOROWICK, JOSEPH J 8/15/1996 10361009 $ 1 BOROWICK, JOSEPH J & 3258/ 141 $0 STANLEY, ELAINE C 6/25/1999 12363/336 $0 Land and Building Description ^Top Land. Building Lot Size(Acres): 0.55 Year Built: 1970 Appraised Value:$62,000 Living Area: 2222 Assessed Value: $62,000 Replacement Cost: $ 161,576 Depreciation: 16 Building Value: $ 135,700 Construction Details ^Top Style: Cape Cod Interior Walls: Typical Model: Residential Interior Floors: Hardwood Grade: Average Grade Heat Fuel: Oil Stories: 1 1/2 Stories Heat Type: Hot Water Exterior Walls Wood Shingle AC Type: None Roof Structure: Gable/Hip Bedrooms: 3 Bedrooms Roof Cover: Asph/F GIs/Cmp Bathrooms: 1 1/2 Bathrms Total Rooms: 7 Rooms Outbuildings &Extra Features ^Top Code Description Units/SQ FT Appraised Value Assessed Value FPL2 Fireplace 1 $2,500 $2,500 Building Sketch ^Top r�7 A J A' http://www.town.bamstable.ma.us/ComeOnhi/Department.../resultsk02.asp?MAPPAR=25805 5/30/02 Town of Barnstable Assessors Division Page 3 of 3 Map Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area (Unfinished) FTS Third Story Living Area (Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area (Unfinished) FAT Attic Area (Finished) GAR Garage UTQ Three Quarters Story(Uni FCP Carport GRN Greenhouse UUA 'Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfi FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) Back - Forward Home I Departments (Town Information I Contact Town Hall Website Developed and Maintained internally by the Town of Barnstable Information Systems Department Town Hall-367 Main Street-. Hyannis,MA-.02601 -508-862-4000 DISCLAIMER: Although we.strive to provide.accurate information,we are.only human. Please.consult directly with the appropriate department if there is a question of accuracy. Copyright 20010 Town of Barnstable. All Rights.Reserved. http://www.town.bamstable.ma.us/ComeOnIn/Department.../resultsk02.asp?MAPPAR=25805 5/30/02 yzr a Septic Inspection Information Data'Entry Date 12/2/97 Septic Inspect Nor, Assessors Map; 258 Parcel': 1051 Lot Business Nurri6er" 144 Addr s Governor's Wav Vulage>;; Barnstable Inspector:, Robert Bortolotti Inspect date 8/26/96 System Status F Comments Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Permit`# Rep'' "ai�,Date: Notification DRC 1/20/00 tr g/Installer:,, Installer Repair Deadline D e 2/20/00 I pf1HE Toy, Town of Barnstable Regulatory Services 9 MASS. Thomas F. Geiler,Director 1639. �prED MA'S A`e Public Health Division Thomas McKean,Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TO: Joseph J. Borowick Date: September 20, 2000 % Elaine C. Borowick 144 Governors Way Barnstable, Ma. 02630 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 144 Governors Way, Barnstable Mass. was inspected on,by Robert Bortolotti a Massachusetts licensed septic inspector The inspection of your septic system showed that your system failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. Our records show that the system has been in a failed state for more than two years and you were notified by certified mail on 4/24/00 of this septic systems failure. This order shall serve as your final notification before the Board pursues court action. Therefore, you are again directed to hire a licensed Town of Barnstable septic system installer to sketch a proposed system into compliance with 310 CMR 15.00, The Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. The septic system must be brought into compliance within (30) Thirty days of your receipt of this directive. You are also directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into buildings, onto the surface of the ground, or into surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health q\hn1th\dbfi1.\d&5i.da ,71 273 502 581 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sent t S Numb o ice,St e, e Postage Certified Fee Special Delivery Fee Restricted Delivery Fee u� rn Return Receipt Showing to Whom&'Date Delivered n Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees Postmark or Date / ti V V U) CL f i Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the QQ) return address of the article,date,detach,and retain the receipt,and mail the article. cc LO 3. If you want a return receipt,write the certified mail number and your name and address °) rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the C CD addressee,endorse RESTRICTED DELIVERY on the front of the article. 000 M 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item i of Form 3811. 6. Save this receipt and present it if you make an inquiry. 102595-99-M-9979 «• n. 4� I � ,. Town of Barnstable � Ae Department of Health, Safety, and Environmental Services 19. Public Health Division 367 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A McKean,RS,CHO FAX: 508-790-6304 Director of Public Health TO: JOSEPH J. BOROWICK DATE: JAN. 20, 2000 % ELAINE C. BOROWICK 144 GOVERNORS WAY BARNSTABLE, MA. 02630 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. - The septic system owned by you located at 144 GOVERNORS WAY was inspected on 8/26/96 by ROBERT BORTOLOTTI a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: BACKUP OF SEWAGE INTO FACILITY OR SYSTEM COMPONENT DUE TO AN OVERLOADED OR CLOGGED SAS OR CESSPOOL. The above system, according to our records has been in a failed state for more than two years. Therefore, you are directed to hire a licensed Town of Barnstable septic system installer to sketch a proposed system that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within(14) fourteen days of receipt of this notice. The septic system must be brought into compliance within (30) thirty days of your receipt of this directive. \ You are also directed to maintain the system by hiring a licensed se to a hauler to pump the septic system to prevent discharge of sewage or effluent into buildings, onto the surface of the ground, or into surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable Town of Barnstable • Department of Health, Safety, and Environmental Services ��� Public Health Division 367 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A McKean,RS,CHO FAX: 508-790-6304 Director of Public Health TO: JOSEPH J. BOROWICK DATE: JAN. 20, 2000 % ELAINE C. BOROWICK 144 GOVERNORS WAY BARNSTABLE, MA. 02630 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 144 GOVERNORS WAY was inspected on 8/26/96 by ROBERT BORTOLOTTI a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: BACKUP OF SEWAGE INTO FACILITY'OR SYSTEM COMPONENT DUE TO AN OVERLOADED OR CLOGGED SAS OR CESSPOOL. The above system, according to our records has been in a failed state for more than two years. Therefore, you are directed to hire a licensed Town of Barnstable septic system installer to sketch a proposed system that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within(14)fourteen days of receipt of this notice: The septic system must be brought into compliance within (30) thirty days of your receipt of this directive. You are also directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into buildings, onto the surface of the ground, or into surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable E X4 -M .................... "M Z* VON, K�. X. ................ ME 51 W*J258 51 0000000 MR MIR. M. .................. .. 55 OROWICK,JO 101 ........... . ..M BOROWICK,ELAINE C ..A x---z 00 44 GOVERNORS WAY ARNSTABLE !630 MA 0263 TOT, k—.,Vk -g� .M 4 i**M.C 01% .0 1036 -ZO.� B ... ........ ........... 0000000 Mz �M 0125 ....... 618 UPM. ssigned Road Name ........... ,�X .............. *.......... O�eZZ .......... ON i i Sewer Information Y1 12/2197 �:.�6:4:< 258 <.«:. 1051 a.m B lGovemors Way Barnstable U Robert Bortolotti F Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. WIN I MEN : aH,.i; - 10? OF FOUNDA110N CONCRZ +E. COV=•=tS 37-rr " 4 G-ST IRON 9'' n 4-S..''-4=LT SO �V-C. 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