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0011 SHEPERDS WAY - Health
l 1 Sheperd's Way Barnstable A= 22.5 09 r i I I k 1� � S��G/s �ay,� � OEF'RF .• - ' BARNSTABLE _FIRE DISTRICT :2 . '-Busy �� �° p WATER -DEPARTMENT 1927 '~ �iqs- `'•.." 7V1841 Phinney's Lane P.O. Box 546 Barnstable, Massachusetts 02630 Phone: 508-362-6498 Fax: 508-362-9616 October 23, 2007 Jeff Goldstein House.Company P.O. Box 1166 Barnstable, Massachusetts 02630 Re:, Lot 2, Assessors Map#259, Parcel 1-1 Sheperds Way Dear Mr. Goldstein: Public water is available to the above referenced property. ..-Sirrcer ly, 1, J R. Erickson, Superintendent �l97 . r. .. Barnstable Town of Barnstable kxlftd - Department of Public Works �16�teutc achy 230 South Strcct, Hyannis MA 62601 ltttp:;'hvwvw.to"rn,.barnst able.ma.us �007 .civision 508-790-6330 Mark S. Ells,Dirrctor ante Division 508 420-2258 R.W."Bud"Bi jult,Jr..,:Asst Director .,etures&(hounds Division 508-790-6320 Olfire. 50$-862.4090 Water Pollution Control Division 508.790.6337 Fax: 508-862-41111 Water Supplytiivi�ion 508-775-0063 tvfichelle Szepesi . Office Ma.ragc;r , c/o The house Company PC lion 1166 Barnstable,:MA.02630 Date:August 31, 2007 Re: House i,.unibcr&:-Mapr'Parcel Assi;.nrmen.t for Map 259 Parcel 001..001 Subdivision , 'Michelle, FlIclosed are copies of the iiew parcel records I created based on the information you and Mr flan U aia submitted.The following are the numbers you need for the building peen applications; itila /Psri.p . t Del er T t Sr.._..�__._� o .a .t net,�d Ires ( - i� Way ..2.9lOO1.U.t1 Lot 47 !1 �shc cTds rh a P i � 259/001;U04 Lot 48 Stu:perds Way , (c}Please:'dote;The address;#l l Saeperds Way was n-mintaire.d for the existing Map/Parcel&house because,you iudicat.d the driveway is to semai-il ill the existing location.Please be aware the plan does not show the access easement over lot 48 to go all the way to lot 47.This could cause the need to relocate the ti drivcm,av for Ic;t 47.Should this liappen,anew address will be assigned based on any future relocation of the driveway for lot 47.Please bring tHs,issue tin Ic attention of the attorney and owner.of lot 47.The address's were established based on you representatioxt of Lhe dt7,,e%vav locations. AIso note the date oh the.deeds;CTF 181405& CTF 18.3405 indicates the date of the plan is April 2;2005 and t v. plant submitted for use is April 4,2005.The Surveyor,Mr.Dan Ojala was notified of this disco-pattcy.rond iudWated he would armage for corrections to be made. Picas,;bring this package with you when you apply for the building permit so the persotanel in p-le,various departments can view the changes of the parcel information.Also note that this property does not abut town seta lines and a"Roan Ope.nirg Permit"is not rcrurc:d because Shcperds Way is a private Road. PirMI contact m..e if you r'gaize further assistmtce witii these bttllding permit applications. s .y, rank Schl al . E911 Date. iuison v Lngineeritig Rocords Nfanagci • �� s w�ra ow•vlus:rau � • � :�:�.�,. ems' 4`��• :�" h �n ': ' '' i�� Ian. . w• �_ I� rt ���--- + + ! 333ttt S ra[1_sx e � yS •f 4 `h� � • ., d.. _ � 3 4,xsa,s wo�n..y,_. a C • �� i� ° ` `�21�fa _ '- • 'n� era.wc cesac uc_ �t ac�'�•4 _ - : 1}k �. 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BQAtr! !v•,- R[W ac ad,te .f�k +•I�koMl lel.x1 w tcc we n . _ `) „ C(! x,wr - •CF�OlIIY FTQ - F. oa.s++a uo ss 40,al�wellru C!O /? �••- �.��y/ ,�•} e-.t+.�M11 s."''s) `T' �L`C?_ AN ' -.1 t[,1n<r,A4v MS d:feC S:R",It[Y�IS alll M AG.'�_n 1Y7Y M LLrC r1V' !t: f •• GCC%VW CCC.21.14[e Ar A' Sapp]S e•sYR,twrw•4f ro�'�4.�i - .. .. . ,r�+ .. � s _ rit,ora..f rr 44.t r.ea• • - ' - E f �Ay1{ cex- ..s _ __..aO�Ql t CLV.i ".LS .�1 • � cstu Esruan/saeS _ i_�tHD SURca:YORa _ 5c arc e.r Ul-k... mar, FdtrcclEdit Page I of I - i M..�(� K• Ty� {�/�Jy ///fir . .;i ... 'MyY/W� ] y�nR}�9"•,'T >- _ �,�.,y+. �J-' '. ��� ��V Y' S���r` + M }. (� `'�• 1 y t x� r •?ti+-. c. J ` -1 l MV. M1/��I^cJ�A'G/V V�� /.j�. �� ffffff,,,,,,IIIIII��������.i.1•�� YI�V..Y.,1 t.agGt�d AS: Friday,Aucust 31,2CGI Frank Sch'e4ipl Pat"Ce Application Center Road Systc m Roports Ro.n System _ �................. _ _.�....�.,...... _..._.r_._.__ _.r..... Farce)ID: �Jfl1� Sewer Acct: _.__........ TJR Devel Lot ...... _ ...... .. Owner: (:IFZh' J {l?v'?1 iCJfiFY J f rJs,'dCES C Co ,.caner. ... Street! R 1 ,iHE.P1ER0 VvAY - r 4 City FP 7—RI, ,BL(..... ._. State* Zip: O�P�o4 _ .., location: SF" PRUS WAY ..:� vi�lage: �afnstabl+~ ._................ r Road Indcx: f14Kaa Prr Frontage: 1.0 Sx--ndary Road: Sec Index Sec Frontage: P. Visions l.ocaticn. 1 1 $11ti✓PE3"�C�3 1iVAY Last Updated: • wrwrrr..•�.. r._w �+ r rvo. Bldgs: Account No 41'F1 Lot Size(acres): - 14,7109541 , 5tzte'Class, ?Qi Year Added, Fire Dist: 1 Deec Date {7—"1',/�:'t?C1 Deed Rat': ,G115 51 , Land Value: C;`);'>3r,1C 8idgs,Vdiu ;? 'iZt'f]'J_.. Ex'ra Features 1w0 Condo Complex *1 Builc:my:��� Urit nuo ... 10 c - NU J. df t' RoadEngineerirl; Page l of l � �4,��,,,,t u, �,y • w dd %t ee �,'. ,I' 4./" di•�'r •...i v i..•irr 4li`ai d.n6:n r ._..... �� I-IL � r.7F.,4�`.. i.. Logr,ed In As, Road ` System ` � p.�y V- Friday, August 31 2007 Frank,Schlwp,; i`oa d SysteF i 1 Ap,okbtioli C�:nr<:r fioad S-r"t(vo par;a k q)d Symnin Search Options Search By New Parcels New Parcel Map Black Lot 25� 009 .. .. P • •�Seate <Prev Ni:xl> Pagel of 9 Add Record Parcel I Location � village '59 L��1 001 i 1 Sl EPERDS WAY- t QT 47 e R - BARNSTABLF 253 001004 9 SHEP R. - E 43S 1NAY LOT�4i3 4, E3AFN.�TABLE L;11 ltl ?'ezrz�7PatrelFdt Page 1 of 1 1•. L �"u r1 1.,5/Nil. 4a it - „-' X � � 'rry` � y:` ; ��• ,7i S. Yt.1. /,Ai .vf7 t- `a ys•• ._.. L (✓ 4'V d� ' ' ��i"'4 J t+• .1.. .."V... .. fy !.o,jgej In i y� Parcel Friday.August 31 2007 Arl)fICOt;m S'FdY.c?r RAr':G fiyfi.tRrtl(�a`.y":Ort::R.oaC system `� The record has been added. —New Parcel Detail New Muppa.xcI f2'�a'9''" 00'01 : FO0`1 , street Number: 11 Unit. Dev Lot: LOT 47 Road Name: &iEPERDS WAY T/P Sec Road 1......_.................. /Fc UiiGage 01 -Barnstable parr.of M/P; Map 259 Parcel 001.001 ..... ..._.._....._._..... ... _.. Pian Per- LC PET•209050 0. Dae Added .......... . ._ Update;) J i s p — E _Illi,r It' JIf1 N F797 F, - Ce3n�T'arcelEdit Page 1 of 1 h W NIA.n h ,{ i Xr lo,7 Ji �•, �yr, z,r lo5gedu'nh;; New Parcel y� Fri(ii,).Auyust 3i ZOOY F,ank Schiegel 3 `�e V Y t GEC 6 cite l Application Center Road System Reports K9 j)d Systr.o., 'The record has been added. New Parcel Detail New Mapparcel: ((2'59 001 J.0�_, Screet Number: 9 �;na 1.. : Dev LciYt LOT 48 1- .:. _ .. Road Name- ....&HEPERt�S WAY r"sl�,^: ar!..,.. R' i.. Sec.Road: vinia�e: Q1 - garnsiable - Part of M;P: IMAP 259 PARCEL 001-001 Plan Ref,- i4�PC.'r 20950 Q � Date Added S , Updated: 1 oFt Tom, Town of Barnstable Barnstable Regulatory Services BARNS"LE. MASS. Thomas F. Geiler,Director 1639. A10 Public Health Division 2007 Thomas McKean,Director Office: 508-862-4644 200 Main Street a ax: 508-790-6304 Hyannis, MA 02601 757 Be Goldstein FECC-Realty Trust 9 Shepherds Way Barnstable,MA 02630, December 14, 2012 RE: 2013 Rental Re istration—Cha ter 170 Re al Pro erties - - l S REMINDER: Uv It is time to renew your renta registration for the Town of Barnstable. All rental .registrations expire each year l D cember'31 St. Checks should be payable to: Town of . Barnstable and sent to Public alth Division, 200 Main Street, Hyannis, MA .02601. Enclosed is a rental application f Please be sure.to reference the address and unit number of each rental unit you are regi ering on separate forms, as well as updated tenant info (name and phone number). �} Should you eed more applications, they are available online at www.town:barnstable. us Go to the Department Menu. Locate the Regulatory Department. Then; within the gulatory Department, you` will find the _Health Division and its ) Applications.. You ay print out as many as you need, and return them to the Health Division with the appropri e 2013 fees included. A $10,1ate fee will be assessed to those that renew - after January 15 2013. Failu e.to comply with this ordinance will result in the issuance of,a non-criminal ticket _;,, a 'ct ?ion iri 9-amount of$100._Each day of non-compliance is considered a separate offense. `" Should you have any questions, please contact the.Health Division,at 508-862-4644. We ppreciate your attention to this matter. Thank you. EB c� Enclosure t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Sheperds Way Property Address FEC Realty Trust Owner Owner's Name information is required for every Barnstable Ma 02630 4/8/2010 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 A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection ICI Company Name 74 Beldan Ln. Company Address Centerville Ma 02632 Cityfrown State Zip Code . 774-248-4850 smjonestitle5@gmail.com SI4522 Telephone Number ' License Number. L B. Certification C CIO 1 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 Oerformed based on my training and experience in the proper function and maintenance of on site co L sewage,„disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Titles-(310 CMR 16.000).The system: j c ®';Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4/8/2010. Inspector'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 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. \ V t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Dis Dsal System•Page t of 17 Imo— Commonwealth of-Massachusetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Sheperds Way Property Address FEC Realty Trust Owner Owner's Name information is required for every Barnstable Ma 02630 4/8/2010 page. Cityrrown State Zip Code Date of Inspection B. Certification (coot.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described. in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments:. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally- unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below):. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 P Commonwealth of Massachusetts Title 5 Official Inspection Form- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r` 11 Sheperds Way Property Address FEC Realty Trust Owner Owner's Name information is required for every Barnstable Ma. 02630 4/8/2010 page. City/rown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is 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 El-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 willprotect 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 icial Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Sheperds Way Property Address FEC Realty Trust Owner Owner's Name information is required for every Barnstable Ma 02630 4/8/2010 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health.(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within. 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. P PP Y Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 a ® 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-09/08 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 11 Sheperds Way Property Address FEC Realty Trust Owner Owner's Name information is required for every Barnstable Ma 02630 4/8/2010 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) 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 16,000 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 iswithin 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 11 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Sheperds Way Property Address FEC Realty Trust Owner Owner's Name information is required for every Barnstable Ma 02630 4/8/2010 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following.have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ Z 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? ® El Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins-09/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System=Page 6 of 17 Commonwealth of Massachusetts . Title 5 official Inspection Foam Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 't 11 Sheperds Way Property Address FEC Realty Trust Owner Owner's Name information is required for every Barnstable Ma 02630 4/8/2010 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on,a separate sewage system?[if.yes separate inspection required] ❑ Yes 0 No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): well Detail: Sump pump? ❑ Yes ® No 3/2010 Last date of occupancy: Date Date CommerciaUlndustrial 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-09/08 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 "< 11 Sheperds Way Property Address FEC Realty Trust Owner Owners Name information is Barnstable Ma 02630 4/8/2010 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (coot.) Last date of.occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,.distribution box, soil absorption system ❑ Single cesspool Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records,.if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the'I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-09/08 Title 5 Official Inspection Forth:Subsuifaee Sewage Disposal System•Page 8 of 17 �. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments 11 Sheperds Way Property Address FEC Realty Trust Owner Owner's Name information is required for every Barnstable Ma 02630 4/8/2010 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: unknown Were sewage odors detected when arriving at the site? ❑ Yes E No Building Sewer(locate on site plan): Depth below grade: 3 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.): Joints ok, no leakage, vented through roof Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑fiberglass '❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is rage confirmed by a Certificate of Compliance?(attach a copy of,certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: 5" " t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17. r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Sheperds Way Property Address lug FEC Realty Trust Owner Owner's Name information is required for every Barnstable Ma 02630 4/8/2010 page. Cityrrown 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 3' Scum thickness 1 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements 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 does not need to be cleaned now but should be done every 2 years as maintenance. Outlet tee intact, water level at bottom of outlet invert. Tank 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 aDate of last pumping: Date t5ins•09l08 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 SVO,� 11 Sheperds Way Property Address FEC Realty Trust Owner Owner's Name information is required for every Barnstable Ma 02630 4/8/2010. page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑polyethylene ❑ other(explain): Dimensions: Capacity: gallons .Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level.' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-09/08 Title 5 Official Inspection Form: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 y� 11 Sheperds Way Property Address FEC Realty Trust Owner Ownees Name information is required for every Barnstable Ma 02630 4/8/2010 page. Cityfrown 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 M 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.): None Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): I Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09108 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 11 Sheperds Way Property Address FEC Realty Trust Owner Owner's Name information is required for every Barnstable Ma 02630 4/8/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ 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.): Leach pit was dry at time of inspection. no signs of past hydraulic failure. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and-configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-09/08 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 11 Sheperds Way Property Address FEC Realty Trust Owner Owner's Name information is required for every Barnstable Ma 02630 4/8/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.)Y ( 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•09/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 official Inspection Forte Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Sheperds Way Property Address FEC Realty Trust Owner Owner's Name information is Barnstable Ma 02630 4/8/2010 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check.one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 13 `rA&W f o f n3'-f ,T C:- CrAtf9��� 6l 'r D `AG t{pi`r 74) t5ins•09108 Title 5 official Inspection Form.Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Sheperds Way Property Address FEC Realty Trust Owner Owner's Name information is required for every Barnstable Ma 02630 4/8/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 30 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) ❑ Checkedwith local Board of Health-explain: El Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: 1)Property is elevated considerably compared to nearby water 2)Town of Barnstable groundwater contour map indicates groundwater elevation @ 30' 3) Design plan for abutting property dated 3/21/2007 shows no groundwater @ 156" Before fling this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Sheperds Way Property Address FEC Realty Trust Owner Owner's Name information is required for every Barnstable Ma 02630 4/8/2010 page. Cityrrown 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 r�v t N SEWAGE PERMIT ' NO. LO.0 Al I0 VILLAGE. a f INSTALLER'S NAME & ADDRESS B UI'LDE R. OR OWNER HC( rY �1 r t._S'o DATE PERM T IaSSUED ®ATE. COMPLIANCE ISSUED // � � rY a T: 7y(. r-�I"lw I Al" gip - co o 00 1 L0,."C''ATION SEWAGE PERMIT N( Pa3' Iuv 2(� — ! `7 VILLAGE of-�- S 4 a ►, f 13 Ct g INSTALLER'S NAVE & ADDRES-S A 4 s, 76- 1342 B U I-L D E R OR OWNER HG DATE . PERMIT ISSUED DATE COMPLIANCE ISSUED // a 1� 0 CA i V No.. ..-- Fna..../ .................. THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH �. •�(�J� ..II- one ��� Application is hereby made for a Permit'to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: sue . �F '--------- ......C` 0........................................ ----- Location-Address ( or Lot o. r^ �Jit F�l X----------------------------------------- ----- ----------.I.. ..---c= F,C�/r l: S_%�CT-. . �f_s�� /,7 Owner Address w - Installer Address d Type of Building s Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms..-_ 3 _-__ -___Expansion Attic ( ) Garbage Grinder, ( ) a4 Other—Type of Building ,Utrx,:/�#Zst/e��No. of persons....flf-------------------- Showers a M - ( ,) — Cafeteria ( ) Other fixtures . f T f.. A l Ti`/:`aC�NFs -------------------------------------------------------------------------- w Desi n Flow____.___. ��............................ allons - er erson er da' Total dail flow....:"°. ?1 gg� P P P Y• Y - -----------------------------gallons. WSeptic Tank—Liquid capacity/SW—gallons Length.�3.1(....... Width................ Diameter................ Depfli---------------- x Disposal Trench—No.............,....... Width.- -------- Total Length-.____-__-___-:__-- Total leaching area__-_._- ±__-_-sq. ft. Seepage Pit No....../............. Diameter..rc��'�. :_ Depth below inlet ------------ Total leaching area--._._._ - __ -sq. it. Z Other Distribution box ( ) Dosing tank,( ) ,a Percolation Test Results Performed by.---_ ................................................- Date* Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water...'_..__._--.-..__. (_, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------:_::______ �i ••.. •---=-•-----------•--------•--- .I----- ` . O Description of Soil------- .... 3 - �� - - ` � --_----------------------- x o�� U --------------------------- •--------=------------.............•-------•-- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable....__.......................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article YI of the State Sanitary Code—The undersigned further agrees not to place the system in ' operation until a Certificate of Compliance has been issued by tt.�e bo d of health. ate Application Approved BY- .-----.....-•••-•••............ ... Date Application Disapproved for the following reasons----------------------------- - ----------•---------------------------------•-.._....----------..._.....--------------------------•---------•-••---•---•-•------------------------------------------..------•...----------------••....... Date " PermitNo......................................................... Issued......................................................... Date .. ----------------------------- a. ►. y't / "10. FEs.....,1. ............... THE COMMONWEALTH OF MASSACHUSETTS )_ BOARD OF HEALTH ........L. /�..�tl},...............OF........ .`( fir. ......'7.................................. Appliration -for Disposal darks Cnutuarurtivii Punift Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: r Location-Address or Lot No. ] J _ ------------------- ^� Owner Address ------------ --= ------------------ Installer Address d Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms_.___.__- - p ( ) g ( )______________________________Ex Expansion Attic Garbage Grinder ' Other—Type of Building -����>'..!�!� L `lJNo. of .................. Showers O — Cafeteria ( ) Otherfixtures -------------------------•----------------------------------- ___ W Design Flow--------- __.____________________________gallons per person per day. Total daily flow.....:.?V-----_-_--_----___-_---.-..gallons. WSeptic Tuck—Liquid capacity/ gallons Length__-.�,X------ Width.........------- Diameter................ Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area.....................sq. ft. Seepage Pit No_______ ____________ Diameter_._ `�� "'' P g t 1 _____ Depth below inlet____________________ Total leaching trea.___.._____._____sc it. Z Other Distribution box ( ) Dosing tank ( ) Q� Percolation Test Results Performed bY----------- ----------- .................................................. Date_-__-•---------------------------------- a Test Pit No. i_______________minutes per inch Depth of "Pest Pit-------------------- Depth to ground water__.---..__.-.---__-.__.. f� Test Pit No.'2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-----------.------------ ---------- Description of Soil ----------�1 � '�,1 . - ,� , //gyp - W l../ UNature of Repairs or Alterations—Answer when Applicable----------------------.............____.._.______-_______-____--_-_-..-__--- _.________....,, --------------- ------------•---------------------•------_-__--__--__--_--------_-_-_-------------------------------------------------------•-------- ----•---------------------- ...................... Agreement: ; The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code- The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by t /boa-d of health. Sig .:: = .- -�..... .. •--.._ ....... �.._20 Date Application Approved B ` PP PP Y .�. . ------ --Y----------------------- -._�y_7L Date Application Disapproved for the following reasons_________________________________________________________________________________________________________________ .........................•--•------------•=-------------•••--•-----------•_•_-••-•••=-••-•-•-...-------- -----------------------_----•-----------------------------------------------••_-_-------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL � ............. ........... ................. %lertifiratle of (01.1ompliatta THIS IS TO CERTIFY, That the Individual•Sewage Disposal System.constructed ( or Repaired ( ) by "`. dh, 1 -- �talle .r at ............... /... { has been installed in accor with he provisions of A �1 XI o��fyyThe State San tv4 Code as described in the application for Disposal Works Construction Permit No.. ........�1-/___---------------- dated.._f�_�_�.-..7.�.................. THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION FUNCTIONpSATISFACTORY. � DATE // /lff._ l-. .__... Inspector-- ------- `""..-------------------•--....•. f THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALT N ........ .... ii1.........OF......... ............ ................... FEE _ S? ••••-•••••••••-•••-••• •- / �" �i����ttl �rk� C�lw��;�tr�trti,ait �rrmit /- `'Permission is hereby granted-----------------------------------------------------------------------------------------------------------------........................... to Const u t ( )• Re air ( a . I.di}''' S g isposal Sy m at No. ��..... �1 (/ - r . /+ as shown on the application for Disposal Works Construction r it No-==------- ----- Datd-�/.-'.!T.'7� Boar of Health DATE.-- FORM 1255 HOBBS & WARREN.. INC.. PUBLISHERS • 1 r� k TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date 2' i �Z Time: In Out Owner R�-'��I Tenant Address I �i�1'I �,J� ii�m Address It �SWA Ck-D ; WA J Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities V 3. Bathroom Facilities 4. Water Supply V/ 5. Hot Water Facilities �/l0 ON 6. Heating Facilities ✓ —"f' � � 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural ✓� Elements 14. Insects and Rodents / 15. Garbage and Rubbish Storage and Disposal V 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms : Number of Vehicles Allow ma Number of Persons Allowed (max) m�-- Person(s) Interviewed L Inspecto If Public Building such as Store or Hotel/Motel specify here �� ,' TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date �9 , " Time: In Out Owner /� r]V Tenant Address ' y rog y lq Address Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities `r! 1n11� win�.arp. 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width � 15 �� 6C) t7 19. Number of Tenants Observed 00 S r.� PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms J Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspecto z;� If Public Building such as Store'or Hotel/Motel specify here ...., ., .., � ._...L . . _., . . ,. ,. .n. ... .... ... ... . _ _ .. �.� .. .� ,. . Barnstable. Fire Department 3249 Main ST Post Office- Box 9.4 -_ Barnstable, MA 02630 Permit Certificate - General with Seal Date: 02/23/2006 Business Name: Francis E Cirrito Address: 11 Shepherds WAY Barnstable, MA 02630 Phone: The following permit has been issued: Permit No. 980350 Type: 01 Removal of tank (s) from property Issued Date: 07/19/2004 Effective Date: 07/19/2004 Expiration Date: 07/19/2004 Notes : Tank removed from ground no evidence of leaking was noted after removal . 07/19/2004 13 : 15 : 14 rcrosby It is the business ' s responsibility to ensure that conditions are in accordance with applicable State and Local fire regulations . Please contact Barnstable Fire Department for more information. 0 Inspector: Robert Crosby Date 02/23/2006 11.15 . Page 1 _ TOWN OF BARNSTABLE ' � — 72— 0 UNDERGROUND FUEL AND CHEMICAL STORAGE'SYSTEMS 0/ ASSESSORS MAP NO. S - PARCEL NO. ADDRESS: 01 0 � Y',ne.v s �1J 6� VILLAGE' '('ao'Q LL NAME;.__ CONTACT PERSON SO PHONE NUMBER 3 Z 9 70 0 ®0. LOCATION' OF TANKS: CAPACITY: TYPE OF 'FUEL. AGE: TYPE: LEAK (� (� OR CHE ICAL: DETECTION 1�►CX o� �`0 0 Q 1�1�� SYSTEM! , DATE OF PURCHASE OF. EACH: 1. 2. 3. 4. 5. DATE.07: FIRE DEPARTMENT PERMIT:"Do M6 ul TESTING CERTIFICATION SUBMITTED: �� �� �� PASSED -jZDID NOT PASS � o PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF- TANKS ON THE BACK OF THIS CARD. e a� ® moa©a r c a w -5. 04 B^Rti sa BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT ,'t SUPERIOR COURT HOUSE BARNSTABLE, MASSACHUSETTS 02630 J PHONE: 362-2511 EXT. 330 LAB 337 CLINIC 340 NAME: Harry Jiison DATE TESTED: 11/15/88 TANK LOCATION: 11 Shepherd' s Way Barnstable TANK AGE: 11 years TAG # : 462 CAPACITY: 2000 gallons Thank you very much for participating in our program to test underground storage tanks (UST) by soil gas analysis. The free test was offered under a grant the Barnstable County- Health & --Environmental_ _ Depa.rtme_nt_ , received f rom —the Protection Agency. Because the use of soil vapor monitoring for UST system release detection is very recent and only limited information and experience exists with using vapor sensors in this manner, we can not guarantee that your tank has not leaked. However, our tests did not indicate. any problem. You should also realize that a "good" result from our test is no indication of how long the tank will remain sound. Because of this and the fact that your tank is so close to your drinking water well , it would be advisable to replace your underground tank with one in the. basement. if you , ever decide ,to remove your tank, it would help our work if you notified us so we could take a look at it after excavation. This method has been given an interim approval for 1988 by your Board of Health. Depending on results of research this year, complete approval may be given, otherwise you may be required to pressure test your tank to keep it in service after 1988. A copy of this . letter has been sent to your Board of Health and the records reflect that your tank test indicated no problem. If you have any questions, please contact Charlotte Stiefel at 362-2511 extension 334. cc: Barnstable Board of Health l �t/ rvsS Ci / [NTSMEAD KEEPING YOU ORGANIZED No.10334 2453L MADE aUSA GET ORGAI M AT SMEAD.COM a /v A o F' 6 IV ,9UGc.i57 ,25� /gJlo SCf7GC � ,� �o � t-lqAee, E �E44e>1 z V4-/02 i SCHGE / _ /6o' ST = CEeT/Fy 7A147- IW is \ Fov�D4Tio�/ 5r14WAI OOV 771iS FeAN Is L o e 4 TT�D or./ 7W 4 r 1 RuG-usT 24 1974 ����� ►� Or t L1E' 6 `uNnyr o ySFr" �- /aao zee w � l 1I 11 �6 �