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HomeMy WebLinkAbout0010 KIDD'S HILL ROAD - Health 10 Kidd's Hill Road 1r. Barnstable P .ate A = 276 014 , 1 I a T4 t3F BARNST LE L(?CA'lE'tONkr- s �7 l 1 SEWAGB# YB� FSSOWSI MAP LOT E'. J lt'S KAXE c PY4Nt PtO o.'OFS Sapon D�tancc,Be�rr,�n�a' _ �:. Mex�ntukn Ns C oan�we Leto the Bott6m of Lea..... . a ty Feet� ituiratei�il8ttUpFrNe3t ang E �Y�r exist Qllt¢Ct Wlt�tit!-77 ??� Si` friBE:IY� Feat Eti�G YJ£ 8 d BA�, .i"o, }tj+ We{ietlta5 BX�Si within 3l�0'fxet afteacEt�a� � , � .,. Feet � C 1c s a i ' Commonwealth of Massachusetts . r* 1. ;!, r Mtn Title 5 Official Inspection. Form' 1-4 :} } ,.0 Subsurface Sewage:Disposal.System Form.-Not for,Voluntary,Assessments 10 Kidds Hill Rd ofii Irilw' a: r,>' 0 0 Property Address Geraldo Defreitas awlI1^ G Owner Owner's Name information is ✓ r r required for every Hyannis' '&Yn S'f*b(C ",. MA 02601 4-2-21,r- " page. City/Town ,e, State Zip Coder / Date of Inspection ♦. Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the�end of the form. A. Inspector Information Shawn Mcelroy . . r,, #w %I r ..s#e: .:��e•^t a•.,r• pd�:r r -i�• . ...#+ •:: i+c .. •� r .ssr. r Name of Inspector 31 ie. r fF. •.a ' { 1?Cfb< r: C fillkr) ,'11 G i YAI 1 f,i F f11 Upper Cape Septic Services Company Name P.O. Box 73 etr^rfrr�•!t,n Company Address East Falmouth r+ ri,K.o•, �;%1110lo ripi? ur, 'lie,rr,,!. MA'r1'-rr , 1wi-0 ni at rnoz''02536 Cityrrown lErAJI it +sir)+,;0.1 tilis LState':Vl± 't4 iot #iesj fn-' 0.1ip Code 508-495-0905 - S13971 Telephone Number License Number B. Certification I certify thata am a DEP approved system inspector in,full�compliance�with,Section 15.340 of Title 5 (310 CMR 15.000);I have personally inspected the sewage disposal system at the;properly address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was perfo'mied based on my training and experience In the'proper_function and mairitenancf3'of"on-site rsewage'disposal'syste`ms'Afte c�onductirig his5inspetio� l have determined that the system: 2., ❑,_I Conditionally,Passes, ri;3c''b!o ct,%P, or ,tr%t t. 1;fern e_,r#•,v i;,or:� o1+T .r ,r 1i. -I .' �._,,• .:i ,! . �.) �i.'i.r 1�^;'. 'iQ+l tif?l�ii i.'� .[7.' iF,'Qr1�! if}!i'S�7.t:..i1Jc'a'..1.ft�`..� r�i�rt C��'�!U ,3. ❑LNeeds Further.Evaluation,by;thei Local Approving Authority i•.ref it 4. ❑ Fails t r `sl AU."111,14 iPi l't,) iU)i l'auaf - t!elfl llzlt)m A �E 7S twsrti aes ;,r .II,#f srI1 fr:Li p ilmn1ifi ea:tlulufr*0 In ector's Signature Date - The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 4 - c y� Commonwealth of Massachusetts -: _ .,a _ r ; ' Title 5 Official- Inspection For&' Z` a �, - .11 1 Subsurface:Sewage Disposal System,Form:-Not for Voluntary;Assessments : 10 Kidds Hill Rd Property Address t Geraldo Defreitas ' Owner Owner's Name information is required for every Hyannis } - '' MA 02601.c• . _.4-2-21 r ; page. City/Town State Zip Code Date of Inspection C. Inspection Summary fl. ' -t r7 3�5 f�► t, .1E .t1 "'! r � P. . + .9 �.t .'f I'1 � . Inspection Summary: Complete'l,-2, 3; orS and all of 4`and'6:' 1) 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,chtena not evaluated are indicated below. `' .. r Comments: System is in good working order with no sign of failure. Recommend pumping septic tank and leach field annually for maintenance and to prolong life. 2) System Conditionally Passes-'" ,. 'c �•� " a ra h ... •r- !• n �❑ One`or more system components as described in the ConditionalPass..section need to be t replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board'of'Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic ta6k'(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank-is replaced with alcomplying septic tank as'approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ON r w❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 4N, Commonwealth of Massachusetts 4. f Title 5 OfficiAl Iftpe.didn'...-Foft/ r,� �I Subsurface Sewage Disposal System Form,.-'.NotforVol u ntary-Assessments,: 10 Kidds Hill Rd Property Address Geraldo Defreitas Owner Owner's Name Information is required for every Hyannis,';.,_ MA 02601 4-2-21%ii page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally,Passes,(cont.): G,., 11rjj,j. ;?j .,,,C! -tj; El Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms - kb repair6d.- vlc d J ij 4o-isrft z nk :,�nlmo.l j-P -1 ruat V I�­t;j S.: i ­% 'Tmala+3 El Observation of sewage backup or breakout or high static water level inJhe distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will j6fr ;111 VI L pass - ' " .6- . pa s inso6cti'bln if Boa�d6f He"a'lth): - ­7­ lip, !; at %F"'I'L -jtr-'.,Lie .,i 'v) • -1 brokie'n,pip' e(s) are replaced' ND (Explain below): N N D (Explain below): o truction is'removed El- '0" - 'distribution box i§,IeVeledorrepladed ,-- ElY' MNP­',E] ND (Explain below): mel,;­'' >ldT k ji,(t ift 1-i tnp, A. J! uvii ri h :2.31! 'a", elfV, A - , ,C. El The system required pumping more than 4 times a year due to broke'n:or,obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): El broken pipe(s) are replaced Ely F-1 N ❑ ND (Explain below): El obstruction is removed - Ely ON ❑ ND (Explain below): 3) Further Evaluation is Required by the'Board,of Health: El Conditions exist which require further evaluation.by.the Board of Health in order to determine if 1 1 .." i.r,. W-1414 rifh4"'Sy'stile'n'is'fa­il`inT6 to­p,Wo"te'c't'pu,bli6, he�lth, safety or th'e'environment. a. System will pass unless Board of Health determines in accordance with 310 CMR L 16.303(l)(b)that the system is not functioningmanner which will protect public health, t safety y and theenIvironineint: in a , t5insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Officialtlhspection F®r li Subsurface Sewage Disposal System'Form -Not for Voluntary Assessments . . .7 -s, ?` 10 Kidds Hill Rd + �` Property Address Geraldo Defreitas t Owner Owner's Name f information is H annis Y ' MA 02601 4-2-21 required for every y page. City/Town r xst l r State Zip Code Date of Inspection , C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a'surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetiand or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ' ❑The system has a septic tank and soil absorption system.(SAS) and the SAS is within 100 feet of a surface water supply Ior tributary to a su,rface water supply. ❑The system has a septic tank and SAS and the SAS is,within a Zone 1 of a public water supply,. - ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑The system has aseptic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. a c. Other: 31 4) System Failure Criteria'Applicable to All Systems-- You-must indicate "Yes"or"No"�to�each of the'following�for all inspections: Yes , No r .ii, El '® _ .'Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ' - ' ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 f Commonwealth of Massachusetts f. Title 5 Official: inspection F:®e f -i Subsurface Sewage,Disposal System Form_=Not for,Voluntary Assessments 10 Kidds Hill Rd Property Address *,,;a+.+.,• r Geraldo Defreitas �;#�:rtE o�i�.-• Owner Owner's Name information is MA 02601 4-2-21,.1 ,.,Hyannis I required for every oe%1 yi .0, g+l page. City/Town �.: 1.5+'. State Zip Code Date of Inspection C. Inspection Summary (cont.) t11; :� 1r1`.4,�fi E.,l .► "?"�E�" : k r 4),,System Failure,Criteria_ Applicable to All Systems: (cont.),10%.•pu,,r '7,114;j sJ)Y 1: ' " ' Pe:rf ' r„• ,''1..t + n.f i is.•� rrkkP';sr,�. i'. ,Jrttt-,; tkJ f{JE sc, .�• JI '��i':"i;�ryF?"t.:+ .i' r�fi Yes; r .No Irt iv it"t{7"t Zif3 i►G. C 'llv.ici�. .}trl!"l ,�,Pa c� T ;jt C IrJ' a� •. I'4ri•. * i r,,Re.M .' ..tf, ,',1 .,+E,.i,.. ^ !#". ,f fl. ••• / wir ra,.t3. .�/.t.,s�r1e 'tJ"'�z �••�` 1-r` }� .:-, 7. h- , Static liquid level in the dlstri6utlon box above outlet invert due to an overloaded ❑ ® "rn fo'r'clogged''SAS or cesspool' "j, ", , r„"'o . l..,,.; Liquid depth in cesspool is less than 6" below.invert or available volume is less ❑ . ®t t�'cthan '/Z day flow a kAj- �3 ' ta`. :Sr ,J''J.I. ,. It 11 4 ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: n'rr r ❑ _:,. ®<<e,., ,Any portion,of,the SAS,;cesspgol`or privy is below high.ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or r `' ❑r°' '' ® '{ R 'tributary to a surface water supplyJ' �- Any portion of a cesspool or privy is within a Zone 1 of a public water supply "'®t Any portion of a cesspool or privy is within 50 feet of a private water supply well. If: iJ�s,,, ,,.� , nr .t r;: •rr«, +r='I :G`ft:':,C .:' 7 ' 1 ❑ ® Any portion of a cesspool oraprivy is less than 100 feet but greater than 50 feet from a private water'supply well with no acceptable water quality analysis. [This .system passes if the,well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence ;of ammonia nitrogen and nitrate nitrogen is_equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.]' *� The system is a cesspool serving a facility with a design flow of 2000 gpd- :1 Q00 f;. I .,1•, + !.❑, f, ®t:fS :� gpd.'7:,"{a"'Nr+. + S.;I• 1ta r+ 1 J 4 '0 f'c 4:,+ . . •. fit•.:_ , - i1,:J; ! ,, r „ �:'•.. ^ �.: " *t �' .:'+°f The system fails. I have determined that one or more of the above failure '/ `"❑ t'' " ® F -q' criter a'exist as'described in 310'CMR'15.303,therefore the system fails. The ,', �3 r ic1 :�_ n•;. ,rrn ,,y,� t,h system'owner,should con tact-theBoard of Health to determine what will be (, ,, ,._ ;Y 1, necessary.to correct the,failure.`.r,yr, t r ;• ",f1 ' r•, r c `: 1 "r .�;. � Ti'0., 13r1L W 111ia+ IM-.1r3•. i i;V4I`-d 5) Large S_ystems:To be considered a large system the system must serve a facility with a design `t flow of 10,000 gpd to"15,000 gpd." '`' ' ' ` ' ' -tr:c ;,++J ,..� _—,For large systems, you-must indicate either;yes";or„'no"to each of the following, in addition to the j,;_.questions'in;;Section,C.47t;aarx ar ai Yes No + ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 m, Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts • ss y13 Tale 5 C� ocial it nspec a®n Fo m, nl Subsurface Sewage Disposal Zysteim -Not for Vol untary'Assessments ir•: , 10 Kidds Hill Rd c Property Address r, Geraldo Defreitas Owner Owner's Name yh information is 1 MA 02601 4-2-21• required for every Hyannis�':a- �• E +, ' •' page. City/Town c. State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the,system is-considered'a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should'contact the appropriate regional A'a"of thete'oirtment. 6. You must indicate "yes" or no for each of the following for all inspections: . r..t . t .. s Jf{1 �? •.'fd,�' i• `ii 1 rJr•.r.i1 ,i .JL 1 r Yes No jj ❑ i ®` Pumping information was provided by the owner,occupant, or Board of Health ®" Were,any of the system components pumped out in the previous two weeks? ®' t `❑ ' Has`the system received normal flows in the previous two week period? I Have large volumes of water,been introduced to the system recently or as part of El` ® this inspection? ` Were as built plans of the,system obtained and examined? (If they were not }r '' ®' '❑ ' " ' available note as N/A) `` A w L I [E (t, cF 1 ,3, Was the facility or dwelling inspected for signs of sewage back up? L. 1 i t. 1- v'' r '",f-.-. ". S ❑°. - .Was the site inspected for signs of break out? ®° ❑ 'Were all system components, excluding the SAS, located on site? ® A❑ Were the septic tank manholes uncovered, opened, and the interior of the tank N •y inspected for the condition of the baffles or tees, material of construction, dim ensions,'dept'h of liquid, depth sludge and depth of scum? r . ' z °Ei - : Wasthe 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 L been determined based on: Z • ❑ Existing•information. For example, a plan tithe Board of Health. rt. ft 1 •. ® ❑' ' �i- Determined in the field (if any of the failure criteria-related to'Part C is at issue approximation of distance is unacceptable)'[310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 r- Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts ' Title 5 OfficiAl- Ifspection. Fdkm6i ,--.):.-f � 0 Subsurface Sewage Disposal System Form_=Not,for(Voluntary.Assessments 10 Kidds Hill Rd Property Address •�, ;,,a, Geraldo Defreitas Owner Owner's Name .,k•F, .y„.r, ,- , information is required for every Hyannis man MA 02601 4-2-21. page. City/Town r t a. .r` x 4A State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: .a,c.'tub:rc�D dat'i 3 rr� uri�Fr;Eo4 x;;rf9D ' Number of bedrooms (design): 3 Number,of,bedrooms (actual): 3 DESIGN flowbased_on 310 CMR 15.203 (for.•example: 110 gpd x#,of bedrooms): 330 Description: ?�f � • l . i if;J?�i[�/:f31.{ill�i.`i Ian,t�-° li': xi ,f t Number of current residents: �_ i , ,, tF. ,, T,# Unknown ..Clt3�#97t�3,Crli, g:�ib.�i,1 .t a�v. 3 U. ,. s Does residence have a garbage;grinder?.t:'j, �fi, nj .s ��,ft erk. 'j;,�,,�y 9 :,1t.,-fjt7l✓1 El Yes ® No Does residence have a water treatment unit? -I °cvc 1i {r fq,r,;ry�� t ,�ttt js.jfe''sl ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry',system inspection El Yes ❑ No information in this report.) IMAI " "'jr-`J.' f y4.,�rt Laundry system inspected? - ❑ Yes ❑ No Seasonal use? - ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): 240gpd/2yrs Detail: n F .� Y� 12rJt�;,�.� lil : • �fi .1Rq ve Sump pump? L",4!M.44 :.lracrttta D r it ❑ Yes ® No `rufti.s Last date of occupancy: r t..i)atflarfpf.,)b h1gtrrr1 olfit>up 2.g-r s004- 4-2021 Date t5insp.doc-rev.7/26/2018 a -+ , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts + :l; ,'. Title 5 offici:ai inspection xi drm -M Subsurface Sewage Disposal System'Form -Not.for.Voluntary Assessments- 10 Kidds Hill Rd ' Property Address Geraldo Defreitas T Owner Owner's Name information is required for every Hyannis, MA 02601 4-2-21 page. City/Towri a State Zip Code Date of Inspection D. System Information (coot.) 2. Commercial/Industrial Flow Conditions: ' Type of Establishment: •. + ' '"" �" Design flow(based on 310 CMR 15.203):` Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other`(des 6e'tielow): 3. Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official inspection Form: ' I,I Subsurface Sewage,Disposal System,form -Not for•Voluntary Assessments 04 L+`.L i�. 10 Kidds Hill Rd Property Address Geraldo Defreitas Owner Owner's Name information is required for every Hyannis ' �, ' r'+3�'_'-t+ �.� MA 02601 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: t+,,#c, V*' IN �1:a_lo r hilin!;Aid-':ram ® ',Septic tank, distribution box, soil absorption system- El Single cesspool ❑. Overflow cesspool''; ❑ Privy. ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator.under contract, :► ❑- -%Tight tank.:Attach a;copy,of;the,DEP,approval:c! C f1a , ❑ Other(describe): Approximate age of all components;�date installed;(if known) and source of,information: 2014 Were sewage`'odors detected when arriving at the,site?;-u_;?tr,qvi frt►a Yes ® No 5. Building Sewer(Iocate;on site,plan):., ;+lotion 0i rY ov 1�roa!!"J 1 t11014 son3t i(l r 18" Depth below grade: 'Y�3f°.rt,",4.1;s> ri '.',feet' Material of coristruction"`roo bn� :t'�isi1 t:,"`^Gr lb�'i�'ii'iax'.k•T 5'�I 4T1 :.GI r,+)1 ?'ta irtyr3��91 try 5�'-'U,!`l .IY�rtTi lfi�Uf, ?# G9 :ti.f't k� •�$•1i`,�I r)£t1�1! ryrt.� hr,� olJhi ,; e. •`l�,+•�A•�t' 7(1 +toGn(!I a' ® cast iron ® 40 PVC - ❑'other(explain): - - Distance from private water supply well or suction line: feet Comments (on condition of joints, venting; evidence of leakage, etc.): Good condition. t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 16,1• ar " Commonwealth of Massachusetts • - - . '- f4 Title 5 ®fficia1 ftpectionfor ;%i Subsurface Sewage Disposal System Form—Not.fortiVoluntary Assessments a 10 Kidds Hill Rd Property Address Geraldo Defreitas i Owner Owner's Name information is r; Hyannis -° v ' MA 02601 required for every _ page. City/Town ��` State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): '' Depth below grade: ,. , .t) ,: f 12" feet Material of construction: ® concrete ❑ metal ❑ fiberglass :-Q polyethylene ❑ other(explain) 4 f l t If tank is.metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal IT Sludge depth: Distance from top of sludge to,bottom,of outlet tee or baffle. .20" ! Scum thickness 6" Distance from top of scum to top-of outlet tee.or baffle - 15" - Distance from bottom of scum to bottom of outlet tee-'or baffle),- !" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.)-,E. Tank is in good condition with baffles,installed and no sign of leakage. t5insp.doc•rev.7/26/2018- Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 i Commonwealth of Massachusetts Title 5 Official Iaispection: Fore. - rah Subsurface Sewage Disposal System,Form,-Not for Voluntary.-Assessmdnts.,,;lc- *m :. 10 Kidds Hill Rd "N 41 Property Address Geraldo Defreitas Owner Owner's Name information is Hyannis; -i, i o--,30 110, MA 02601 4-2-21 required for every page. City/Town' +' :r--e State Zip Code Date of Inspection , D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: . feet L ." Material of,construction: ❑ concrete ❑ metal ❑ fiberglass -k):❑I polyethylene i-t_" ❑ other(explain): Dimensions: Scum thickness - Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle • Date of last pumping:k 'Date-— Comments(on pumping recommendations, inlet and,outlet tee orbaffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage;etc.)"t '`'�',"1"' ` "� ` ,r In.Eli- l"'4fuEy at 1, ', ' C) °Ft:u �?+. ( 01.=w f ,;Tl.11r ; l ,t ,,t-t,J It, 'l,'t ry 3+' h L- 8. Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction:- ❑ concrete ❑ metal ❑ fiberglass, ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 4 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18- = d Commonwealth of Massachusetts { �s- • rr s Fill 4 F. Title 5 Official Inspectioh Foft�,, .4 ME Subsurface Sewage Disposal,System Form--Not for Voluntary Assessments^. +,; . r s. i� 10 Kidds Hill Rd � Property Address Geraldo Defreitas Owner Owner's Name information is + required for every Hyannis MA 02601 4-2-21•, page. City/Town State Zip Code Date of Inspection D. System Information (cont.) }�, .: ' : ?. • t 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes t ❑• No Alarm level: Alarm in,working order- E1 Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached?-b. a ❑ Yes ❑ No 9. Distribution Box:(if present must be'opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from field. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts tT j Li•,X,- - :+ -0 Title 5 Official I hspection...FoVm.. ;� , 4 Subsurface Sewage.Disposal System Form Not.for.Voluntary,Assessments Pll.c + 10 Kidds Hill Rd tzA trli Property Address Geraldo Defreitas Owner Owner's Name information is Hyannis MA 02601 4-2-21 r ir' ?? r-• required for every y r �c `s' page. City/Town t- State Zip Code Date of Inspection D. System Information (cont.) ;o• °,:. �% � ,r ? .�1 10. Pump Chamber(locate on site plan): I if (P,y`; ,, %, o:."tt ±;:dA 1.1#6f .'tl 1l#'.i\-E,4'0 r7fr}a•9.: 'wet', f�xp',OPI).) :i�1Jr ;_*—rtwr ^* Pumps in working'order: El Yes ❑ No -r Alarms in working order: tt31ri.,, „ d �_ fi. ��.�� +, 7i °�rl r r� tm:❑ + , ❑ No* j tluN 1rj - r711� �� -f;,'tr<�;Fll ,� ,�:I .,.r;ak. ,C#YYeS,rl Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is,a conditional pass:v60JV4' 11. Soil Absorption System (SAS) (locate on site plan,excavation,not,requ i red):"jo If SAS not located, explain why: . •ter .r «. .v... . ..,� of Type: !- ME)i7'fit 5fZl%41.,WIG In,J(, hi),I&lIb II ;o "t, ti; leaching pitssf,;;. �i Ifj .1otnumber:`,, ',• •7 r�, ® leaching chambers - number: 2-500's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields - number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.712 612 01 8 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts < ; ;,{ r. t r , Title 5 Official� Inspection i=of �Q Subsurface Sewrage,Disposal System,Form=Not for Voluntary.Assessments,: 1 10 Kidds Hill Rdlei Property Address Geraldo Defreitas Owner Owner's Name information is Hyannis} '_ '1 MA 02601 4-2-21 -:.i• ' required for every page. City/Town . ,.I State Zip Code Date of inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure„level,of,ponding,•damp soil, condition of vegetation, etc.): Leach chambers were holding water at 3" below inlet invert with no other stain lines. Recommend pumping annually for maintenance and to prolong life. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth.—top of liquid to inlet invert i• Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes, ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): ;T. t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts - ,-4 Title 5 Offidial�-, intpection' --,F-o'r'm' 'h'i Subsurface Sewage Disposal System Form Not.for.Voluntary Assessments- 10 Kidds Hill Rd Property Address Geraldo Defreitas Owner Owner's Name information is required for every Hyannis MA 02601 4-w2-21: page. cityrrown > Ili State Zip Code Date of Inspection D. System Information (cont.) v,), ntN�,-z#T!-,Z�4-(13 IYI 1,*!: .I I 13. Privy (locate on site plan): C :fv,''op, g0 6M.-t"P. 4.1 c"A 11,3;.m Materials"of constructions 71;1d j)j 1; Dimensions r",113 Vj oi Depth of solids Comments (note condition of soil signs of hydraulic failure, level of porlding, condition of vegetation, etc.): N t5insp.doc•rev.7/2 612 01 8- Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 L t % Commonwealth of Massachusetts _► r• �. Title 5 Official Inspection i bein ` . p Subsurface Sewage Disposal System'Form -Not foriVolunta Assessments, F' 9 p Y rY 10 Kidds Hill Rd Property Address Geraldo Defreitas .r Owner Owner's Name information is required for every Hyannis : ;rr MA 02601 4-2-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: , . .t ® hand-sketch in the area below ° ❑ drawing attached separately 0i 8 O t5insp.doc•rev.71262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts -(p, Title 5 Official4,lritpection.,F.O-'i M Subsurface Sewage Disposal System,Form,' Not-,for Voluntary Assessments r",-%t,d,4S W -Z 10 Kidds Hill Rd -t r, to)q 01 Property Address Geraldo Defreitas Owner Owner's Name information is required for every Hyannis i c Q111;0 X11 MA 02601 4-2-21 page. Cityfrown -o, -...% ".,- r State Zip Code Date of Inspection D. System Information (cont-e) .1.;Ir %,. -'- 7 15. Site Exam: :0 "v! U1 JAI q, ,01 714",710 ;J ❑ Check Slope rj,4­ij arm, -I El surface water �.j rLi .e t is*)9jLj:j x ni.,8 :,,t0t7::Dj;,T.)3 Lq El Check cellar 0 Shallow wells Estimated depth to high ground�water: 12'+ -feet' Please indicate all methods used to determine the high,ground,water,elevation:'�) Obtained from.system;design plans,bn recordj,7j,:'1kHV1, ,)1# .6 ol If checked, date of design r plan!reviewed--�,-vz%'Date­,0'_,­ ' , ' *-' '; '-. Observed site,(abutting property/observation hole within.1 501feebof SAS) Checked with local Board of Health -explain: z Checked with local excavators, installers- (attach documentation) El Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doo-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection F®rm i �%i Subsurface Sewage Disposal System Form_-Not for.Voluntary Assessments�'. •. ' Rf• fir. ? 10 Kidds Hill Rd "> Property Address Geraldo Defreitas r'f Owner Owner's Name information is required for every Hyannis "� MA 02601 4-2-21 =•1" ;, page. City/Town State Zip Code Date of Inspection ; E. Report Completeness Checklist,J Complete all applicable sections of this form inclusive of: <' ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked t: ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed' I+ •� t r``-"•.3 - ® D. System Information: „► _. _ri t ,a,, r .G. sar+ „ For 8: Tight/Holding'Tank=Pumping contract attached For 14: Sketch,of,Sewage Disposal!System drawn on pg.16(or,attached For.45: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 f Certified Mail#7006 2150 0002 1042 0521 rtK w Town of Barnstable Regulatory Services natuvs^r.�s3L�,� :M ss. Thomas F. Geiler, Director p t63q. AllPublic Health Division Thomas McKean, Director' 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 20, 2008 Paul Venditti 58 Acre Hill Road Barnstable,MA 02630 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION, THE STATE ENVIRONMENTAL CODE, TITLE 5. The property owned by you located at YO Kidd's Hill Road, BarristableJMA was inspected on August 19, 2008 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint. The following violations of the State Sanitary Code were observed 410.450 Means of Egress: Observed rooms within basement being used as bedroom without second means of egress. According to current tenant these rooms in the basement are being used as bedrooms. There were a total of three (3) bedrooms observed in the main part of this dwelling; one (1) was 'observed on the second floor, two (2) were observed on first floor. Your septic (#99-046) is for three (3)bedrooms not for six (6). You are directed to correct the violations listed above within twenty four (24) hours . of your receipt of this notice by removing all beds from basement and ceasing and desisting from-using any part of basement as sleeping quarters. Due to the fact this room in the basement does not have the proper egress; it is not considered a bedroom by Health Division. Although, it may not be used as.a bedroom due to septic restrictions. If you choose to install an egress window in said bedrooms you must remove bedrooms from the main part of house. This can be done by removing door and enlarging opening to a 5.0ft cased opening. You may request a hearing before the Board of Health if written petition requesting same, is received within ten (10) days after the date the order is served. Non-compliance ill result in a fine of $100.00 per violation. Each day's failure-to comply n or er shall constitute a separate violation. Thomas A. McKean, R.S., CHO Q:\Order letters\Housing violations\Rental ordinance\10 kidds's hill barn. Applicant may decide to seek legal advice to prepare a properly worded deed restriction. DEED 'RESTRICTION Y WHEREAS, ��,�c. of (59 (_oncA�,E•,o �- C[4zy�&Q MA (owner's name) �V(address) is the owner of io K.gs M,�N V& located at (address) MA (hereinafter referred to as a and being shown on a plan gCA. [. /VrQcCtn entitled "Subdivision of Land in ''&Y_A.S bte MA, Property of et al, duly recorded in Barnstable County Registry of Deeds in Plan Book 17a , Page 11 ;`}-• }�)cv► t¢�cx��( 0�5� 4cAy� . WHEREAS, as the owner of said lot has agreed with the Town of (owner's na ) Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a variance from the 310 CMR 15.214 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and to obtaining a building permit for this lot; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting the variance from 310 CMR 15.214, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this lot is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, }Nry 1 ' Me,ca,. NOW, THEREFORE, o1.�a ddoes hereby place the following restriction on (owner's none) his above-referenced land in accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: i dccdr 13N 1 c'_S37 FEU 192 10017 10 may have constructed upon the lot a house containing no (address) more than 4Nsee (3) bedrooms. l agrees that this shall be permanent deed restriction (owners name) affecting 9 4 _ located on_16 X,� - �'w,�� Q�`�,►S�<.bI�MA, and being shown on the plan r-ecofded in Plan Book i7a , Paged i/ y. Plat hook , �`�9�- 5-9- ��o.«��. { mehGA 3 For title of .�1 seethe following deed: Book a 3; Page q (owners na Executed as a sealed instrument this / `71A day of. ';5e (date) g `� �..ohC deedr §ARNSTA tt AMISTRY OF DEEDS r ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 't 10 Kidd's Hill Rd. Property Address VENDITTI, PAUL S& LAURIE ANN Owner Owner's Name information is required for every Barnstable Ma 02630 12/6/2013 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information , on the computer, use only the tab 1. Inspector: key move your cursor-do not Sean M. Jones y use the return Name of Inspector key. S.M.Jones Title V Septic Inspection IC—V Company Name 74 Beldan Ln. Centerville Ma 02632 Clty!Town State Zip Code 774-248-4850 smjonestitle5@gmail.com SI4522 Telephone Number License Number J B. Certification . I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: . ® Passes ❑ Conditionally Passes ❑ Fails Needs Further Evaluation by the Local Approving Authority 1 /6 Inspector's Signature ate The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office,of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. j ti 13�� t5ins•3113 Title 5 Official Insp Forth:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Kidd's Hill Rd. Property Address VENDITTI, PAUL S & LAURIE ANN Owner Owner's Name information is required for every Barnstable Ma 02630 12/6/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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 dwelling located at 10 Kidd's Hill Rd is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 2 500 gallon leaching chambers. The system was found to be in proper working condition at the time of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank.failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available.- El Y ❑ N ❑ ND(Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments M 'y 10 Kidd's Hill Rd. Property Address VENDITTI, PAUL S & LAURIE ANN Owner Owner's Name information is required for every Barnstable Ma 02630 12/6/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due , to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑, Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/1 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Kidd's Hill Rd. Property Address VENDITTI, PAUL S& LAURIE ANN Owner Owner's Name information is required for every Barnstable Ma 02630 12/6/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has aseptic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100.feet but 50 feet or more from a as water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or."No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to,overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool.is less than 6" below invert or available volume is less than day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ti 10 Kidd's Hill Rd. Property Address VENDITTI, PAUL S& LAURIE ANN Owner Owner's Name information is required for every Barnstable Ma. 02630 12/6/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. , For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ Y rY 9 PP Y ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is'considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 i ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 10 Kidd s Hill Rd. Property Address VENDITTI, PAUL S& LAURIE ANN Owner. Owner's Name information is required for every Barnstable Ma 02630 12/6/2013 page. Cityrrown State Zip Code Date of Inspection ' C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction„ dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. z ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 3110 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins•3/13 Title 5 official Inspection Porn:Subsurface Sewage Disposal System•Page 6 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y�< 10 Kidd's Hill Rd. Property Address VENDITTI, PAUL S & LAURIE ANN Owner Owner's Name information is required for every Barnstable Ma 02630 12/6/2013- page. City/Town State Zip Code Date of Inspection D. System Information Description: 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last'2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 10 Kidd's Hill Rd. Property Address VENDITTI, PAUL S& LAURIE ANN Owner Owner's Name information is required for every Barnstable Ma 02630 12/6/2013 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): J General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons gallons How was quantity pumped determined? size of tank Reason for pumping: routine maintenance Type of System: ® Septic tank, distribution box,,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,.' 10 Kidd's Hill Rd. Property Address VENDITTI, PAUL S & LAURIE ANN Owner Owner's Name information is required for every Barnstable Ma 02630 12/6/2013 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: system installed 2-1-1999 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Kidd's Hill Rd. Property Address VENDITTI, PAUL S & LAURIE ANN Owner Owner's Name information is required for every Barnstable Ma 02630 12/6/2013 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of,leakage, etc.):. Tank was cleaned at the time of inspection and should be done again every 2 years for proper maintenance. Inlet and outlet tees intact and in good condition, water level was even with outlet invert, tank was not leaking and was structurally sound Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Kidd's Hill Rd. Property Address VENDITTI, PAUL S & LAURIE ANN Owner Owner's Name information is required for every Barnstable Ma 02630 12/6/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition,_structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Kidd's Hill Rd. Property Address VENDITTI, PAUL S& LAURIE ANN Owner Owner's Name information is required for every Barnstable Ma ' 02630 12/6/2013 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Distribution box was in good condition, no rot, water level was even with outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No'` Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order,system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M °�< 10 Kidd's Hill Rd. Property Address VENDITTI, PAUL S & LAURIE ANN Owner Owner's Name information is required for every Barnstable Ma 02630 12/6/2013 page. Citylrown State Zip Code Date of Inspection D. System Information (corit.) Type: ❑ leaching pits number: ® leaching chambers number: 2x500 gals El leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): soil and stone surrounding s.a.s. was probed and found to be dry with no sign of past hydraulic overloading. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—.top of liquid to inlet invert d Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Kidd's Hill Rd. Property Address VENDITTI, PAUL S& LAURIE ANN Owner Owner's Name information is Barnstable Ma 02630 12/6/2013 required for every - page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Kidd's Hill Rd. . Property Address VENDITTI, PAUL S & LAURIE ANN Owner Owner's Name information is required for every Ma ' 12/6/2013 page. Cityrrown State Zip Code Date of Inspection Da System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately q a U CJ 7 I i3--F )s 10 3 A-Z= ys A-3 = �� - t5ms•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 ` Commonwealth of Massachusetts o- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Kidd's Hill Rd. Property Address VENDITTI, PAUL S& LAURIE ANN Owner Owner's Name information is required for every Barnstable Ma 02630 12/6/2013 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 12'+ Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 't 10 Kidd's Hill Rd. Property Address VENDITTI, PAUL S & LAURIE ANN Owner Owner's Name information is required for every Barnstable Ma 02630 12/6/2013 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn.on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 a + t NEh/- L)oR -3z cl 1 r f " r ,F f y f • I .. • ,. � V` •'•. •. a •.rf• + t _ Y � � • • � f r y . , L o i z + '' �7 ,, w C �'•fYS� f i'i_ • t i zl- CAJJ 9 f _,.---------- tT• 1l COMMONWEALTH OF _ . MASSACHU3ETT3 E MCUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF E1I MONMENTAL PROTECTION MAP ARc L 0 LOB OFFICIAL INSPECTION FORM NEEOT $ - J ARY SUBSURFACE SEWAGE DISpOSAI,SYSTEM FORM PART A RM CERTMCATION Property Address: d /d C �n5 ot�o.�-t7 Owner's Name: v w�or Owner's Address: o Date of Inspection: d-6 37 RECENED Name of Inspector. (please print) Orr 7"'o%le APR 1 6 2004 N Psi' ate: — Mailing Address: o o�c G Telephone Nnm --- CERTIFICATION STATEMENT -,T I certify that I have perso 'telly inspected the sewage disposal system at this below is tn�accurate and complete as of the time of the inspection The• address and that the information reported training and in the proper function and inspection was formed based on my approved system inspector pursuant to woe of on site sewage disposal systems.I am a DEPP 15-M of Title S(310 CMR 11000). The system: Passes Conditionally passes Needs adss Further Evaluation by the Local Approving Authority Inspector's Signature: Date: 3-- The system inspector shall submitycopyof this' DEP)within 30 days of completing this inspertioanspnectd If the o is a shared rigstem Authority (Board of Health or gpd or greater,the inspector and the system owner shag submit the report to the or has a design flow of 10,000 DEP.The original should be sent to the system owner and copies sent to the buyers 1e,and the Office regional oapprthe authority. g Notes and Comments ""This report only describes conditions at the time of inspection time.This inspection does and not address how the system Will in under the the future ender conditions o y�use at that conditions of use. or different 1' %me2of11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART A CERTIFICATION(conned) Property Address: l0 Jo f �L'.?o Owner._ ���ive�v► Date of Inspection:-.-. ,3__/f-00 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sy I have not found any information which indicates that any of the failnre aiteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist Any failure criteria not evabuated are meted below. Comments: B. S Conditionally Passes: Ow or more system components as described in the"Conditional Pass"section need to be replaced or repaired The system,upaa completion of the replacement or repair,as app Wed by the Board of Health,will pass, Answer ex yes,no or not determined(Y,N,ND)in the for the folloa+ing statemeautt If"not&ermined"please The septic tank is metal and over 20 years old'or the septic tank(whether metal or rat)is str wfinany e i fdtration or exfiltration or tank failure is imminerd,Sys will Paw won if the mNYing septic tank as approwed by the Board of Health. *A metal septic tank will pass inspection if it is sawfiw any sound,�leaking indicating that the tank is le 20 years old is available. and if a less than Certificate of Compliance ND explain: Observation of sewage backup or break out or high static water level in the distribution box an 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 obsanction is removed distribution box is leveled or replaced ND explain: p "ere required pumping more than 4 times a year due to broken or obstructed pipe(s).Tice systemwill approval of the Board of Health): broken pipes)are replaced obsauction is removed ND explain: f Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:10 Arl 0, �� /Z/ /� Owner-. /2-e�l NP qI' Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require fnrta evaluation by the Board of Health in publi is failing to protect c health, order to determine if the safety or the environment, system 1. System will pass unless Board of Hearth determines in accordance with 310 CMR 13.3031 )that system is not functioning in a manner which will protect public health,safety and the envirohe ft6e Cesspool or privy is within 50 feed of a surface water — Cesspool or privy is within 50 fed of a bordering vegetated wedmd„*a sak marsh Z. System win fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is fuwdOning 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 I00 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 I of a public water supply, — The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. — The system has a septic tank and SAS and the SAS is less than 100feed but 50 feet or more from a private water supply well**.Method used to determine distanoe **Thus system passes if the welt water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indices that the well is fife from pollution from that facility and the Presence of ammonia nitrogen and nitrate nitmgea is equal to or less than 5 ppn,provided that no other More criteria are triggered A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: /o e Owner: �� t vr.�✓e^ w t_� Date of laspection: D. System Failure Criteria applicable to all systems: You most indicate`yes"or"no"to each of the following for all inspections: Yes No/ `of sewage into facility or system component due to overloaded or Discharge or cloggedSAS or cesspool Pig of enhwa to the surface of the ground or suitwe waters due to as overloaded or Aogged SAS or cesspool —_ Static liquid level in the distribution box above outlet invert due to an overloaded or clo ¢e Sec or depth in cesspool is less than 6"below invert' — _L�Nired Ong more 4 times in the last or available volume is less than%day now At�lamps y�N�due to clogged or obstructed pipe(s).Number portion of the SAS,cesspool or privy is below hi gh— A► 'portion of cesspool or end elevation Zar privy is within 100 feet of a surface water supply or tributary to a surface portion of a cesspool or privy is within a Zone 1 of_— �Y a public well. — ,✓Any portion of a cesspool or�s lesswithin than 100 feet but greaten than 50 feet from a private water Performed at a DEP certified laboratory,for colifor�acteri �system Passes if the well water analysis, indicates that the well is free from pollution from that f organic compounds nitrogen and nitrate en hi aci7ity,and the presence of ammonia nitrog equal to or less than 3 ppm,provided that no other failure criteria are triUM&A copy of the analysis mast be attached to this form.] (Yes WO)The system tO I have deterndned that one or more of the above fail described in 310 CUR15.303,therefore the ure criteria es�as Health to determine what will be system fails'The m owner should contact the Board of to correct the failure` E. Large systems: To be considered a large system the system must serve a facility with a design flow 10,000 gpd to 15,000 gp� 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 the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply — Zone 11 of the SYstems looted in a�gen esensitive area(Interim Wellhead Protection Area—M?A)or a mapped public water If you have answered"yes"to any question in Section E the system is considered a significant "Yes"in Section D above the large system has failed,Tire owner or operator of threat,or answered significant threat under Section E or failed under Section D shall aIIY large system considered a appropriate 15.304.The system owner should contact the a o the s'�in acxordance with 310 CNR regional office of the Department, Page 5ofll OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: � f --Ids / /S rn S e 001- Owner. de, I VC of Date of Inspection; —O Check if the following have been done.You mast indicate`Yes"at"no"as to each of the following Yes" i�o�tion was— — � pmn+ided by the owner, at Board of Health Wen any of the system cow pumped out in the previous two weeps the system received normal flows in the previous two week perzod Have large volumes of water been mbo&xmd to the system reo o*or as part of this inspection Wen as bu&gurus of the system obtained and examin a(If fty were not awaflable note as N/A) Was the facility or•dwelling inspected for signs of sewage beck up v — was the site inspected for signs of break out Were all system components,excluding the SASS located on.site , ✓_ ware the sepft tank mmnholes w=vered,opt and the interior,of the tank of the es ar tees,n>aterial of eonstroeti dimensi inspected for the conditioo a4 dimensions,depth of liquid;depth of sludge and depth of scum _ Was (and occiVants if dim from owner)provided with information on the proper subsurface sews mainteaoanoe of ge disposal systems The size and locates of the SoR Absorption System(SAS)on the site has been deterrmned based on; Yno — Existing information.For example,a plan at the Board of Health. Determind' the field(if( any of the hibire criteria related to Part C is at issue approximation of distance ss smacceptnble)[310CMR 15.302(3)(b)} Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner. oZ 6 Date ate:— —ice, o /e dof/ RESIDENTIAL FLOW CONDITIONS Number of bedrooms deli A rso G 7 c �p �.� Jr ( �k� Number of bedrooms(acival}: .3 DESIGN Bow based on 310 CA�IIt 15.203(for example. 110 gpd x#of bedrooms): Does reddence,have a garbage grinder(yes or no). Is launchy on a separate sewage system or ao): Ej*[if yes system inspected fps or n0�L" 1 Seasonal use:(yes or no)r_ water meter read,if avaftle(last 2 y orne• v )' Last� '��a — COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CUR 15.26): a� Basis of design flow(� sgR,etc.}: Grease trap press(yes or no):— Industrial waste holding tank present(yes or no):_ Nou-santt waste discharged to the rifle 5 system(yes or no): Water meter readmg%if available; oY� Last date of OTHER(describe) GENERAL INFORMATION Damping Records r Source of informttim - Ile— O f ��Mim pied as part of the inspection(yes or no): '�e✓ l �S/" e oo How was derunnep i � upe&��� AT - -=SYSTEM tnk&strJbution cesspool box,soil absorpaion system Overflow cesspool --Shared system(yes or no)(if yes,attach previous inspection I�'a��Alternative technology.Attach a �T�'if any) . obtained from system owner] of the current operation and Contract(to be —Tight tank _Attach a cOPY of the DEP approval —Other(describe): Approximate age of all components,date installed(if)&own)and source of inf 99 maybon. Were sewage odors detected when arriving at the site(yes or no): r Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / SYS INFORMATION(continued) Prone Address: 6 �C5 gj Owner. 7 Date of Inspection; BUILDING SEWER(locate *site plan) Depth below grade: Materials of won: cast irrm 4Q PVC other(explain)• Dis�e fiam�Pie water�p1y well oar suctioa line• Comments(on condition of joints,venft evidence of leakage etc.): SEP' C iAri> (locate site plan) x bolo w grade: Material Ofco nsbrnction. oonciete . metal fiber —�O —' ass—1)o1Yeftleae If tank is metal list av-— Is age cow by a Certifi ;ic of oertidicatej COmP (yes or no): (attach a copy of Dimensions: A S depth,-- (� Mft=Am —=to bottom of outlet tee or baitle: .3/ v Distance Am top of scum to top of outlet we or Distance fiam bottom of scam to of out tog, r e H Cow uvments(ems deteamined: M, leg mommendatio»sy inlet and as to outlet invert,evidence of IealcaSk etc. tee or baffle condition,strucp�' gri ►,liq levels / 04 00p.c�tc,i✓s . GREASE TRAP: /4/icat' a on site plan) Depth below grade:_ (eMataidof co c)n _"concrete metal—fterglass—polyethylene_ottt� Dimensions: Scam thictmes:_ Distance from top of scamscvm to top of outlet tee or bade: Distance from bottom of scam to bottom of outlet tee or Date of last pmW iag bafne• Comma"(Cn leg n onsy inlet and outlet tee or baffle conditi as W13W to orrtlet evidence of leakage,etc.): °n, dual integrity,liquid Ievels Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEMINFORMATION(contimuad) Property Addr Owner. 6e Date of Inspect; TIGHT or HOLDING TANS;A/ (task must be pumped at time of aWecti0n)00c210 an site plan) Depth below gtadc Material of construction: Concrete Metal fiberglass--.-- Ylene ems: Design Flow. ~day Alarm present b=ar nor Alann level: Alm Date of last pumping worktagorder or no):--- Comments(Condition of alarm and flat switches,etc.): DISTRIBUTION BOX-`. if ( present must be oFe on site plan) Depth of liquid level above outlet Wvert v Comments(note if boas is level and distribinion to outlets equal,any evidence of solidr leakage into or out of boa,ettx3'm"�.auk►evidence of PUW CHAMBER:"(I on site plan) PuMPS in Waskiag order(yes or no): Alaems in working order(yes or no): Cammems(note c Ondkim of pomp ehamber,condition of pumps and Vputenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(co, Property Address: Owner. lvo q h Date of Inspection: 7777.4 - O SOM ABSORPTION SYSTEM(SAS): (locate on site plan,exavatlon not required] If SAS not located explain why: Type V gpits6 leaching chambers,numbw 300 leaching galleries,number: leaching>reWhel6 number,length: �j C17 leaching fietde,mint,moans• overflow cesspool, mm*w. Comment�ovativeWtmnathe system Type/mame of technology: etc.): (n �of soil,signs of hydraulic iailitie,level of ponding,damp soil,condition of vegetation, yL CESSPWL3�cesspcd Mnst be pumped as part of inspoctionxlocate on site plan) Number and conBiguation: Depth—top of ligW to inlet invert: Depth of solids layer: Depth of scam layer: Dimensions of cesspool: Materials of ooa�rvction; won of gramdo ww inflow(yes or no): COMMON(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:"on site per) Materials of construction: Depth of solift Continents(note condition of soil,signs of hydraulic failure,level of pond mg,condition of vegetation,etc.): Pale 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued} Property Address 0 CS # / cd 6��' Owner. Date of lkispectim J' -0 SKETCH OF SEWAGE DISPOSAL SYSTEM Ptovideasicetchofthesewage&mml system inchxfng ties to at least two permanent reference laadtuarJcs or benchmaft Loe ate A wells within 100 feet Locate where public water supply enters the hfflkb , 14- ;141- Ll 4� e— c�y ' ,� 31 .3 r Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(conti=4 Property Address: o Owner I ve<4 V19 r6 Date of Inspection: - STYE EXAM Slope Surface water Check cellar Shallow weds F.sbmabed depth to ground water 6�j!;7 feet 7— Please indicnte(check)all methods used to determine the high pound water elevation: Obtained from*Vm dedgp plans on record-If checked,date of design plan reviewed: site(abutting property/observation hole within 150 feet of SAS) with local Board of Hmdth-expiain: 'yam C%02 - Chedkod with 1=9 ummtoM installers-(attach docume �on) ro Accessed USES database-explain; Yon must describe how ou« tabtished the higJe ground water deratioaaS kawf r6e Aaw S.3 . yr e'G �I . �a TOWN OF BARNSTABLE I n CF?NE T0� OFFICE OF 6 t HaHa9TeHz BOARD OF HEALTH 'moo rb 9• �em� 367 MAIN STREET _ nM HYANNIS, MASS.02601 .February 18, 2000 Scott A. Gardner P. O. Box 1026 Centerville,.MA 02632 RE: 10 Kidd's Hill Road, Barnstable, MA 02630 Dear Mr. Gardner: You are granted a variance from 310 CMR 15.214, restricting sewage flows to one bedroom for every 10,000 square feet of land within Zone II districts. You are granted permission to construct a one-bedroom addition at 10 Kidd's Hill Road, Barnstable, with the following conditions: (1) No more than three (3) bedrooms total are authorized. Dens, study rooms, finished attics, sleeping lofts and similar-type rooms are considered "bedrooms" according to the Massachusetts Department of Environmental, Protection. (2) The applicant shall record a properly-worded deed restriction at the Barnstable County Registry of Deeds limiting the dwelling to three (3) bedrooms. The deed restriction shall be signed by the property owner. A copy of the recorded deed restriction shall be submitted to the Board of Health pE!2r to obtaining a disposal works construction permit. (3) The doorway to the "playroom" shall be constructed without a door. This variance is granted because it is the Board's policy to grant applicants approvals to construct three (3) bedrooms on lots of more than 18,000 square feet in size. This property is 21,549 square feet in size. Sincerely yours, Susan G. Rack, R.S. Chairperson Board of Health Town of Barnstable SGR/bcs TOWN OF BARNSTABLE �- e LOCATION %6 /Z S 1JI Gt SEWAGE # 6 VILLAG '��- ASSESSOR'S MAP & LOT E INSTALLER'S NAME&PHONE NO. ! it:��.g 0- 7-7 SEPTIC TANK.CAPACITY lS LEACHING FACILITY:. (type) a '• (size)AL f,;— NO.OF BEDROOMS BUILDER OR OWNER C'/Zy'1-.1,5 PERMPTDATE:2= `g COMPLIANCE DATE"! Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching.Facility Feet Private Water Supply We11 and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) , Feet Edge of Wetland and Leaching Facility(If any wetlands exist, within 300 feet of leaching facility) Feet Furnished by I - I a 9 1 ti R �R ,x. el No. �^ Fee 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �, es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Miopozar *p!5tem Conztruction Permit Application for a Permit to Construct( )Repair(K )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 10 K i d.s Hill Road, ner's Name Address.and Tel.No. �. Barnstable , arry Gerrior Assessor's Map/Parcel n L 1660 Phinneys Lane , Barnstable , MA "CJ iVtaller's Name Ad refs,and Tel.No. Designer's Name,Address and Tel.No. M. E. Robinson Septic Service P.O . Box 1089, Centerville , MA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Gravel/Sand. Natureo . e i or r io s( ns rw n licable New Title 5 Septic System consisting , � ga �'an`�k, - 'cox an) . 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 issued by this Boar /of Health. ^^�� Signe Date C` 9 Application Approved by Date Application Disapproved for the following re o Permit No. Date Issued &41 IVY v..�c-�..„y.�.• ,y,.�^'r++._:r,",-,,,ter...-..-:,.�*.�'.:..+�.re,;:LM.;.�,.,,�:.++1.-..,,. . :.-�^ :`.,��,. ....:..::. , ....^..r'��j'Awh"�...-. .r.n;:. .:x. A F. No. k Fee 5 0 THE COMMONWEALTH OF MASSACHUSETTS "�ntered in computer: \,,Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprication for �N_4pozaf 6potent Construction Permit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System. El Individual Components Location Address or Lot No. 10 Kids Hill Road. ner's Nam Address.and Tel.No. Barnstable, MAarry errior Assessor's Map/Parcel Q 166o Philneys Lane, Barnstable , Installer's Name_Addre§s,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P.O. Box 1089, Centerville , KA Type of Building: c ~- u 3 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( Other Fixtures Design Flow gallons per day. Calculated daily flow e` gallons. Plan Date Number of sheets Revision Date Title +. Size of Septic Tank Type of S.A.S. Description of Soil Gravel/Sand. a f � — — A. New Title 5 Septic System consisting Nature o��epalrj orSAl ra gT(4&ryg,,w1B Vp8kcabal� leach chumbers . 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 issued by this Ward/of Health.- Signed c�" Date C� = _ Application A roved b - Date Application Disapproved-for the follawing'rle oti Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Gerrioe Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( X )Upgraded( ) Abandoned(Ki�V 4 U4 g . 5objnson4.Seiptic Service at 1 h s een constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. & dated Installer Designer n „ The issuance of this errriit shall not be construed as a guarantee that the sylm / w 1-1 unctionas de/s9.ned/ Date l} I Inspector "/P�l l Uf �/.�l►lr'u'�li( J _$K O No.--�-- -------- ------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,. MASSACHUSETTS Gerrior Migogal 6potem Construction Permit Permission is hereby granted to Construct( )Repair( .X)Upgrade( )Abandon( ) System located at 10 Kid.s Hill Road., Barnstable , MA 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:Construchorymq4t be completed within three years of the date of t s p Date: Approved byl 1 TOWN OF BARNSTABLE LOCATION _1_� /� �S 1J1 it C-1� SEWAGE # 7 '7—Z VILLAGE'IZ-A- -J . ASSESSOR'S MAP & LOT( 1[ INSTALLER'S NAME&PHONE NO. ��+/ it.~,4' d ��- % �: i' SEPTIC TANK CAPACITY LEACHING FACILITY: (type) , C• S^>�a� (size) NO. OF BEDROOMS �3 BUILDER OR OWNER L A i In A- PERMITDATE:,-A-- - 9 COMPLIANCE DATE,'-^/ "9 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Ir 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 IJ� 7 NOTICE: This Form Is To Be Used For The Repair`Of pailed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at 10 Kids Hill Road Barnstable,MA meets all of the following criteria: * There are no wetlands within 100 feet of the proposed leaching facility. * There are no private wells within 150 feet of the proposed septic system * There is no increase in flow and/or change in use proposed. * There are no variances requested or needed. * If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: J, l A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) B)Observed Groundwater Table Evaluation(according to Health Division well map) SIGNED: -� �� DATE '-�- C ' LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). a l f C b rf . O4( of tHE tom, DATE: � ti O� FEE: r • BAMSTABLE. MASS, 1639• ,0� REC. prF° �A Town of Barnstable S CHED. DATE- Board Cs�' 3 of Health ° aims.reet, Hknnis MA 02601 «Li v-dOffice: 508-790-6265 Q 199 & Susan G.Rask,R.S. FAX: 508-790-6304 9 Sumner Kaufman,M.S.P.H. B� �T�� Ralph A.Murphy,M.D. IANCEe R pUEST FORM LOCATION 'S Y ' Property Address: .I'GhG - j y;7d� Assessor's Map and Parcel Number: O �t_` Size of Lot:_ � Wetlands Within 300 Ft. Yes Subdivision Name: No x Business Name: B�11lA1�'12S 1_. � -;., /mow o APPLICANT --J CONTACT—PERSON Name: SC©4 Sfk-ZDne-\Z—. Name: CO tr k��eF Address: l\ C�S x LL �`� Address:p Phone: 36 Z ©Zc� \ Phone: �(o — 2� C.en-,,eZ,2,k C?Z co 3 FAX: FAX: VARIANCE FROM REGULATION(List Res.) REASON FOR VARIANCE(May attach if more space needed) Q,kf L•A n e 2 ''o SL 23 2es e,:�a l y• 2 3 e6lizco a1'S �Gu��na 3 3a:>Zoo vwN Zo+1 P C7� Checklist(to.be completed by office staff-person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) Variance request application fee collected[no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only].outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G. Rask, R.S., Chairman NOT APPROVED Sumner Kaufman, M.S.P.H. REASON FOR DISAPPROVAL Ralph A. Murphy, M.D. Q:/WP/VARIREQ Design Data Daily flow 3 bedrooms = 330 GPD 2-500 gal. chambers with 4' stone = 355 GPD.D. Soil Log Top Soils Medium Sand 1 —A wA�e 1 —A gNcau111'fEL'r� 8 fiz 0 . 132 AC +/- 05)719, s APPROX. LOCATION 500 apt, < WIRES o S`Y: (SEE 'BK. 1458, PG. LOT 4 097, CAPE & VINE- Cn� o YARD EASEMENT) 159800 No. 10 SF 5 _OiAL= �►,5y5b s _ 125.03 KIDD 'S HILL ROAD j (JAIL LANE--PLAN) MORTGAGE LOAN INSPECTION �`"��� IV SAGAMORE SURVEY ASSOCIATES SCALE: 1 IN.= 40 FT. ., P.O. BOX 28 DAT APRIL 21 , 99 ��*` SIP. SAGAMORE BEACH, MA. 02562 'or THOMAS C (508) 888 8667 I CERTIFY TO NORTH 'AMERICAN MORTGAGE CO. "?o Poro.34314 y� ",� No.343Id THAT THE LOCATION OF THE BUILDING SHOWN HEREON CONFORMS 1 4 % TO THE ZONING OF THE TOWN OF BARNSTABLE - �9oFFssioaA ' I CERTIFY THAT LOCUS DOES NOT LIE. WITHIN THE FLOOD HAZARD "OSuave°� ZONE AS DELINIATED ON MAP 0005C COMMUNITY NO. 250001 PLAN REFERENCE: BARNSTABLE REGISTRY OF DEEDS BOOK/PAGE: PB 172, PG 011 & PB 253, PG 059 LOT NO.: .4 & 1 -B r PLAN BY: NELSON BEARSE-RICHARD LAW & CROWELL & TAYLOR CORP. DATED: JULY 16, 1962 & JANUARY 31, 1972 THIS INSPECTION NOT MADE FROM AN INSTRUMENT SURVEY AND IS NOT TO BE USED FOR FENCES, HEDGES OR TO ESTABLISH LOT LINES. FOR USE OF BANK ONLY. I 2-8"x6,81 0 6'x 6'existing decks i to j 36'0 o 0 8' `i � 7 7-3FF , 2-8'x 4'0" '-8"z 6' 2=8"x 4'-0" � I 2'8"x4 " CM { cn , �3-6- ,-0,F Bath 2 0 is o1 v cv) � 1Gtchen \\_ Cl) ,v '\\N ti e N Of � N 2'4 Bedroom i N �O tp I 5-10" W 2' 6- -\, �' 12-10" w --------- 2-6"x 6-6" 2' "z 6' " Z-8"z 61-eFL N O o 4 ^' Living Room tA , - O CO F Z-OFF N j v i Bedroom id) i V i -0" O I � I 3-0"x 6--8\ 2-8"x 4-0 ' ------ `—� 5 6" -0"x 92-0"x 42-0"x 4-0" 7-O" 7-3 20'-0" j1-7;F' 2-4",�2-5^�1�1-6"� y / 7-10" } 6'x 6'existing deck - I s F • '._ . . - a ., . C,cs�n 36'-0" T 6" 15'-6" 7-3" 5--9" 2'--8"x 4'-0" Z-8' ^ Cm2'-8"x 4'-0" W i N O O k ^f �c IV Of N O I) O ---------!- I (� \� ej -47 4-6"—r 4-6 ° fi rn a ' c� j 2' 144 6-2" 12-6" cr o to o ;o -0"x 4-0'"x 4-0 -0"x 4'-0""x 4-0 1-8"�2-2"7(i-87� t No Fee 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ves PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for �Digpoga[ br5tem Conotruction Permit Application for a Permit to Construct( )Repair(K. )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 10 Kids Hill Road ri ars a eGAedre sl OdrTel.No. � Barnstable , y Assessor's Map/Parcel 1660 Phinne s Lane , Barnstable , MA 49 � taller's Name Ad�re$s,and Tel.No. Designer's Name,Address and Tel.No. m. E. obinSOn Septic Service P.O . Box 1089, Centerville , MA Type of Building: +0 Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) j- 1 Other Type of Building No.of Persons Showers( ) Cafeteria w ,e � Other Fixtures 3 ,Ks Design Flow gallons per day. Calculated daily flow g lons. Plan Date Number of sheets Revision Date - rs Title Size of Septic Tank Type of S.A.S. / Description of Soil Gravel/Sand. �OU Natureo .. eerf or r ( ns rw n licable New Title 5 Septic System consisting ga 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 issued by this ar of Health. Signe Date C '1— Application Approved by Date Application Disapproved for the following rea o Permit No. Date Issued ,.. -- - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Gerrioe Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( X )Upgraded( ) Abandoned Rob°n on Se tic Service at 10 L1_ `�.n�' -�arn0U�� een constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. '— dated Installer Designer The issuance of this e t shall not be construed as a guarantee that the s m nctio as"d""Date Inspector >'�- No. ——' Fee $5O + —..— --------...._..�.. ..^.................-ter. Y �- poi.v C-G,.c, ��..s'�' � GAS r,✓__--_- Sc,.�� f�'t�'�G _ .,- Ca.-�-e aY� a/c, �a�,e � /���.., ____ `a=r,�-o - Q ,_ . - S'� G _�,, /ale l a� ;� ``` � �I � � � � j i I liI _ � I I - - - _� �=1 - -- - � _ =I- I - r i -- -•-- - // ��Y"� L✓r�k� __. `S-''/C� . (/t/.��j G+ � �/✓ f G�- �V U C�Li l-e-v"r_Gp`'�- ��V"_-- -- p�� 0&j �' _o� _ f f �'�g��_ _ T >. p _, C OLW 0-7 50 /0 A-'1- e tn..i SS!w,s d� S cam,.oC o-'' �-.S�G a-l�__e•sG�-.c�,✓� �-� Gv �.+�,. �� C��-�_.._l��.�c�_ _ Y 61� 4v lc/ ov e_ _ 5/ ate` �S l� //,� i,L v; s -- -- _ �011-Le_ -U,( '`_ Sam,,, �n�•t ��Qe.�a-rS 5 � �_ 4Y_ . t - i I 1 f I P077 { I C 1 f ± } cr s c4904 Cc/ 1 — 1 s4L- 11-e wr- at a G� Coc -S'� Z ►-o�C 1 C�.1QJ / w �. F z7- c� c o-c,�` ' .�_ - 1. cQ -�.c.cc� a � - ��.����S, .L s� � c�,�l� �✓- . . � .ram ��.�� !' t >..: ��, a � t i � ., _ ... � i; .«. .. �` i y y o-# r x , 1,. ll _y lav 1 PJ / i�j "5am - + _. - r _ r � � L✓LL `kEIPS7 y fir+ 1 yy . .......7.�--.` ........... di ---------- '1 L n v m � ' - - ---u - - --- -- s I. , L eAT ■ ■ MEYER REVISEC�O ,. .49QA Professional Building Designer So.Ya P.O. utthXMA 02664 wwc eo (508)394-5296 e s.