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T a S PARCEL LOCATION SEWAGE PERMIT NO. :. VILLAGE I N S T A LLER'S NAME i ADDRESS B U I L D E R OR OWN ER DATE PERMIT ISSUED 3 l ~,Za - DATE COMPLIANCE ISSUED L r S-4a -30 Ll O S z , ti No...•/�-. .. VV FE$..3.0........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Uiiipuual Vorku Tunutrnrtiun runfit Application is hereby made for a Permit to Construct ( ) or Repair (L,)"a4n Individual Sewage Disposal System at: --.......... U r I- ...................................................... ............ ............................................................. Location- •A dress r�► or Lot No. �- � L .... ----- j a ..............................................-O-n� I...�_:.---'--•-'------^------.. tY�x fl.0 l..'!. Ad__e W Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms._2_________________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) p•' Other fixtures W Design Flow_______-5—7 ____________________gallons per person day. Total daily flow_._�.a�_______.__.__.__________gallons. WSeptic Tank 1 Liquid capacity!0Wgallons Length.... Width____.._. Diameter________________ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. - Seepage Pit No.......JI.......... Diameter.../,�_t...... Depth below inlet---6 ____..... Total leaching area_.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ 4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... fs. Test Pit No. 2................minutes per inch Depth of.Test Pit---_................ Depth to ground water........................ a •-----•---•-•--••-•••--------------------•--•-----•---•----...-------'-'-•--•••-•-'-•••••••......-••................................... --------------- ••- 0 Description of Soil..................................................................................-------------------•---•---- V .....--•--•-----------•----•--------•------••-------------•-•---------•---•-----------------••-•-----•-----•--------------------••------•----------------------.-.-.------••'••---'-•'--..__"""''---- W -----------•-----------------------••--- ...................................................------•----- •-----••-•--------•-••---•-------•-•- U Nature of R,�Pairs or Alterations—Answer when applicable_.._, (fieSTj Jr---_--C��--� �L-----. . -----'-•-�-----/J� --••-------- . Cl ! Gci�( � '�Too Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions df TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed�bbjof h th. Signed .... .--.... —------ ........................ .......�rr� Date Application Approved By .... - .. .------- .- �, .... ,-3 Date Application Disapproved for the fol owing reasons: .................... ................................ ...... ........................................ .................... -------------------------------------------------------------------------------- --- ----- ----------------- ---------------------- -- -- ------ -------------------------------- -------- -------------------------------------- Date PermitNo. .................................. ...................... Issued ................................................................... Date No.- y -- FEs.. M,.?. ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE - = Appliration for Wtipos al Vorkg Tonotrnr#'ton Vrrufit Application is hereby made for a Permit to Construct ( ) or Repair (,,,�-°an Individual- Sewage Disposal System at: b 39 ............ ...... s. c .........s------------------------------- ----------• ........................................................... Loc'ati'bn-Address or Lot No. ------------ -\r ��, =�-�-�.-__ . .z�___------------------ ....................... ,� ------...--------------------------- - . W n O� r - ./..._ a � j!1_..�.1 !' (. .._.. Qr...�L.1___��-- Ada C--___. ..._ /IJ.. Installer Address UType of Building 1l Size Lot................ Sq. feet Dwelling—No. of Bedrooms....................................Expansion Attic ( ) Garbage Grinder ( ) aOther=Type of Building. ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures 1_=s_.... ---------•-.•••-•---••----....................•-•••-......_..--•--...._....•.................. W Design Flow-------- "S ......_! --------gallons per person per day. Total daily flow.,.-? cO________________________gallons. Septic Tank C-,Liquid capacityibb�,lgallons Length.... Width." ....... Diameter................ Depth................ W Disposal Trench—No._.._......•......... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......I------------- Diameter.•_,(o_�...... Depth below inlet_..(-C_...._... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by--••----•-•-••---••----••••-•--••--•--••---•--••-••••--•-••--•••--•••-•-- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r " (14 Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water........................ a ••••-•••--•••--•--------•---•-•-•-...._..•--••••-•...•-•-••-••--•-•••--•--•-.........•----•-•...........................••...-••----••••----•----•-----_...-- 0 Description of Soil................................................................................................................................. ...................................... x U -•--•-•-•••••-••-••••••-••••••••••--•••----••--••----•••••••••-•--••-•••-••---••--••--••-...•----•-••••-••--•--------••••-----••-•-••----•-•••--•••---•--•••-•-•----••••••....-••••----•••-•------•---•. W Z .......--•-••-----••--------••-••--•-......•----•......•• •---•••••••••--------••••-•-•-••-•••--------- ----•--------------•••---••-•-••-----••------------------------------------------------------- U Nature of Re airs or Alterations—Answer when applicable____ ._C1'yC�:�r._.....1� ).. 1� „__._.. !� Q. :. li1.� ;....------•---------------------------------------•---•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—Thy undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued�-thne--b-0-a!rd�off h-alth. Signed ...�...----- --- -- ...... . ..............- . ...------ Date Application Approved By -�*J �` i -----------: ------------------ _------ Date Application Disapproved for the fo owing reasons- .............---- ---- ----------- -------------------------------- ------------------------------------------------------- .................... .. ............... ... .......................................................... ................... .. ................................................ .. ......... ................................... Date PermitNo- ................................................................... Issued ............................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Telrttfi ate of Torayli are ,THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by-------------------------------------- Vc ................ f4 I`f V 1 Installer .. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. Icl.a.- ...y ........... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE - /--^ _ :.. .. - Inspector V -V------ ---------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE-3 Miposal Work.5 Tomitr ion anti# Permission is hereby granted L-�114ff /y ' ,�J7 l Ls------------ ...................................... to Construct ( ) or Repair (L�Tr Individual Sewage Disposal System at No.................. jit _fN6� C�1�-?. Street as shown on the application for Disposal Works Construction Permit N __ 2. Dated.......................................... �..............................................................-- Board of Health DATE { . --- FORM 3880E HOBBS&WARREN,INC.,PUBLISHERS ;,7 73 -6?a7 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH / TOWN OF BARNSTABLE Application is hereby made for a Permit to Construct ( ) or Repair )(X:d an Individual Sewage Disposal System at: ................Castlewood Circle Hyannis _.. ..... ...... ......... ..........••••-••-•......---...............•-•--•-•-------•••-----•-•----•----------....-----•--•- Location-Address or Lot No. Mi�ha el n.--------•----------------•-------..............----------•----...... .......... __........._..... ..._... .._.. - --.......-- Owner Address aJ.:.P:Macomber Jr. ..------• ••-•---• ...... Pq Installer Address 14 Type of Building Size Lot............................Sq. feet aDwelling-X No. of Bedrooms.........I................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ----------------------------------------------------------------•-•--•- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0.4 Percolation Test Results Performed by.......................................................................... Date------------------------------.......... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fX4 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ 0 9 •----••--•-•--------------------••••---•••••------••---••••••-•-••--••-••-•.....-••-..........--••-•........................................................ Description of Soil.......................................................-.......................-----------------------------------------------------.................................. � Sand & Gravel V ..••-•-•-••--•-•---•••---•-••••-•••-•--•-•••......•--•---•-•-•-•-•••_-•-- W U Nature of Repairs or Alterations—Answer when applicable__1--10 0 Q- g a 11 on 1 e a ch i ng _pit . ------------------------------------------------------------------------------•-••••.....-••-•-.-•••-•-•••-•--•-----------------•-----••---••_...---•--•----•----•-•-•-•---------•-•-•--•-••••-•-...•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce has b n 'ssued by the b/ rd health. Signed --- --- -- -- - ....----- � . .- f.------.............. ............. Application Approved By . I� Sl,.\ ate .............-. � V ...... Dare Application Disapproved for the following reasons- --------------------------------------------- -- ------- ------------...................-------------- ---------- -------------..................Date Permit No. ------.1...r�-----.._- ��------------_-----. Issued -- ---------------------------------- -- ---------- Dare 73 % THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for his nott1 Works Tonstrurtion rrnmit Application is hereby mad fe or a Permit to Construct ( ) or Repair .(x an Individual Sewage Disposal System at: / 42 Castlewood• Circle Hyanni..........._ --- - - -- -- - -Location-Address or Lot No. Mh 1 ,Q ------------------------------------------------------------------ Owner Address aJ .P.M a c ombe r Jr- --------------------------------------------------- ---------------------------------------------------------------------------------------.__ Installer Address UType of Building Size Lot---------------------------Sq. feet l—1 Dwelling—X No. of Bedrooms________I_________________________________Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of a' Building -__---_•-__________________ No. of persons____________________________ Showers Cafeteria ( ) Other fixtures --•----------------- W Design Flow--------------------------------------------gallons per person per day. Total daily flow-------------------------------------------•gallons. WSeptic Tank—Liquid'capacity------------gallons Length---------------- Width---------------- Diameter----------------Depth--------------- x Disposal Trench—No--------------------- Width--------------------Total Length--------------------Total leaching area-------------------- ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet--------------------- Total leaching area-----------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date--------------------------------------- Test Pit No. I----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ f%q Test Pit No. 2----------------minutes per inch Depth of Test Pit____________________ Depth to ground water------------------------ P4 -------------------------------------------------------------------------------------------------------------------------------- - - - -- ODescription of Soil--------------------------------------------------------------------------------------------------------------------------------------------------- -- - x Sand & Gravel V -----------------------------•------------------------------------------- ----------------- ----------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable__1-100 0 cra ll on le a Ch i n pt .___ __ --------------------------------------------------------------------------------------------------------------------------------------------------------------=--------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce has been -ssued by the board of health. - wC, f Signed -- `�� / -- ---�---------=------ ,-I- "" - -5[ -2 0/9 2 .�-� r Application Approved By (1 )_-t�..,.- �-�(----_9_ ------- ------------------------------- - Application Disapproved for the following reasons- ------------------------------------------------------------------------------------------= ---------------------------------------------- ------------------------------------------------------_------- ---------------------------------------------------------------------------- ---------------------------------------- ------- Dare d----------`-`-- Permit No. ----d--------------------- � Issued ------------------------------------------------------------------- Dare THE COMMONWEALTH OF MASSACHUSETTS \ , BOARD OF HEALTH TOWN OF BARNSTABLE Tertifirate of (gompltance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX) by-----J.-P-.Macomber Jr. - - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Installer at42----C a s t e l w o o d-- Circle---Hyannis------------------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 g The State Environmental Code as described in the application for Disposal Works Construction Permit No. ________--_ __�__�-�---_�-�______ dated ________________________________________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. --------------------------------------------------------------- DATE--------------- -----------------------------------:---------------------------------------- Inspector ---------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No....7 .�-nd TOWN OF BARNSTABLE F -3o_00_� Dis junial Varks Tnnstrudiatt Vrrttnit 1 ------ J.P.Macomber Jr.. Permisston is hereby granted ....=---------------------------------------------------------------------------------------------------------------------- to Construct ( ) or Repair �X�) an-Individual,Sewage Disposal System ' 42 Castlewood--- Circle Hyannis. -----------------!at No.. ------ ---- - --- - H - -_-- Street as shown on the application for Disposal Works Construction Permit No._ Dated___-_•______________•_-___________-___---_ s _. - - "- r -------------------- q Board of Health DATE-------------- / (�-"- ----- FORM 3630E HOBBS Q WARREN.INC_.PUBLISHERS 128 Pine Street Hyannis A 248 025 l I i i i TOWN OF BARNSTABLE LOCATION ' Z' 1 !� SEWAGE # 40 D5 VILLAGE yy n ` S ASSESSOR'S.MAP & LOTy ° INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY , ' LEACHING FACII.ITY: (type) (size) 17,- 11 NO.OF BEDROOMS 1 $El$BE OWNER 0ME- /W'o Gym c.0 PERMTTDATE: Z. " c'� COMPLIANCE DATE: 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 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 rr-- r: .J;.,1 � � ivy•� �� r� i �- '`� � � �� � � � � Q �, ,. �. .. - _ r J� �, `�'�. �. A e i t. 1 TOWN OF BARNSTABLE LOYATION �a Q�� S SEWAGE# VI�I!T �U - �` - , ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. s-- �2 4 0 0(ofI SEPTIC TANK CAPACITY -A o Q O / O W�C... . r LEACHING FACILITY. (type) V 3 2 , T X /.2 r S7 : NO.OFBEDROOMS �nS �i Nets. C . .., ?�e�P OWNER M S PERMIT DATE: 1�2 G f Cj COMPLIANCE DATE: S 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 on ` site or within 200 feet of leaching facility) Feet Edge of Wetland•and Leaching Facility(If any wetlands exist within -,300 feet ofyIcaching facility) Feet FURNISHED BY -7 �e } Y _ No. � "'�� Fee med,>_� THE COMMONWEALTH OF MASSACHUSETTS Entered in coputer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIPPlitation for Vspospl *pBtPm Construction permit Application for a Permit to Construct( ) Repair(✓f Upgrade( ) Abandon( ) ❑Complete System []'Individual Components Location Address or Lot No. '�a �i n�� } Owner'sIme,Address,and Tel.No. a Assessor's Map/Parcel " jV10ftAjhf, v✓ �pY��" c l Installe 's Name,Address and T 1. Designer's Name,Address,and Tel No b cZ,W'Prt.� t t�'3 O L c� �%°�,r vv �ZGo c'� i S"�G c o &Yd tX- fZ.j 14 S4 r., k-\ Type of Building: Dwelling No.of Bedrooms Lot Size rl sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) U Q C) gpd Design flow provided 11� 02 gpd Plan Date_ [`� Number of sheets Z Revision Date Title Size of Septic Tank ex�`3 `�V u Type of S.A.S.3 (1 fs--L Description of Soil { a , S�x I 'IT 9 a Nature of Repairs or Alterations(Answer when applicable) r,x 6-c 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 Certificate of Compliance has been issued by this Board of Health. Si Date v Application Approved by Date Application Disapproved by Date for the following reasons Permit No. rf Date Issued tkj No. .�J '7 Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in corn uteri Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplication for Mispo,sal.6pstem Construction 3permit t Application for a Permit to Construct( ) Repair(iX Upgrade( ) Abandon( ) ❑Complete System Eridividual Components Location Address or Lot No. 101�, P1^�a} Owner'srl e,Address,and Tel.No. Assessor's Map/Parcel rA /' J,/16+� C Installer's Name,Address,and T 1.No. Designer's Name,Address;and Tel.No. 'b(0 kN Vrw`k � '3 o\d Yc ("&Vv� ZCo{Yc't.� 1 S S Gco 2ydcr 2d S CL.� 1-1( 16PIAr Ls .. Type o Building: Dwelling No.of Bedrooms LA Lot Size 'U 15 S(( sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min_.required) l r r h gpd Design flow provided I , I _ 0 7? gpd Plan Date 1 k (1 Number of sheets Revision Date Title j Size of Septic Tank e x\' Type of S.A.S. Z L-1 u 10 ( L �t�3 a Description of Soil �A a 6 ID 1:2.S' Y k-- �4-C Nature of Repairs or Alterations(Answer when applicable) r 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 Certificate of Compliance has been issued by this Board of Health. t Si e Date d Application Approved by Date k _ Application Disapproved by Date for the following reasons Permit No._ /q Date Issued J �_ --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by C,g{ �r� ��j AnLA- at � � has been constructed in accordance With the provisions of Title 5 and the for Disposal System Construction Permit No.. _ dated Installer�` Designer DG�ur11 L,4,.,OLA) #bedrooms LA Approved design ow ( _ gpd ' The issuance of this pe it s 'all not be construed as a guarantee that the system will \ctio designed. Date Inspector C ----------y------------------------------------------------------------------------7--------7------------------------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction 3dermit Permission is hereby granted to Construct( ) Repair lV) Upgrade( ) Abandon( ) System located at�r � � ,� �Ae v , and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mustt be completed within three years of the date of this permit`: Date r5' / /1 Approved by \ _ SOOILrtTEST .LOOS L;. DES ( N CALCULATIo DG DC�3a C�a��N���1��0o a� ' SOIL EVALUATOR: DAVID D. COUGHANOWR. ASE *461 ,DESIGN FLOW: 4 BEDROOMS X 110 GPD - 440 GPD t WITNESSED BY: WITNESS REQUIREMENT WAIVED - TEST PIT p BC ATOUDNDWAT2ER�ENNOCHNTERESOILS I SEPTIC TANK: 440 GPD X 2 DAYS = 880 GALLONS USE EXISTING 1000 GALLON SEPTIC TANK /F IN ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOUND STRUCTURAL CONDITION. IF NOT. INSTALL INCHES HORIZON TEXTURE (MUNSELU MOTTLES NEW 1500 GALLON SEPTIC TANK. 55.15 0-8 Ap SANDY LOAM 10 YR 3/2 NONE FRIABLE DISTRIBUTION BOX: INSTALL UNIT DEPICTED 8-45 B LOAMY SAND 10 YR 4/4 NONE FRIABLE 45-72 Cl COARSE SAND 10 YR 5/4 NONE LOOSE -(OIL ABSORBTION SYSTEM: 51.40 72-144 C2 MEDIUM SAND 10 YR 5/3 NONE LOOSE 'THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE 43.15 SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES TEST PIT 2 NO GROUNDWATERCH ENCOUNTERED PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. THE 33.5 ft x 12.5 ft x 2 ft LEACHING GALLERY ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER ; DEPICTED BELOW CAN LEACH: INCHES HORIZON TEXTURE (MUNSELU MOTTLES I 55.10 0-8 Ap SANDY LOAM 10 YR 2/2 NONE FRIABLE BOTTOM AREA = (33.5 x 12.5) =418.75 sq. ft. 8-44 B LOAMY SAND I YR / SIDEWA 0 4 4 NON FRIABLE LL AREA [2x(33.5 - E BLE 12.5>] x2 18 4 so. ft. 44-80 Cl COARSE SAND 10 YR 514 NONE LOOSE - I TOTAL AREA - 602.75 sq. ft. 51.43 80-132 C2 MEDIUM SAND 10 YR 6/3 NONE LOOSE FLOW CAPACITY = 0.74 x 602.75 = 446.03 gal/day 44.10 'INSTALL A 33.5 ft x 12.5 ft x 2 ft GALLERY AS CONFIGURED 100 00 0o (GA n n Ong SEPT9C TANK , nnK , ;BELOW. FLOW CAPACITY = 446.0A FOUR B WHICH EXCEEDS L�(L- 0V lt� /r=�1llV ;THE 440 gal/day REQUIRED FOR A FOUR BEDROOM DESIGN. EXISTING UNIT - DIMENSIONS & DETAIL TANK TO BE PUMPED DRY AT TIME OF INSTALLATION IS O M A D S O R P T§O N AND EXAMINED FOR STRUCTURAL INTEGRITY. INSTALL M NEW PVC OUTLET TEE EQUIPPED WITH A GAS BAFFLE. S I/ SS TEM CONSTRUCTION DETAIL REPLACE WITH A NEW IUSE SHOREY PRECAST 500 GALLON LEACHING DRYWELL 1 /n 1500 GALLON TANK TAPER IF CRACKED. ROTTED (DRYWELL OR OTHERWISE 33.5 ft COMPROMISED. UNIT co _. -- 0o m - Lr In ® ® - Q c\1 NOT i N TO 1 SCALE STONE ro 4 ft 8.5 ft 8.5 ft 8.5 ft 4 ft � 8 ft-6 in A i INLET OUTLET I500 GALLON DRYWELL COVER - COVER DIMENSIONS & DETAIL INSTALL ONE INSPECTION RISER TO WITHIN THREE 3 IN DROP INCHES OF FINAL GRADE USE & INDICATE LOCATION � FLOW LINE H-10 ON AS-BUILT FROM -' UNI T BUILDING 10 in 14 TO !^ D-BOX ,p' 33 48 in � 010�0 in LIQUID GAS - p'�D�,D LEVEL BAFFLE ! p� 1 �$ -_ - - --- - - 102 in b aln STONE BASE IF NEW SEPARATION BETWEEN INLET & OUTLET 'CROSS SECTION .VIEW TEES NO LESS THAN LIQUID DEPTH INSTALL AN APPROVED GEOTEXTILE CROSS SECTION VIEW FABRIC OVER STONE DQS TR§B T§OIIV BOX U08-3 SE SHO Y 20 0 ■ DIMENSIONS PIPES EXITING D-BOX TO RUN LEVEL 28 1-1/2/in 0 EL EFFECTIVE■ 3/4 In TO 1-1/2 In GRAVEL AND DETAIL in x ' -■ DEPTH ■FOR F T F P 2 EE BE ORE ITCHING DOWN I I 46 in 58 in 46 in 12 in 150 in C MIN ALL STONE TO BE DOUBLE WASHED AND FROM ` FREE OF IRONS, DUST AND FINES IN PLACE N TANK T h _ b O -INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE 0 p; N SAS N STARTING WORK. O O -ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC b In STONE BASE T •�(� CODE (310 CMR 15). 21 in r 2� CROSS SECTION VIEW E -SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. O U - �._ v V O TOP OF FOUNDATION RAISE COVERS_TO WITHIN ALL PIPE TO BE 4 in SCH. 40 PVC EL = 57.27 +- 6 in OF FINAL GRADE AND TO PITCH AT 1/8 in/ft MIN 54.5 D=BOX j 3' MAX II EXIS TNIS USE H-20 52.15 EXISTING 1000 GALLON a000°o�o 0 P4CA0 o�8F4o� SEPM TANK 53.13 00°000��a 16 in .50 DRYWELL 5 EXISTING REFER TO DETAIL BOX STONE SM ABSORP Il �O(f� + 51.67 BASE 151.40 SYSTEM -REFER TO EXISTING r DETAIL BOX 60 ft 5-12 ft 49.40 NO GROUNDWATER BELOW': MOTTLING OBSERVED-:_-' 43.15 SEWAGE DISPOSAL SYSTEM PLAN 1128 PINE STREET CENTERVILLE. MA MARCH 18. 2019 ETE-4371 PG 2/2 i THIS PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM THIS IS A DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING COLL 0 PROPOSED SOIL PLACEMENT ADDITIONS. SHEDS, FENCES OR SWIMMING POOLS. OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. � PLAN AR PROPOSED R ABSORPTION USE COLOR PLAN ONLY pT SYSTEM FOR INSTALLATION OWED / 54 FULL DETAIL IS BEST -SEE DETAIL I VIEWED IN �_ / ON BACK i w FULL COLOR 123.83 f.,t 55 APTIO N SYSTEMI il. Ag5o i ® 13.5 fr 54 EXISTIN C) O O ` IN PLACE' NDONED TO BE AgA o I � 1 I � a ' .i EXISTING PAVED DRIVEWAY 56 CONY p�R (T �n MINIMAL _ v GRADING PROPOSED \ w nnnn �Uv° 55 O 61 � o I I D 1 rn � x 0 LOT 25 c, O AREA = 14986 sf+ sM a� DEED BOOK 12080 PAGE 22 �a ASSR MAP 248 PCL 25 56 oATER y 82 80 it WGATEI 23.14 f t VEMENT E D E s pWFe LEGEND PLAN SEPTIC COMPONENTS - SICA L E: 11 n = 20 f t EXISTING I 1000 GAL_, • 0 20 40 SEPTIC TANK e ve oO epANS uVIIgrUM _ r r - DISTRIBUTION BOX55 / • � / SpgLE GIS p � f ELEVATION 1 0 10 20 TEST PIT PRINT ON 8-1/2 x 14 in rOP 57.27P�\o � PAPER FOR PROPER SCALE OF FOUN�� wFsl Mq� �oarF�,� SEWAGE DISPOSAL N SYSTEM PLAN nS T ���N OF MgSs9r �P�(N Of MgSS9 � -TO SERVE EXISTING DWELLING NOT ° DAVID dG DAVID rya " H O W A R D A N D = o m TO D. D. ;t�� +x. L NANCY THOMAS m a SCALECOUGHANOWR y u COUGHANOWR " a m 1 C,� OWNERS/ OF RECORD No. 1093 No. 461 i kn z ! 128 PINE STREET PINE 5RETT O R EtSP o0 '�Fcl DPP ��o CENTERVILLE. MA old1P SOS/ E �� ,Cha ham, MA Ryder Rd S PROPERTY ADDRESS avidcou@Hotmail.com CEN TER VILLE. MA DATE: MARCH 18. 2019 D L O C U S M A P 508 364—�894 PG. 1/2 -)oa# ETE-4371 IA CD t Town of Barnstable: Regulatory Set vices Sa Richat d V. Sc.tlt, Interint Director 4 IIAW:srnuc.F rips. g Public Health .Divisiocl �6qq. �e ;. Mata Thomas McKean, Director a 200 Main Street, Hyannis, MA 02601 Y• Officc: 308-862-4644 Isar. 508-790-4304 I:ns Biller& Desis,ner�Certiftution Farm Date: M41y %.Mq Sewage Permit# 0 Ass essifr's iVla l;l'utcel Designer... 01 b . ifo vqA.q1ioWr Installer: Address: l5 GeV I' q-2 A w�r �� �'���Acicli.esS. �l ?j ��� �ittt Oil uas-issued;tr.perniit.io instirll::a chat' (installer) septic system at ��- �)t+r9C 5f S 'Sbased on a design drawn by (addre ss) �{ # (designer) :l certify that the.septic system refcrenced above was installed substantially acccrtdint. €r the design, which nMuy include minor approved changes such its.. lateral relocation of`the distribution box anti/car Sufic tank. StHp.nut ,(if rcgUI'red) was iri:spette'I arrd the soils : were found Satisfactory.; l certify it::the septic s_vstern rekrenccci above. was installed with major changes t :e: greater than 10' lateral relocation of the SAS.or any vertical relocation of any component of the septic; systern) but in accord=tree:with State Local.lt:cgulations.; Plan revistoll or; certit.icd as-built by rle,r iicr to follow., Strip out (if,required) wits inspected and the snails 4vt;rc��ounci sittt�fat;t€>ry..: � l certify that the, systuna cefercnucci abt�vt tivas constricted i ante with the teruati- cif the WN approval lctt F erp)1'icable) t !t dIURGHANOINR (installer's Si rittturc) 'No • l esi' rier's Signature}._ (AftivDcsi�;trcr's Stamp I1cre) I'I:,EAS.E RETURN 'FO BARNS'rABLE PUBLIC HEALTH .DIVISION. C:ERTIFICAJJ!'. OF CONIPLiANCE WILL NOT BE ISSUED UNTIL BOTH THIS FOR:yI AND AS- BUILT CARD ARE RECEIVED B.Il'I"1-IC 'BAI2NS'rABLF PUBLIC FICALTH DIVISION. THANK YOU 0:'Scp60Dvsi'vner 0:r6fication Form Rev S-1d-13.doc IT• o I L cD Certified Mail Fee $ r a�7 Extra Services&Fees(check box,add fee as appropriate) ❑Return Raceipt(hardcopy) $ - r ❑Return Receipt(electronic) $ 'y POS m` � r3 ❑¢erErfied Mail Restdcted,Delivery $ I -HB78 Q ❑Adult Signature Required $ ❑Adult Signature Restricted Delivery$ U f Om Pdstage Total $ THOMAS,HOWARD A&NANCY TRS Ln r-q Sent. 248 PINE STREET cr) CENTERVILLE,MA 02632 Giry�S 10immu:am OEM �Alw Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail in A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present thisc delivery. USPS®-postmarked Certified Mail receipt to thee, ■A record of delivery(including the recipient's retail associate. r i signature)that is retained by the Postal Service' Restricted delivery service,which provides ^U for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent -I /mportantReminders: Adult signature service,which requires the 0, is You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class WHO,first-Class Package Service®, available at retail). t or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mail. and provides delivery.to the addressee specified' ®Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent t with Certified Mail service.However,the purchase (not available at retail). i yy of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a.I certain Priority Mail items. ( USPS postmark.Ifyou would like a postmark on i"i ■For an additional fee,and with a proper . _,.,this,Certified Mail receipt,please present your —'I endorsement on the mailpiece,you may request Certified Mel item at a Post Office'for F-, the following services: ' postmarking.If you don't need a postmark on this -Return receipt service,which provides a record -Certified Mail receipt,detach the barcoded portion u of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply r You can request a hardcopy return receipt or an_,appropriate postage,and deposit the mailpiece.C: electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece;' IMPORTANT.Save this receipt for your records. PS Form 3800,April 2015(Reverse)PSN 7530-02-000-9047 7Article d items"1 2,and 3. A. Signature �/ 4 ❑Agent r name and address on the reverse X f ❑Addressee e can return the card to you.is card to the back of the mailpiece, B• Received rinted Name) C. Date of Delivery front if space permits. dressed to: T9. Is delivery address different from item 17 ❑Yes If YES,enter delivery address below: ❑No j THOMAS., HOWARD A.&,NANCY J TRS 248-TINE-SITREET CENTER_V IL.LE, MX.02632 i 3. 11I Illlil I'll 111 11111 I II I I I III II 11 II I I (III ❑Adult Sivice gnature ignature ❑Registered s ered Mai ss® l- dult Signature Restricted Delivery ❑Registered Mail Restricted 9590 9402 3759 8032 3746 09 ertified Mails ehvme Gartified Mail Restricted Delivery IV Receipt for ❑Collect on Delivery Merchandise 2. Article Number(transfer from_service label) ❑Collect on Delivery Restricted Delivery ©Signature Confirmation*"' 7 14 ; ❑Signature Confirmation 5. 173 0 0 0 01 4 9.8 7.=9 316 : 'Restricted Delivery Restricted Delivery r PS Form 3811,-July 2015 PSN M0702-000-9053 Domestic Return Receipt ; i US IRA Postage&Fees Paid USPS United States '0-Senderr:Please print your name,address,and ZIP+411 in this box* Postal Service liealth Division IVIIIAN 200 Main Street Hyannis,MA 0,2601 | ' |�-��[/������i� oo/�/U/ ' � � | ' ' r. SHE T� Town of Barnstable Barnstable edcaCity Regulatory Services Department 11111.1 ' HARNSZAB y MASS. 16gq. ,� Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 9316 November 7, 2018 THOMAS, HOWARD A &NANCY J TRS 248 PINE ST CENTERVILLE, MA 02632' ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 128 Pine Street, Hyannis, MA was inspected on 10/13/2018 by Sean M. Jones, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF T E BOARD OF HEALTH Y o a cKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\128 Pine Street Hyannis.doc f table Barn Town of s RARNWMILE. 9�AMAM Regulatory Services Department tfD MA'l a Public Health Division 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A_McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title•V: 310 CMR 15.000) An"x"marked in the ❑is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground - - - ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE 1 YEAR DEADLINE CRITERIA tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO.(2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe,relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments71 128 Pine Street ' Property Addressor/ C:� Howard & Nancy Thomas Owner Owner's Name information is required for every Hyannis V Ma 02601 10/13/2018 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. Inspector Information on the computer, Sean M. Jones use only the tab key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Company A Lane Co Company Address Centerville Ma 02632 City/Town State Zip Code 508-658-3456, 774-248-4850 SI 4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes S 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails 10/13/2018" 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 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 Commonwealth of Massachusetts �9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Pine Street Property Address Howard & Nancy Thomas Owner Owner's Name information is required for every Hyannis Ma 02601 10/13/2018 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summar y Inspection Summary: Complete 1; 2, 3, or 5 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 criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: i ❑ 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 I , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Pine Street Property Address Howard & Nancy Thomas Owner Owner's Name information is required for every Hyannis Ma 02601 10/13/2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Pine Street Property Address Howard 8r Nancy Thomas Owner Owner's Name information is required for every Hyannis Ma 02601 10/13/2018 page. Cityrrown 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 wetland 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 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**. 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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Pine Street Property Address Howard & Nancy Thomas Owner Owner's Name information is required for every Hyannis Ma 02601 10/13/2018 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® ❑ 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 1/2 day flow ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ® ❑ 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. 5) 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 CA. 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Pine Street Property Address Howard & Nancy Thomas Owner Owner's Name information is required for every Hyannis Ma 02601 10/13/2018 page. Cityrrown 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 office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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. ® ❑ 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Pine Street Property Address Howard & Nancy Thomas Owner Owner's Name information is required for every Hyannis Ma 02601 10/13/2018 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd Description: Number of current residents: unknown Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Pine Street Property Address Howard & Nancy Thomas Owner Owner's Name information is required for every Hyannis Ma 02601 10/13/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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(describe below): 3. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Pine Street Property Address Howard & Nancy Thomas Owner Owner's Name information is required for every Hyannis Ma 02601 10/13/2018 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): i Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 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 leaks or blockages. Vented through roof Lt5iinspAoc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Pine Street Property Address Howard & Nancy Thomas Owner Owner's Name information is required for every Hyannis Ma 02601 10/13/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 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: 1000 gallons Sludge depth: --- 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.): 1000 gallon septic tank is original and in good condition. Tank was recently pumped. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Pine Street Property Address Howard & Nancy Thomas Owner Owner's Name information is required for every Hyannis Ma 02601 10/13/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concretei ❑ 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form '4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Pine Street Property Address Howard & Nancy Thomas Owner Owner's Name information is H required for every y annis Ma 02601 10/13/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. 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.): D-box not located I t5insp.doc-rev.7r2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Pine Street Property Address Howard & Nancy Thomas Owner Owner's Name information is required for every Hyannis Ma 02601 10/13/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Pine Street Property Address Howard &Nancy Thomas Owner Owner's Name information is required for every Hyannis Ma 02601 10/13/2018 page. Cityrrown 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.): Leaching chambers were full to top resulting in a failing inspection 12. 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 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Pine Street Property Address Howard & Nancy Thomas Owner Owner's Name information is required for every Hyannis Ma 02601 10/13/2018 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts +� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Pine Street Property Address Howard & Nancy Thomas Owner Owners Name information is required for every Hyannis Ma 02601 10/13/2018 page. Cityrrown 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: ❑ hand-sketch in the area below ❑ drawing attached separately E A( Z� ❑ Bk A? 99 07- (P° A3 Yy Q3 4V t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Pine Street Property Address Howard & Nancy Thomas Owner Owner's Name information is required for every Hyannis Ma 02601 10/13/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 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: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Pine Street Property Address Howard & Nancy Thomas Owner Owner's Name information is required for every Hyannis Ma 02601 10/13/2018 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist 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 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Pine Street Property Address THOMAS, HOWARD A& NANCY J TRS Owner Owner's Name information is required for every Hyannis Ma 02601 7/29/2013 page. Cityrrown 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 to move your cursor-do not Sean M. Jones U use the return e. Name of Inspector key. S.M.Jones Title V Septic Inspection Company Name 74 Beldan Ln. Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmail.com SI4522 Telephone Number License Number 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 7/29/2013 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. t5ins•3113 Title 5 Of Form: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 ,M 128 Pine Street Property Address THOMAS, HOWARD A& NANCY J TRS Owner Owner's Name information is required for every Hyannis Ma 02601 7/29/2013 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: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The dwelling located at 128 Pine St Hyannis is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 3 500 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. ❑ 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 128 Pine Street Property Address THOMAS, HOWARD A& NANCY J TRS Owner Owner's Name information is required for every Hyannis Ma 02601 7/29/2013 page. City/Town 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•3/13 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 M 128 Pine Street Property Address THOMAS, HOWARD A& NANCY J TRS Owner Owner's Name information is required for every Hyannis Ma 02601 7/29/2013 page. Cityrown 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**. 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 1/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 128 Pine Street Property Address THOMAS, HOWARD A& NANCY J TRS Owner Owner's Name information is required for every Hyannis Ma 02601 7/29/2013 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 ❑ ❑ 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•3/13 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 M , 128 Pine Street Property Address THOMAS, HOWARD A&NANCY J TRS Owner Owner's Name information is required for every Hyannis Ma 02601 7/29/2013 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. ® ❑ 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): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd t5ins•3113 Title 5 Official Inspection Form: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 M 128 Pine Street Property Address THOMAS, HOWARD A& NANCY J TRS Owner Owner's Name information is H annis Ma 02601 7/29/2013 required for every Y page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 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: current Date Commerciallindustrial 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 I Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 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 128 Pine Street Property Address THOMAS, HOWARD A& NANCY J TRS Owner Owner's Name information is required for every Hyannis Ma 02601 7/29/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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): 15ins•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 M 128 Pine Street Property Address THOMAS, HOWARD A& NANCY J TRS Owner Owner's Name information is required for every Hyannis Ma 02601 7/29/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system repaired 12/28/2005 per town records .Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 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 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: 1000 gallons Sludge depth: 611 t5ins•3/13 Title 5 Official Inspection Form: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 128 Pine Street Property Address THOMAS, HOWARD A& NANCY J TRS Owner Owner's Name information is required for every Hyannis Ma 02601 7/29/2013 page. City/Town 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 5 Distance from top scum of to to of outlet tee or baffle 6 P Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, 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 should be cleaned soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Outlet tee was intact. Inlet cover is on riser. 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 , 128 Pine Street Property Address THOMAS, HOWARD A& NANCY J TRS Owner Owner's Name information is required for every Hyannis Ma 02601 7/29/2013 page. Citylrown 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 128 Pine Street Property Address THOMAS, HOWARD A& NANCY J TRS Owner Owner's Name information is required for every Hyannis Ma 02601 7/29/2013 page. City/Town 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 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.): Distribution box was in good condition, no rot, water level was even with outlet invert. Cover is on a riser. 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 128 Pine Street Property Address THOMAS, HOWARD A& NANCY J TRS Owner Owner's Name information is required for every Hyannis Ma 02601 7/29/2013 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: U500 gals leachinggalleries El ga a es 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.): Leaching facility was found to have 3"of standing water with no sign of past hydraulic overloading. Cover is on a riser - 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•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 °M 128 Pine Street Property Address THOMAS, HOWARD A& NANCY J TRS Owner Owners Name information is required for every Hyannis Ma 02601 7/29/2013 page. Cityfrown 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 128 Pine Street Property Address THOMAS, HOWARD A& NANCY J TRS Owner Owner's Name information is required for every Hyannis Ma 02601 7/29/2013 page. Cityfrown 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 Ono Z TAI\VC A-1 )3_i -Z Zoo El A-3 `) 5 5- 3 bO S� A � l5ins•3/13 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 , 128 Pine Street Property Address THOMAS, HOWARD A& NANCY J TRS Owner Owner's Name information is required for every Hyannis Ma 02601 7/29/2013 page. CityrFown 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: 12'+ 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 128 Pine Street Property Address THOMAS, HOWARD A& NANCY J TRS Owner Owner's Name information is required for every Hyannis Ma 02601 7/29/2013 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 f FORM30 &W HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LTH CITY/TOWN c_ W DEPARTMENT ADDRESS M sey`0 4i TELEPHONE Address 6 1!I/ �� Occupant I L. i Floor Apartment o. No.of Occupant No.of Habitable Rooms 10 No.Sleeping Rooms No. dwelling or rooming units No.Stor' s Name and address of owner Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: IA BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom(1).. Bedroom 2 lOd Bedroom 3 60 �- Bedroom 4 E Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: S ks, Flues,Vents,Safeties: Kitchen Facilities 4inb ve Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION RE ORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PE R ." INSPECTOR TITLE A.M. DATE 4 ��� TIME h P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 71 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises,shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other,violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water-sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. 1. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. , (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as. required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. No...=J 5 ta I$e100.00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _ ..PUBLIC HEALTH.DIVISION - TOWN OF BARNSTARLE, MASSACHUSETTS Yes Z.pplication for �Diqoal 6p$tem Cowgtru.rtton VErmtt Application for a Permit to Construct( ) Repair(4 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. 7 7 8—0 7 5 8 128 Pine St, Hyannis Howard Thomas Assessor'sMap/parcel 24 25 .248 Pine St, Centerville Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4 Wm E Robinson Sr Septic Eco-Tech PO Box 1089 Centerville 43 Triangle Cir, Sandwich Type of Building: ,� (wy') Dwelling No.of Bedrooms r v' Lot Size sq.ft. Garbage Grinder (n9 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when a plicable) Install a new Title 5 leach system to plans otpEco-Tec , #ETE-2238. 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 I�vironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo A f jhth. Si ned Date /� O Application Approved by Date 1 Application Disapproved by: Date for the following reasons Permit No. Date Issued `/ y Entered in computer: THE;COMMONWEALTH OF MASSACHUSETTS ` PUBLIC HEALTI PIV'ISION - TOWN OF BARNSTA5,;LE,I MASSACHUSETTS Yes _.__Z ficatiariJor Rio of pgtemc construction 'Bermit Application for a Permit to Construct( ) Repair(X) Upgrade( ) Abandon'( ) ❑ Complete System ❑Individual Components Location Address or Lot No. ;; Owner's Name,Address,and Tel.No. 7 7 8—0 7 5 8 128 Pine St, Hyannis Howard Thomas Assessor's Map/Parcel248,25 248 Pine St, Centerville o- - Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4 Wm E Robinson Sr Septic Eco—Tech PO Box 1089 Centerville 43 Triangle Cir'i Sandwich Type of Building: Dwelling No.of Bedrooms / Lot Size sq.ft. Garbage Grinder (ncj Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 14atui'e of Repairs or Alterations(Answer when applicable) Install a new Title 5 leach system to plans of Eco—Tech, ETE-2238. F $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 Certificate.of Compliance has been issued by this Boar ofF.Helth. ----" ' _ _ Signed Date ' / 'µI ?vQ Application Approved by Date Application Disapproved by: Date for the following reasons V 3 Permit No. Date Issued ------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS Thomas BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (X ) Upgraded ( ) Abandoned( )by Wm E Robinson Sr Septic at 128 Pine Street, Hyannis has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. -,)OC>5 51?R dated ) Installer Q0 Designer Coo ,,o r,0 J t� #bedrooms Approved design flout -53 d gpd The issuance of this permit shall not be construed as a guarantee that the system/wi•1 fun(ctioxr>sas designed. Date Inspector ' 4 ' No. -oc $�1e0 9� THE COMMONWEALTH OF MASSACHUSETTS Thoma!PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS igpo5at:*pgtem Construction Permit Permission is hereby granted to Construct ( ) Repair (X ) Upgrade ( ) Abandon ( ) System located at 128 Pine Street, Hyannis and`as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special co�ndit'ons. Provided: Construction m t be co ed w11hi a thxee-years of th�date of thi p t. Date Appro b May 5, 2007 Mr. Thomas McKean Town of Barnstable Public Heath Division / 200 Main Street Hyannis, MA 02601 RE: 128 Pine Street,Hyannis, MA Dear Mr. McKean, I would like to request a hearing in regards to my rental propegy:...at-128 ieTS�;fIyam-us - and the Health Department Inspection of April 5, 2007. I received a letter from the Health Department on April 23, 2007 noting a discrepancy in the number of bedrooms in the house and town records. The letter indicated that I would need to remove one bedroom by removing a door and increasing the size of the opening to one room so that the number of bedrooms would agree with the number recorded on my septic permit. I did not submit this request within the 10 days.because in December of 20051 had the system rebuilt by Robinson's Septic as a 4-bedroom system and thought that all I would need do is have him get the as built record on file corrected. After receiving the Health Department letter, I contacted Robinson's and they s d that was in their records and that most likely they had neglected to go back to the neer and have the plan revised to be filed with the Town. However,they assured at the ; w had in fact built a 4-bedroom system and would take care of the paperwork at Town. m � u: On May 3, 2007, Bill Robinson went to the Health Department to resolve the iss e. It o rn was then that I found out that the septic system was only part of the Town's con rn. B8 r informed me that he had met with the department and that the Town records indi ated that the house was a 2-bedroom house and that I should go down and talk to the Health Inspector. On May 4, 2007, I went to the Health Department. I spoke with Timothy O"Connell,the inspector who had been out to the house for the rental inspection, and with his help discovered that although the septic issue was a question,the real issue was that I had a 4-bedroom house in a zone of contribution that only allowed for 3-bedroom houses. In addition, Town records indicated that the house was a 2-bedroom house. He suggested that I meet with Thomas McKean,the Director of Public Health and that perhaps we could resolve the discrepancy. He also suggested that I request a hearing so that in the event the issue could not be resolved within the Health Department my request would be - in for a hearing at-the next board meeting. The house was built in1955 as.#two story 3/4 Cape and has 4-bedrooms. My family and I moved into the house in 1980,renting the house with an option to buy. Eventually in af• �i 1987, we purchased the house. At some time during that period,we removed the closet from what was the rear first floor bedroom and turned it into a laundry/spare room. In 1992, we upgraded an old cesspool to a title 5 system for a 3-bedroom house. We did not build the system as a 4-bedroom because we were not using what had been the fourth bedroom as a bedroom. In 1995, we moved to 248 Pine Street in Centerville and began renting the house at 128 Pine Street. At first it was rented to our children and the eventually to some of their friends who are presently living there. In each instance,the lease has been limited to four people. At present, there are a couple and two other adults living there. In 2005,the septic system failed and we had it rebuilt by Robinson's septic. Since the house was originally a 4-bedroom house and since the system had failed, I asked him to rebuild it as a 4-bedroom system as it should be. However, as indicated above, it was never recorded that way. I would like to respectfully request that since the house existed as a 4-bedroom house prior to the 1995 Zone of Contribution determination, it be listed in that fashion on Town records and that the septic system be shown as a 4-bedroom system. Respectfully, Howard A. Thomas 248 Pine Street Centerville,MA 02632 P f 'IKE Town of Barnstable Regulatory Services Department BA.RNSYABLE, MASS MPublic Health Division qj 1679• 0 MAC N. 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO May 18, 2007 Howard Thomas 248 Pine Street Centerville, MA 02632 Dear Mr. Howard, In response to the correspondence dated May 15, 2007, the single family house located at 128 Pine Street Centerville is approved to be rented as a four-bedroom dwelling. Therefore, the order letter dated April 19, 2007 referring to the April 5, 2007 inspection may be disregarded. The certificate of registration for this rental property is enclosed. Please post the certificate in a conspicuous area located within the rental unit. Thank you for your cooperation. Sincerely, o as McKean Director of Public Health Town of Barnstable �- r May 15, 2007 aZ ° Mr. Thomas McKean Town of Barnstable Public Health Division 200 Main St. Hyannis,MA 02601 RE: 128 Pine Street, Hyannis,MA Dear Mr. McKean, As we discussed on May 14,2007, enclosed you will find floor plans for my house at the above address. As I mentioned in my first letter, May 5, 2007,originally one of the closets shown in the front bedroom actually opened into the rear bedroom. We did not need to use the room as a bedroom and wanted more closet space in the front room so we switched the closet around. Tenants renting the house have off and on used it as a bedroom for guests. Although we did not think of it as a bedroom, Timothy©'Connell did observe that it was being used in that fashion when he performed his inspection. I hope that this provides you with in information needed to arrive at a decision regarding the number of bedrooms. Respectfully, qL—S Howard A. Thomas 248 Pine Street _ Centerville,MA 02632 : - , cn Work Phone: 508-428-5400 ex 211 3:, DD Home Phone: 508-778-0758zr o ca M rn I ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■r■11■■■■■■■■■■■■■l�I1■■■■■■■■■11■■ �■■■I■1 i■■■■■■■■■■■[I■E�1�■■■■■■■■■il■■ ®■■■�■��■■■■■■■■s■■■�IJI�■■■■®r ■■■II■■ �■■■�■11■■■■■■��■■■■I�-:���a■■■fir-�■■■I I■■ ■■■1■nl■■■■■■■�■■■■�w�fj,■■■■��■■■Lir■■ ■■■1■II1■■■■■■■�■■■r■�e�.■■■■was■■lir■■ ■■■1■tel■■■■■■■■■■■■�■����■■■■■■■■■���■■ ■■■i;■11■■■■e■■■■■■■��.�� ■■■■■■■■il■■ ■■■ ■;11■■■■■■■■■■■■.�..■■■■■■■■■■11■■ ■■■1■11■■■■■■■■■■■■■�I!■A■■■■■■®11■■ ■i■11■■■■■■■■■ses■.�I��.�e�.■��-=-=.1■■ ®■!�■1■■►�■■!!!r!lf 11/�■Illl�!!��■!�■■■■■1►�.'J■���!1■1■■ �■L�■1■®■1�1�■11■IIIII�■��Illl�/�1■■■■■■■li■11�J�1■ ■■■■■■■■■■■■■■■■II■■■■�'e■i ii��®11■■ ■■■!�I1■■■■■■■■■■■■■■■■■■■■■■■■I�l■■ ■■■1■11■■■■■■■■■■■■■�■■11■■■■■■■®!■■ ��■11■■■■■■■■■■■11■.��':��■■■■■■■��■■ ���k�l■III■■■■■■■■■■■1�■E�J�d��■■■■■■■DI■■ ����1■III■■■■■■�■■■■11■r��■��■■■■■■■■®1■■ �i����1■11■■■■■■■■■■■f1�■�i��■�'■■■■■■■11■■ ■■■�■��1■■■■■■�■■■■111� 1�1�■■■■�■11■11■■ �■■■[■III■■■■■■■■■■■IL�....�®■■■■�■11■1�1■■ ■■■i,III■■■■■■e■■■■11■■■■as■■�■Irl■��u■■ ■■■1�11■■■■■■■■■■■�11■■■1■■■■■�■I�a■fyll■■ u■■■■i■1�1■■■■■■■■■■■e���■re��r._�__.�■I'■■ I � � 'II ■1■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e m■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■i M■■■■■MMMMMMM■MINERIN mllmolmm■■■I ■■■■■■'fir■■■■�■■■■■■■■■ '� �l111■■�,■■■■■I �■■■■■■Ili■■■■�i�1■■E�■■1��■�'�r1�■i l l�O 11■■■■I Mon ■■■11��■■■■■■�■■Ili■= ��� �■■■■■I Ilia■■■®oi ,■�1■■1�'■�%1■■■■■1■■■■■I M■■e■■_ �.. __ . __ .. . ....__.���..■®■i ■■■■1■■■r ���■■■■■■■m ■■■■■■■■■■■■i rl IIIIIIIIIIIIIIIIIIIIII01111111 ON DELIVERY: ■ Complete items 1,2,and 3.Also complete A g ature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. Received by(Print ame) C. Date of Delivery-- ■ Attach this card to the back of the mailpiece, - or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No /IT3. Service Type �6 3 29-Certified Mail ❑Express Mail © ❑Registered M-Retum Receipt for Merchandise ❑Insured Mail ❑C.O.D. i 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7006 Q'81D`= OOOQ 3525 2728 I(rransfer from service label) Ps Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATE," A$.SWVW,*.`l' R.;i. 'sirIs T._.r.. ,��,,. c... �,:�.k:��..r r r r .. �.r •�ermiY'fVo.,�-TO'"T'�„» • Sender. Please print your name, address, and ZIP+4 in this box • 11 Town.of Barnstable `11 Health Di-vision — 200 Main Street Hyannis,MA 02601 HOBBS&WARRFN THE COMMONWEALTH OF MASSACHUSETTS FORM 30 �� BOARD OF HE LTH CIT /TOW W a � PART NT _ ADDRESS p r /��U-- i( _ PT�LHONE �t `d�,VfiWO Address i �"_" y __..___ —_ Occupant__ A^ FloorApartment No. __No.of Occupants- No. of Habitable Rooms (p No.Sleeping Rooms _q No. dwelling or rooming units---'- nits _ ' No.Itor Name and address of owner f- _ `f .,,.:A1 4yt Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: ` Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom(1). Bedroom 2 1 9-0 6 �- Bedroom 3 1 P-U Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties.- Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT 18JIGNED AND CERTIFIED UNDER THE PAINS AND ` PENALTIES SOOF_PPERJU Y.' I INSPECTOR140; TITLE J�� '�ccam� DATE V TIME A.M. THE NEXT SCHEDULED REINSPECTION P.M. t 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist'in residential premises, shall be deemed conditions which may endanger or impair the heaith, or safety and well-being of.a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0) shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. .-. _ ..,�riyY-•....,...,..y�.,_ y,_.. ...�-,ti•,Y.,.r^��-„-+.. .•--...-.-.ws.,,.�..•.- ...-.....n. -, -.- r r .. ,_" _Y ..>-_... ,....-..iy-...-,.-..•--„'..-.•.•ar .... ,. _ .. { fORM30 �IIw> HOBBS&WARREN' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LTH CIT /TOW W � c DEPART NT ADDRESS �..0 3 TELEPHONE SvOr. Q Address Occupant _ Floor_Apartment No. No. of Occupants No.of Habitable Rooms__._ No. Sleeping Rooms No.dwelling or rooming units - [ No. ories �Name and address of owner— _. Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress: and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains.- Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: 't STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: k HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters, Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP:- Gen:Cond•: Distrib. Box: r _ 4GenNBasement Wiring: DWELLING UNIT VertPl;:g L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room _ Bedroom(1) Bedroom 2 Bedroom 3 1��/f Bedroom 4 i(�y 4 ft Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties.- Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin, Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted ) Locks on Doors: ONE:OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT I SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY.' f^^ Q INSPECTOR /= TITLE A.M� DATE �1 TIME __ �M• A.M. THE NEXT SCHEDULED REINSPECTION �~4 P.M. ___ „ � -... � .,--"'�y�isfi`.9?°M 3.-f J"• .....w.�.:4rSt'�*tI a%ti(+S 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3) or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0) shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. Parcel Detail Page 1 of 3 —w THE 34 i4k= -: I: H 1 Ah'I :.., "' '' .k xs. " 'asv° ". f :ww ', u,,,,,. s :0IN— _- Logged in As: Parcel Detail Thursday, A Parcel Lookup Parcel Info - - Parcel ID 1248-025 Developer A— Lot Location 1128 PINE STREET Pri Frontage j 106 Sec Road j Sect - Frontage village IHYANNIS Fire District'HYANNIS Sewer Acct i Road Index 1258 Interactive _ ��`qLTMap 40 Owner Info owner THOMAS, HOWARD A& NANCY J TRS co-owner & NANCY THOMAS TRUE" Streetl 1248 PINE ST - Street2 City!CENTERVILLE - State IMA zip 02632 Country Land Info Acres 10.37 Use Single Fam MDL-01 zoning FRB rvghbd j0106 Topography Level Road Paved Utilities jPublic Water,Gas,Septic Location Construction Info Building 1 of 1 Year 1955 Roof Gable/Hip ExtWood Shingle Built Struct. Wall Effect Roof l'—� _�____ AC Area 1376 Cover Asph/F GIs/Cmp I Type None Style Cape Cod Wall':DrywaII -�- Rooms 2 Bedrooms Model Residential Int Bath 1 Full + 1 H Floor Rooms Heat; � Total Grade€Average Type Hot Air Rooms 5 Rooms http://issgI/intranet/propdata/ParcelDetal1.aspx?ID=17585 4/5/2007 1 Parcel Detail Page 2 of 3 V' _ _ Heat Found- _. ..... ..._ ` R Stories i 1 SStory F A Fuel 011Typical ........ Permit History Issue Date Purpose Permit# Amount Insp Date Comme1 9/5/2000 Demolish 48399 $0 1/1/2001 12:00:00 AM DEMO S Visit History 2 EDate Who Purpose 4/2001 12:00:00 AM Martin Flynn Meas/Listed Sales History _^ Line Sale Date Owner Book/Page Sale P 1 2/23/1999 THOMAS, HOWARD A& NANCY J TRS 12080/022 2 10/15/1987 THOMAS, HOWARD J & NANCY J 5958/146 3 7/15/1987 CELESKI, JENNIE E EST OF 5819/008 i 4 CELESKI, JENNIE E 1488/346 - Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parce 1 2007 $124,900 $0 $0 $168,200 2 2006 $122,400 $0 $0 $171,700 ; 3 2005 $111,400 $0 $0 $157,600 4 2004 $99,900 $0 $0 $116,500 5 2003 $81,000 $0 $0 $45,400 6 2002 $81,000 $0 $0 $45,400 7 2001 $80,200 $0 $0 $45,400 8 2000 $59,300 $0 $0 $34,400 9 1999 $59,300 $0 $0 $34,400 10 1998 $59,300 $0 $0 $34,400 11 1997 $56,800 $0 $0 $27,500 12 1996 $56,800 $0 $0 $27,500 13 1995 $56,800 $0 $0 $27,500 14 1994 $58,300 $0 $0 $31,000 http://issgl/intranet/propdata/ParcelDetail.aspx?ID=17585 4/5/2007 Parcel Detail Page 3 of 3 15 1993 $58,300 $0 $0 $31,000 16 1992 $66,400 $0 $0 $34,400 17 1991 $70,200 $0 $0 $55,100 18 1990 $70,200 $0 $0 $55,100 19 1989 $70,200 $0 $0 $55,1.00 20 1988 $38,500 $0 $0 $24,400 21 1987 $38,500 $0 $0 $24,400 22 1986 $38,500 $0 $0 $24,400 / Photos _ http://issql/intranct/propdata/ParcelDetail.aspx?ID=17585 4/5/2007 Certified Mail#7006 0810 0000 3525 2728 Town of Barnstable Regulatory Services &4RNSTABM MASS. 1,�5 Thomas F. Geiler, Director 16390. 6 Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 19, 2007 Howard Thomas 248 Pine Street Centerville, MA 02632 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 128 Pine Street, Hyannis, MA was inspected on April 5, 2007 by Timothy O'Connell, Health Inspector for the Town Of Barnstable. This inspection was conducted on the basis of a rental registration. The following violations of the State Sanitary Code were observed: 105 CMR 410.300 and 310 CMR 15.00: There were a total of four (4) bedrooms observed in this dwelling; two were observed on the first floor and two were observed on the second floor. However, the existing septic system (permit # 2005-598) was not designed for 4 bedrooms. It was designed for three (3)bedrooms. You are directed to correct the violations listed below within thirty days (30) days of your receipt of this notice by removing entrance door and by opening door-way entrance to any of the four bedrooms to minimum of five feet wide opening. By doing this you would be removing a bedroom and reduced total to (3) bedrooms which is what your septic system is designed for. 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 will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. QAOrder IettersU-Iousing violations\Rental ordinance\128 pine hyannis PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean R.S. CHO Director of Public Health Town of Barnstable Cc: Timothy O'Connell, Health Inspector QAOrder letters\Housing violations\Rental ordinance\128 pine hyannis I Certified Mail#7006 0810 0000 3525 2728 Town of Barnstable �T Regulatory Services �. �$ MASS. 1�$ Thomas F. Geiler,Director Public Health Division r Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Vol$ Office: 508-862-4644 Fax: 508 90-6304 �w ,1)0 April 19, 2007 Ckj,12� Howard Thomas 248 Pine Street Centerville, MA 02632 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 128 Pine Street, Hyannis, MA was inspected on April 5, 2007 by Timothy O'Connell, Health Inspector for the Town Of Barnstable. This inspection was conducted on the basis of a rental registration. The following violations of the State Sanitary Code were observed: 105 CMR 410.300 and 310 CMR 15.00: There were a total of four (4) bedrooms observed in this dwelling; two were observed on the first floor and two were observed on the second floor. However, the existing septic system (permit # 2005-598) was not designed for 4 bedrooms. It was designed for three (3)bedrooms. You are directed to correct the violations listed below.within thirty days (30) days of your receipt of this notice by removing entrance door and by opening door-way entrance to any of the four bedrooms to minimum of five feet wide openings. By doing this you would be removing a bedroom and reduced total to (3) bedrooms which is what your septic system is designed for. 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 will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. QAOrder letters\Housing violations\Rental ordinance\128 pine hyannis Wm. E. Robinson, Sr: Septic Service � P.O.Box 1089 Centerville MA 02632 L,LLLL (508)775-8776 Fax(508) 790-1694 December 10, 2007 Mr. Thomas Enclosed are two sets of plans from Eco-Tech. It is stated that the system is sufficient for four bedrooms. You will want to file one with the Town of Barnstable Board of Health and keep one for your records. The Board of Health should revise your Certificate of Compliance on file. Thank you, Tracy f Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM hereby certify that the engineered plan signed by me dated °� 23 , `ids,concerning the property located at I Zl Pi ne QQ�-r meets all of the following criteria: • Two soil evaluations excavated for detailed examination(no hand augering) and two percolation tests shall be conducted. • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) �� ' V B) G.W. Elevation 2-Z +adjustment for high G.W.4-•Z = 2-6 -9 DIFFERENCE BETWEEN A and B SIGNED : DATE: NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptic\percexemp.doc W- Town of Barnstable 7')" ^� 0_p1HE T Regulatory Services -1 Ilonlas F. Geiler, Director • BARWrABLE. 9� t639. �0r 1)11blic health DiN ision ArF10) Thomas McKean, Director 200 Main Street, 11yannis, NIA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Desiencr Certification Form Date: /�-Z�._ • Designer: Eco-Tech Wm E Robinson Sr Se tic a 1; Installer: P Address: 43 Triangle Circle Address: PO Box 1 089 Sandwich Centerville On Wm E Robinson Sr Sept,,qs issued a perinit to install a (date) (installer) d.. septic system at 128 Pine Street, `Hyanrri's-pa,, ; based on a design drawn by (address) /Eco-Tech dated 1 1 -23-05 j (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic. tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revlslorl or certified as-built by_eles-i-gncr-to follow. ZN OF M,gss C+ d 9 DAD. VID yes � :. (Installer's Signature) COUGHANOWR No.: 1093 ((\ STE'' (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABL E PUBLIC HEALTH DIVISION. CERTIFICATE' � OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- � BUILT CARD ARE, 1ZI CT I�'EU BY THE BARNSTABLE PUBLIC HEALTH DIVISION. TI1ANK YOU. Q: t-1calth/Septic/Designer Certification Form