HomeMy WebLinkAbout0055 BETTY'S POND ROAD - Health 55 Bettys Pond Road
Hvatmis
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No. (.�� ppo��Zv�
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01ppYieatiou for Disposal 6pstPI-t-oustruction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon()) ❑Complete System ❑Individual Components
Location Address or Lot No. �j ,��"r+ Ile PO fib R'I> Owner's Name,Address,and Tel.No.
14%/A j&tS 9TC-P0G70 Z;P-0ca>xl
Assessor's Map/Parcel a9 0 fog 575 nv(i-lWS ?olvb P-0 #*%tolls
Installer's Name,Address,and Tel.No. 5 O g- 77-$£c 77 Designer's Name,Address,and Tel.No.
C A i9c-w 1 D 67 e 1j—1 E P _6 iES L-(. N/ 4
15
Type of Building:
-i
Dwelling No.of Bedrooms / 64 Lot Size 1 40 S sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided /✓1f gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
A f3iq,wbow r,167 r r,JGr
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. r/` �ll L�
S' ed Date Y'_`(1 19 T
Application Approved by Date 6 �O/ L
Application Disapproved by Date
for the following reasons
Permit No. 20 14— 101 Date Issued qla 2o
a 0 1 / G Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF.BARNSTABLE, MASSACHUSETTS
ftpIitation for r3moosai *Ps teem-Construction Permit
Application for a Permit to Construct N( ) Repair( ) Upgrade( ) Abandon A El Complete System ❑Individual Components
J } Y
Location Address or Lot No.%j S �$ (�o IUD`Q� Owner's Name,Address,and Tel.No.
RVAi mS 5TE Pf+EiJ &R d ta»CJ
R Assessor's Map/Parcel 39 p D-L 5 5 6 E-21"/',S P OWIj P-0 (*AVJV IS
r Installer's Name,Address,and Tel.No. 50$-'.477-1?f�77 Designer's Name,Address,and Tel.No.
I c O e c4� �-r-- ^•c -S 6t' .
Type of Building:
Dwelling No.of Bedrooms Am " Lot Size 9 e 4O's sq.ft. Garbage Grinder( )
„, Other Type of Building No.of Persons Showers( ) Cafeteria( )
_.<Other Fixtures
�,
"Design Flow(min.required) gpd Design flow provided /y� gpd
Plan Date Number of sheets Revision Date`
f Title
- Size of Septic Tank Type of S.A.S.
Description of Soil
/l
Nature>of Repairs or Alterations(Answer when applicable)
A DAygp w !
o mac. 5T r
Cx SePrt G S Y S?gv-,,.
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. }
Sig ed Date
Application Approved by Date
Application Disapproved by Date
r
for the following reasons
Permit No. 0 y b Date Issued
TH E COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS ..
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned(X)by CA P t:vj i m; t!='I-j-TW k(5� C4.C_
at 55 1�E"fTy OIyT) gj> HYp4jxl(S has been constructed in accordance
G/with the provisions of Title 5 and the for Disposal System Construction Permit No.2'�,`��D1 dated
Installer P&>)o OG C-07i7ZP215S_ U .: Designer PIA
A ,]
#bedrooms Approved design-flow. �! „ gpd
The issuance of this permit shall nd/be cone trued A a guarantee that the system willf n�ctionn a,js,designed. ��/ ,��J j���
Date / /® Inspector /�t //I� it 71V � �� f ! �I�f �R. 1AZ
-- - . r - - .
Y�
- _ - - --- -. -- _- .-_ ------ --- - - -------- - —--- -----------------------------------------------------
No.7d 1 q W/' Fee h
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
30isposal *pstem Construction Permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ,•__- °�
System located at 5,s 3 ETN lS p00-b pwxb H YA N K)t.S
�Iand 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 must be completed within three years of the date of this permit
Date U h 6/20/`� Approved b,
Q K
Commonwealth of Massachusetts f
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form =Not for Voluntary Assessments
55 Bettys Pond Rd
Property Address
Fannie Mae a
Owner Owner's Name
information is
2
required for
Hyannis-, MA 02601 -2-. , 09
pity/Town
pit State
every page. Y _ y, Zip Code Date of Inspection •
Inspection results must be submitted on this form. Inspection forms may not�be-altered in any
T way' ,
A. General Information
1. Inspector:
Shawn Mcelroy
Name of Inspector' , ;: ; ;.:; fi oil,
Upper Cape'Septic Services
Company Name
29 Atwater Dr
Company Address ,
E. Falmouth 02536
City/Town State Zip Code s
508-495-0905 S13971 '
Telephone Number License Number
B. Certificationsr
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 baseii'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: ,
w , Eq. Passes , ' ❑ ConditionallyPasses ❑ Fails
❑ Needs Furtherfivaluation by the Local Approving Authority
2-2-09
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 DER 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. ,
2-109
t5insp official document•03/08 t Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Fort
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
;M 55 Bettys Pond Rd
Property Address
Fannie Mae
Owner Owner's Name
information is required for Hyannis MA 02601 2-2-09
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments:
System is in good working order with no sign of failure.
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.
Answer yes, no or not determined (Y, N, ND) in the ❑ 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.
ND Explain:
❑ 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
❑ obstruction is removed
t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15
• 3
Commonwealth of Massachusetts .•
F Title 5 Official Inspection dorm
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
55 Bettys Pond Rd �{
Property Address
Fannie Mae ".
Owner Owner's Name
information is r
required for Hyannis':'•F MA 02601 2-2-09
every page. "City/Town State+ Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):'
❑ distribution box'is leveled replaced
• ;� '"
ND Explain:
0 ,
a
r:
., :0 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 ofthe Board.of,Health):
" ❑ broken pipe(s) are replaced
❑ obstruction is removed
ND Explain:
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:
4 '! ,_._•.f' -i If � -• Jr�f 1(r • - 1" i iy- .. _.'+',l'_ i r.. • .5.."#..k,�. .
❑ Cesspool or privy is within 50 feef of a surface water
"' ❑ Cesspool or privy is wl~thin 50 feet of a`b-ordering vegetated wetland or a salt marsh
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:' "` '. `"• ` _ ' '"_
. ,: ;. ❑ p: 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'.
• 0 , :The system has a septic,tank and SAS and the SAS is within 50 feet of a private water
supply well.
t5insp official document•03108 ,... - - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
55 Bettys Pond Rd
Property Address
Fannie Mae
Owner Owner's Name
information is required for Hyannis MA 02601 2-2-09
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ 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 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
El ® 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 '/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.
t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Fora
- Subsurface Sewage Disposal System Form-Not for Voluntary.Assessm'ents'• :+:-
�M 55 Bettys Pond Rd
Property Address
Fannie Mae
Owner Owner's Name
information is a `
required for Hyannis,, L MA 02601 2-2-09
every page. City/Town V1, , State Zip Code Date of Inspection
B. Certification (cont.) _.
D) . System Failure Criteria Applicable to AII.Systems (cont.): .
Yes No
Ej _ 0 -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�portionaof a cesspool'or privy isless 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 neothei,failure criteria are triggered.A copy of the analysis
,•f °,, .; T,and chaimof custody must be-attached to this form.]
El
1 The system is a cesspool serving a facility with a design flow of 2000gpd-
i' `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
<f.I'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 f Not c.,�., .. . u. a:
; ..'the system is within. 400 feetaof,a surface drinking water supply
El
'Elt., tiie systemjs within 200 feet'of a tributary to a surface drinking water supply
El 1-1 the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—.IWPA)or mapped Zone II of a public water supply well
If you have answered,-"yes"to any question in Section E the system is considered.a significant threat,
or answered "yes"in Section D above the large system has failed.The owner or operator of any large
system considered a,significant threat under Section E or failed under Section D shall upgrade the
system.in accordance with 310 CMR 15.304. The system"owner should contact the appropriate
regional office of the Department.
Lt5inspofficial document•03/08 Title'5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 55 Bettys Pond Rd
Property Address
Fannie Mae
Owner Owner's Name
information is required for Hyannis MA 02601 2-2-09
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
Yes No
❑ ® 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
® El information on the maintenance of subsurface sewage disposal systems?
proper 9 p Y
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 Pa-t C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp official document-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15
Commonwealth of Massachusetts
Title 5 Official.-I ftspection..Form
Subsurface Sewage Disposal System Form -.Not for.Voluntary Assessments
M 55 Bettys Pond Rd
Property Address
Fannie Mae • 1
Owner Owner's Name *• ,
T":
information is .�>,
required for Hyannis. MA 02601 2-2-09 .
every page. City/Town 4 State ' Zip Code Date of inspection r,
D. System Information ,;, • - �
Residential Flow Conditions:,,.",-c, . •, :
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
Number of current residents: , , ,s.I Y, z► 0 ,
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if,yes separate inspection required],t, ❑ Yes ® No
Laundry system inspected? ;a ❑ Yes ® No
Seasonal use? . •j ;r: ❑ Yes ® No
Water meter readings, if available (last•2years usage (gpd)): r,
Sump pump? ® Yes ❑ No
Last date of occupancy: r 12-08
Date
Commercial/Industrial Flow.Conditions: -
,"Type of Establishment:
r Design,flow(based on 310 CMR,15.203):
Gallons per day(gpd)
Basis of,.design;flow(seats/persons/sq.ft.,4etc.):
Grease trap present?. - .- . , s, , ,. r.;t 1 ❑ Yes ❑ No
Industrial waste holding tank present? 3. .,; ;,• .� El Yes El 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): a j -
t5insp official document•03fi1S y n Title 5 Officiallnspection Form:Subsurface Sewage Disposal System•Page 7 of 15
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
w 55 Bettys Pond Rd
Property Address
Fannie Mae
Owner Owner's Name
information is required for Hyannis MA 02601 2-2-09
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information:
N/A
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
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):
Approximate age of all components, date installed (if known) and source of information:
1996
Were sewage odors detected when arriving at the site? ❑ Yes ® No
t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
Commonwealth of Massachusetts r
Title 5 Official Inspection- Form
Subsurface Sewage Disposal Sy.'stem:Form=Not for-Voluntary Assessments
�M 55 Bettys-Pond Rd
Property Address
Fannie Mae
Owner Owner's Name ; +
information is r
required for Hyannis MA 02601 2-2-09.
every page. City/Town. c State Zip Code Date of Inspection
D. System Information (cont.) ;� �. {. -,e
Building Sewer(locate on.site.plan):
Depth below grade: ,,, r. , M }. : , 24"
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.):.-
Good condition. '
Septic Tank.(locate on site.plan)
Depth below grade: 18"feet
Material of construction: ,•, +,�;.
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal,list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ': ❑ Yes ❑ No
---------- --------------------- ----------- ----- ---------------- ----------- ---------------------------
Dimensions: 1500 Gal
Sludge depth: 12'
20-1
Distance from top ofsludge.to bottom,of outlet tee or baffle
Scum thickness r 0
6„
Distance from top of scum to top of outlet tee or baffle
16„
r- Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined? Tape
t5insp official document•03/08 - - Tide 5.Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M
55 Bettys Pond Rd
Property Address
Fannie Mae
Owner Owner's Name
information is required for Hyannis MA 02601 2-2-09
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank is in good condition with baffles installed.
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
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):
t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15
Commonwealth of Massachusetts
F Title 5 OfficialInspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t
55 Bettys Pond Rd
Property Address
Fannie Mae
Owner Owner's Name -
information is ,
required for Hyannis". '' ,' MA 02601 2-2-09
every page. City/Town , }, State Zip Code bate of Inspection ,
D. System Information (cont.) itt ,> , f4'f3 ,-` � • ,
.►j-.' .-Tight or.Holding.Tank (cunt.),
Dimensions: -
j
Capacity: gallons
Design Flow:
gallons per day
Alarm present: • k❑i.Yes ' ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
t .
*Attach copy of current pumping contract(required)�Is!copy'attached? ❑ Yes ❑ No
Distribution Box:(if.present must be opened)(locate on`site,plan): ,
Depth of liquid level above outlet invert 0'
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.): }`
Good condition. ,,.. ,: ;,u=•,rr- :_. .
-
Pump.Chamber(locate on-site plan):
Pumps in working order: r� y ❑.Yes ,1 ❑ No
Alarms in working order: ❑ Yes , ❑ No
Ltl5m.p'offlcial document-03/08y..->, .i� 1 p, Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page11 of15
Commonwealth of Massachusetts
w u Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
55 Bettys Pond Rd
Property Address
Fannie Mae
Owner Owner's Name
information is required for Hyannis MA 02601 2-2-09
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments note condition of um chamber, condition of pumps and appurtenances, etc.):
( pump P P PP � )
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
® leaching fields number, dimensions:
1-14'x44'
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leach lines show no sign of back up or break out into surrounding stone.
t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15
Commonwealth of Massachusetts,
Title 5 Official Inspection; Form '. .
Subsurface Sewage,Disposal System form -Not for Voluntary Assessments',I I
y 55 Bettys Pond Rd -
G„M L '
Property Address
Fannie Mae
Owner' Owner's Name
information is
required for Hyannis + MA 02601 2-2-09
every page. City/Town 4 State Zip Code Date of Inspection
D. System Information (cont.) , . . .
Cesspools (cesspool must be pumped as part of inspection)(locate on site plan):
Number and configuration . s ,
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
t
4 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
-r -r
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.): r
t5insp official document-03M8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
55 Bettys Pond Rd
Property Address
Fannie Mae
Owner Owner's Name
information is required for Hyannis MA 02601 2-2-09
every page. City/Town State Zip Code Date of Inspectioi
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a sketch 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.
t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15
f
Y
usetts
Commonwealth of Massach t
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 55 Bettys Pond Rd
Property Address
Fannie Mae
Owner Owner's Name
information is required for Hyannis MA 02601 2-2-09
every page. CityfTown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope J
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: feet
.- 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: pate
® 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:
Original design plans show groundwater at 5'. Leach field was installed with variences.
t5insp official document•03/08 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
f
Certified Mail#7006 0810 0000 3525 2858
Town of Barnstable
Regulatory Services
RARNSfARM
MASS. $ Thomas F. Geiler, Director
sbgp.A,�
Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
June 6, 2007
Josue De Macedo -
55 Betty's Pond
Hyannis, MA 02601
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE II — MINIMUM STANDARS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE CODE CHAPTER 170 & 59 AS WELL AS
TITLE V.
The property owned by you located at 55 Betty's Pond Road,Hyannis was inspected on
May 23, 2007 by Timothy B. O'Connell Health Inspector for the Town of Barnstable
because of a complaint.
The following violations of the State Sanitary Code were observed:
105 C105 CMR 410.300 and 310 CMR 15.00: There were a total of six (6) bedrooms
observed in this dwelling. However, the existing septic system (permit # 1996-670) was
not designed for six (6)bedrooms. It was designed for four(4)bedrooms.
The following violations of the Town of Barnstable Code were observed:
&170-10 of the Town of Barnstable Code: Maintenance of Smoke Detectors and
Carbon Monoxide Alarms.No CO detectors within home.
59-3 of the Town of Barnstable Code: Number of Occupants able to reside within
dwelling.
Tenant stated that(7) seven people live at this property.
You are ordered to correct the violations listed above within thirty (30) days
of your receipt of this notice by pulling any required building permits (if
applicable); You are ordered to remove two of the bedrooms in the basement by
removing entrance doors and by opening all door-way entrances to each room in the
basement to minimum of five feet wide openings. This will bring the total bedroom
Q:\Order letters\Housing violations\Rental ordinance\55 betty's pond.doc
s �
count down from(6) six to the appropriate(4) four as designated by your septic
permit. Furthermore, only five (5) people are allowed to reside within this home.
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.
Should you have any questions regarding above violations, please contact the Town
Health Division and ask to speak with inspector who performed the inspection.
PER ORDER OF HE BOARD OF HEALTH
omas A. McKean, R.S., CHO
Director of Public Health
Town of Barnstable
Cc: Timothy O'Connell
Q:\Order letters\Housing violations\Rental ordinance\55 betty's pond.doc
FohM 30 C&W •Hoses&W4RRENT" THE COMMONWEALTH OF MASSACHUSETTS tom,,. +�k �°t FF.*k•. 's.+a
BOAR OF H �ATH
1
CITY OW
F e ,
DEPARTMENT
ADDRESS i 50C
4�M SyO y`ew l.. (�
TELEPHONE
Address _ Occupant--Floor Apartment No. No.of Occupants
No. of Habitable Rooms No.Sleeping Rooms
No.dwelling or rooming units_ No.Stories TT
Name and address of owner__ 6L C- e-d y
emarks 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: z.
BASEMENT Gen.Sanitation: 0-0 Cu
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
Bedroom 3
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 IS IGNED AND CERTIFIED UNDER T E PAINS AND
PENALTIES OF JURY." '
INSPECTOR TITLE
�� �,��/j _ A.M.
DATE V " T TIME P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
T 1
410.750: Conditions Deemed to Endanger or ImDa r Health or Safety
The following conditions,when found to exist it 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 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.lis-ing. 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 sufficien- it quantity, pressure and temperature, both hot and cold,to meet the ordinary
needs of the occupant in accordance with 105 CrAF: 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 i:n 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 dwelfing 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 tl-at 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 faill-re 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-ire, 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 oy 105 CMR 410.482.
(0) Any of the following conditions which remEin uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or corditions:
(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 I eating 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.
FORM30 CIW' HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS
w BaOARD OF HEALTH
CITY/TOWN
w
b � D PARTMENT
ADDRESS c6
—
�� 0 TELEPHONE
Address Occupant--
Floor-Apartment No. No.of Occupants V
No. of Habitable Rooms No.Sleeping Rooms
r' No. dwelling or rooming units--No.Stories
Name and address of owner _
{ - .,Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
�. Containers:
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches: t
v *' � Dual Egress:and Obst'n.:t
El B 1;❑ F`` ❑ M�r Doors"'Windows:
Gutters, Drains:
Walls:
Foundation:
Chimney: t. !
BASEMENT Gen.Sanitation: �J'Q (± ."` ,.:.,
Dampness:
Stairs:
Lighting:
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling: 1
Hall Lighting:
Hall Windows:
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:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to Outlets Walls Ceils. Wind. Doors Floors, Locks
Kitchen
t Bathroom
Pantry
Den
Living Room \
r ,
Bedroom 1 ., ! �
Bedroom 2 t
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas,Oil, Elect..-
Stacks, Flues,Vents,Safeties:
Kitchen Facilities Sink
Stove
Bathing,Toilet Facil. 'Venf., Plumb.;S46it'n::
Wash Basin,Shower or Tub:
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n: 1 Vic,
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 IS IGNED AND CERTIFIED UNDER TkIE PAINS AND
PENALTIES OF�E-F�iJUAY." '
INSPECTOR TITLE
O,. A.M.
DATE _ 9 TIME P.M.
y,5,, .+t r rr+« A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
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 o 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 potertial 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 vioiation(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 n 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 CIVIR 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 CIV:R 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 creaticn 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 a-id gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure:o 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 o�heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, cr 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.
FORM 30 C&W HOBBSBWARREN'M THE COMMONWEALTH OF MASSACHUSETTS
f u
a. B4OARD OF HEALTH
CITY/TOWN
'o f DEPARTMENT
f ^,
ADDRESS
,��� a ^ ���>�� TELEPHONE
Address _ Occupant_-
Floor Apartment No. No. of Occupants
No. of Habitable Rooms No.Sleeping Rooms—
No.dwelling or rooming units--No.Stories
Name and address of owner 7 ) `'a 7C
zd^Uemarks Reg. Vio.
YARD Out Bld s.: Fences: J
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stair's, Porches:
-�..,,Dual Egress:and Obst'n.
❑ B ❑ F ❑ M Doors,,Windows:
M Rdof
I a i
Gutters, Drains:
Walls:
Foundation: t
Chimney:
BASEMENT Gen.Sanitation: L ✓ w ., ,., f " " ... .-
Dampness:
Stairs:
Li htin :
i
STRUCTURE INT. Hall,Stairway:
I
Obst'n.:
` Hall, Floor,Wall,Ceiling: I j
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N E ui . Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
i
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 11220 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 V f
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.:
Stacks, Flues,Vents,Safeties:
Kitchen Facilities Sink
_ Stove
Bathing,Toilet Fac 1. —Vent, *mb.,Sanit'n.' __ #r s
Wash Basin, Shower or Tub:
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n: �.. .
General Building Posted ! 61 U
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
r OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR. (See Over)
"THIS INSPECTION REPORT ISA. IGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OFPERJURY."
?2
INSPECTOR 1 TITLE
A.M.
DATE TIME a P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
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 cuantity, pressure and temperature, both hot and cold,to meet the ordinary
needs of the occupant in accordance with 105 CMR L10.180 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 Ieadbased 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
N1,
41
41
1 ttAR;,F't AU I q
k�D. �i�o �iFJ .✓' ew��r�.^` '' �».^..»_- k .w"shy
Logged in As: Parcel Detail Wednesday, It
Parcel Lookup
Parcellnfo
Developer
Parcel ID 290-124 I Lot LOT 2
Location j55 BETTY'S POND ROAD _ _I Pri Frontage
-.....
Sec
Sec Road; Frontage[
Village 3HYANNIS I Fire District HYANNIS
Sewer Acct I Road Index 0121
� � v
Interactive ,
Map
Owner Info
Owner 10STAPACHEM, HILARIOI Co-owner %DE MACEDO,JOSUE�
streets 155 BETTYS.POND.RD �� I Street2
City IHYANNIS State[MA zip j02601 _ . Country IUS
Land.Info.
Single Acres 10.17 use Fa m MDL-01 1 zoning RB Nghbd 0105
Topography Level I Road Paved
Utilities jSeptic,Gas,Public Water I Location
Construction Info
Building 1 of 1
Year 1966 ROof Gable/Hi Ext Wo od Shin le
Built i I Struct' p I Wall g
_ .
Effect 290-` Roof Asph/F GIs/Cmp I AC None
Area Cover - — Type
Int'_...... Bed
Style jCape Cod I Wall DrywallI Rooms 4 Bedrooms _I
Model Residential I Int I Bath 2 Full I
Floor' Rooms
Heat _ :... ._..... _ _.__..___ Total
Grade:Average Type!:
Rooms Hot Water }7 Rooms
I > I i _ _ 1
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=22462 6/6/2007
Parcel Detail Page 2 of 3
„a r-
y
Heat Found-�--- �
stories j 1 Story F A Oil :Typical -'
Fuel ation+
T
Permit History .
Issue Date Purpose Permit# Amount Insp Date Comrr
8/17/2005 Remodel 86047 $3,500 11/1/2005 12:00:00 AM
Visit History�____.
Date Who Purpose
4/27/2007 12:00:00 AM Jeannette.Kirwan In Office Review
11/1/2005 12:00:00 AM Martin.Flynn Mea./List Bldg.Permit Only
8/5/2004. 12:00:00 AM Paul,Talbot Meas/Est
2/24/2004 12:00:00.AM Paul Talbot Meas/Est
2/26/2001 :12:00:00 AM SM Meas/Listed
7 Sales ---
Line Sale Date Owner Book/Page Sale P
1 10/27/2003 OSTAPACHEM, HILARIO 17846/023
2 11/15/1992 TULLIS, ROBERT D JR 8289/226
3 6/15/1992 FLEET BANK OF MASS N A 8079/064
4 KAROLCZAK, ZYGMUNT R 1657/282
Assessment History
Save# Year Building Value XF Value OB Value Land Value Total Parc(
1 2007 $122,200 $1,100 $0 $139,500
2 2006 $122,400 $0 $0 $141,200
3 2005 $114,500 $2,700 $0 $124,300
4 2004 $103,500 $2,700 $0 $93,300
5 2003 $84,100 $2,700 $0 $28,200
6 2002 $84,100 $2,700 $0 $28,200
7 2001 $79,900 $2,600 $0 $28,200
8 2000 $59,000 $2,400 $0 $17,700
9 1999 $59,000 $2,400 $0 $17,700
10 1998 $59,000 $2,400 $0 $17,700
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=22462 6/6/2007
Parcel Detail Page 3 of 3
11 1997 $54,1@0 $0 $0 $17,700
12 1996 $54,100 $0 $0 $17,700
13 1995 $54,100 $0 $0 $17,700
14 1994 $54,700 $0 $0 $21,200
15 1993 $54,700 $0 $0 $21,200
16 1992 $62,100 $0 $0 $23,600
17 1991 $74,200 $0 $0 $38,300 ;
18 1990 $74,200 $0 $0 $38,300
19 1989 $74,200 $0 $0 $38,300
20 1988 $49,900 $0 $0 $15,400
21 1987 $49,900 $0 $0 $15,400
22 1986 $49,900 $0 $0 $15,400
'� Photos
0
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=22462 6/6/2007
` Commonwealth of Massachusetts
w Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�^M 55 Bettys Pond Road
Property Address
Hilario Ostapechem
Owner Owner's Name
information is Hyannis Ma 02601 1/19/07
required for y
every 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.
Important:When filling out A. General Information
forms on the
computer,use 1. Inspector:
only the tab key
to move your Robert Paolini
cursor-do not Name of Inspector
use the return
key. Capewide Enterprises,LLC
Company Name
t� P.O.Box 763
Company Address
Centerville Ma 02632
City/Town State Zip Code
(508)428-4028
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 t
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 Z t C'f JCU
❑ Conditionally Passes ❑ Fails cr,
❑ Needs Further Evaluation by the Local Approving Authority
r Cn M
1/19/07
Inspector's Signa ure 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.
55 bettys pond•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 2
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments
;M 55 Bettys Pond Road
Property Address
Hilario Ostapechem
Owner Owner's Name
information is required for Hyannis Ma 02601 1/19/07
every page. — City/Town 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:
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.
Answer yes, no or not determined (Y, N, ND) in the ❑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.
ND Explain:
❑ 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
❑ obstruction is removed
55 bettys pond•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2
f
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 55 Bettys Pond Road
Property Address
Hilario Ostapechem
Owner Owner's Name
information is required for Hyannis Ma 02601 1/19/07
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ distribution box is leveled or replaced
ND Explain:
❑ 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
❑ obstruction is removed I
ND Explain:
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
r
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
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.
55 bettys pond•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 3
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
55 Bettys Pond Road
Property Address
Hilario Ostapechem
Owner Owner's Name
information is required for Hyannis Ma 02601 1/19/07
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cone):
❑ 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 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
El ® 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 'h 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.
55 bettys pond•08/06 Title'5 Official Inspection Form:Subsurface Sewage Disposal System•[Page 4 of 4
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
^M 55 Bettys Pond Road
Property Address
Hilario Ostapechem
Owner Owner's Name
information is required for Hyannis Ma 02601 1/19/07
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® 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 o y
h in f custody must be attached to this form.
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ Z 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
E] ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,-,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
55 beftys pond•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 55 Bettys Pond,Road
Property Address
Hilario Ostapechem
Owner Owner's Name \
information is required for Hyannis Ma 02601 1/19/07
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
® ❑ 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)]
I
55 beftys pond•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 6
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 55 Bettys Pond Road
Property Address
Hilario Ostapechem
Owner Owner's Name
information is required for Hyannis Ma 02601 1/19/07
every page. City/Town State Zip Code Date of Inspection
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
Number of current residents: 4
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ® Yes ❑ No
Seasonaluse? ❑ Yes ® No
750
:90,
Water meter readings, if available (last 2 years usage (gpd)): 2002005:90750
Sump pump? ❑ Yes ® No
Last date of occupancy: present
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe):
55 bettys pond•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 7
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
^M 55 Bettys Pond Road
Property Address
Hilario Ostapechem
Owner Owner's Name
information is required for Hyannis Ma 02601 1/19/07
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information: Capewide Enterprises
Was system pumped as part of the inspection? ® Yes ❑ No
If yes,volume pumped: 1500
gallons
How was quantity pumped determined? measured
Reason for pumping: maintenance
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
1997
Were sewage odors detected when arriving at the site? ❑ Yes ® No
55 bettys pond•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•IPage 8 of 8
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
55 Bettys Pond Road
Property Address
Hilario Ostapechem
Owner Owner's Name
information is required for H annis Ma 02601 1/19/07
y
every page. City/Town _ State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on)site plan):
,
Depth below grade: 28"feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: 10+
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Joints appear tight.No evidence of Ieakage.System vented through the house vents.
Septic Tank(locate on site plan):
Depth below grade: 32"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: 10'6"x5'8"x57'
Sludge depth: 0
/Distance from top of sludge to bottom of outlet tee or baffle 0
Scum thickness 0
Distance from top of scum to top of outlet tee or baffle 0
Distance from bottom of scum to bottom of outlet tee or baffle 0
Pumped tank at time of inspection.
How were dimensions determined?
55 bettys pond•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 9
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
55 Bettys Pond Road
F M
Property Address
Hilario Ostapechem
Owner Owner's Name
information is required for Hyannis Ma 02601 1/19/07
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pump tank every 2-3 years. Inlet and outlet tees are in place.Tank is structurally sound.No evidence
of leakage.
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
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):
55 bettys pond•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 10
L
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
;M 55 Bettys Pond Road
Property Address
Hilario Ostapechem
Owner Owner's Name
information is required for Hyannis Ma 02601 1/19/07 .
every page. City/Town . State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank (cont.)
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
Distribution Box (if present must be opened)(locate on site plan):
Depth of liquid level above outlet invert No
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.):
Box is Ievel.No evidence of solids carryover.No leakage into or out of box.Box has two laterals.
Pump Chamber(locate'on site plan):
Pumps in working order: ❑ Yes ❑ No;
Alarms in working order: ❑ Yes ❑ No
55 bettys pond•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11
i �_
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form = Not for Voluntary Assessments
,M 55 Bettys Pond Road
Property Address
Hilario Ostapechem -
Owner Owner's Name
information is required for Hyannis Ma 02601 . 1/19/07
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS-not located, explain why:
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
® leaching fields number, dimensions: 1-44'x14'
❑ 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.):
Sandy soil.No signs of hydraulic failure.Vegetation appears normal,
55 bettys pond•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 12
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 55 Bettys Pond Road
Property Address
Hilario Ostapechem
Owner Owner's Name
information is required for Hyannis Ma 02601 1/19/07
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
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.):
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.):
55 bettys pond•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 13
I
15
Commonwealth of Massachusetts
L W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 55 Bettys Pond Road
Property Address
Hilario Ostapechem
Owner Owner's Name
information is required for Hyannis Ma 02601 1/19/07
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a sketch 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'.
ti
• .�sG' .�/`��. ass p
O
1 �w
55 bettys pond-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 14
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
^M 55 Bettys Pond Road
Property Address
Hilario Ostapechem
Owner Owner's Name
information is y
required for Hyannis Ma 02601 1/19/07
every page. City/Town- State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
❑ Shallow wells
Estimated depth to ground water: 20
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:
AS-Built card
® Checked with local excavators, installers- (attach documentation)
® Accessed USGS database-explain:
http://town.barnstable.ma.us
You must describe how you established the high ground water elevation:
Used:Gaherty&Miller Model 12/16/94 Groundwater elevation above sea Ievel.Used:USGS
Observation well data June 1992.Used:Annual ranges of groundwater elevations for Cape Cod 92-
000-01 Plate#2
J
55 bettys pond•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
i
LP-
f .
Health Complaints
26-Aug-04
Time: 8:50:00 AM Date: 8/25/2004 Complaint Number: 17677
Referred To: DAVID STANTON Taken By: Sally Shea
Complaint Type: GENERAL
Article X Detail:
Business Name:
Number: 55 Street: Betty's Pond Road
Village: HYANNIS Assessors Map-Parcel: .
Complaint Description: On Betty's Pond it is two houses after the
mechanic's on the left hand side. They did
septic work last night and at 6am finishing up.
The caller does not believe they have a permit.
There are about 12-15 people living in in the
` house
Actions Taken/Results: DS AND DD WENT TO SAID AREA TO
INVESTIGATE. WE STOPPED AT#55
BETTYS POND, WHICH WAS AFTER THE
MECHANICS HOUSE, AND COULD
OBSERVE SOME DISTURBED SOIL. WE
SPOKE WITH THE OWNER HILARIO
OSTAPECHAM. THERE WAS ONE OTHER
PERSON PRESENT AT SAID LOCATION
DURING THE INVESTIGATION. DS AND DD
TOOK A LOOK AROUND THE PROPERTY
TO SEE WHAT WAS GOING ON AND TO
SEE IF IT APPEARED THAT A SEPTIC WAS
INSTALLED ILLEGALLY. THE OWNER WAS
VERY COOPERATIVE, AND SAID HE DID
NOT DO ANYTHING WITH THE SEPTIC, AND
WASN'T SURE OF ITS EXACT LOCATION.
WE TOLD THE OWNER HE COULD COME IN
AND GET A COPY OF THE LOCATION OF
1
Health Complaints
26-Aug-04,
HIS SEPTIC. THE OWNER COULD NOT
FI
ND THE INSPECTION REPORT FROM
WHEN HE BOUGHT THE HOUSE A YEAR
AGO. THE OWNER INSTALLED A SUMP
PUMP DRAIN TRENCH. THE OWNER SAID
HE WAS HAVING PROBLEMS WITH
MOISTURE IN THE BASEMENT. WE
OBSERVED THE DISTURBED AREA OF THE
DRAINAGE TRENCH GOING FROM THE
LEFT REAR CORNER OF THE HOUSE TO
THE LEFT REAR CORNER OF THE
PROPERTY. DD LOOKED IN THE
BASEMENT TO CONFIRM THIS IS FROM
THE SUMP PUMP, AND NOT THE BUILDING
SEWER. THE OWNER WAS ALSO MOVING
SOME SOIL TO REGRADE THE SURFACE
NEAR THE HOUSE TO DIVERT SOME OF
THE RUNOFF AWAY FROM THE
FOUNDATION TO ALSO REDUCE SOME OF
THE MOISTURE IN THE BASEMENT. NO
FURTHER ACTION REQUIRED, AS NO
VIOLATIONS WERE OBSERVED. CANNOT
CALL BACK COMPLAINANT TO LET HIM
KNOW WHAT IS GOING ON AS HE DID NOT
LEAVE ANY INFORMATION TO CONTACT
HIM.
Investigation Date: 8/25/2004 Investigation Time: 2:45:00 PM
2
TOWN OF TABLE
LOCATION �e11 S ® BARNS� SEWAGE #
VILLAGE_ f�����I/�6. / ASSESSOR'S MAP&LOT I�!
INSTALLER'S NAME&PHONE NO: � � 1
j SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) — (size)
NO.OF BEDROOMS y //• {
BUILDER ORI ®;F
• I
PERMTTDATE: Z/ ZDb COMPLIANCE DATE: — '7
Separation Distance Between the:
CMaximum Adjusted Groundwater Table and Bottom of Leaching Facility sf 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 J
within 300 feet of leaching facility) �/ Feet
Furnished by
i
it
o 0 rot
1.7
� 9
�� 'r1i�� • �f
is `yz'���`�F�r lir r, £: � �1>.•�� L is.f
s
r
r
r
3arnstable Assessing Search Results Page 1 of
-tome: Departments:Assessors Division: Property Assessment Search Results
55 ]BETTY'S POND RMOAD
awner:
TULLIS, ROBERT D JR Property Sketch legend
Map/Parcel/Parcel Extension' n
290 /124/ 33
Mailing Address {
TULLIS, ROBERT D JR
3f3 3 1
�o, f
1 LAUREL CIRCLE
FORESTDALE, MA. 02644 /
!004 Assessed Values: '
Appraised Value Assessed Value
3uilding Value: $ 103,500 $ 103,500
:xtra Features: $2,700 $2,700
Outbuildings: $0 $0
Land Value: $93,300 $93,300 Interactive Property Map: ap requires Plug in:
Totals:$ 199,500 $ 199,500 1 have visited the maps before �; First time users
Show Me The Man Click Here
April 2001 photos available wo
Sales History:
Dwner: Sale Date Book/Page: Sale Price:
TULLIS, ROBERT D JR 11/15/1992 8289/226 $39,780
FLEET BANK OF MASS N A 6/15/1992 8079/064 $30,000
KAROLCZAK,ZYGMUNT R 1657/282 $0
2004 Tax Information: Tax Rates: (per$1,000 of valuation)
Town Tax $ 1,318.70 Town Fire District Rates Other Rates
6.61 Barnstable 2.01 Land Bank 3%of Town Tax
Hyannis FD Tax $404.99 C.O.M.M. 1.10
Cotuit 1.52
Land Bank Tax $39.56 Hyannis 2.03
West Barnstable 1.36
Total: $ 1,763.25 Due to rounding differences these values may vary
Land and Building Information
ittp://www.town.bamstable.ma.us/tobO2/Depts/AdministrativeServices/Finance/Assessing/AssessO3/displa... 8/25/200,
3arnstable Assessing Search Results Page 2 of
Land Building
Lot'Size(Acres) 0.17 Year Built 1966
Appraised Value $93,300 Living Area 1470
Assessed Value $93,300 Replacement Cost$ 124,651
Depreciation 17
Building Value 103,500
Construction Details
Style Cape Cod Interior Floors Hardwood
Model Residential Interior Walls Drywall
Grade Average Heat Fuel Oil
Stories 1 Story F A Heat Type Typical
Exterior Walls Wood Shingle AC Type None
Roof Structure Gable/Hip Bedrooms 4 Bedrooms
Roof Cover Asph/F GIs/CmP Bathrooms 2 Bathrooms
Total Rooms 7 Rooms
Extra Building Features
Code Description Units/SQ ft Appraised Value Assessed Value
BRR Bsmt Rec Room 660 $2,700 $2,700
Property Sketch Legend
III BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished)
BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished)
CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished)
FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished)
FCP Carport GRN Greenhouse UUA Unfinished Utility Attic
FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished)
FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck
FOP Open or Screened in Porch TQS Three Quarters Story(Finished)
ittp://www.town.bamstable.ma.us/tobO2/Depts/AdministrativeS ervices/Finance/Assessing/AssessO3/displa... 8/25/200,
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE.OFF•ICE OF.:ENUIRONMENTAL AFFAIRSx1
DEPARTMENT OF ENVIRONMENTAL PROVE
IVED
V.V!: NOV 1 1 2003
TOWN OF BARNSTABLE
HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION- MAP
Property Address: S PARCEL • ZZ 4-
LOT
;
Owner's Name:
Owner's Address:
Date of Inspection: o on
t 1 NO V 0 6 2003
Name of Inspector: leas print . e_<+ .7 Wiz'
Company Name: Qj� b� TOW EALTOF H DEP TA Bf�
Mailing..Address: �.
Telepho.neNumber:. C1 '77/-
'CERTIFICATION STATEMENT'''
'I'ceriify that I have personally inspected the sewage disposal system at this address and that the,information rEported
below is true,accurate and completeas 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:
_J/Passes
Conditionally Passes
Needs.Further Evaluation by the Local Approving Authority
ails
Inspector's Signature: Date: U
_ 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.
Notes and Comments .,
t ::M..h... n. y., � ,. .........N. '.�. � r 1•f'T.i S �t�` .�f'3ht,"`y.RNt,'.,
Y'(^a C ..9 1 •' .Pwu. i: .. .i^tz.ia3tRrl..n ii _}.:•r +.i1'. ern: •' Srv1 + �.N .fi�..ftl
k g� - ****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.
Title 5 Inspection Form 6/15/2000 page 1
r �
Page 2 of l 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address. Gs Rowp `
Owner:
Date of Inspection: A2hez, QQQ3
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. S stem Passes:
I have not found an information which indicates that a it Y any of the criteria described in 310 CMR
15:303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired.The system,upon completion:of the replacement or repair, as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the 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.
ND explain:
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
obstruction is removed
distribution box is leveled or-replaced
ND explain:
The system required.pumping more than 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
obstruction.is removed
ND explain:
2
Page 3 of 1'1
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM'INSPECTION FORM
. .. .: PART A .
CERTIFICATION(continued)
Property Address:
Owner:
Date of Inspi ction: G 3
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.
L"' System will pass'iititess'Board of I3`eaith a termines in*accordance wi'tt.'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
2r '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 I of a public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private.water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100,feet but 50 feet or more from a
private water supply well"..Method used to deiermine`distance
"This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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:
/ ':a. Jig+
3
� f
Page 4 of l 1
OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: CO&W
Owner: — '
Date of Inspection: c,
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 sui.face waters due to an overloaded or
clogged SAS or cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow
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.
Anyportion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_ _jL 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 coliform bacteria and volatile organic.compounds
indicates that the well is free from pollution from that facility 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.]
(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,the 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•
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes 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 Il 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.
4
Page 5 of 1.1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION-FORM
CHECKLIST
Property Address:
4
Owner
• o
Date of Inspection:
Check if the following have been done. You must indicate"yes"or."no"as to each of the following:
Yes No
A_ 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?
1/ 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 forsigns of breakout? '
L/,._ Were all system components,excluding the SAS, located on site
Were the septic tank:man holes uncover ed,.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:
Y no
Existing information. For example, a plan.at the Board of Health..
V _ 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(3)(b)].
5
Page 6 of 11
OFFICIAL INSPECTION-FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
.,PART C -
SYSTEM INFORMATION
Property Address:
Owner:
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL / J
Number of bedrooms(design):- Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.20.3(for example: 11:0 gpd x#of bedrooms):
•Number of current residents:
Does residence.have.a garbage grinder(yes or no
f
Is laundry on a separate sewage system (yes or no [if yes separate inspection required]
Laundry system inspected(yes or no
Seasonal use: (yes no .. 0'2—��37 Water meter readingg s, if available(last 2 years usage(gpd)):Bl � �
Sump pump(yes or no):
�
Last date of occupanc
COMMERCIXUINDUSTRIAI�_
Type of establishment:.
Design flow(based on 310 CMR.15.203): gpd -
Basis of design-flow(Seats/persons/sgft,ete:):, . ,
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system'(yes or no):_
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:. r t-
Was system pumped as part o the inspe tioIn.( s or no
-If yes,volume pumped: gal]ons'-How was quantity pumped determined? s
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 technologv.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
—Tight tank _Attach a copy**of the DEP.approval
_Other`(describe):
proximate age of all compb ents, date insta]led(if known)and source of information:
Were:sewage odors-detected when arriving at the site(yes or no .
6
Page 7 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS_
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
` PART C
SYSTEM INFORMATION(continued)
Property Address: o10 t R '
Owner:
Date of Inspection: % 3
BUILDING SEWER(locate on site plan)"Ar
Depth below grade:
Materials of construction: cast iron;_40 P.VC_ _ other(explain):-
Distance from piivate water supplVweii or suction liner
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: locate on site plan)
Depth below grade: —
Material of construction: concrete_metal_fiberglass polyethylene
—other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance.(yes or no):_-(attach a..copy of
certificate) �; ;�
r
Dimensions: IM��& ' ,XS- i ,e s
Sludge depth: /q N �/�.• r :, ;
Distance from cp of sludge to bottom of outlet tee.or baffle: Z�J
Scum thickness: _ /o
Distance from top of scum to top of outlet tee or baffle: Z U �� leeY .
Distance from bottom of scum to bottom of outlet tee or baffle' /V
How were dimensions determined: P
Comments(on pumping recomme ations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
related to outlet invertevidence of leak ge,et .
fhb Ab�i
j �i
GREASE TRA locate on.site plan)
Depth below grade:_
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: s•
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage;etc.): _
7
Page 8 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
.PART C
SYSTEM INFORMATION(continued)
Property Address: :D
Owner-3�2u '
Date of Inspection: ,00D 3
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/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches, etc.):
DISTRIBUTION BOX:1z(if present.rust be opened)(locate on site plan)
Depth of liquid level above outlet invert
Comments(note if box is level and distribution to outl s equal, any evidence of solids carryover, any evidence of
J,aOge into rout of boxtc.):
Liz" 6'64"Y-P'�
PUMP CHAMBER&&7(locate on site plan)
Pumps in working order.("yes or no):
Alarms in working artier(yes or no): "
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
z PART C.
SYSTEM INFORMATION,(continued)
Property Address:
a •
Owner:
Date of Inspection: �3
SOIL ABSORPTION SYSTEM(SAS):. (locate on-site plan,excavation not required)
If SAS not located explain why:
Type
leaching.pits,number:_
leaching chambers,number:
leaching galleries,number:
leaching trenches,number, length:
aching 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,
eeiE'.l` C
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 or no): J
Comments(note condition of soil,.signs of hydraulic failure,-level of ponding,condition of vegetation,etc):
PRIVYv/.U(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.):
9
9
Page 10 of 1 l
OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:,
Owner: '
Date of Inspection: ex—) �dU�
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch 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.
o
o �
�ecr o e
—7
�o
1�
10
Page I of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
,PART C '.
SYSTEM INFORMATION(continued)
Property Address: 'Z>S /� C.'
L�
Owner:
Date of Inspection: %` �3
SITE EXAM.
Slope
Surface water
Check cellar.
Shallow wells
Y
Estimated depth to ground water`y feet
Please indicate(check).all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design.plan reviewed:
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)
l� Accessed USGS,database-explain:
You must describe how you established the high ground water elevation: °
11
Permit Number: Date:
Completed by:
HIGH GROUND-WATER LEVEL COMPUTATION
Site Location: �� 5 Al /�1, /yS Lot No.
dewOwner. / Address:
�/?
Contractor:_ � y/V Go�rs�; Address: G✓��,I�f ?`/Y
Notes:
S T E:P 1 Measure depth to water'table
to nearest 1/10 i. ....................:. Date
................
month/day/Year
STEP 2 Using Water-Level Range Zone
and_'Index Wel1'Map locate
site and determine:.
O Appropriate index well...........................
i
Water-level range zone ................................
STEP 3 Using monthly report."Current
Water Resources Conditions" I.
determine current depth to / ---
water level.for index well ......................... ((� o
month/Year
STEP a Using Table of.lNater-level Adjustments i
for index well (STEP 2A), current depth
to Water level for index.well (STEP 3)., i and water-level zone (STEP 2B)
determine water-level adjustment-....................
STEP 5 . Estimate depth to highwater
by subtracting the water-
-level adjustment (STEP 4) i
from me-asured'depth to water
level at site (STEP 1) .:.................:
I
Figure 13.--Reproducible computation form.
. .
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THE icy, Town of Barnstable
Regulatory Services
9 snar ASnS. '
MASS. �• Thomas F. Geiler,Director
A
1 rip. Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis, MA 02601
Office: 508-862-4038 Fax: 508-790-6230
September 4, 2002
Robert Tullis
55 Betty's Pond Road
Hyannis,MA 02601
RE: Illegal Apartment Map/Parcel: 290-124
Dear Property Owner:
A review of our records, including the permitting history of 55 Betty's Pond Road,
Hyannis, as well as Zoning Board of Appeals records indicate that the use of that address
as anything other than that of a single-family home is illegal.
You are hereby ordered to discontinue the use of the above-referenced property as it is
now being used and restore it to a single-family.home. You are to accomplish this work
and notify this office to inspect within fourteen (14) days of receipt of this letter.
A building permit must be applied for to redesign the layout to accommodate the
conversion. You must do this before you make any changes.
You have the right to appeal this decision. If you so choose, we will be more than happy
to help you. If we do not hear from you within the 14 days, we will be forced to seek
criminal action against you.
Very truly yours, e
7�
Gloria M.Urenas
Zoning Enforcement Officer
GMU/lb
Qoio9oaa
TOWN OF BARNSTABLE BAR-W 2888
Ordinance or Regulation
WARNING NOTICE
Name of Offender/Manager --n)L i S dob
Address of Offender L.T 111� ,L.r. �O�l MV/MB Reg.#
Village/State/Zip QTk2 ` S S# _
Business Name —N - //p '; 0 200
Business Address �u
ignature _o of ing Offic
Village/State/Zip
Location of Offens e
0 ObTrk6 ull Enfo king Dept/D'v sinn
Offense V (dE62 E1�2E ls CGod --f ' , .
Facts 9 0 GAaAO--�e
o t
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This- will serve only as a warning. At t is time no legal action has been to en.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
Town of Barnstable
Department of Health,Safety and Environmental Services
Public Health Division,367 Main Street Z' �s �� U.3.P O J I A G
P.O.Box 534 :, APR-9'0105
6L wo°°�o ���� ' L � ✓�1 /_•d�..�A�c'LS�YE.5 R6 4 �ti Hyannis,s,MA 02601 a KF 6 A 8 4 4 3 '
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T TULLIS, ROBERT D JR I` 101 .
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1 LAUREL CIRCLE -" +� 00
FORESTDALE ='' MA 02644 'a „ 00-0000-000
1101 12 ;~� 8289 226
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u 'x TULLIS,ROBERT D JR 1192 8289/226
iy an z 000028200 E : 000082500 q 00)0000000
POND ROAD. 0121 0070
t HY 0000 f 0000
TOWN o B,QNSTATILE
LOCATION y 10 , K SEWAGE #
VILLAGE_ff V� ✓ti iti i,� �� ASSESSOR'S MAP& I.OT
INSTALPR'S NAME&PHOME NO.
SEPTIC TANK CAI'AC1TY
LEACHING FACILITY, (tM) e ld (size),
NO.OF'BEDROOMS
BUILDER OR OWNER
PI RMIT®A,TE: _w___ r.COHYl,WTCE DATE:
Separation Distance Between Ehe.
Maximum A.djusW Groundwater Table to the Bntom of leaching 1~acility
i tag
Private Water Supply Well atac9 Leaching Fadlit (If any wells exist
on site or within 2M feet of leaching facility); __. Fact
Edge of Wedand and Leaching Facility(If any wetlands exist
within 300 feet� leaching facility)
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INSTALLER'S NAME&PHONE NO. //7�G J ���1c5�. 7V
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) - (size)
NO.OF BEDROOMS
BUILDER OR6!SK '
PERMITDATE: /Z�� �6 COMPLIANCE DATE: — "7 — z
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility �� Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any,wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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No.,.9 0 (�� G/) YIS Vol Fee �_..
y THE COMMONWEALTH OF MASSACHUSE Entered in computer:
t Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Zipplication for Xh5 oear * stem Construction i3erm
it
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. �` / Owner's�Njame,Address and Tel.No.
Assessor'sMap/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.N9.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( )
Other Type of Building 12_e e yee_ No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow //® _gallons per day. Calculated daily flow gallons.
Plan Date /Z Cry Number of sheets l Revision Date
Title
Size of Septic Tank Type of S.A.S. X
Description of Soil
Nature of Repairs or lterations ns,er h applicable
��11� 1-f , � GdslG�2 yeAP V/ L.e/Q'�
hr�/ asp T P
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued h' o d ealt
Signed DatePft
Application Approved by Date �Z l
Application Disapproved or the following reasons
Permit No. Date Issued
.-w..rEgr x'•'s....-+-�,...� •-�-'�.^�.�-` �.:.}#,r.�,�y �.iy."�• .11, :��'`t..��.:.ti.c �Y�,,,<.,th'..�.+�. :.,.- .+:,-.%r*,`..t �-'�.-'�',
- No. L �i - Fee
t THE COMMONWEALTH OF MASSACHUSE TM Entered in computer:�^
Yes
-PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
_ Z(oplication for ;Diopozar 46p.5tem Con.5truction Permit/
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete,Systemf L,0 Individual Components
Location Address or Lot No.S5` 5�� Owner's Namej)6dress and Tel.No.
Assessor's Map/parcel
Installer's Name,Address,and Tel.No. `�1 Designer's Name,Address and Tel.N
Type of Building:
Dwelling No.of Bedrooms Lot Size so.ft.j Garbage Grinder( )
Other e' Type of Building 12,0 eeee_ No. of Persons Showers( ) Cafeteria( )
Other Fixtures
f Design Flow gallons per day. Calculated daily flow 17 gallons.
{ Plan Date A* Number of sheets Z Revision Date
i
R _ Title
Size of Septic Tank pe of S.A.S. Y�YY 'S�'dae ic'l
~s
Description of Soil
�5 Nature of Re airs:orAlterations nss er he ap licable)J i>5AZ��
G4,0Cr2��"�
Date last inspected:
Agreement: , .
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued Ith• o d ealth.
Signed Date /Z-//���
Application Approved by -Date--'*' ,? /<
-4 Application Disapproved or the following reasons
Permit No. Date Issued
-----.. ----.-------------------.-- ----- 3
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
` THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( �raded( )
Abandoned( )by
at�,� ,i0Cll Y.S 4ee O % � S has been constructed in accordance
with the prov•sions of Ti t�e 5 as the for Disposal System Construction Permit No. dated
Installer A4r�`�GD// / C/��sT. Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date Inspector _
,
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
�hgpoar *p5tem40grade
ongtruction Permit
Permission is hereby granted to Construct( ) epair ( Abandon(r )
System located at 6--
/vJ
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit.
Date: 2 Z b % Approved by
i
H.K.FdTZ GERALD architects & engineers
29t) ('elitre.1t. , Suite 203, !N'eirMN. Ala. 0215S
(W 7) 527- 029 1-AX 964-9539
December 18. 1996
Board of Health
Town of Hyannis
387 Main Street
Hyannis, %Ia. 02601
Atm. : Thomas McKean, Health Inspector
Re : 55 Betty's Pond Road
Septic System Replacement
Pursuant to our telephone conversation of this morning I am enclosing two copies of the final plan
which has been revised to conform to the Board's comments when the vote of approval was
taken.
Thanking you for your cooperation in getting this underway, I am,
V ry trulPra'
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STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE,
CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front).
Cal
1. If you want this receipt postmarked,stick the gummed stub to the right of the return address
leaving the receipt attached and present the article at a post office service window or hand it to
your rural carrier(no extra charge).
2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return
address of the article,date,detach and retain the receipt,and mail the article. rn
3. If you want a return receipt,write the certified mail number and your name and address on a 2 e
t
return receipt ca,d,Form 3811,and attach it to the front of the article by means of the gummed (a
ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT
REQUESTED adjacent to the number.
4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M
endorse RESTRICTED DELIVERY on the front of the article. L
0
5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If LL
return receipt is requested,check the applicable blocks in item 1 of Form 3811.
A
6. Save this receipt and present it if you make inquiry. 105603-93-B-0218
Town of Barnstable
Department of Health, Safety, and Environmental Services
BAMSTABM
MAW � Public Health Division
1b39•
EDM�� 367 Main Street, Hyannis MA 02601
Office: 509-790-6265 Thomas A.McKean
FAX: 508-775-3344 Director of Public Health
July 25, 1996
Robert D. Tullis
65 Ridgecrest Drive ' .
Westfield, MA
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL
CODE, TITLE 5.
The septic system owned by you located at 55 Betty's Pond Road, Hyannis was inspected
on July 24, 1996 by Thomas McKean, the Director of Public Health for the Town of
Barnstable.
The inspection of your septic system showed that your system has failed under the
guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Raw sewage observed on top of the ground on several dates including July 24,
1996, July 19, 1996, July 12, 1996, and July 5, 1996.
You are directed to hire a licensed professional engineer (PE) to design a system that will
bring the septic system in compliance with 310 CMR 15.00, The State Environmental
Code, Title 5 within ten (10) days of your receipt of this letter.
You are also directed to hire a licensed septic system installer to install the system
components within twenty (20) days of your receipt of this order.
You are further directed to maintain the system by hiring a licensed septage hauler to
pump the septic system to prevent discharge of sewage or effluent into the buildings, onto
the surface of the ground, or in to surface waters:
Any person aggrieved by any order issued by the local approval authority may appeal to
any court of competent jurisdiction as provided for by the laws of the Commonwealth.
PER ORDER OF BOARD OF HEALTH
T omas A. McKean, R.S., C.H.O.
Agent of the Board of Health
'Town of Barnstable
Department of Health, Safety, and Environmental Services
Health Division
367 Main Street, Hyannis MA 02601
Office: 508-790-6265 Tbomss A.McKean
FAX: 508-775-3344• Director of Public Health
1!1!
� ItwwtrrA�a, �
MANS.
tt11�
[ENGINEER LET R] �—
T0: - �(�S (Date)
F6rn Pr
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE_5.
n b you loc ted at b� A-&sinspected on
____-The septic system owned y y .�
99 by �, tic-Mspector. `� 1're-cf tr
The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE
5 (310 CMR 15.00)due to the following:
Oh '-
AM
19ffi
You are diredtid to hire a li ensed profession engineer (PE) to design a system that will bring the septic
system in compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within tom' 1)
qeo C6, days of your receipt of this letter. e
licensed septic system installer to install the s � �J
You are also directed to hire'a stem components withi
p y Y
days of your receipt of this order.
You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system
to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface
waters.
Any person aggrieved.by any order issued by the local approval authority may appeal to any court of
.competent jurisdiction as provided for by the laws of the Commonwealth.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S., C.H.O.
,Agent of the Board of Health
Town of Barnstable
• ` P t
1 Parcel Id: 290 124- - Account No: 197833 Parent:�- 33
Location: 55 BETTYS POND Neighborhood: 62AC Fire Dist: HY
Devel Lot: Lot Size: . 17 Acres
Current Own: TULLIS, ROBERT D JR State Class: 101
1 LAUREL CIRCLE No. Bldgs: 1 Area: 1680
Year Added:
FORESTDALE MA 2644
Deed Date: 110192 Reference: 8289/226
January 1st: TULLIS, ROBERT D JR Deed MMDD: 1192 Deed Ref: 8289/226
Comments:
Values: Land: 17700 Buildings: 54100 Extra Features:
Road System: 55 Index: 121 (BETTY'S POND ROAD ) Frntg: 70
Index: ( ) Frntg:
Control Info: Last Auto Upd: 050695 Status: C Last TACS Update: 120193
Land Reviewed By: Date: 0000 Bldgs Reviewed By: Date: 0000
Tax Title: Account: Taken: Account Status: Hold Status:
Cancel [ ]
Press XMT for more data
Next screen [PAR ] Action [ ]
Owners Name [ ]
Road Index [ ] Road Name [ ]
Parcel Number [290] [ 125] [ ] [ ] [ ]
c- SENDER:
C ■Complete items 1 and/or 2 for additional services. 1 also wish to receive the
w ■Complete items 3,4a,and 4b. following services(for an
y ■Print your name and address on the reverse of this form so that we can return this extra fee):
C card to you. ai
4? ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address
permit. �
y ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery rn
« ■The Return Receipt will show to whom the article was delivered and the date a
delivered. Consult postmaster for fee.
-a 3.Article Addre sed to: 4a.Article Nu bCL r m
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y ❑ Registered ® Certified ta'`
to ❑ Express Mail ❑ Insured
❑ Return Receipt for Merchandise ❑ COD '
a 7.Date V70
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D 5.Received By:(Print Name) 8.Address e's Address(Only if requested
W and fee is paid) t
g 6.Signature: (Addressee or Agent)
T X tilt4 i it (f�ti'
y PS Form 3811, December 19 4 Domestic Return Receipt
i
UNITED STATES POSTAL SERVICE First-Class MailPostage&Fees Paid
Permit o.G-10
I
• Print your name, address, and ZIP Code in this box •
I
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Health Depalrt w
Tgwn of Barnstable
P0,Box 534
rtafs,Massachusetts owl
FaX(508)775-3344
M( )
11111i=tIddli.il{ifiiiilithiiiliIif !L!i fill,11i!if11111ill
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-TOWN OF BARNSTABLE BMi-W ?
Ordinance or Regulation
WARNING NOTICE
Name of Offender/Manager k9�eel I a dob
Address of Offender . X L J'le . MV/MB Reg.#
Village/State/Zip 1 � � � � w MA A OV/74 S S# �
T
Business Name Y ipm_; on, 2001
Business Addresst
Signature _of�n i=f6cing Office?
Village/State/Zip
Location of OffenseA �! ,' RR 9YUM " i_...t' ( � � (., ,
to
7.1 Enforcing Dept/Division
Offense
Facts OOS1. OLT G i,fC_By/ ""�C....� At TPASH M/ GOQVAlf)
M9 Hho,,_S6 ---'PLc)W1A1 e-5. A&i� 0" V' e*)"C PRof 154�1
This will serve only- as a warning. At thi's time_ no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
l"•-s.y(`l-✓'F-'c' ..4-..Y�.`F'^'�..C^ra i:.�'L.?�"'7-�..sr -..-li.�.iL.r+f^`�ry�^`"I'F". `"�"'e `'r.^'".-i"°�:.�i�...,r.,r. `" ,. _ ,• 6+,...-•y.....y..j`-.t"r'r"I!'r---•..-^-:..
TOWN OF BARNSTABLE %�, % 4 t -W
Ordinance or Regulationrt
WARNING NOTICE
Name of Off ender/Manager &.' �' ., �, µ, •�r dob
Address of Offender I LAW ulll e ., MV/MB Reg.# .
Village/State/Zip r "t �' {�• Lnr M 00 S S#
Business Name am on' 2d9j
Business Address � i ! .j
Signature .of/Enforcing Officer
Village/State/Zip
Location of Offense,
Enforcing De t Division
Of f en s e ,R #
FactsD W" 9,"
j .
L 0
This will serve only- as a wa=ning. At .this time no legal action has been taken.
It is the goal -of Town agencies" to achieve voluntary compliance` of Town
Ordinances, Rules and' Regulations ' ," Education efforts and warning notices are
attempts to gain voluntary compliance: Subsequent violations will result in
appropriate legal action' by the Town.'
SlPIIt N1'si! \t_.t,l \!!i\i '+tt11
SIT—
t• 1 ult•%%other%%ise•spe rdicc!•the;%�%k•m conortcrtion %halt confirms its "I Wr t"Of the• Matti ~ p.. / r4 ' A_At x I ,
t n%frcnru►entaf t ntic or the I oral Ilealth t ode. %%hwhe%er is rffore stringe►at•
iittendetl re%tmon of prnposcd etc%aliun%and`or•horirontt4 location, a%%hewn 4An /
hcraeirrt\haft he alsliru%ed Inittt \rChitcc{'t'n�inetr prior to implementation. Q "�t ' t �
3. .\lf isurk on lirsc%. grades• and details shtn%n arc to he preformed b� a Licensed
t +� �
v'
t#ispuszet\t orks In%tallet" o „ r{
-# lines, shouts hereon are approximate.roximate. The .Architect, Engineer should bey�'•
1. t'roperi, 1 P
41
cousulted regarding record hearings,distances,and areas as well as staking requirements.
c. Flay .issuance of a Permit to €onstruct. or a 4 ertiCcatc of (omphanrc, shall not be .`• ft- --
1t?Q 4 F�tC, t,
• p tee . .' �` � ...,._.....,� � �.,.,......�•- � • � '`�'. -•� ` �\y,e �. � _
construed as to a guarantee that the disposal s}strm will function ro rf%.
6. at (ontractor shall aotif% the proper Inspectors and aRo%% such time is required for - t f
ID
inspections. � ,{
'. -#:afro measures, tta%-to-day control of the ►cork and construction rnethtuls sh:ttl be the
ti l t • a `^ (l.
responsibifiiv of the Contractor. ��it ����� MIdTi&i�1�aS.� ��� • d
2•.,��,_-tip ;� "�- "�"� tt'�• 'p�'���z:.y � �':`
8, Precast reinforced concrete s}stem components as shown shall be rnanufacturm Shca t
(:oncretr Products,ttilmin ton. \}a. or approved eq►tal. :4t!components shad be ratted for ,
- s
14-20 loading.
•t r shown on the tans are proposed unless other%-#ise noted as existing.
9. All fea u cs P P P +r �-... fel-
10. Al! large boulders shill be rento%ed and replaced with clean fill as required in %'tile �. _ �j► �,. `�
Section 15.225(3).
!1. if features or conditions during construction are found to be different than %ho-#+n on _..�_.._.
the plans file Architect.Engineer and the }oral Board of NeatthAt
:ire to be notified $D%, x
ittimcdiatel%.
sl
r r ,
\11 1ffp,• \h:,tf hr `�rtnthtte #ft }'\t c%cclH rc fluted lilt file plan\ ant! Iwo ilc%. of Ifipc
\haft he prc,Ix•r!% hcdlird,harttecitcd and f,:u l,ftdr,t \!I 1°+ant\ tittal!hc• ,%ak•ctt;;ht. i.cak h,,,� _ � •^� — _ """ T fy `�* i�,
trench pale \fa:ttl he trcrtof and P\f . pertnrationk\hall he if:a•cf1 faun dna%rt. ii
pipe\hail hr;i% per ►w f \!'-!!t , c stiles\ \prettied uthert%i\c. `+tc "t't+rlile" :snd "llcla`t\ !} t-L-
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a 11.\tand;ird precasi reinfirrced concrete con%tr•netiort. '\et IC%C1 oi►stable erase that %-#tit notsettle. .%If openings%halt he sealed aatertrght. It•sitlr ntlet ofseptic tank I%nsed,!orate inlet '"'t � ! ' 4 tIWT
ter below access utanholeat Centerline oftank. ere detail. Al
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l.lMIfl\(, :RF,Shall ire constructed in :accordance%%ith the tine,.erade%.and details shotsn. \11 topsoil, h+orstauic ;end other%%isr unsuit:able material shall be returned and replaced as specified on 14" MA,• '% - �%'tan" and "Profile" . li) ` Ww
1). st WN l: ' C'^ �t� we "`dune used try lcachittgparra sh�t be ofsitcs anti atnonn{s cho-#%n oft the details.w:#shed free of all foreign material rior to lacement. Bottom of e%ca%ation shall he scarified -#liar to `u4placement of stone.Shall be composed of hard.durabfe stone and medium to course sand. tree of fort�gnmaterials i loan% and cla% etc.)with no Stolle o%er12" in an% dimension.compacted in ' �+ m'4 - �i
I_" laicrs b► appro%rd mechanical means or at o%%ed to settle into place. for tueh c months �. _.
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or as directed. l ill shall III
compaction a Percolation rate of t%%o minutes per inch or faster,after
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compaction<tnd.or settlement in place. Bottom of exca%ation-#..half be Scarilied prior to
placement of fill. Place fill as ssho%%n on "Plan" and "Profile"
t. t \r•��� C:trs,l% rC\rcieucC 'ttth � ttcdrutrtsa\.l,;.rbs,;r t)ittl'ti►scc �+ t"
2• f)csi••�tt 1#u%% b.thtsont\ % I iti(,Pt)=a%erav dad% floe _ ._.__ (sl'U 6;0
3. Soils ciassificatiutt (.lass t)c%ii;n Percolation rite .__.- itrtn Inch € 1i✓ „� r 6 `� r/ AI
Effluent loadin t:itr �►�.±{� _.
4.4rtrund %-#atrrelr%7tiun Ate ,yam ��a• `%rptic t anl. _-..liquid caparst% T%
b. lristiCt:iron t3ox . _.__._ of outlets
'. %oits:thsorbtion %stem
Required Q _GPiJ�F� 3. - q' ' - "'
Pro%rded - t t Ise ind Size`%�.\_S.
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