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VI:.LAGE ASSESSOR'S MAP & LOT�,��`�'j �
INSTALLER'S NAME & PHONE NO. 1?0 i:ws
SEPTIC TANK CAPACITY /C G----B
LEACHING FACILITY:(type) /o G j (size)
NO. OF, BEDROOMS PRIVATE WELL OR PUBLIC WATER S,
BUILDER OR OWNER j-
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: 1-91—'�'f
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c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
a
T '
147 Cedar Street
Property Address i
Baystate Realty
Owner Owner's Name „
information is Hyannis required for every y MA 02601 10/15/2019 r r
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. Inspector Information �, 14/a36o
on the computer,
use only the tab A.Riker
key to move your Name of Inspector
cursor-do not Cape Dig Inc.
use the return key. Company Name
PO Box 726
Company Address
South Yarmouth MA 02664
City/Town State Zip Code
508-776-6460 S1 4590
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above;the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
10/15/2019
Inspec or's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time. This inspection does not address how the system will perform
in the future under the same or different conditions of use.
t5insp.doc•rev.7/2 61201 8 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar Street
Property Address
Baystate Realty
Owner Owner's Name
information is required for every Hyannis MA 02601 10/15/2019
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) 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:
No failures observed on inspection of septic tank d-box and chambers
2) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5insp.doc+rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar Street
Property Address
Baystate Realty
Owner Owner's Name
information is required for every Hyannis MA 02601 10/15/2019
page. City[Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well"..
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate "Yes"or"No"to each of the following for all inspections:
Yes No
Backup of sewage into facility or system component due to overloaded or
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
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Fora
I a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar Street
Property Address
Baystate Realty
Owner Owner's Name
information is required for every Hyannis MA 02601 10/15/2019
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑. Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
c � Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar Street
Property Address
Baystate Realty
Owner Owner's Name
information is required for every Hyannis MA 02601 10/15/2019
page. CitylTown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y2 day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section CA.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA) or a mapped Zone II of a public water supply well
t5insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar Street
Property Address
Baystate Realty
Owner Owner's Name
information is H
required for every y annis MA 02601 10/15/2019
page. Cityfrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered "yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate "yes" or"no"for each of the following for aff inspections:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
�r Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar Street
Property Address
Baystate Realty
Owner Owner's Name
information is Hyannis MA 02601 10/15/2019
required for every y
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 GPD
Description:
Plan on file March 28,2013
Number of current residents: unk.
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)): 2019=
2018=
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: unknown
Date
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
1' �a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar Street
Property Address
Baystate Realty
Owner Owner's Name
information is required for every Hyannis MA 02601 10/15/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information:
homeowner
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping: biannual pumping recommened
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18
cam, Commonwealth of Massachusetts
f Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar Street
Property Address
Baystate Realty
Owner Owner's Name
information is required for every Hyannis MA 02601 10/15/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology.Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
04/14/2014 per COC
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 2feet
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.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar Street
Property Address
Baystate Realty
Owner Owner's Name
information is required for every Hyannis MA 02601 10/15/2019
i
page. Cit /Town State Zi y p Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: 1.5
feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
H-20 concrete septic tank with PVC Tys
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 11 x6x6
de Sludge the
P
Distance from top of sludge to bottom of outlet tee or baffle
26"
Scum thickness
4"
Distance from top of scum to top of outlet tee or baffle
5"
Distance from bottom of scum to bottom of outlet tee or baffle
12"
How were dimensions determined? Sludge Judge
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank was observed to be in goodcondition with no defects observed
'f I
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Fora
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar Street
Property Address
Baystate Realty
Owner Owner's Name
information is required for every Hyannis MA 02601 10/15/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. 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.):
8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar Street
Property Address
Baystate Realty
Owner Owner's Name
information is required for every Hyannis MA 02601 10/15/2019
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank (cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert equal to speed levelers
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.):
H-20 D- box had riser and no evidence of high water stains or carry over observed.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
c Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar Street
Property Address
Baystate Realty
Owner Owner's Name
information is required for every Hyannis MA 02601 10/15/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
® leaching chambers number: 3 x 500 gal. withstone
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
le Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
e
147 Cedar Street
Property Address
Baystate Realty
Owner Owner's Name
information is required for every Hyannis MA 02601 10/15/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.)`
Chambers had no standing water observed and stain line 2" up from bottom of chamber Syatem
16'5'W x 30' Lx 2' D
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
n l�
�� 7a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 p Y rY
tom,
147 Cedar Street
Property Address
Baystate Realty
Owner Owner's Name
information is required for every Hyannis MA 02601 10/15/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18
5
TOWN OF BARNSTABLE
/ 1 L01
LOCATION SEWAGE#
VILLAGEa.�,,,5 ASSESSOR'S MAP&PARCELS
°p INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type),PV SG9.,1. (size) Or
(� NO.OF BEDROOMSu�-
-� OWNER j47Ay—S4k Alt/
a PERMIT DATE: �'Y�7"/' L/ COMPLIANCE DATE:
Separation Distance Between the:
y o Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
y Private Water Supply Well and Leaching Facility(If any wells exist on
n (-� site or within 200 feet of leaching facility) N14 Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
b 300 feet of leaching facility) Feet
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
emu, 147 Cedar Street
Property Address
Baystate Realty
Owner Owner's Name
information is required for every Hyannis MA 02601 10/15/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system;including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
® <; 147 Cedar Street
Property Address
Baystate Realty
Owner Owner's Name
information is required for every Hyannis MA 02601 10/15/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: > 12'feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: 0 312 8/2 0 1 3
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
Test hole on file
❑ Checked with local excavators, installers (attach documentation)
❑ Accessed USGS database- explain:
You must describe how 9
you established the high round water elevation:
Y 9
Test hole on file with deep hole to 126"with no water encountered
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar Street
Property Address
Baystate Realty
Owner Owner's Name
information is required for every Hyannis MA 02601 10/15/2019
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) completed
® D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
Fee 1 - v
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
aUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Applitation for I8 osar Btrm Construction Prmit
) /I
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) El Complete System ❑Individual Components
Location Address or Lot No. L®-r 3 119 Gk4-44. Owner's Name,Address,and Tel.No.I<r6C.
a
Assessor's Map/Parcel _f ?� � 3�yS�•�e 7741- ,,36-6 yG f
Installer's Name,Address,and Tel.No. F6 06'e 7;,(P Designer's Name,Address,and Tel.No. ,f&ff
Type of Building:
Dwelling No.of Bedrooms ✓' Lot Size IS7 ia.3q.ft. Garbage Grinder( )
Other Type of Building Cewdc,441'i No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ® gpd Design flow provided gpd
Plan Date a l is Number of sheets f Revision Date
Title
Size of Septic Tank 'roe Type of S.A.S.
Description of Soil Xt
S4�
Nature of Repairs or Alterations(Answer when applicable) Y��+g 1, AJG� (�-
)",a,e� AAA 20IAt i►ram WOc
.S�GG�Uo� I�Tj�S
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. as, //S/Jo
Signed Date
Application Approved by r1 Date —aZ 72— t
Application Disapproved by Date
for the following reasons
Permit No. — 6 Date Issued J �'Z?
No. ;,.; 4 r`_ _ Fee I
r Entere m computer:
i a ' /
THE COMMONWEALTH OF MASSACHUSETTS,, , . I � � Yes
UBLIC HEALTH DIVISION - TOWN OF Bl4RNSTABLE SSACH•USET/TS
0�p
2Ai
� ZippYltatiOTY forY' .
BI8�JD8`a�Y �ipstern Construttfon Permit
Application for a Permit to Construct( ) Rep t())��Upg3a�peb 7don( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 'f" y , ( j
1.0 3 17, �$�. Ownerry�s Name,Address,and Tel.No (�fit. _
Assessor's Map/Parcel .. �J- " / !-�'Vy � 779- 3(,'(,yel)
Installer's Name,Address,and Tel.No.=77 Designer's Name,Address,and Tel.No.�;fae Jr S C'O®
►!�
r � E✓ Lan
Type of Building:
Dwelling\ No.of Bedrooms �//' Lot Sizes o ft. Garbage Grinder
rSShowers(
( )
Other Type of Building � �oJcn��%� i N6.1oFPersons Showers( ) Cafeteria( )
Other Fixtures ` J
Design Flow(min.required) �� gpd ;,Design flow provided gpd
Plan Date Number Number of sheets f Revision Date S
Title
Size of Septic Tank j <Q Type of S.A.S.
�c
Description of Soil g e 1a o � ,
Nature of=Repairs or Alterations(Answer when applicable) 'V.A��A Ade� +&^
Date last inspected:
' Agreement: t j
<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. O.� //S/.)01�
a
Signed Date
Application Approved by r� Date
Application Disapproved by U Date
for the following reasons
Permit No.- P-o 1 —d0 G Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERpTTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ).
Abandoned( )by e[n
at I'1 641Z,- 54. 14V4AA has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No., y-G�6 dated
Installer A Rix. Designer Sw<e
#bedrooms Aa✓✓ Approved design-flow L /Y gpd
The issuance of this permit shal n be cons rued s a guarantee that the system will �nci'o .a si ed. t '.
Date Inspector .. V
v ✓-
- - - - - - - --- ----------- - -- - - ------
No. , G '� .� ... Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal 6pstem ConstrULtlou'Vermlt
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( )
System located at 14 f r p JA r D
- and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.✓�
Date �� l Approved by
Barnstable
Town ®f BBarnstable Regulatory Services Department "' '
i * t
MAES Public Health Division
200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 FINAL NOTICE Richard Scali,Interim Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7012 1010 0000 2851 2675
April 22, 2014
Bayridge Realty,LLC
96 Summit Road
Plymouth, MA 2360
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5
The septic system located at 147 Cedar Street,Hyannis,MA was last inspected on 1/18/2013 by
Shawn Mcelroy,a certified septic inspector for the State of Massachusetts.
The inspection of the septic system showed that the system"Fails"under the guidelines of the
1995 TITLE 5 (310 CMR 1.5.00) due to the following:
• Stains observed above the inlet invert of the leaching pit.
• Also,there were stain lines observed in the distribution box above the outlet
invert.
You are ordered to repair or replace the septic system within sixty(60) days from the date you
receive this notification.
Any person who shall fail to comply shall be fined not less than $10.00 or more than $500.00
for each day's failure to comply with an order which shall constitute a separate violation.
You may request a hearing before the Board of Health, a Written petition requesting a
hearing on the matter,within seven (7) days after the day this order was received.
PE ER OF THE BOARD OF HEALTH o
y
Thomas McKean,R.S. CHO o�
Agent of the Board of Health
i
Q:\SEPTIC\Final Order\147 Cedar St Hyt 2014.doc
'
i a
Town of Barnstable Barnstable
Regulatory Services Department
,O� Public Health Division
1639. A 2007
QED MAy 200 Main Street, Hyannis MA 02601
Office: 508-862-4644 SECOND NOTICE Richard Scali,Interim Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL #7012 1010 0000 2851 2538
March 5, 2014
Bayridge Realty, LLC j
96 Summit Road
Plymouth, MA 2360
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The Y
septic system located at 147 Cedar Street, Hyannis, MA was last inspected
p
on 1/18/2013 by Shawn Mcelroy, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the
guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Build up of sewage in facility. -
0 I
You are ordered to repair or replace the septic system within sixty (60) days
from the date you receive this notification.
i
Failure to repair/replace the septic system within the deadline period will result in
future enforcement action.
PER ORDER OF THE BOARD OF HEALTH
I
as cKean, R.S. CHO j
Agent of the Board of Health
I
Q:\SEPTIC\L.etters Septic Inspection Failures or Future Eval\147 Cedar St Cent Feb 2013.doc
U.S. Postal ServicF.
CERT1,Fg I E Pj MA►ILTM RECEIPT
' Domestic Mail Onl Na lnSUranCe,COvera a Provided
1
IForr,d61 ery,informationvisit our,website at www.usps.coma
OFFICIAL
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i
Certified Mail Provides:
n A mailing receipt
o A unique identifier for your mailpiece
n A record of delivery kept by the Postal Service for two years
Important Reminders:
e Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®.!
o Certified Mail is not available for any class of international mail.
a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables,please consider Insured or Registered Mail.
o For an additional fee,a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to cover the
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for
a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is
required.
o For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"Restricted Delivery".
o If a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed,detach and affix label with postage and mail.
IMPORTANT.Save this receipt and present it when making an inquiry.
PS Form 3600,August 2006(Reverse)PSN 7530-02-000-9047
i ,
r`
Town of Barnstable Barnstable
Regulatory Services Department
' KASS Public Health Division D I
• .19.
D1A�A 200 Main Street, Hyannis MA 02601 200�
Office: 508-862-4644 Richard Scali,Interim,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL #7012 1010 0000 2851 1845
January 24 2014,
Bayridge Realty, LLC
96 Summit Road
Plymouth, MA 02360
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 147 Cedar Street, Hyannis, MA was last inspected
on 1/1812013, by Shawn Mcelroy, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the
guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following:
C Stains observed above the inlet invert of the leaching pit.
You are ordered to repair or replace the septic system within sixty (60) days
from the date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in
future enforcement action.
PER ORDER OF THE BOARD OF HEALTH
Thomas McKean, R.S. CHO
Agent of the Board of Health
Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\147 Cedar St Cent Feb 2013.doc
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e
C
QASEPTIC\Letters Septic Inspection Failures or Future Eval\147 Cedar St Cent Feb 2013.doc
C3 .. . ,
OFFICIAL S
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Certified Fee
C3 r7�Postmark F
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Restricted Delivery Fee �Qf
0 (Endorsement Required) Q r
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flJ Se— - -- - `
a Ribeiro & Ronaldo Teixira -- -----
0
�- or % Bay Ridge Realty, LLC ____________________
�� 96 Summit Road
Plymouth, MA 02360
Certified Mail Provides:
o A mailing receipt
o A unique identifier for your mailpiece M�
e A record of delivery kept by the Postal Service for two years
Important Reminders:
o Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile,
o Certified Mail is not available for any class of international mail.
o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables,please consider Insured or Registered Mail.
o For an additional fee,a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to cover the
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for
a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is
required.
o For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"Restricted Delivery".
a If a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed,detach and affix label with postage and mail.
IMPORTANT.Save this receipt and present it when making an inquiry.
PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047
,�
Town of Barnstable Barnstable
of >se�c�ty
swF r�y� a�-ame
Regulatory Services Department ►
Health Division
• s^NAM039. Public Hea 200�
Fu r�°i 200 Main Street, Hyannis MA 02601
SECOND NOTICE Richard Scali,Interim,Director
Office: 508-862-4644 Thomas A.McKean,CHO
FAX: 568-790-6304
CERTIFIED MAIL#7012 1010 0000 2851 1159
November 25, 2013, 2013
Ribeiro & Ronaldo Teixira
% Bayridge Realty, LLC
96 Summit Road
Plymouth, MA 02360
• WITH STATE ENVIRONMENTAL CODE, TITLE 5
ORDER TO COMPLY
The septic system located at 147 Cedar Street, Hyannis, MA was last inspected
on 1/18/2013, by Shawn Mcelroy, a certified septic inspector for the State of
Massachusetts.
e ins ection of the septic system showed that the system "Fails under the
Thp
guidelines of the, 1995 TITLE 5 (310 CMR 15.00) due to thefollowing:
Stains observed above the inlet invert of the.leaching pit•
You are ordered to repair or replace the septic system within sixty (60) days
from the date you receive this notification.
Failure to re air/replace the septic system within the deadline period will result in
p
future enforceriment action.
PER ORDER OF THE BOARD OF HEALTH
Thomas McKean, R.S. CHO
Agent of the Board of Health
es or Future Eyahl47 Cedar St Cent Feb 2013:doc
Q:\SEPTIC\Letters Septic Inspection Failur
e
,.r
Barnstable
Town of Barnstable
t�t
Regulatory Services Department 1
lth Division
rrr'srA61E Public Hea 2007 B`
�i6y9.
fn act e � 200 Main Street,Hyannis MA 02601
SECOND NOTICE Richard Scalia-Interim,Director
Office: 508-862-4644 Thomas A.McKean,CHO
FAX: 508-790-6304 -
CERTIFIED MAIL#7012 1010 0000 2851 1159
November 25, 2013, 2013
Ribeiro & Ronaldo Teixira
% Bayridge Realty, LLC
96 Summit Road
Plymouth, MA 02360
ORDER TO COMPLY WITH STATE ENVIRONMENTAL-CODE, TITLE 5
The septic system located at 147 Cedar Street, Hyannis, MA was last inspected
z on
111812013, by Shawn Mcelroy, a certified septic inspector for the State of
Massachusetts.
ins ection of the septic system showed that the system following rider the
The p
guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the
Stains observed above the inlet invert of the leaching pit.
You are.ordered to repair or replace the septic system within sixty (60) days
from the d yo
u ou receive this notification.
Fa
ilure to repair/replace the septic system within the deadline period will result in
future enforcement action.
PER ORDER OF THE BOARD OF HEALTH
• Thomas McKean, R.S. CHO
Agent of the Board of Health
Q:\SEPTIC\Letters Septic Inspection Failures or Future Evahl Cedar St Cent Feb 20t3.doc
F.
Parcel Detail http://issgl2/intranet/propdata/ParcelDetaii.aspx?ID=27921
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Logged In As: Pa I'Ce) Detail Tuesday, October 22
2013
Parcel Lookup
Parcel Info
Parcel -k�__.__.� .__.__- _..�___ __ .__ Developer
ID328-175 I Lot ILOT 3 I
Pri
Location 147 CEDAR STREET I Frontage i50 I
Sec Sect
Road F — I Frontage'
-�-Village HYANNIS I District Fire[HYANNIS I
Town sewer exists at this Road�0259
address No I Index
Asbuilt Septic Scan: u
328175_1 Interactive
328175 2
3281753
• Owner Info
Owner RIBEIRO, RONALDO TEIXEIRA& ( ''Co %BAYRIDGE REALTY;LLG --
Owner '/
Streetl 196 SUMMIT ROAD I Street2[C4 ,,5,3 y 4'�J S
City PLYMOUTH I StateTMA Zip 02360 I Country
Land Info
Acres 0.13 Use Single Fam MDL-01 I Zoning jMS Nghbd 10105
Topography Level I Road Paved
Utilities All Public �I Location
Construction Info
Building 1 of 1
Yearl;928I Roof[Gable/Hip - -I ExtWood Shingle I
Built i Struct Wall
LArea 1584 I Cover iving Roof, AC,
IAsph/F GIs/Crop T Pe INone _.._
Conventiol Int Plastered Bed
Style na ;4 Bedrooms
�___ _ .__ _I Wall I I Rooms 1
Model Residential I Floor Pine/Soft Wood I Rooms Full I
Grade jAverage Minus I Heat HoWater J Total,8 Rooms
Type' Rooms'
Stories .2.3 _ Heat Gad s Found- Typical
Fuel ation
http://issgl2/intranet/propdata/ParcelDF0l.aspx?ID=27921 10/22/2013
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1704 09-Jul-13 09-Jul-13 FAS Plan Peter Mao 170 Grand Island Dr Ost n 2013.doc results Car 8/29113 O+M and repair
old owner State
MicroO-FASTJohn Doyle 20 Grist Mill path MM list/Car yes
Q:\SepticjO&M
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Maint. Brian/ Brian/ Hy DEC State provisional
1786 10-Dec-13 10-Dec-13 micro-FAST Contract Shelby Shelby 32 Hemeon Rd Hy 12013.doc no show. list/Car 'follow up required I
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} 964 13-Jan-09 FAST Plan Ellen Ellen 27 High St WB plan car last inspection 1/25/2012
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Monitoring Gere, 88Hilliards plan of a 1508-543-
965 13-Jan-09 13-Jan-09 Micro fasl Plan Gere,Tom Tom 88 Hilliards Ha ay WB Jan2009.doc FAST list/Car 'last'inspection 2009 8221
Failure to
test,etc Dale
Hearing-VA MicroFAST Iist,State
193 16-May-06 Micro fast Monitoring Needham Needham 549 Huckins Neck Rd Cent system list/car contract obtained 10/10/13
Clearwater Lakeside
Recovery Center
contract LLC 1545 I anough Hyannis CAR 5/15/13 ins ection
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Commonwealth of Massachusetts
Title 5 Official Inspection Form »
s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
4 M 147 Cedar St
Property Address..
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 1-18-13
page. CitylTown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply
❑ The system has a septic tank and SAS_ and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and.the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must
be attached to this form.
3. Other: ,
I
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes"or"No"to each of the following for all inspections:
Yes No
Backup of sewage into facility or system component due to overloaded or !
❑ clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
® ❑ Static liquid level in the distribution box above.outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in.cesspool is less than 6" below invert or available volume is less
than Y2 day flow
t5ins-11110 Title 5 Official Inspection Form:Subsurface.Sewage Disposal System-Page 4 of 17 i
Town of Barnstable
ter.
Regulatory Services
SG Thomas F. Geiler,Director
Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-8 2-46 Fax:.508-790-6304
Date: 03 a7 o7G Sewage Permit l�{Gglp Assessor's Map/Parcel
Installer& Designer Certification Form
Designer: ��� �''` '''���"K Installer:
Address: 713 Address: R15 y
On 03
�dGv'1 l �C
°��� I � was issued a permit to install a `V
(d te) (installer)
/
septic system at .l L17 �`r� /'� T yes based on a design drawn by
(address)
dated 3 lf� 20(Y
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with State &Local Regulations. Plan revision or
certified as-built by designer to follow. Stripout(if required).was inspected and the soils
were found satisfactory.
�1�yZN OF,y�q��q.
Y TERENCE cys
U M.
( taller' ature HAYES cn
-- -,,No. 979
C:............._...._� RG/STEREO
c '' NI TARIP\�
(Designer's igna e) (Affix ffe'sTJW9 Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
q:\office forms\designercertification form.doc
{f
I4 Town of Barnstable p# 13-9 02
Department of Regulatory Services
Public Health Division Date March 11, 2013
MASS
� .659. �� 200 Main Street,Hyannis MA 02601
1Fp MA't�
Date Scheduled March 29, 2013 Time 11 : 0 0 AM Fee Pd. $10 0 . 0 0
Soil Suitability Assessment for Sewage Disposal
Performed By: Robin W. Wilcox Witnessed By: Don Dema r i s
LOCATION& GENERAL INFORMATION
Location Address 147 Cedar Street Owner's Name Ronaldo Teixeira Ri eiro
Hyannis Address 147 Cedar Street, Hyamnis
Assessor's Map/Parcel: 3 2 8/17 5 Engineer's Name Swe e t s e r Engineering
NEW CONSTRUCTION REPAIR XX Telephone# 5 0 8-3 8 5-6 9 0 0
Land Use ���(�� '��Q�7 Slopes(%) G Z— Surface Stones �y /
Distances from: Open Water Body ( /� ft Possible Wet Area ft Drinking Water Well /<11—ft
Drainage Way 64 ft Property Line ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
1
Parent material(geologic) Depth to Bedrock �C1Y
U 1
Depth to Groundwater:,Standing Water in Hole: ( Weeping from Pit Face -1'4
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_
PERCOLATION TEST nate�ul �"Vl'ime
Observation
Hole# Time at 9"
Depth of Pere Time at 6"
Start Pre-soak Time @ 4 Time ff-6")
End Pre-soak
Rate Min./Inch i✓
Site Suitability Assessment: Site Passed. t/ Site Failed: Additional Testing Needed(YIN)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
. I
***If percolation test is to be conducted within 100' of wetland,you must first notify the
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
1�/
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
�r
zC)
DEEP OBSERVATION HOLE LOG Hole# 2
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
Consistent %Gravel
p-!( AP
Z.7 G ZSy
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
Flood Insurance Rate Map:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No ✓ Yes
Within 100 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pervious Z( ,
rviusmateriooial?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the ove analysis was performed by me consistent with
the required training,experti /rnd�e7/��Date
R 1.5.017.
Signature e�
Q:\SEPTIC\PERCFORM.DOC
4
Town of Barnstable Barnstable
Regulatory Services Department AS&WcaChy
+ BARNSTABM " D
MASS. r Public Health Division
i63� A�0 Eo Nut 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 SECOND NOTICE Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL #7012 1010 0000 2851 1159
November 20, 2013, 2013
Ribeiro & Ronaldo Teixira
96 Summit Road
Plymouth, MA 02601
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 147 Cedar Street, Hyannis, MA was last inspected
on 1/18/2013, by Shawn Mcelroy, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the
guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Stains observed above the inlet invert of the leaching pit.
You are ordered to repair or replace the septic system within sixty (60) days
from the date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in
future enforcement action.
PER ORDER OF, E BOARD OF HEALTH
Thomas McKean, R.S. CH _
Agent of the Board of Health
Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\147 Cedar St Cent Feb 2013.doc
r• _
I
Town of Barnstable Barnstable
SHF
Regulatory Services Department edegCity
saxrisra
st.E.MAS& Public Health Divi
sion
,j 200 Main.Street,Hyannis MA 0260.1 2007
Office: 508-862-4644 SECOND NOTICE ThomasF.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL #7012 1010 0000 2851- 1159
November 20, 2013, 2013
Ribeiro & Ronaldo Teixira
96 Summit Road
Plymouth, MA 02601
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 147 Cedar Street°,H annis, MA was last inspected
p Y Y p
on 1/18/2013, by Shawn Mcelroy, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the
guidelines of the-1995`TITLE 5 (310 CMR 15.00) due to the following:
Stains observed above the inlet invert of the leaching pit.
You are ordered to repair or replace the septic system within sixty (60) days
from the date you receive this,notification: -
,a
Failure to repair/replace the septic system within the deadline period will result in
future enforcement action.
PER ORDER OF E BOARD OF HEALTH
Thomas McKean, R.S. CH
Agent of the Board of Health
I
QASEPTIMLetters Septic Inspection Failures or Future Eval\147 Cedar St Cent Feb 2013.doo-
Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=27921
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Parcel Info
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Land Info
Acres 10.13 Use lSingleFam MDL-01 I Zoning MS Nghbd,0105
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Town ®f Barnstable Barnstable
°FIHE
Regulatory Services Department16
'MM&`Yr Public Health Division
200 Main Street, Hyannis MA 02601 2007
1
Office: 508-862-4644 SECOND NOTICE Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL #7012 1010 0000 2851'bB�
October 15, 2013, 2013
Ribeiro & Ronaldo Teixira
147 Cedar Street
Hyannis MA 02601 0
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 147 Cedar Street, Hyannis, MA st inspected
on 1/18/2013, by Shawn Mcelroy, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the
guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following:
® Stains observed above the inlet invert of the leaching pit.
You are ordered to repair or replace the septic system within sixty (60) days
from the date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in
future enforcement action.
PER ORDER OF TH OARD OF HEALTH
Thomas McKean, R.S. CHO
Agent of the Board of Health
Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\l47 Cedar St Cent Feb 2013.doc
ah
Town of Barnstable Barnstable
Regulatory Services Department
� p
i '"R; 0 Public Health Division
fON`"`p 200 Main Street, Hyannis MA 02601 200�
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL #7012 1010 0000 2843 1938
February 14, 2013
David Holt
Today Real Estate
1533 Falmouth Road
Centerville, MA 02632
Re: 147 Cedar Street
• ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 147 Cedar Street, Centerville, MA was last
inspected on 1/18/2013, by Shawn Mcelroy, a certified septic inspector for the
State of Massachusetts.
The inspection of the septic stem showed that the system "Fails" under the
p p Y Y
guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following:
Y Stains observed above the inlet invert of the leaching pit.
You are ordered to repair or replace the septic system within sixty (60) days
from the date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in
future enforcement action.
k PER ORDER OF THE BOARD OF HEALTH
• Thomas McKean, R.S. CHO
Agent of the Board of Health
Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\147 Cedar St Cent Feb 2013.doc
Commonwealth of Massachusetts J D ul
�m v Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar St
Property Address
Bank Owned (Contact David Holt c@ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 1-18-13
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
A. General Information
1. Inspector:
Shawn Mcelroy
Name of Inspector
Upper Cape Septic Services
Company Name
29 Atwater Dr
Company Address
E. Falmouth MA 02536
City/Town State Zip Code
1-508-495-0905 S13971
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage,disposal system at this address and that the
-information reported below is true, accurate and complete as of the time of the inspection. The inspection.
was performed based on my training and experience in the proper function and maintenangee,of one, ite
sewage disposal systems. I am a DEP approved system inspector pursuant i)!Sectionsi.3405f
Title 5 (310 CMR 15.000).The system: '' --
❑ Passes ` '" 1❑ Conditionally Passes ® „Fails ril
❑ Needs Further Evaluati by the Local Approving Authority
%0
a
1 UJ .
1-18-13 - -.
Inspector's Signature Date 0
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•11/10 Title 5 Official Insp toForm:Subsurface Sewage Disposal System•Page 1 of 17
r `
Commonwealth of Massachusetts
W Title 5 official Inspection Form T
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 147 Cedar St
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 1-18-13
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:
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass section need to be
replaced or repaired.The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined,"please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
i Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins-11(10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 147 Cedar St
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 1-18-13
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board,of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑' Cesspool or privy is within 50 feet of a bordering.vegetated wetland or a salt marsh
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar St
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 1-18-13
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes"or"No"to each of the following for all inspections:
Yes No
® ❑ Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar St
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 1-18-13
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ N Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1.of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
1 0,000g pd.
® ❑ 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
❑ El Area
system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed.The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins-11l10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar St
Property Address
Bank Owned (Contact David Halt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 1-18-13
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 b the owner, occupant, or Board of Health
Y p
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Fora
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar St
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 1-18-13
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: 2012
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.):
C
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins%11/10 r - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar St
Property Address
Bank Owned (Contact David Holt c@ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 1-18-13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: 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
Priv
❑ Y
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative techn
ology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
I
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar St
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 1-18-13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
1995
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
18"
Depth below grade: feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Good condition.
Septic Tank(locate on site plan):
Depth below grade: 12"feet
Material of construction: J
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of.certificate) ❑ Yes ❑ No
Dimensions: 1000 gal
i
Sludge depth:
12"
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
S.ubsurface Sewage Disposal,System Form -Not for Voluntary Assessments
147 Cedar St
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 1-18-13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
20"
Scum thickness
2"
Distance from top of scum to top of outlet tee or baffle
6"
Distance from bottom of scum to bottom of outlet tee or baffle
14"
How were dimensions determined? Tape
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank is in good condition with baffles installed and no sign 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
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts }
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar St
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) t
Owner Owner's Name
information is required for every Hyannis MA 02601 1-18-13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No
t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar St
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is
required for every y H annis MA 02601 1-18-13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate'on site plan):
Depth of liquid level above outlet invert
omments (note if box is _ o ou a vidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Good condition with watert at working level and stain lines above outlet invert.
Pump Chamber(locate cn site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located explain why:
P y
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,
147 Cedar St
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is H
required for every y annis MA 02601 1-18-13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 1-1000 gal
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of
vegetation, etc.):
Leach pit was empty at inspection with stain lines above inlet invert.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins-11110. „ Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
i
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 147 Cedar St
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 1-18-13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
" Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,
147 Cedar St
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 1-18-13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.) `
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
a�
-d-g30' 6-,9-30 '
35
t5ins,•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
Commonwealth of Massachusetts
F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
147 Cedar St
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 1-18-13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
e❑
Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high 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:
® Checked with,local excavators, installers- (attach documentation)
® Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
USGS and town maps show groundwater at greater than 20'.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
- f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
GqM , 147 Cedar St
Property Address
Bank Owned (Contact David Holt c@ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 1-18-13
page. City(Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary:A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins 11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
F
r
Town of Barnstable Barnstable
��z�Teti
Regulatory Services Department e``aM
# �" r Public Health Division
a 2007
200 Main Street, Hyannis MA 02601
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL #7012 1010 0000 2843 9231
June 10„ 2013
Ribelro & Ronaldo Teixira
147 Cedar Street
Hyannis MA 0260.1
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 147 Cedar Street, Hyannis, MA was last inspected
on 1/18/2013, by Shawn Mcelroy, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the
guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following:
0 Stains observed above the inlet invert of the leaching pit.
You are ordered to repair or replace the septic system within sixty (60) days
from the date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in
future enforcement action.
PER ORDER O HE BOARD OF HEALTH
as McKean, R.S. CHO
Agent of the Board of Health
Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\147 Cedar St Cent Feb 2013.doc
Free People Search I WhitePages http://www.whitepages.com/name/Ronaldo-T-Ribeiro/Hyannis-MA/2625wnO
WhitePa4es
First name Ronaldo
* Last name Ribeiro
. City, State or ZIP Hyannis MA Submit Query
Advertisement:ID Unknown Calls &Texts!
Advertisement:See What Ronaldo Ribeiro's Home is Worth
STAR.
Bank I Imurance(Pflyalc C+dAwry
uK¢WG'iA: LJ. Gyxif gliFT4wxl rtanp
ice#
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•
2
I4M;„
Ronaldo T Ribeiro
Claim & Edit
Save Address to Mailer
Home (508) 771-6831
147 Cedar St
Hyannis, MA 02601-3013
Age: 55-59
Associated: Havdee S Silva
6/24/2013
II
Town of Barnstable - Barnstable
Regulatory Services Department u4medcaNy
R'RN^ Public Health Division
2007
200 Main Street, Hyannis MA 02601
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL #7012 1010 0000 2843 9231
i
June 10„ 2013
Ribeiro & Ronaldo Teixira
147 Cedar Street
Hyannis MA 02601
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 147 Cedar Street, Hyannis, MA was last inspected
on 1/18/2013, by Shawn Mcelroy, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the
guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Stains observed above the inlet invert of the leaching pit.
You are ordered to repair or replace th j septic system within sixty (60) days
from the date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in
future enforcement action.
PER ORDER O HE BOARD OF HEALTH
as McKean, R.S. CHO
Agent of the Board of Health
Q:\SEPTIC\Letters Septic Inspection Failures or Future Eva1\I47 Cedar St Cent Feb 2013.doc
Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=27921
R
\STA61 Ys
I s e
11 e— e,
Logged In As: Parcel Detail
etail Monday,June 10 2013
Parcei Lookuo
Parcel Info
Parcel ID 328-175 DevelopeeY LOT 3
Location 147 CEDAR STREET Pri Frontage 50 _
Sec .
Sec Road Frontage
Village HYANNIS Fire District�HYANNIS
Town sewer exists at this address No Road Index 0259
Asbuilt Septic Scan: k: 4
Interactive �a
328175_1
Map
328175_2
Owner Info
owner RIBEIRO, RONALDO TEIXEIRA& ( Co-Owner ISILVA, HAYDEE TEREZINHA --�
Streets 1147 CEDAR STREET Street2 j
City 1HYANNIS State MA zip 1 2601 Country
Land Info
Acres 10.13 Use Single Fam MDL-01 zoning MS Nghbd 0105
Topography�LeV21� T) Road Paved
Utilities iAll Public I Location
Construction Info
Building i of 1
Year r`�1928 _ Roof E x t
Built Struct iGab�le%Hlp � ) wall Wood Shingle
Living 1584 Roof Asph/F GIs/Cmp� AC None I
Area Cover- Type
Style(Conventional Wall Plastered I Rooms 4 Bedrooms
Model rRes�i�dent ial Int Bath
Floor Pine/Soft Wood Rooms F2 Full
3 n�Total a
Grade jAverage Minus Type Hot Water Rooms Rooms
_
Heat Found- 8;
Stories2.3." Fuel ation�TyprCal I 8,
Gross Area�3200
1
Permit History
http://issg12/intranet/propdata/ParcelDetail.aspx?ID=27921 6/10/2013
Town of Barnstable Barnstable
Regulatory Services Department "" '
i � � ►
anxtvsrest.E.
MPS& � Public Health Division
200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL #7012 1010 0000 2843 1938
February 14, 2013 q�
a
David Holt
Today Real Estate •
1533 Falmouth Road
Centerville, MA 02632
Re: 147 Cedar Street
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE TITLE 5
The septic system located at 147 Cedar Street, Centerville, MA was last
inspected on 1/18/2013, by Shawn Mcelroy, a certified septic inspector for the
State of Massachusetts.
The inspection of the septic system showed that the system "Fails" under the
guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following:
e Stains observed above the inlet invert of the leaching pit.
You are ordered to repair or replace the septic system within sixty (60) days
from the date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in
future enforcement action.
PER ORDER OF THE BOARD OF HEALTH
Thomas McKean, R.S. CHO
Agent of the Board of Health
Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\147 Cedar St Cent Feb 2013.doc
Health Master Detail http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=328175
Logged In As: Health Master DetailTuesday, September 17
TOWN\flynnj 2013
Application Center Parcel Lookup Selection Items Reports
Parcel ( Septic Perc Well Fuel Tank
Parcel: 328-175 Location: 147 CEDAR STREET, HYANNIS Owner: RIBEIRO,RONALDO TEIXEIRA&
Septic 1, 1/26/1995 New Septic..
Permit number: 1995071 Permit type: Selecttype I3 Complete system: f-
Issue date : 1/26/1995 Complete date 1131/1995
P Type/Size Septic tank size: T e/Size of SAS
Installer: Select Installer ;i Card on file [`
I/A service type: Select service Innovative/Alternative Technology type: Select IA type
Variance date :h �SA Abandon complete date :I ai Abandon permit number:
Repair deadline date : 9/14/2013 Repair notification date i 2/14/2013 Keyword: �!
Comments: RPR INSTLL 1000 GAL STANK,D BOX AND LP/2 BRS Delve SeptiCI
T.
Inspection 1/18/2013 New Inspection...
Number Inspection Date Inspector Result
7671 1/18/2013i McElroy,Shawn,UPPER CAPE SEPTIC SERVICES r F(Fail)
The following condition(s) are occurring:
r discharge or ponding of effluent to the surface of the ground
r pumping more than 4 times during the last year NOT due to clogged or obstructed pipe
G backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool
r static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
r any portion of the SAS, cesspool, or privy below high groundwater elevation
r any portion of the cesspool within a Zone 1 to a public well
j f. any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis
Received Date Comments
1/25/2013 Perc.Test-3/29/2013 Delete Inspection �j
_ .... -
Save Septic Changes ) Return to Liiokup
i
r
http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=328175 9/17/2013
Parcel Detail http://issgl2/intranet/propdata/ParcelDetaii.aspx?ID=27921
s.
Logged In As: P�rye �� � Wednesday, September
18 201.3
Parcel Lookup
Parcel Info
Parcel 328-175 Developer
'LOT
ID Lot'
Location 147 CEDAR STREET ��— � Pri I50 —
Frontage
Sec F— __�___ _._ � Sec
Road Frontage
Fi re
J _
Village HYANNIS District HYANNIS
Town sewer exists at this Road
0259
address No ( Index
Asbuilt Septic Scan: .
328175_1 Interactive =^
328175_2 Map ( �
3281753
Owner Info
Owner RIBEIROLDO TEIXEIRA& -- ( Owner %BAYRIDGE REALTY, LLC
, RONA �
Streetl 196 SUMMIT ROAD— � Street2
City PLYMOUTH State FMfl Zip 1023 0'—-I Country,
Land Info
Acres 10.13 Use ISingle M 01 Fam DL- Zoning[MS Nghbd T0105
Topography Level Road IPaved
Utilities All Public Location�—
Construction Info
Building 1 of 1
Ext
Buat 1928 Strr�ct Gable/Hip� � wall IVY/ood Shingle
Living[1584 �I Roof Asph/F GIs/Cmp AC INone
Area Cover Type
Int Be
Style lConventional Wall P dlastere I Rooms 4 Bedrooms
--
Model Residential I Int Pine/Soft Wood Bat 2 Full 1
Floor Rooms
;
Grade Average Minus I Type Heat Hot- Water R Total
ooms i8 Rooms
Heat _ ___-- Found- —
Stories 2.3 Fuel Gas ( ation`Typical
http://issg]2/intranet/propdata/ParcelDetaii.aspx?ID=27921 9/18/2013
` BAY RIDGE � .
To Whom It May Concern,
RE: 147 Cedar St, Hyannis MA 02601
We purchased this property as a 4 bedroom, that is what is currently there and being used as.
Dennis Kerkado
Bayridge Realty LLC
16 KINGS WAY. HYANNIS,MA 02601 PHONE: 508.534.9768 E-MAIL: BAYRIDGEREALTY@GMAIL.COM
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Print Page Page 1 of 4
Print this page
• Owner Information - Map/Block/Lot: 328 / 175/- Use Code: 1010
Owner
Map/Block/Lot ,
328 / 175/ �.
MAPS
BAYRIDGE REALTY, Property Address
Owner Name as o�r LLC
111113 96 SUMMIT ROAD 147 CEDAR STREET
PLYMOUTH, MA. 02360
Co-Owner Name Village: Hyannis
Town Sewer At Address: No
GIS Zoning Value: MS
• Assessed Values 2014 - Map/Block/Lot: 328 / 175/- Use Code: 1010
2014 Appraised Value 2014 Assessed Value Past Comparisons
Building $ 97,100 $ 97,100 Year Total Assessed
Value: Value
Extra $ 15,000 $ 15,000 2013 - $ 208,400
Features: 2012 - $ 207,000
Outbuildings: $ 1,400 $ 1,400 2011 - $ 233,600
Land Value: $ 94,800 $ 94,800 2010 - $ 233,700
2009 - $ 291,700
2008 - $ 281,000
2014 Totals $ 208,300 $ 208,300 2007 - $ 280,500
• Tax Information 2014 - Map/Block/Lot: 328/ 175/- Use Code: 1010
Taxes
Hyannis FD Tax $ 464.51
(Residential)
Community Preservation $ 56.99
Act Tax
Town Tax Residential $
( ) 1,899.70 Fiscal Year 2014 TAX RATES HERE
S
2,421.20
http://town.barfistable ma.us/Assessing/printl4.asp?ap=0&searchparcel=328175 3/4/2014
Print Page Page 2 of 4
• Sales History - Map/Block/Lot: 328 / 175/- Use Code: 1010
r
History:
Owner: Sale Date Book/Page: Sale Price:
BAYRIDGE REALTY, LLC 8/28/2013 27650/148 $100000
DEUTSCHE BANK NATIONAL TRUST CO 7/29/2013 27577/52 $164000
RIBEIRO, RONALDO TEIXEIRA & 7/31/2002 1.5426/035 $100
RIBEIRO, RONALDO TEIXEIRA & 2/15/2002 14828/246 $100
RIBEIRO, RONALDO TEIXEIRA 2/15/2002 14828/235 $162000
MCGUIGGAN, WILLIAM D 12/11/2001 14559/264 $130000
JENKINS,NATALIE R 7/15/1990 7223/209 $1.
JENKINS,NATALIE R ; 9/1.5/1989 P1310-El $1
SEARS, RUBY R 3/2/1989 6645/193 $1
SEARS, CEDRIC T 12/2/1936 524/251 $0
• Photos 328 / 175/-Use Code: 1010
There are not any photos for this parcel
• Sketches - Map/Block/Lot: 328/ 175/- Use Code: 1010
,y
As Built Cards:Click card#to view: Card "i1 I Card 4121
Constructions Details - Map/Block/Lot: 328 / 175/- Use Code: 1010
Building Details Land
http://town.barnstable.ma.us/Assessing/printl4.asp?ap=0&searchparce1=328175 3/4/2014
Print Page Page 3 of 4
Building value $ 97,100 Bedrooms 4 Bedrooms 1 SE CODE 1010
Replacement Cost $149,355 Bathrooms 2 of Size SE
(Acres)
Model Residential Total Rooms 8 Rooms Appraised $
Value 94,800
Style Conventional Heat Fuel Gas Assessed Value 94,800
Grade Average Heat Type Hot Water
Minus
Year Built 1928 AC Type None
Effective Interior Pine/Soft
depreciation 35 Floors Wood
Stories Interior Plastered
Walls
Living Area sq/ft 1,584 Exterior Wood Shingle
Walls
Gross Area sq/ft 3,200 Roof Gable/Hip
Structure
Roof Cover Asph/F
GIs/Cmp
• Outbuildings & Extra Features - Map/Block/Lot: 328/ 175/- Use Code: 1010
Code Description Units/SQ ft Appraised Value Assessed Value
BMT Basement- 856 $ 13,700 $ 13,700
Unfinished
FOP Open Porch-roof- 32 $ 1,300 $ 1,300
ceiling
FGR1 Garage-Poor-Wd 240 $ 1,400 $ 1,400
Shingle
• Sketch Legend
Property Sketch Legend
62N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only
BAS First Floor, Living Area FTS Third Story Living Area SOL Solarium
(Finished)
BMT Basement Area FUS Second Story Living Area SPE Pool Enclosure
(Unfinished) (Finished)
BRN Barn GAR Garage TQS Three Quarters Story
(Finished)
CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished)
CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished)
FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area (Unfinished)
http://town.barnstable.ma.us/Assessing/printl4.asp?ap=0&searchparcel=328175 3/4/2014
Print Page Page 4 of 4
FCP Carport KEN Kennel UTQ Three Quarters Story
(Unfinished)
FEP Enclosed Porch MZ1 Mezzanine, Unfinished UUA Unfinished Utility Attic
FHS Half Story(Finished) PIRG Pergola UUS Full Upper 2nd Story
(Unfinished)
FOP Open or Screened in PRT Portico WDK Wood Deck
Porch
PTO Patio
I
http://town.barnstable.ma.us./Assessing/printl4.asp?ap=0&searchparcel=328175 3/4/2014
Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=27921
iai '
Logged In As: Parcel Detail Wednesday, September
18 2013
Parcel Lookup
Parcel Info
........
Parcel o er eve
-175 Developer _ ---__.__.__ _ ..__.._____._�
ID�328 Lot SLOT 3
Location 147 CEDAR STREET -� Pri Frontage 150
Sec ` Sec
Road� �� Frontage'
Village HYANNIS Fire IHYANNIS
District'
Town sewer exists at this Road
address lNo iv Index 0259
Asbuilt Septic Scan:
328175_1 �J d Interactive
328175_2
Ma
3281753
Owner Info
Owner RIBEIRO, RONALDO TEIXEIRA& CO Owner %BAYRIDGE REALTY, LLC
Street1196 SUMMIT ROAD Street2 F �)
City�PLYMOUTH State MA Zip 02360 Country
Land Info
_.w .__ ....... _
Acres 10.13 J Use Single Fam MDL-01 Zoning I S ( N g h b d,0105 J
Topography[Level� Road F aved
Utilities All Public Location
Construction Info
Building 1 of 1
Year 1928 -- Roof Gable/Hip Ext jrWood Shingle
Built Struct Wall
Living __n.. Roof_.._ _ . _ AC,,-"_
i1584 Area Cover Asph/F GIs/Cmp Type j one
_..._._. __. . - Int; _, ..._..... Bed,tt .,. ._..._ .__.. ._. ,.
Style.Conventional I Wall Plastered Rooms'4 Bedrooms
Int _ .__ Bath, __.
Model ,Residential Floor}Pine/Soft Wood Rooms 12 Full '
Grade jAverage Minus Type[Hot Water Rooms#8 Ro���
HeatTotal
i
Found-
Stories Fuel Gas ation'Typcal
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=27921 9/18/2013
TOWN OF BARNSTABLE.
LOCATION /'V 2 r
SEWAGE # /
VILLAGE ASSESSOR'S MAP & LOT5,,.9,f
INSTALLER'S NAME & PHONE NO. -iC
SEPTIC TANK CAPACITY ,!�.�.... ;
r
LEACHING FACILITY:(type) %n (5 (size) ;-rC
NO. OF BEDROOMS__` PRIVATE WELL-OR PUBLIC WATER S
BUILDER OR OWNER C./;= X ,
DATE PERMIT ISSUED:.= .S
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes
Arl
- f
• J J I:
J /'
Y%
1
V
a�
YOU WISH TO OPEN A BUSINESS?
Business ce
rtificates cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which
For Your Information: ( FL. 367
you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerks Office, 1 ,
Main Street, Hyannis, MA 02601 (Town Hall)
DATE: l� in please:
APPLICANT'S YOUR NAME/S: y
6i €i1 t 1Ttlp % —
�= x rF , F BUSII�IESS YOUR HOME ADDRESS f
s,
TELEPHONE # Home Telephone Number
NAME OF CORPORATION: - C-f t
NAME OF NEW BUSINESS t. TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? YES N , - Assessin
ADDRESS OF BUSINESS MAP/PARCEL NUMBER 9J
When starting a new business there are several things you m st do in er a in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the informa n you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
make sure you have the appropriate permits and licenses required to legally operate your business in this town.
Rd. &Main Street) tom y P
u 1. BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
2. BOARD OF HEALTH -
This individual ha rmed of the a it r ui ments that pertain to this type of business. MUST COMPLY WITHALL
HAZARDOUS MATERIALS REGULATIONIS
Authorized Signa e**
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
Date: ��/��/ IU
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS: y
BUSINESS LOCATION: I4-1e—�&` 24AA 11"T INVENTORY
MAILING ADDRESS: '"'1 '"` TOTAL AMOUNT:
TELEPHONE NUMBER:
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE?
TYPE OF BUSINESS: C-0A-)37_0,,(_) O/,) E-LAM
INFORMATION/RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous.waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic
or hazardous characteristics and must be registered regardless of volume.
Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED
Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (inc. carbon tetrachloride)
NEW USED Any other products with "poison" labels
Paint & varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor&furniture strippers Other products not listed which you feel
Metal polishes may b�us (please list):
Laundry soil & stain removers
(including bleach)
Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
TOWN OF BARNSTABLE
LOCATION SEWAGE# CJ�t�' 0
VILLAGE ASSESSOR'S MAP.&PARCEL X78 v
INSTALLER'S NAME&PHONE NO. )C.L. C. 77(&,
SEPTIC TANK CAPACITY
LEACHING FACILITY.(type),reZ09,i DaygllS (size) X�lrr S
NO.OF BEDROOMS
/ Gu✓+
OWNER a
PERMIT DATE: Z 7 k q COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility. Feet
Private Water Supply Well and Leaching Facility(If any wells exist oW `..
site or within 200 feet of leaching facility) ./11 Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) P Feet
FURNISHED BY� �e/
izN
vex a
i i 'loco �
tN 9 .) l iN
00 'l (o
ZN IQ O
R \ R
f
TOWN OF E'A�RNSTABLE
LOCATION l 7 7 CP�C�/ S� sr-,WAGE #
ASSESSOR'S MA6P&L.OT___.,___�_____,
INSTAL. ER'S NAME&PHONE NO. r
1
SEPTIC TANK CAPACITY
LEACHNG FACILrff, (rm) �,,� i (size)
NO.OF'BEDROOMS 3.d..�........., �`�
BUILDER OR OWNER. i..
PERNITDATE:,.,,.,,,_,,, COWLJANCE DATE: - --
Sepamdion Distance Between tie.
Maximum Adjusted Groundwater Table to the Bohol rn of Leaching Facility Fee,
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility), Feel
Edge of Wetland and Leaching Facility(if any wetlands exist
within 300 feet of aching facility)
FuriVshed by- w•� ( (�!
` O
Q t b
� r
r
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TOWN OF BARNSTABLE BAR-W 5917
Ordinance or. Regulation
WARNING NOTICE
Name of Offender/Manager � � /
Address of Offender / 4 `�'� / '° �1 MV/MB Reg.#
Village/State/Zip UAT
r +
Business Name 0 A am/pin; on 4 2OL)-7
r jj M
Business Address I t. 1k �l� r
Signa�f.u're,"'"b-f"-Enforcing Officer
Village/State/Zip
Location of Offense � `(4491 . Auy/,1,/�,�, A'-'5 MJ'�` ��l 1 Jf�+LJ�✓.
t 4f EnforcingD�e„pt/Division
Offense �.:.J/4 �(�n A"I,�r P: (P 9 ���� �ll� Tl� qrn)k)d&r-r"
Facts ��-,rp,my)'KV. J4
This will serve only as a warning.t�At this time- no legal action hastbeen 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.
WHITE-OFFENDER CANARY-ORD./REG.-PROD. PINK-ENFORCING OFFICER ' GOLD-ENFORCING DEPT.
Date: 04 1�/002
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS: A9WfKnLeZZEjE mg 5hloxl
BUSINESS LOCATION1416tgM/2
MAILINGADDRESS: /1 Mail To:
/�
TELEPHONE NUMBER: C .fo 6 Board of HealthTown of Barnstable
CONTACTPERSON: P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: S�� - 6�� Hyannis, MA 02601
TYPEOFBUSINESS:
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own
use? YES NO X
This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed
envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site other than your mailing
address:
ADDRESS:
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity Quantity
Antifreeze(for gasoline or coolant systems) Drain cleaners
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salt (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet Fuel Photochemicals (Fixers)
Diesel fuel, kerosene, #2 heating oil NEW USED
Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Battery acid (electrolyte) Swimming pool chlorine
Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car waxes and polishes Leather dyes
Asphalt & roofing tar Fertilizers
Paints, varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
NEW USED (inc. carbon tetrachloride)
Paint & varnish removers, deglossers Any other products with "poison" labels
Paint brush cleaners (including chloroform, formaldehyde,
Floor & furniture strippers hydrochloric acid, other acids)
Metal polishes
Laundry soil & stain removers Other products not listed which you feel
(including bleach) may be toxic or hazardous (please list):
Spot removers & cleaning fluids HA ( /Z 1)y2 C Pe YI^kq S
(dry cleaners)
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
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