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Home My WebLink About2015 Feb 19 - Violation Notice with Back-up Information - , J_�`'� /i f,y,��C;t,/ i�.� fs Ll�.rii�'/ �c �'A ��`° �� TOWN OF YARMOUTH a �"'3 114G ROUTE 28 SOUTH YARn40UTH n4r�SSACHUSETTS Q`2664-4451 � nAiiqGME[S � �,q.e,� o�,r� Telephone (508) 395-223I, Ext. 1241 —��- Fax (508j 7G0-3472 B O A 12 D 4 F H E A L T H February 19, 2015 Ms. Christine Smith 6'7 Elmwood Avenue Dedhazn, MA 02026 RE: Vialarion Norice—93 Acres Avenue,West Yarmouth for Expired Operarion and Maintenance Contract for Innovative/Alternative FAST� Sepric System Deaz Ms. Smith: The Yazmouth Health I7epartment has been notified that the mandatory aperatian and maintenance coniract for your FAST wastewater treatment system has expired or been cancelled. To date, we have not received evidence that you, as the new owner af record, have entered inYo an operatian and maintenance aontract. This letter is a reminder that the MA Department of Environmental Pratection (MA DEP) and the Yazmouth Health Department require you to keep an operation and maintenance {O&M}contract in effect at all times far the life af your septic system. Information about these requirements may be found at http•//www barnstablecountyhealth.oreJia- svsfems/ia-owners-�uide. Please forward a copy of a signed contract via mail, fax(508-760-3472), or email (avonhone�a7,varmouth.ma.us}within fifteen(15}days af receipt of this letter. For yaur aonvenience, I am enclosing a list af wastewater operators we aze aware of that do business in Barnstable County. The firms listed operate multiple types of I/A technologies and aze not associated with any particular technology or vendor. The last known operatar under contract with your praperty was Todd Palmatier of Coastal Engineering. Piease be advised that failure to respand to the above request may require an appearance before the Yarmoath Board of Health to show cause your failure to maintain the required contract. If there are any questions cancerning the above matters,please contact this office at 508- 39$-2231 X1240 between 8:3d am and 4:3d pm daily. erely, G. Murphy, .5., C.HA., M.P.H. Health Director cc: file BGM/avh H:\OFFICEIAMY�Violaiion Notices143 Acres FAST Contract Viotaiion02.19.2015.docx � Q�D� 6am9tabie CoUMy Department of iiealMf . ,�i hs� andEnviron�nt �$�g�,�y� 8arnstabie County Licensed Wastewater Operators P.o.gox,z,,6amstabie,MA02630 U 'i�i`' 'F4 � Phane:�568)775-BssB g' .Hu '� August 2Q13 Fax:i308�362•2b03 . . .• � . • . . . � • . ��`�Joe Makins.�: "Accu Sepcheck .. . ��17 Norlhside Driue ' � ��` Sauth Dennis "MA 02860-1820 ��.(5b8)3858891� Winston Steadman II PA!Ca e Onsite t 105 Miiistone Raad 6rewsker MA 02631-2615 (774 373-6602 ��David Bennett � ��Bennett Environmetatai Assoaatea,�ine. � P:O,Box 9743 � �� 6rewster�� MA 42831 7667 �� .�.(508)896-1706 Stepben Nelson Clearwaier Recovery 175 Sprin Streei Rockland � MA 02370-2647 (781)87$-384$ ��Todd Palmalier � � � ��Coastai Ed ineedng,�tna � � � .� 260 Cranberry Highway ... � -� Qdeans �� MA �� p2653 3114�� .�(508)255-6511 Dan Schwebach Dan Schwebach Home Sen+ices 745 Doane Road � Easiham MA 62642-2272 (508 237-2233 JasonEOis:....: ��d.C.Eilis�DesinCo;tnc:��. . . . . � :�P.0.6ax2152� : . Brewsier�� MA � ��02631-8152 �. �. �(508)385-2228.. Ja Quinn J85 stems 77FairmeadowRoad Wilmin tan MA p1887-1616 {978)658-2585 ��Keith Femandes �� J�:Mr O'Rei � &Associatex � � 1573 Main Stieef/P�O,Box 1773 � � Brewsker �� MA � 02631-1773 �� . �{548)896-68U1� David Baecher Moles Environmental Services,Inc. 306 Winthrop Street Taunton � MA 02780-4355 {548)680-6770� ��CharlesPires ��:'Prio' ��Wa�erMana ement ` � ��347MapleStreef � NeWBedford �� MA 02740-2333 � '�. 508 958•4291"< Brian Tiftan The Buildin inspector of Ca e Cod �� P.O,Box 307 Eas�ham MA p2642-�307 {866)737-8244 �'�.Robert�E � eraitl � '��166Ma owerTerrace � �� SouthYarmoutfi ��MA 02664-1118 :'{Stl8J776-7558 �� Sco[i Kraihanzei 5 Susan Car&le Way Sandwich MA Q2563-2773 {508)681-8323 � ��rHeW'5tockford �� -7tiKearDrive �� Eastham-:�� 'MA 0�842-2743 ;.(5Q&)2A0-7959 ��. � .. . • - i • ! a + i s • • t : " ��• •� � Waterloo Biafilter Clearrrater Ir�duslries P.O.Box$25 t swich MA Oi 938-0825 S78)356-0779 �':Am hidrome-� -�F.R.�Mahotie�:&Assodates � �273 We ouih�Sireet ftocManil� � �`MA 02370-1143 '� 781 $82-9360�� ftUCK Nolmes aod RAcGrath � 362 Gifford Sireet Falmouth �MA 02540-2912 � � (508 274-7950 "�Nitrex ".lombardp�Associates�� - ��: 49:Ed eHitl,Road � Newton�<. ��MA ,02467-1170 � � 617)924•2924� . White Kn' ht Se tic Preservafion Services 38 Haro�d Sweet Drive Aitleboro MA 02703-4311 � 508 222•2203� ��RosanaDavis ' � '�:�5e [itech��`�� 9Ro Lane �:�� Cohasset� ��'�MA 0202b-1350 '�.78tl)383-68$8.:. Norweco Sin ulair 5ie mund Environmental 3ervices,Ine. 49 Pavilion Avenue Providence RI 02905-1534 401)785A130 '.'Bio=M1Aicrobics��FAS7 ��'Waetewater7teatmentServices 44 Gommercial$ireet Ra nhdm�� MA 02767-13tl6 ��'� 508)$60.0233'� � Wesion and�Sam son � � 5 Centenniai Drive Peabod MA 0196U-7906 � 978)532-1904 �'�-HUUT �+- � � � ��Wi �in�Precast 798erlowsLandin Rqad '' � Rocessett�. "MA �:02959-Odp `'508 564fi776 :- Inclusian af a Licensetl Wastewater Operatpr on this list is in na way an endarsement of any particular operalor or technology type. ` ,�— ^ �%"c� �z—i i�'� ! . . ir��u:.�� = �� C ,_ ,,., � . �<<.-.�r�k''�"�'�` �a' ot �� ''. �,ys� ✓'� �' •,��C�� Naveniber 25, 2014 , i� Ms. Christine Srnith �„�y 67 Elrr�wood Avenue Dedharn, MA p2026 +�� RE: Violatian Natice—93 Acres Avepue,West Yarmouth for Expired Operation � and Maintenance Contract for lnnovative/Alternative FAST`�Septic System �� Dear Ms. Srnith: � �`� The Yarmauth }Iealth Department has baen notified that the mandatary ogeration and ` maintenance contract for your FAST wastewater treatment system has expired or been cancelled. To date, we have not received evidence that you have entered into a new �p�ration and maintenance eantraet. \�� This leiter is a reminder that the MA Department of Environmental Protection(MA DEP) �� and the Yannouth Health Department require you to keep an operatian and maintenance (O & M) cantract in effect at all times for the life of yaur septic spstem. Information ,�,� about these requirements may be found at ht�t :/Iwww.barnstablecountyhealth or ia- \' systemsiia-aumers-�uide. Plcase forward a capy of a signed contract via mail, fax (508-760-34'72), or email (avonhoneC�n varmauth.ma.ns}within fifteen {15} days of receigt of this]etter. Far your convenience, I am enclosing a list of wastewater operatars we aze aware of that do bueiness in Barnstable Gounty. The firms listed operate multiple types of UA technologies and are not assaciated with any particular teehnology or vendor. Tha last known operator under contract with your property was Todd Palmatier of Coastal Engineering. Please be advised that failure to re�pond to the above request may require an appearance before the Yarmouth Board of Health to show cause yaur failure to maintain the reqvired contract. If there aze any questions concerning The above matters,please eontact this office at 508- 398-2231 X1240 between 8:30 am and 4:30 pm daily. Sincerely, ,i' Bruce G. Murphy, R.S., C.H.O., M.P,H. Health I�irector cc: file BGM/avh vonHone, Amy From: Todd Palmatier<tpalmatier@coastalengineeringcompany.com> Sent: Tuesday, August 26, 2014 3:11 PM To: Brian Baumgaertel; Olusegun Onatunde; vonHone, Amy Subject: Steven Hobert, 93 Acres Ave., West Yarmouth To all concerned, This is to inform you that Steven Hobert has passed away, and that the FAST UA treatment system at the above referenced location is no longer being serviced by Coastal Engineering. Our information is that the house has been sold, but we have no further information as to the new owners. Todd Palmatier Coastal Engineering Company, Inc. 260 Cranberry Highway,Orleans,MA 02653 Nantucket Office:9 Amelia Drive,Nantucket Phane 508-255-6511 e�R.554 Cell 508-237-4979 www.CoastalEneineerin¢Companv.com INADVERTENT DISCLOSURE— The information contained in this e-mail is confidential and privileged, intended for the sole use of the addressee. Unauthorized use, distribution, copying or disclosure of this information is prohibited. If you are not the addressee and have inadvertently received this communicaYion,please contact the sender at (508)255-6511. i - '•VisianGovernmentSolutians Page 1 of3 93 ACRES AVE Location 93 ACRES AVE Assessment $206,600 Mbtu 24/ iJ// PID 635 Acct# OOS4600 Building Count i Owner SMITH CHRISTINE M Currant Value .—__.. ....-�-- ..__--- ..__--- __..— ____._–__-- ...._— ---.._-- AssessmeM .. .....—_ ...'. , ....— valuationYear ... � ImProvementS .,_ Land �� L Tatal .,. ...._' —_ — _� __ ._'_ .i i2015 . _..-- $b9,506�:' ...-$137,100i �. . , $20b,b�0i Ow�cr of Record 4wner SMTfH CHRISTlNE M Sale PNqe $260,000 Co-Owner Spok&Page 2]771j 72 Address 67 EI.MWOOD AVE Sale Date SO/21J2013 DEpHAM, MA 02026 qwnership History ---..__ .._-----._. _.___ .___.._ ____.. ---� -- ....___ . ._._..- --.__---- .. � Ownership History � .___.__ ......_.. _... .__ ._...__ ____ ____ ___.. _._.._—_.__. ___. Owner Sale Price Bpok Bi Page Sale pate ��.. __.......— _.__ _.__ '___... _.__..._ , ... . .'- __._._ _.____ ..._ _.� - � �HOBERT DIANE M $100 27771/69 '�.� 1OJ21/2013 ��.. i :HOBERT DIANE M $I6�i 27771Jfi8 ,, 1OJ21j2613 !H08ERT STEPHEN f $76,000��i 10282( 158 �'� p7/Ol(1996 ' i TOWNSENp FRANCES R ��. Sn I ' 'i Buiiding Tnfarmation Building 1 : Section 1 Year Built: 7454 Building Photo Living Area: 860 ReplacementC�t: $43,8a0 Building Percent 70 Gobd: Replacement Cost Less Depreciation: $65,?00 _. .__... ._- _.— __._ _- _.. BWlding A}ttributes � . Field _ I Description :. .... — .__- _ a __. _...._ � I Style !Ranch � i Modei ;Residentiai . ��G�ade: '�.Bebw Average �� Stories: ... .��'..�1 Story .''. http://gis.vgsi.com/yarmouthma/Parcel.aspx?Pid=b3S 8128l241� • -�Vision Governrnent SolutiQns Page 2 of 3 ,.,,OccupancY i�y ,' . . . ,. �i Exterior Wall 1 �Wood Shingle ''�, �Ezter�or WaH 2 .._..—... ,' �. . T . � ��Roof SLructure: _.. ��...;GatNelHiF .... _.. �Roof Cover ;Asph/F GlsfCmp �� 4�.._ i Interipr Wall 1 '��..Plastered '��.. �Intenor Wai�2 '��..Drywall/Sheet ��,. �In[eriac Fir i s VIny7Jfv5phaiC �, �In[erior Flr 2 �hWrdwood �. j Heat Fuel �'�..Gas �'� {http://images.vgsi.cam(pho[os/YarmoukhMAPhotos/(\00�00 'i Heat TyDe: '�,Forced Air-Duc I \12187.jpg} �AC Type: �None � BUildilt9 LdyOUt '�7otal Bedmoms: j 2 eedrooms �'.. � _'. j 7otal Bthrms: ''�1 '' i Total Half Baths: �'��..0 '. .�`TaWi Xtra Fix[rs: ... �'... I Total Rooms: I,Ba[h 3Cyle: ,Avarage . �` _._ Kitchen Sryle: Mpdern '� a�y � ��,_ .._—._— ._..___.. _...._ ._..—_. ' ;� �. z�C :� .___. ..__....__. _— ......— ....—_..__'—_'—i ��'�� Building Su6-Areas j,.pl�Yp{�i _ —. I aross Living Code Descript3on �. . . . Area �..� Area .i... _... _ ......_ _. __J ��..BAS 'First Floor 860 �'�.860 � !FST 'U[ility,Finished 40 '0 i ..��..WDK ��Deck,Wood �:....,240 �.:0 j 1146 860 ._._ . .__.. _.__...- _....__...__ . _._—�.� Extra Features . _— ..._ .—___._ _.__._ __.. __._— __. - __.._. ___..__.. - _.._._.._— ' Extra Features y�q$i �—_..__ _i ____ _.._ _... _._ — . ._ i . Code _.I_ .__ DescNption l _.. Sf e-.. � _._ Value __.. I _BId9# . : a __ � ��,FPI.1 '�FIREPLACE i ST ; 1 UNITS', $1,500,�'� 1 I i,M7L j HEAT7L4TQR VEN ... ..... i UNITS'.. $7,660' .... i i Land Land Use Land Line Yatuation Use Code 1030 Size{Acrex) 4.5 Desoription SINGtE FAM MDL-03 Fron#age 0 Zone D�p� � P7eighborhood 0050 Assessed Value $137,100 Alt Land Appt No http:iJgis.vgsi.comlyarmouthmalParcel.aspx?Pid=635 8/28/2014 � • '•Vision Governynent Salutions Page 3 of 3 Categary Outbuildings _.__. .- __--- .____.. ..__.... .___ _._.. .. ._..__. ._ __.. ..... ....___ _ . � Outbuildings 1SG.@O.Q'��.. Cotle � .� Descriptioo I Sub Code � Sub Desaiptian � � Size !. Value I eldq# ., ':SHDi j SHED FftAME ��, '.., ''.., 120 S.F ..... $500( 1.'; Va�uation History —..._ ._---..... .--._ _-__.. __.__ _.__- _.._ __. .___.. __--- - �- . AssessmeM � _ _. _._ _ . _. i _. ; Valuadon Vedr Improvements _.( Land I_ Total , . _— '_._ ._ �'_.. ._ .__ _... .____ .. ,2014 �, $64,200��.. $123,200�� $187,40� �..2Qi3 .... $62,960.. $130,200; $193,160'.... ,,:2Q72 �� 569,700', ......�. $137.400.:, #268,7Q0'� .__— ....._ _—..._—_ ..._._. (c)2013 Visian Govgmment SWutions,inc.All rVghts reserved. http:/lgis.vgsi.comlyarmouthmalParcel.aspx?Pid=635 812812014 . � � ; R��[��MI�� Commonwealth of Nlassachusetts Title 5 Official Inspection Form A"' 082��3 Subsurface Sewags Dlsposal Syatem Form-Not tor Vduntary Assessmen HEALTH DEPT. 93 Acres Ave Propeny�aureu Diane Hobert �� OMrtiers Name �� Yartnouth AAA 02673 7/19/13 �uired tor �Y DaGa� �Y/Town SLU Lp Cotls Wte of Iropemon . I�psctlon resuks must be submlCed on fhis form.Inap�etion fams may�rot be altered In any way.Please see complateness ehecklfat at the snd of the fortn. �„� A. General information Mmis on Me �iiBai�1B6 1. InSpector. only Me teb key �D1"0V8 y01f Jason P Bumie cursor-do not Name of InspBQOr uae Ms�atum icey. Nei9hborhood W�te Wetet CompanyName � 350 Main St � ComWnrAdd�sss Yamwuth MA 02673 �+ cnyRw«n smce zp,coae 508-775-2620 515017 Tebphone Number Lifsrue Numbsr B. Certification 1 certify that 1 have personatly inspectad the aewege disposel system at this address and that the infarnation reporteC bebw is true,axurate and complete as of the dme of the inspecdon.The inspection was perfortned based on my training and experience in the proper function and maiMenance of on site sewage disposal systems. 1 am a DEP approved system insp�ctor purswn!to SecNon 75.3�0 of Title 5�310 CMR 15.000).The system: � Passes ❑ Condidonalty Passes ❑ Fails ❑ Needs Further Evaluatlon by the Local Approving Authority �.��(�j�` 7/19/13 Inspadots sipna "' Daro The system inspector shali submit a copy of this inspecfion report to the ApproWng Authority(Board of Health or DEP)within 30 days of compieting this inspectlon. If fhe system is a shared system or has a design flow of 10,000 gpd or greater,the inspec6or and the system owner shall submit the report to Me appropriate regional office of tl�e DEP. The original should be seM to the system owner and copies sent ro fhe buyer, fi applicable,and the approving authority. ""This raport only describes conditbns at the tlme of i�npeetion and undx the condidons of ua at that drtre.Thb inspeetlon doss not addnss how the system wiN periortn in tlro fi�d�re under the same or dMfereM eonditlo�M use. �sa,..ana rar s aiear�wrum��wuro &w�p�obD�SY.bm•pY��1� ' � . • � Commonweaitlf of Massachusetta Title 5 Official Inspection Form Subsurfece Sewags Dbpoeal System Fmm-Not for Voluntary Assessments 93 Acres Ave aropenr naanas Diane Hobert � owners wme �0��' Yartnouth MA 02673 7/19113 required ta ,�ry�.y,. carrtow� sreee nv coaa �a i�aw� B. CertifiCBtion (cont.) Inspaction Summary:Check A,B,C,D w E/ahvays comptete atl of Section D A) Sysbm Pssses: � I have not found any infortnefion which indicates that any of the faNure criteria described in 370 CMR 15.303 or in 310 CMR 15.304 exist My tailure criteria not evaluated a2 indicated bebw. Comments: The system was found in good working order at Uie 6me of inspection. The system is a"f�t system" which goes to a pressure dosing leach fieW.All covers are within 8"of grade. 8) System Conditionally Pass�: ❑ One or more system components as described in the"CondiGonal Pass'szc6on need to be replaced or repaired.The system, upon completion of the�eplaoemeM or repair,as approved by lhe Board of Health,will pass. Chedc the box for"yes',"no'ot"rmt determined'(Y, N, ND)for the following stetements. If"not detertnined,'please explain. The septic fank is metal and over 20 years old•w the septic tank(whether metal or not)is structurally unsound,e�ibits substanGal infiltration or e�cfilbation ar tank Yailure is immineM.System will pass inspecdon H the exisdng tank is replaced with a canptymg septic isnk as appmved by the Board of H�Ith. •A metal seplic tank will pass inspection if it is sWcturally sound, not leaking and "rf a Cerbficate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): � tA�s.Y13 Tb501�mIYP��FPIrt&A�1�1p9M'�7p9Jp�18y�EY11•FOQY]OFt1 . , . , ; � Commonwealfh of Masaachusetts Title 5 Official Inspection Form Subsurfaca Sewage Dbpwal Systam Form.Not for Voluntary Assessmenta 93 Acres Ave arooeny naarees Diane Hobert Ovmsr Ovmefs Neme �"�0�8tl0°° Yarmouth MA 02673 7/19/73 iaquka0 Wr a�Y DaBe� ��YR� SYete �P Cotls Date of Inapection � B. Certiflcation (cont.) ❑ Pump Chamber pumpslalartns not operational. System will pass with Board of Heaqh approval if pumps/alarms are repaired. B) System Conditlo�qlly Passes(conG): ❑ Observation of sewage backup a break out or high sfatic water level in the distn'bution box due to broken or obstructed pipe(s)or due to a broken, seltled or uneven distribufion box. System will pess inspection'rf(with approval of Board of Heallh): ❑ brolcen pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(E�lain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system requirad pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspeclion iF(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain bebw): ❑ obshuction is remwed ❑ Y ❑ N ❑ ND(Explain bebw): C) Further Evaluation is Rpuired by the Bosrd of Hplfh: ❑ Conditions radst which require further evaluation by the Board W Heatth in order to de6emiine if the system is failing to protect public healfh, safety or the emironment 1• Syatem wili pass unless Board of Nealth determines in axordanca with 310 CMR 15.303(1Nb)that tl►e system is not functloning in a manner whkh will protset public health, safsty and the enWronment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is wifhin 50 feet of a bordering vegetated weUand or a salt marsh I6iw.31t3 Tilb 3 Omd�tWdbn Fam SUEw�Io Swp�Wpq�l�•p�W 9 af 17 � Commonweslth of Massachusetts Title 5 Official inspection Form Subsurtaee Sewage Disposal System Form-Not for Volur�ry AssessmeMs 93 Acres Ave a�aperty neaAse Diane Hobert �B� Ownefs Name ��nieon�' Yamwuth MA 02873 7/19/13 r��a ror ca�rrtowo s� zw coae o�m or��a� �� B. Certification (cont.) 2. System wfll hil unhss the Board of H�1lh(and Publk Water Suppifer,It any) determines that the system is functbning in a mannsrthat prote�ts the publk healtli, sa(ety and anvironmeM: ❑ The system has a septic tank and soil absorption system(SAS)antl the SAS is within 100 feet of a surfa�water suppty or hibutary to a surtace xater suppty. ❑ The system has a septic tank and SAS and the SAS is within a Zone 7 of a public wa�er supply. ❑ The system has a septic tank and SAS and the SAS is wifhin 50 feet of a private water supply well. ❑ The sysbem lias a septic tank and SAS and the SAS is less Cian 1�fcet but 50 feet w more from a private water supply well". Method used Lo determine distance: "Th�system passes N the well water anatysis.perfortned ffi a DEP certiBed laboratory,for Tecal coliform bacteria indicates absent and the presence of ammonia nitrogen and ni6a6e nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the enetysis must be attached to this fortn. 3. Other. D) Syabm Faflure Cribria ApplicaNe to All Systsms: You�Indkete"Yss�or"No"to each of fhe following fw�I inapections: Yes No � � Badcup of sewage into facility or system component due to overioaded or clogged SAS or cesspool � � Discharge or ponding of eflluent to the surtace of the ground w surface waters due ro an overloaded or cbgged SAS or cesspoot � � Sfatic liquid level in the distribution box above outlet invert due to an overbaded or dagged SAS or cesspool � � Liquid depth in cesspool is less than 6'below invert or available volume is less than Y:day flow �..ana rw s abar�saan vwm sauio ew+os�+srum•vy.�a n � Commonwealth of Massachusetts Title 5 Official Inspection Form subsurfaee Sewage Dispoeal SysMm Fortn-Na tor volurrtary Assessmems 93 Acres Ave P�operty/Vtldress Diane Hobert � OwnefsName ��0f116 YertnoWl uhse ior MA 02673 7N 9/13 �YDWs. CRy/fown Shle ZqCotle W6eoflropWbn B. Cerfiflcation (cont.) Yes No � � Required pumpi�more than 4 times in the last year NOT due to dogged or obstructed pipe(s). Number of times pumped:_ ❑ � My portion of the SAS,oesspool or privy is below high ground water elevation. � � My portion of cesspool or privy ie within 100 feet of a surface waher supply or tributary ro a sutface water suppy. ❑ � My portion of a cesspool or privy is within a Zone 1 M a public well. � � My portion of a cesspoot or privy is within 50 feet of a private water supply well. ❑ � Any portion of a cesspool or privy is less fhan 100 feet but grea6er tlian 50 feet from a private water supply well with no aaepfable waEer quaiity analysis.[Thk system passas H the wsll water anrlysis,pertortned at a DEP eeRifled Isboratory,for feeal colHorm bacterla indieabs abssM a�M 9�s prosence of ammonla nMrogen and nitrab nitrogen Is equal to or less than 5 ppm, provWad that no MAerhilure criteria are triggeretl.A copy of the analysk and cAain of custody must be atlached to thb form.] � � The system is a cesspool serving a facilily with a design flow of 2000gpd- 10,OOOgpd• � � The system faik.I have detertnined that one w more of fhe above failure criteria exist as deacribed in 310 CMR 15.303,therefore fhe system fails.Trie - system own�should conqd the Board of Healfh to deEermine what will be necessary tp corted the failure. E) Large Systems: To bs conaWerod a larpe sysbm Me systam must sarve a faeUlty wiM a design flow ot'10,000 9Pd to 15,000 gpd. For large systems,you must indicete either°yes'a"no'to each of the folbwing, in addition to the questions in Section D. Yes No ❑ ❑ the system is wilhin 400 feet of a suAxe drinking water supply ❑ ❑ the system is within 200 feet of a tributary W a surface drinking water suppty ❑ ❑ the system is located fn a nitrogen seruidve ar�(Interim Welihead Protecdon Ar�—IWPA)or a mapped Zone II of a public water suppy well If you have answered'yes'to any quesGon in Section E the system is considered a signifipnt threat, or answered"yes'in Sedion D above fhe large system has failed.The owner or operator of any large systam considered a significant threat under Section E w Yailed under Section D shall upgrade the system in accorclance wifh 310 CMR 75.304.The system own�should contact the appropriate regional office of the DepartmeM. axn.ana ressom� �■w�cm�:a�m.aw a...w ucow�•vy�.s a n � Commornvealth of#ilassachasetts Titie 5 Official Inspection Form 8ubsuRacs Sewags Dispoe�al Systam Form-Not for Voluntary AssessmeMs 93 Acres Ava p�enynaaren piane HobeR . Oh+iar owner"s Name '^�0""Bd0"'� MA 02b73 7119N3 rowtRa ra Yamwuth �, �,coaa oaee u�� e�q�. CAY C. Checklist Ghedc'rf tire fallowing hava been dwro. Ycu must indicafe'yes'oc"ro'as tn each of Me folbwing: Yes No � ❑ Pumping infamaton was provided by the amer�occupent,or Baard of hleatth ❑ � Were any of the sys�m camponents�mped twt in the previous txro week�9 � ❑ Mas the sys�m received nortnai flows in the previous iwo weelc period? ❑ � Have targe votumes of watgr been iMroduced to Me system recently or as part of ihis inspection? Were aa buift pfans of tlte system�ined and�amined7(If ft�ey were rwt ❑ � availaWe nWe as NtA) � ❑ Was the fadlity or dwe�ling inspeGted tor signs of sewag8 back up? � [] Was the site inspected for signs of break outT � ❑ Wcre aN sys0em components,exciuding ihe SAS,iocatatl an si[e4 � ❑ Were the seplie tank manhal�ur�covered,opened,and the intarior of the#ank inspected for!he condition of the baf�es or tees, material of oonstru�tion. dimensiats,depth of liquid,depth of sludge and depth of scum? W8s the i8ci�ity owner(and occupants if dilfererrt from owner}provid�!with � ❑ infomia�dan on the V� maintenam:e of subsurf�aewage d'+sPosa�sys�ms? The size and tocaiion ot the Soli Absotpdo�Systam{SAS)on the site has been deiermined baseci on: � � E�ting infom�ation. For e�nple,a plan at the Board of HeaHh. Q � Determined in the fieid('rf any oi the failure cri6eria reiaied M P�t C ia at is�e approximaGon oP di�tance is unaaepCahie)[3t0 CMR t5.3ff2(5y� D. System irtformatian rteswemia�Flow conaitio�+s: Number of bedraoms(design): 2 Number ot bedrooms{ectual): 2 DESIGN flow based an 310 CMR 15.2p3{for exampie: 110 gpd x#af bedraoms): �� sn.�.Yna rm�saryr`rpecemFam:siea.t�sswa{�Oiqa�d8r�'�fMBan � � Commonwesith of Maasachusetts Titte 5 Official Inspection Form ��,��,�o�,.��v�� S3 AdES Ave Property Add� diAn6 Ho6ert � orvnsra Mlame "�°��0"�° Yartnouth MA 02673 7lt9/13 �e4twhed tar e�er�'Dpp. CilYRaxn State LP Cotla �M Urerepadian D. System infornnatian i�tiOn. System consists of a 2 part fank wMh the faat system in i�a pump chamber tl�at presaure dosea to a ieaah 5oid. Number of current reside:nts: 8 Daes reeidence have a garbage grinder? ❑ Yes � Na �s Iaundry on a separa�e sewage system9(ir�dude iaursdry system inspectksn inTamation in tl�is reQort.) ❑ Yes � No laundry systtrm inspect�.W? � Yes ❑ No S�esonaluse7 � Yes ❑ No Water meter r�dings.if available(last 2 years usage(9pd)): 12=178ppd 11=159gpd Detail: Sump pump? ❑ Yes � No Ssasonai Last dabe ot occupa�cy: � CommercitYlndwtrisl Fbw Cor►ditlons: Type of Establishmenk Qesign 1�(based art 310 CMR 15203); �� Basis of design fknw{seatsfpersons(sq.ft.etc.}: Gt�sse traP Fxesent? ❑ Yes ❑ No lndu�riai waste hot�ng tank present? ❑ Yes ❑ No Nptrsanitary waste discharged�the Trtle 5 system? ❑ Yes ❑ No Water me#er ts�adings, if ava�abie: 156s.3'f8 � TarSdSe'ibRee�n�Fomc$E,ulen�BM�}pyp0i/�Mm•1MWT147 � Commonwealfh of Massachusetts Title 5 Official Inspection Form Subsur(aq Sswage Dispopl System Form-Not for VoluMary AssessmenLs 93 Acres Ave P�openyneea�as Diane Hobert �K Ownela Neme �O�8h0e i6 Yartnouth MA 02673 7/19l13 �aquired far �Y PaDs� abRovm Slate ZIP Cotle Dame at I�on D. System Information (cont.) Last date of accupancy/use: � Other(describe below): CienerallMortnatlon Pumping Re�rds: Source of infortnation: �s�P�mped March 2013-Yartnouth BOH Was system pumped as part of the inspecdon4 ❑ Yes � No If yes,volume pumped: qaDons How was quantity pumped detertnined? R�son for pumping: TYPe�sysmm: � Septic Nank,tlisfibution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ �Y ❑ Shared system(yes a no)(if yes,attach previous inspection records, 'rf any) � InnovaWe/Attemative technology.Atfad�a copy of the curtent operdtion and maintenance eontrad(to be obtained from system owner)and a<wpy of latest inspaction of the VA system by system operaror under contract ❑ Tght hank.Attach a copy of the DEP approvaL ❑ Other(describe): ISw•9�14 TtlM b phig F�p,eEm Fam:Bubpu4os 51Yya Oiopq�Lypam•pq Bd77 � Cammomrealth af Massachwetta Ti#te 5 Qfficiat inspectian Form Subsurtacs Sswags Dlsptpoal System Fwm-t�kri for Yolurrtary J+sReasments 99 Acres Ave Pt4perly Atldr9p Diane Hobert �� Ownefa Nmie "'�'�0°�B YBrmoufh bfA 62673 7159113 �� CGyRown SfaOe 7JD Cods Daro Of Im}ixtion avbry pepe. Q. System 1ltforntation (conc} Approximate age of sli cnmponenks,da6e instaiied(if kna�m}and source of intormadan: 1�8 pe�r Wan ar fNe at tt�e Yatmoutlt 80H W�e servage odors detected when artiving et the site? ❑ Yes � No BuiWing Sewer(lacate on sile plan): Depth bebw grade: �•4� � Material af construdion: ❑cast iron �40 PVC ❑ofher(explain): Dislance from privaCe wa6er supply well ar suction line: � Comments(on condi6on ofjoiMs,venting,evidenae of I�kage,etc.): We ran a sewer carrrera up the lirre end ft was ok eF the time of inspedion. Septic Tank QacaEe on sfte plen): Depth bebw grade: Inlet cover-2" Outl�-8" � Materiat af constructlon: �concrete p met�l p fiberglass ❑PolYsthYieee ❑cd�er texplan) If fank is melal,list age: rmrs !s age Lo�r�m,ea cy a certifi�te�c�na�nce�tas�a,a«�py��erork�) ❑ Yes ❑ Na D'unensbns: 150pga! gludga deptA: a — �s«.•ana Ttl950l�C1i tqMt�t�f iOme S�Jwafo S�ape()Ypoqi$y�R�'t+oP 6aF t7 � GommornveaNh of Massachusetts Title 5 Official inspection Form Subsutlaes Sewags Dispoaai Sysbm fortn-Pbt fior YWuatery Rssessments 93 Aeres Ave PropeAy Atltlroas Cli2t18 HObBft Ovmm Owners Nwm,+ ��p1f� Yartnouth h4A 02673 7t�9113 requiroQ for .—,.._ ewry ppg. Cily/fown Ste� ZiP Cotle Dada of Impaetiai D. Syste,m in€aRnation (cant.) Saptic Tank(cont) Distance fram mp of sludge to boRtom of ouqet tee or baftle 2+ Scum tlrickness �• DisMance from Wp of scum Ln top of outlet tee or baffle 4�+ Distance from bottom of scum ta bottam of outlet tee or baffle 1'+ How were dimensions determined? ��'�L� Cammenis(on pumpirg recornmendations,iniat and outlet tee or baffle oondRion,struch�tai integrityr, liquid levels es related to ouUet iavert,ev�dence ot leakage,etc.): The septic iank is a 1500 galion tank that has 2 chambers in it qne houses fhe fast system the otl�er tuwses a holding aree fw effiuerrt. liroasa Trap{bcate on stte plan): Depth bebw grade: � Ma�1al d cbn�rudiwa: �cDnCr+� 0 mef91 ❑fit�sr9�s �P�Y�Ylene ❑other(ercPlain)- DIt718l18IORS: . wSCUtii�tICECRC58 Distance irom top of sa�m�top of oud�tee or baffle �nce from bottam of scum to bottom af out�t tee or t�le Qste af iast pumping: � re.u.ana rm.a oear t�wm�nu+.e.sw+w�a�+asrem-R+u�ma n � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sswape Dbposal 8ysbm Form-Not for Voluntary Assessments 93 Acres Ave �m� niane Fwnert 0""� Ownar'a Neme �M°m"e°°w Yarmouth MA 02673 7M9/13 'equ'vedfor �eiY W9e. Cily/fown Sfete Zlp Cotls Oste of�mpsUion D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet bee or baflle condition,structural iMegrity, Rquid levels as releted ro ouUet invert,evidence M leakage,etc.): TIgM or HoWfng Tank(tank must be pumped at time of inspection)(locate on sfle pla�): Depth beiow grsde: Material of conshuction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Capacity: 9� Design Flow: w�s v�d�7r Alartn qesent ❑ Yes ❑ No Alartn Ievei: Nartn in workinp ortler: ❑ Yes ❑ No Date of last pumping: oaoe Cornments(condRion of alartn and tloat switches,etc.): 'Attach copy of current pumpin8 contract(required). Is�py atlached4 ❑ Yes ❑ No uw•sna res s omor F�pmm Fmrc&lvlw 3eR dWv��n•Yp 11 0l1] � commornvealth of Massacnusetts Title 5 Official Inspection Form Subsurface Sewege Disposal Sysbm Form-Not for VoluMary AssessmeMs 93 Acres Ave P�opeRy ned�eu Diane Hobert �'�^KK Ovmers Name ��` Yartnouth MA 02673 7/19l13 roqui�etl for /fam SYaoe ZIP Code Dah d I�sPemai h'ery P�. CM7l D. System Information (cont.) Distributlon Box(if present must be opened)(bcate on sfte plan): Depth of liquid level above outlet invert Comments(noTe if box is level and distributan to ouUets equal,any evid�ce of solids cartyover,any evidence of leakaga iMo or out of box,etc.): """"THERE IS NO DISTRIBUTION BOX ON THIS SYSTEM""""'"` Pump Chamber(locate on site plang Pumps in working order: � Yes ❑ No` Alarms in working order. � Yes ❑ No' Commenis(nate condition of pump chamber,condition of pumps and appurtenances,etc.): The pump chamber was found to be in good working order at fhe tlme of inspection. `If pumps or afartns are not in working order,system is a conditional pass. Soll Absorptbn System(SAS)(locate on site plan,excavation not required): It SAS not locatad,exp�ain why: SAS vvas located. u:u.a�a � rar s o�em m.oem+Fa�:&m.sn ss.w��sr+«�•�u a i� � Commornvealfh of Massachusetts Titie 5 Official Inspection Form Subsurface Sevwge Dbposal System Form-NM for Volurrtary Assessments 93 Acres Ave PrapehY Atldress Diane Hobert �� ow�era wme �� Yamwufh MA 02673 7/19N3 requiisd for rt� SYate LD Cotla WM af trspe�lbn �Y P�. �y D. System Information (coM.) rype: � ��9 p� number: ❑ leaching chambers number. � �My�� number. � leaching trenches number, length: lesch field �9 ❑ leaehing fields number.dimensicns: � �e��pp� number. ❑ innovativdaltemative system Type/name of techrwlogy: CommeMs(note�ndition of soil,signs of hydraulic tailure, level of ponding,damp sal,condi6on of vegetadon,eec.): There was no odd vegetatlon on top of leaching.There were no signs of hydraulic falure or ponding. C�spools(cesspool must be pumped as part of inspection)(bcate on site plan): Number and configuration Depth—top of Ipuid to intet invert Depth of solids tayer Depth of scum layer Dimensions of cesspool Materials of consWction Indicetion of groundwater inflow ❑ Yes ❑ No �..3ns TMs S OIMJaI Yw�m Fam:BiW�rr 8tiwpe D'speW Spkm•Yp�1J o/1] � CammonweakFr uf Massachuastis Title 5 Official �nspectian Form Subsur[aes S.w.ge�ispoea,8,tsten,Pc,,,s-Not for VWunt�r,,NasesaunerRs 93 Acres Ave arope�ty nadresa Diane Hober! � Qwnafs Nanr . �°�'�` Yarmouth MA a2673 7H91SS �� City/fawn stato~ Zp Code� �Iw of Uspedlon every Depe. D. System Infarmatian (cont.} Comments{rrote c�itian of sat,signs of hyd�aul�failure,level of P�din9.candi�on af vegetatan, etC.): privy(locate on site pl�n): AAaterials of consbvc6an: — Dimensions Depth of solids Cpmm9nis(note condidon af soii, signs of hydrauiic failure,ievet of pondmg,corrdition of vegetation, etC.)- smsoaaae�t�.ua�r-ane s�nr+toawew�er�*•wo.uarsr lyw-L13 �, cammorw�r..ilh cf Y�ass+�d+us.m Ti#le 5 Ofificiat lnspection Farm �.«�...Q.��-�� ,�c aw �a�.» �� a�► ow�.r.�a.�. �'"� y� Mp 02873 7ItlY13 � �yp�p Ct�MTarn 8mr 2tpC� C+Msdkww�rt a. sysEsm �n€orination t«�nt.) skdch Of sawape�I 5Ys�m:Provider a vMew at nie eewa�e dbpamd syamm.indudh�p tlas w �le�t iwo pernqn�nt�oe i�rcd�'lierks or 6xwfi�wks.toeals i�wslNt vrkHn 100 OeaR loCe*s whMe FM+bic wa4x supWY atFets tlie t�u�ding.Chedc qts of the bwces bekr+r. � f�d-akelch Mr U�e ares bebw a �� '� �»� � �� SA s . � � , , r � , � ,� , . � �, . _+ _ _ ~ - - — � � ,�� p 3 t� p(c �4 � i�� 1 _ �� aa' a - c = �� ' D �"� ' 3 .. G = 1R ,Sn.•'JM1S ,NI Sd1oW✓�4�'�Fdm;eW.,.»e.BF»...�Mq�+ar..•P.O.,3b,� - _ ____ _----------__ �__ _ _ __ , ,\ , __ _ _____�. ' � I � � I� - ----� ��` . � � �; � � � ; � �� ;oa � ��--r � �?� a o� 1� 4 ' �==- _ � � � � __ I� I � � �' � /� ` `t ', �..� -. . � � � h �� ." l ' � �i i �� i: , }' _� .. C+.� ` �l !' 'T... f.._. _ ... .. .. � . . . . _ ._ ��. _ / 1 A � /�/(� � �. i �{ " l' �.-___.__'_._C. . __ i ( ' � _ _J ' n�� c I ��"� \ � �ti �, �.� � R� �, �� i r �i� �f .Jl; `� ,-,�� ,/� �/ � � ,� � r �. �t;. � CommonweaHh of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Dbposal S�rstem Form-Not for Voluntary Assessmerns 93 Acres Ave ProPeRy Addmaa Diane Hobert � OwnstsName "�� Yarmouth MA 02673 7/19l13 requpsa wr �Y Ppe. �YRown � SWs ZP Cotle DaM M�nsp�lbn D. System Information (corrt.) Site Ezam: � CheGcSbpe � Surtxe water � Chedc cellar � Shalbw welis Estimated depth to high ground water. r belo�`SAS pe�PWn dated 1896 faet Please indicate all methods used to determine the high ground water elevation: � Obtained from system design plans on record If chedced,date of design plan reviewed: ��°"file at the Yartnouth BOH Date ❑ Observed site(abutting propeAy/observation hole within 150 feet of SAS) ❑ Checked witl�local Board of HeaMh-explain. ❑ Chedced wRh bcal excavators, ir�l�rs-(attach documenla0on) � Acc�sed USGS database-explain: MIW-29 Zone A water level 7,3 7.1x12= 1'1"adiustrnent You must describe how you established the high grourM water elevatbn: The SAS is a mounded pressure dosing system. Due to fhe"fast system'a 7 seperation variance was grented from bottom of the SAS to groundwater(see attachedy.We fountl tliat Uie system was put in according ho plan and thet there was at least 2'of seperetan from bottom of fhe SAS arM where groundvratar was known to be. Before fili�g this Inspeetlon RepoR,plsase see Report Completeness Cheeklist on next pags. C:.•sns rm.s om�l tiwdcn fam:S�Earlo Sw.p�DYpoW SyaYm•Pep 78 a1/7 :ar�; - 1 � � �a�`� TQWN OF YARMOUTH � G3 Y�8 R6LTE 2R SOL:TH 4":1Rt1UlTFi YtA55ACjiL'4E7T 026(rrt�SI . . . � . ...t��y�� T��Irpix>n�t5,lhl i9r-ri,t. E�t. ?+f — Fz>:c50N1 i9n�._>il+� ; y.� i BOARD CfF HEALTH ; i � yA[�,jgTSf�,�,PFR�VAL � j�¢T'E: 3uiv�,$ 3945 VgRjEjN PP OVAL S EROM S"FATF _� 5��; HTIVCRONMEritT t. C!D Frances R. T w d Minimum Requiremeats for Subsurface ¢ 5�.,� � !^ Disgosal of Sanx^��w�e Tide V: ntrsr�K�e,��$4 „_ Sectlon(s):15.4 5�)_ r5.405tixbt_ � ' 1.�,221 ; �C)GATION• 93 Acres AvenLe + West�armou2h Tovuri Amendmerns to T`ide V: _,,j.7 Dt�rr �S Tnwnsend The Yarn3outh Iiaard ofHeaitta,having rcviewed your apgIication on June 24. 1946.for a variance from the provisions of Re¢ulauon 15.405f 1)(al. 15.405(IXbI. t5.212 of Tide V of the State £nvironmental Code and1or�'ram the Town�—Yarmc:ut�Ameadm�ts to 7itle V,Section for arm �,�� a subsurface Sewage Disposal Syscem and, having daxermined strict enforcement�these ragutations ia this�as4ance woutd da manifest injustice and,further>that your requested variaoce does not canflict with the spirit pf the Sta3e Envirqnmentai Code nor the Town of Yarmouth Amendmenzs,has hereby graated she variance(s}wtrich shsll become effectiva Uurty(30)days after the Departm ent of Environmenta(P'rotecrion(D.E.P.)begins review of the requested variance(s). Ple�se be advised,tY�t in accordance with�10 CMR 4.0 you mustgro�1y apply to the L�gartmeat of Envirommental ProtecLion to activate theu review of this Board of Health action. The Department of Enviranmental Protection will advise yoa of the beginniag of the thim•(30)day teview time fiame and coauncnt thereafter. T'he varianae(s)gtanted are as fo3tows: SEE ATTAC�SI�E7 FOR LIST OF VARIANCES. Variances are as shown an the engineered ptan prepazed by Sutson Ha![,R5. anci dazed May 10, 1996 and revised June 27, 1945. You sre fiuther advistd that�work shall be commecx�d under this variance until the elapse of the thirty (30) day filing perial with the Department af Environmeafa3 Frotection It is the res�onsibiGty o#the appiicant and the projeci eng�neer to submit the requested variances to D.E.P.for review. The uariauce(s)granted herein shal]expire nirretv{9p1 davs from the date that D.E.P. thirty �0)day review " e frame terminatea �.,,� :`7'� 7— as=�� Bruce Cr_Ivfurphy,R..S., ealth Agent Daze cc: StetSon Haii,I2.S. Varianca A raved by the Board of Heatth at Wittiarn E. Kirkpaa�ick M�tittg of�g 24. I496 NTirtam A.Burns Jeazme D. ODonaell file e 1 of 2 _._.,,✓ Pa8 _ __ _ _.____-- S•S ��`,`� !� Z_1 Paa� � r►�xu o��.�ra�oE.n�v�g�r,u,rcr�v��s,��s 3pCATTOIV: 93 Acres Avmut, West Yazmouth ,a�'OWNERc Fcances R Townsend 53 Caanmore Road,Braimree,MA A2184 ' APPROVED VARi1►1�iCES: rnte v,yiri.� 1. sacaon ts.aos�zx�): va�;ance c�£�'fivm ct�e coquirca ra�upuaaon taecw�xn p�a�cnr li�and iesching fac�lity,a 3'seQaratian is ap�ovsd. �. Saxicm l5.40S(lxa): Variamx of 5'&am the roQuired 10'up�aion beh��c,ea the p�openy Iine end the.septSc taaic and the punnp c�ambcr,s 5' seperation is approved. Section IS.2i2: Yarisnce af 3'fram the required 5'separation bctween�bottom of the Ieaching faciliry and the gou�vaur. An alt¢r�tive FAST system with a Z'segazatiqn ta gron�idwaater is approved. 4. Sx�aa 13.252(s}: Variance fmm the ct;quired minimum aumber of two disaa"butian iines wiUun a leach field O�re dismbuuon line is app�oved To�ye Ameedmeets• i. Seciiqn 3.7: Vazianc�of 30'from t!�reqidxcd t QO'sep�mtion betw+een the 2eachiag£�ility and tt�e edge of wetlaad,a 50' sepm¢atian is approved 2. Section 3.7: Vsriance of 1 T from the required 54'sepazation hMtivicen zhe sepkic taak a�l the edge of wcflaads, a 33'sep�atioa is ap�xtoved. 3. Sxdaa 3.7: Varisnce af T from the ra}uirai 54'upsration baiwnd�ihe pump chsmber and the edge of wettands,a 43`scQaration is appcoved psge 2 of 2 �°`�T� AUTNQRfiZATlON FOR ENGIPJEERYNG PRflFESSlQNAL COMPANY>INC 1Ap Cpnh�ny Nghwaq.Orkao,MA 02653 SERYICES SOB255.0511 N FY$09.s55.bJOD • Tp: SbW Fbbar4 , Dete;: 08f14l12 Pro]a�ctNo. P12D8ld_tQ g3 Avea Ave�w Wesi YwmwU+.MR 02873 i �O�' p��+6,�SY�n H:SQB-T75�a2(12 C:T7d�836-0572 lctation: 93 ACtRs Avinue Wast Yarmauth.MA Ct�ntm E�pk�arinp Camm�+y.4x.(C£G)wAf P�rf�� i Fixed Fes: S45Q_Olf tai�w��0 Gratpsbnd s�v��ro1a8n4 t6 Mtl Mta»rwed � Plult 530.00 80Md d}IBiIMI F7in9 FM P��- � � SC61'+E OF 3ERVICES: • Condu�Tttle 5 Sraage D+spwa�9Yst�+��putia^ • � 'vi�apapan c�aport M Me DEP,Boattl��Hea1tE�and{p�EP)p��tams. •Naae: Pumpnrp,�reWired,is not irw�uded ana wal be bined aa an adCitionW cnerge. Recatls w�bs malnlsiratl bY fiio�t FatpinaarinQ CemtPdry, ine. TJRlvaw "��'�_ '� •� StIBJECT T4 TERMS AND CONDITIONS 4fi AUTr+wquD POR'C�OAStJ► N�G: � REYERSE SIDE -"`�.� �� '` _� /i�. � We ars Wa".eadinp with sarvioMe)nated u P�Y�+� 8Y� i ,�-'c" ''',� : Ciroction.immed4r�naUtfeWion in w�tin0 is roQ� John G. ,..` ' .TNM � �T ypu�wµt+io aifar thk audwr'vaiidn. � Pbee e�a,�ehR a�rarnant. t�: lw�+st ta,2ot2 AUTMORlZED BY Cl7ENT: � TNs dopnrMnt w�dsoome wu aiginal agresment, 3ignetlue P�inted Name aMi Siris �p�w d ria ag��bY�� GQASTAL ENGINEERING�ptoCeed as tlescibed.Ttus Oa�: Prppq�a!ax,piras Io 9U days�not si�peed bY botl+parrtlea. PlEA6�SIGN 1dtG RETIIRN OI�iE COPY j . D.��PROMKUUS,!/IGIL'.Mes�rc.�7S164rrA/FSB77-0II-/I.tar _ � � � �, <7_� f�,� �'� rm�l��"�� _ _ �� ^� >�,U�' t't:�f,`z� i�7 l� ..� �.r.U- . _ r � n, f t�'t .�Cl I / �` " �. �-'r�s�cF" io�� 4 �` � . r',��-Y :�` . . .�' J"q i' ,-��,: / Y � . 1 . ' � / d rti y' i c&l_ �.. 1 "`� , �r / �� , _: �� ,, , �- �,/ � b i�i , ,{_/� ; ��:)-f << o< . , ._ � ��r f� u ,�u� S ��r .. �'�� ' ' CC3ASTAL � � ENGINEERING COMPANY,INC. �'� r+,<c.�-o.�t 2,q�+.t`,r� i o 260Ganber7µ9�+f'.�ksn.+Aa4Z353 �IjllG �`tb�•._,l (0��.�M^ sae.ns.as,� . c..soazssaroo-. ��.,�9�,»�,�,P,,,ri�... raP��r'�^'le�d` 'E�rr�n-}. �(��`}C. FAST SYSTEM F1ELD INSPECTIQM & SERVICE REPaR7 � Project No. � C�c},.� •a O Date: Time: 8 1�.31 i �-- la:3oP ' crrenL , o(�eir�l— cernr,ea operator: ~ BR�� c� Lows: � CS •�J G Certilication#: �'`t(d . fkfLrrf a9 f��"' Air Temp: �4 A � lNSTAt,lA774N iHFORMAitON ' &10DE1 WO. SERiAL FIp. DATE pF INSTALLATION DATE OF LASS PUYA OUT r i EQUIPMENT YES NO MAINfENANCE PENfORMED AND GOMMENTS Electrical Pand(s} x �� n � Yrsual A1arm Opera4ing X j Aud»a A1arm Operating ( if resent � �. Blower(s� C t r:Ane.� Air In{et Fiker Ciean .�c Cl , 5 l r' � -� '� Bbwer Hpod V�nfs Gear x — 6ccessive Noiss � Excessive vbratlon Treatment Uniqs) 5.G P� ln �l Urwsuat Odor PumpOutRequired }� �}q-t7' vn+,.L �'t'1e,.� tt15 Cc.. p pr P[imarySBttling2 d�1- � (�rc •S�u�'! Aerobic TreatmeM Zone - j tB" in. �l" Sc.J�"'"1 �CXt �K�"SS C" vCf 1 � EFFLUENT LIMR RESULT GOMMENTS ( Estimated 6aAy Flow �pH{Standard Units) (o,q Cotw L{'. c 1(0 Temperature t.�,;,d c... Oissofved ChcY9e� 5,G? L R.�k ! Odtx � { S.o Nro c � 1 �1 � ive.n�- 5t,.�${'c.,v� G�Oe.rc',�TiYtG �et'(� orvuronsrcnunme �iamce��i � se{,t�c. -E-�k n� p�„-��,,.�� `�' - 4 D:iDOnDepmm�mt TedwteN�Servic�etF'asvlFoesSyu7urpRp1911�08-0C.dae � CommonweaHh of Massachusetts Title 5 Official Inspection Form Subsurhe�Sewag�Dlsposal3yatsm Form-Not for Voluntary Assessmerds 93 Acres Ave PropertY Addrea Diane Hobert �� Ovmete Nams "��` Yamrouth AAA 02873 7l19/13 '°°"'�e°ro` o�yR„Y„ s� na coas �m i� e�n 000e. E. Report Completeness Checklist � Inspection Summary:A,B,C, D,or E checked � Inspection Summary D(System FaiWre Criteria Applicable to PJl Systems)completed � System Infartnation—EsGmafed depth to high groundwater � Sketch of Sewage Disposal System eitlier drdwn on page 15 w attached in separate fi� L4M•9l13 Tlb S ORti��roP�Fam:&bWw Bw�ps�pos�Spr�•P411 att]