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Home My WebLink About0210 COMPASS CIRCLE - Health 210 Compass Circle Hyannis F A = 310 409 I e y a u 1 1 tl G ��e �• r GDmplain''W41 i�Qp Pnntes On 3123124�tf . 3 t 2'10 �CONl�AS�CIRCLEg HYANNISf Case#: C-20-119 Address: 210 COMPASS CIRCLE, Date: 3/23/2020 HYANNIS Owner Info: Property Info: PERALTA, MARINO A MBL: 210 COMPASS CIR 310-409 HYANNIS MA 0.2601 Owner Notified?: Complaint Details: Type of Complaint Classification of Complaint Method of Complaint Zoning, Illegal Dwelling unit Medium Priority Phone Complaint Summary: All, Yesterday afternoon we had a fire at 210 Compass Circle. It appears that the fire started in the basement due to electrical issues in a makeshift kitchen... We did ask for a representative from the BOH and the wiring inspector for Hyannis to respond to the scene. Bill Amara, Tom McKean, and Hyannis FD thought it was best to have Eversource turn off the power to the house.The residents are living elsewhere for now. The resident/owner of the property is Morino Pfaita 508-514-8574. Once the fire was out,we found a number of concerns/potential issues that your agencies may want to be aware of. I've listed them below. We do have pictures but did't want to send them all in one email. I'm sure there's more, but like all of you, the FD is extremely busy with planning for COVID-19. Let me know if you need anything else. • 70-80 Mopeds stored in the back yard for sale • Appears the camper in rear is tied into the septic • 3 bedrooms in the basement with no proper egress • Numerous wiring concerns throughout the basement Thanks, Captain David Webb Action History: Action Taken Date Description Fee Inspector Inspector Assigned to Complaint: bowerse Filed by: sheas Comments: Date, 3/23/2020 . ble �.. . � rns Town o#,Ba Property oF, Marino Esteban Peralta Address: 210 Compass Circle Hyannis, MA 02601 Opening S' Opening-... -9 3-3 .� Storage Space m m i � o Storage Space P' 0 T-10` .. ...g' '-4 Opening The S' openning are the new ' modifications to be added to the existing structure a �� b r—• 3 oro -i Q � S Q� r 0 Q o n � o (D O U O � ro ro � O O � N O -r; S I Certified Mail#7006 0810 0000 3525 3084 IKE r, Town of Barnstable Regulatory Services MASS g Thomas F. Geiler, Director %bq. ,$ Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 October 1, 2007 Marion A Peralta 210 Compass Circle Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY _CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION, THE STATE ENVIRONMENTAL CODE, TITLE 5. The property owned by you located at 210 Compass Circle, Hyannis, MA'was inspected on October 1, 2007 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint. The following violations of the State Sanitary Code were observed: 105 CMR 410.300 and 310 CMR 15.00: There were a total of six (6) bedrooms .observed in this dwelling; three (3) were observed on the first floor, (3) three were observed within the basement. However, the existing septic system (permit # 03-136) was not designed for six bedrooms. It was designed for four(3)bedrooms. 105 CMR 410.350-Plunbing Connections: Observed the toilet within basement leaking and not working properly. The leaking of this toilet is leading to chronic dampness throughout basement. Also observed the toilet on first floor not installed in accordance to accepted plumbing standards. 105 CMR 410.452-Egress Obstruction: Observed dresser obstructing access to second exit from bedroom which is off the kitchen. 105 CMR 410.482- Smoke detectors: Observed that there was not a smoke detector within proper vicinity of bedroom off kitchen. Also in need of CO detector within basement area. I Q:\Order letters\Housing violations\Rental ordinance\210 compass hyannis f You are ordered to correct the violations listed above within fourteen 14 days Y of your receipt of this notice by pulling any required building permits (if applicable); by repairing both toilets mentioned above so that they meet proper plumbing standards and codes; You are ordered to remove all of the bedrooms from the basement and one bedroom from the first floor by removing entrance doors and by opening all door-way entrances to each room to a minimum of five feet wide openings. This will bring the total bedroom count down from (6) six to the appropriate (3) three as designated by your septic permit. You must either complete the above alterations to the bedrooms or up grade the current septic system to represent the current number of bedrooms. Due to the fact you are not within the Zone of;Contribution to public water supply wells you are eligible for this second option. This will entitle you to be able to keep the current number of bedrooms (up to five or Board of Health approval). You also have twenty four (24) hours of your receipt of this notice to install a smoke detector in bedroom off kitchen and to install a CO detector within basement. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDE OF TH BOARD OF HEALTH Thoma A. McKean, R.S., C Director of Public Health Town of Barnstable Cc: Timothy O'Connell, Health Inspector QAOrder letters\Housing violations\Rental ordinance\210 compass hyannis b 3 3 TOWN OF BARNSTABLE 3 8 BOARD OF HEALTH ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date °� b o j�- i Owner � "*A_., Tenant � ��- Address Address �lO Compliance Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply t 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 3v� 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal --- Soy 16. Sewage Disposal 17. Temporary Housing (,)�C7 PART II 37. Placarding of Condemned Dwelling; �C3 (� I �2— Removal of Occupants; Demolition } L f� 7-0 Person(s) Interviewed Al? Inspector If Public Building such as Store or Hotel/Motel specify here z•— _ .#Y-..�{ � ,fir >xs".gtt 1 '410W wry' :�jld�'^« :: ;-r. iv, TOWN OF BARNSTABLE BOARD OF HEALTH ti ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date ' Owner ��✓`^'�'' ' Tenant 5 Address Address M b Cvyyt!..t.. 10 107 Compliance Remarks or Regulation# Yes No Recommendations (h 2. Kitchen Facilities am 3. Bathroom Facilities r A. Water Supply 5. Hot Water Facilities . 6. Heating Facilities 7 _ P 7. Lighting and Electrical Facilities -- Z✓ � `-- - 8. Nentilation GJ 9. Installation and Maintenance of Facilities Y 10. Curtailment of Service 11. Space and Use 12. Exits .� 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents , 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing ' PART II 37. Plocarding of Con 2 Condemned Dwelling; ` � — 1 Removal of Occupants; Demolition / % � r ` Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here t. i TOWN OF BARNSTABLE i LOCATION e1//PC ZF SEWAGE # 'Z�'c 5 i VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE N0. \-1 iAv SEPTIC TANK CAPACITY /occ 'i1• �al/ �4 -- LEACHING FACILITY: (type)' /�S (size) -V>e ice'' NO. OF BEDROOMS ti-,Zo BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: i Maximum Adjusted Groundwater Table to the.Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist, on site or within 200 feet of leaching facility) / Feet Edge of Wedand and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by /0' .mooLsC JZ Ae f Po/z7' BG Zor i Parcel Detail Page 1 of 3 o A, IkA I gr le 47� i t Logged In.As: a ldav, Oc. c Detail parr_rxl Lookup u Parcellnfo ......................... Parcel ID 310-409 Developer;LOT 23-A _.. Lot ... ...... .. Location 210 COMPASS CIRCLE Pri Frontage 127 Sec SecRoad. .... .,_.. _.._ _._..._....�__..._._._._ ._..__.�....__.._�_._.. Frontage --------------------- village;HYANNIS Fire District Sewer Acct; _...._ ... .._._ . . Road Index 1_... 0340 Interactive26 A IF. k ti Map i Owner Info _... . . Owner'PERALTA MARINO A Co-Owner. ................................ ......... ........................................... Streets 1210 COMPASS CIR Street2 77 ......... _ ........... City 1HYANNIS State MA Zip€02601 Country'us Land Info Acres 10.23 use Single Fam MDL-01 Zoning RS Nghbd 0105 Topography i Level Road Paved Utilities i Public Water,Gas,Septic Location Construction Info Year 1979 Rf Gabie/Hip ... J Strruct t wall Wood Shingle Built Effect .. ..... ._. ._ Roof"' AC 1144As h/F Gls/Cm None Area Cover p Type Style;Ranch Wall Drywall nt Be Rooms 3 Bedrooms Model Residential Int ____ Bath-1 Full " Floor 3 Rooms Heat'''�� _ -"� �� `-� Total Type Rooms Grade,Average {Hot Water 6 Rooms . http://issql/Intranet/propdata/ParcelDetail.aspx?ID=25921 10/1/2007 f Parcel Detail Page 2 of 3 4 r � Stones 1 Story Fuel Oil Found-ation Poured Conc. Permit History Issue Date Pur;303 Permit# Amount Ins a Date Co rr 6/28/2002 Repair Work 62095 9/18/2002 12:00:00 AM SHED Visit History Date Who Purpose 5/12/2003 12:00:00 AM Paul Talbot Meas/Est 9/18/2002 12:00:00 AM Martin Flynn Mea./List Bldg Permit Only 13/19/2001 12:00:00 AM Paul Talbot Meas/Listed 8/15/1987 12:00:00 AM ML - Sales History Line Sale gate Owner ook/Page Sale P 1 12/31/2004 PERALTA MARINO A 19400/286 2 4/8/2003 PERALTA, WINSTON R& 16710/269 ; 3 4/23/1999 SYLVESTRE. JACQUES &VIERGELA R 12219/081 4 9/15/1995 PRINCIPE, DENNIS J 9859/290 5 11/15/1990 PRINCIPE, DENNIS J &ANNE K 7361/239 6 WOODS, PAUL & FLORA 2931/322 Assessment History Save Year Building Value XF Value OP>Value Land ValTotal Par r 1 2007 $144,700 $2,600 $500 $161,800 2 2006 $128,500 $2,600 $500 $162,000 3 2005 $120,100 $2,600 $500 $128,100 4 2004 $97,500 $2,600 $500 $96,000 5 2003 $79,500 $2,600 $0 $35,400 6 2002 $79,500 $2,600 $0 $35,400 7 2001 $79,500 $2,600 $0 $35,400 8 2000 $60,000 $2,500 $0 $21,700 9 1999 $60,000 $2,500 $0 $21,700 http://issql/intranet/propdata/ParcelDetail.aspx?ID=25927 10/1/2007 FORM30 C&w HOBBs&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF LTH CIT �/TOWN �,. W c DEPARTMzk \ GSM SVByW ADDRESS TELEPHONE Address d`L L C"' " V� C� Occupant . Floor Apartment No. No. of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units_ No.Stories Name and address of owner e Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents.- PLUMBING: Supply Line: -- L 10 . SC ❑ MS ❑ ST ❑ P Waste Line: ' H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1) 0 UV Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted I Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJ R; Q� INSPECTOR c PEW TITLE A.M. DATE L0 41 — 0 TIME P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. - (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. 1 . FORM 30 &w Hosss&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF LTH CIT /TOWN v` a � ^ DEPARTMEJVT 2&0 ADDRESS �M 5ey`0 (!- TELEPHONE Address � ..� Occupant_ Floor Apartment No. Z N;o.of Occupants No. of Habitable Rooms No.Sleeping Rooms No. dwelling or rooming units r No.Stories TA Name and address of owner a l Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: n PLUMBING: Supply Line: LA,-K,,-A VV113 T IL^IV i L))0 • ❑ MS ❑ ST ❑ P Waste Line: _ H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. I Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 ., L410 00 Bedroom 2 Bedroom 3 - J - L'IJ 7) Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: YKitchen Facilities Sink _ - Stover. - Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: ' Wash Basin,Shower or Tub: Infestation Rats,\Mice, Roaches or Other: Egress Dual and Obst'n: General I Buildlik Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." S INSPECTOR TITLE A.M. DATE 10—1 0 3-- TIME P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises,shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or,safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to-eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. o FORM30 'C w HOBBS&WARREN Im THE COMMONWEALTH OFMASSACHUSETTS BOARD OF HEALTH CITY/TOWN (� DEPARTMENT a ADDRESS / G1A' yVey`0� TELEPHONE Address f � Occupant_ Floor Apartment No. No.of Occupants i No.of Habitable Rooms No.Sleeping Rooms No. dwelling or rooming units No.Stories Name and address of owner F�'b�.'f441 'tom b _ Remarks Reg. Vio. YARD Out Bld s.: Fences: ` Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n..- El B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: i Foundation: Chimney: i BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Su ply Line: `y - '='C Ltr�-E',� firth-v> "w cf"�"'�'\. j E L) `> ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s)1 ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT i Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room j Bedroom M, {Z. f '`'1.( ,, ! �.a- t410 -1(7� Bedroom 2 I Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink - - - -� — Stove_ �Bathin`g,Toilet Facil. Vent.,'Plumb.,Sanit'n.: Wash Basin,Shower or Tub: I Infestation Rats, Mice, Roaches or Other.- Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH 'MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-,BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." , INSPECTOR - TITLE A.M. DATE 10-I - 0 � TIME P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns,shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. TOWN OF BARNSTABLE � LOCATION e-%/Pe LF SEWAGE # i VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. i SEPTIC TANK CAPACITY LEACHING FACILITY: (type)' (size) NO. OF BEDROOMS ti-,za BUILDER OR OWJR C�'E:fToP� PERMITDATE: S`' COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching.Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist / Feet within 300 feet of leaching facility) Furnished by I r tl A D A AG �0 1 �3 i �z Eor Parcel umber 310409 I � enta) roperEy�Y/N) Busi ess Name 0 n�e�3f%Cor�tr n(Y/N)rbutro , Area Number � �` ��Gonta�minant Rely N)' P pne ��*� � �� ei Sto ge T+a k Pe its, ,.• Ca d U°n�� r/ d P�erc Test � 1NeII,Pernnit Cons�ucti"on� r 20031361 ' ; FrleiPermrt No: _ � 04/04 20 03 s ypelSrze of SA5 , 4 HI CAP INFILTRATORS W/4 STONE Tanks X1000 Comme is eXISTING 1000 GAL S.T./ nO RESERVE ... mappar €310409 O ner SYLVESTRE JACOUES&VIERGEL proploc 210 COMPASS CIRCLE �/ a• r . ...,r ...,.,, vv ' Y f rinovatrue/Alternative echnolog'ySe tic S ste s rn n �A TYfe % I A Service��Type y y ' ' ,"�_ :r,,;r. .. .,,, ,,, ,.i „ ,,•,:. �. yam,,, _...,, .vr,,..� -..;�$ TOWN OF BARNSTABLE I%CATION �"I�o Ca�ry�''Fff' //P�<<` SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) --5;7e—ZA (size) NO. OF BEDROOMS ti�,Ze BUILDER OR OWNER S Lds'Fs7'iPC PERMIT DATE: 5`` V o COMPLIANCE DATE: 3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 3.r :9A 7e 79 a9 ;9d f No. 1. -Z-?, ' 3 1p Fee 50 . •THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppritation for Mtgpoe al *p5tem Cougtru>ction 3perm it Application for a Permit to Construct( )Repair( )Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. af_4.9 .2/0 Co14W,� S-..r G i9. Owner's Name,Address and Tel.No. r Q c.�'J' J>,e!/LCi�/�f Assessor's Map/Parcel —:?/cr Co4w�rp c/<' Installer's Name,Address,and Tel.No. Designer's Name,Address.and Tel.No. �'/h, LE`�E'vF ,7.S�o>o j 'J�G�iGsETiIEi`JP C NG/NFFiC/�✓�j 39�39d.L Type of Building: Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder( ) Other Type of Building ,Of e6 r No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow J-1 0 gallons per day. Calculated daily flow - gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Ooo��1Nit'Ti.�-9 Type of S.A.S. e Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed Date �— 3 Application Approved by ® Date Application Disapproved f the following reason Permit No. Date Issued l 310 50 It f No�-: �..�.J :Fee � � k7HE COMMONWEALTH OF MASSACHUSETTS `" Entered in computer: 1 1Yies PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migoof *pgtem Con.5truchon Permit Application for a Permit to Construct( )Repair( )Upgrade(>)Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. G ior. Owner's Name,Address and Tel.No. d"4 P J'ytvc�;PT�i l- Assessor's Map/Parcel 3/p fio 9 �O toifjr.4lr G/�. /fy. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. S/sl, LG�G-�OF�/C 7js oJoJ J'lrl"E'T,rFiPC'�.G�...Fir.�/y,9 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 6V'e1` No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow _`S o gallons per day. Calculated daily flow �S/ gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank -e Type of S.A.S. s' Description of.Soil: r Nature of Repairs or Alterations(Answer when applicable) Date last inspected: tf€i a 0- U Agreement: The undersigned agrees to ensure the construction and'maintenance of the afore described on-site sewage disposal system a `---in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cat of Compliance has been issued by this Board of Health.,,,,// ------.Signed - $./ /An 4 m Date r3 v Application Approved o Date Application Disapproved f rqr e following reason Permit No. _ Date Issued fp ... L 3 -w THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded) Abandoned( )by J�.� <<`��"vF , at Z/o c h s n construct�e i accordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated ' - z/ 6 3 Installer cT-c! e e Q7e'o/c Designer JYv•cr7Tcr�P E' The issuance_/o t 's permit shall not be construed as a guarantee that the syste nct' a esigned. y Date �l �'P 0� Inspector J. No.------- --- ------ ------Fee 003 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS xisspozar 6potem (Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrad )Abandon( ) System located at IC Aee« h y.low,( i and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5�and the following local provisions or special condition's. - ' Provided:Cons u be completed within three years of the date of this •ermit: 01 /Date: ��i7onnt Approved by , i' `mil COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROT-�EE��I �N�E® OCT 2 4 2002 TOWN OF BAR�;STABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION `� U Property Address: 210 Compass Circle FAILED INSPECTION Hyannis MA 02601 Owner's Name: Jacques Sylvestre Owner's Address: Date of Inspection: October 18 2002 Name of Inspector:(Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Map:310 Osterville,MA 02655-0049 Parcel.409 Telephone Number: (508) 862-9400 Lot:23 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Need Further Evaluation by the Local Approving Authority ✓ Fails Inspector's Signature: Date: October 22, 2002 The system inspector shall subm t a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page.l ' Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 210 Compass Circle Hyannis, MA Owner: Jacques Sylvestre Date of Inspection: October 18, 2002 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 210 Compass Circle Hvannis, MA Owner: Jacques Sylvestre Date of Inspection: October 18, 2002 . 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 CNIR 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 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 coliform bacteria and volatile organic compounds.indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 210 Compass Circle Hyannis, M4 Owner: Jacques Sylvestre Date of Inspection: October 18, 2002 D. System Failure Criteria applicable to all systems: You must indicate either"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 '/z 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 I of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,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 System: To be considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 210 Compass Circle Hyannis, MA Owner: Jacques Sylvestre Date of Inspection: October 18, 2002 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ re not available note as N/A Were as built plans of the system obtained and examined . (If they were ) ✓ 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: Yes No ✓ 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(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 210 Compass Circle Hyannis, AM Owner: Jacques S*estre Date of Inspection: October 18, 2002 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: S Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped in 2001-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) s; Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: May 22179 Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of l l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 210 Compass Circle Hyannis, AM Owner: Jacques Sylvestre Date of Inspection: October 18, 2002 WELDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: Approx. 12" Material of construction: ✓ concrete metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: I" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Baffles were present The liquid level was even with the outlet invert. There were no signs of leakage. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of I I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 210 Compass Circle Hyannis, AM Owner: Jacques Sylvestre Date of Inspection: October 18, 2002 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal _fiberglass _polyethylene'_other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order.(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 f Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 210 Compass Circle Hyannis, AM Owner: Jacques Sylvestre Date of Inspection: October 18, 2002 SOIL ABSORPTION SYSTEM(SAS): ✓. (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 6'x 6'-10001za1. 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.): The pit was full and had 6'of water on the bottom. The liquid level was up to the inlet pipe. The cover was approximately 1'6, below 1;rade. The bottom to grade was approximately 7'6". CESSPOOLS:' None (cesspool must be pumped as part of inspection)(locate on site plan) - Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: . None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level-of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 210 Compass Circle Hyannis, MA Owner: Jacques Sylvestre Date of Inspection: October 18, 2002 Map:310 Parcel.409 Lot:23 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or, benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. C� 0 0 a r . 31) 3 A f • 33 1�,� , 3q rya• 33 10 Page 11 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 210 Compass Circle Hyannis, MA Owner: Jacques Sylvestre Date of Inspection: October 18, 2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 18 +1- feet Please indicate (check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the leach pit to grade was approximately 7'6" Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately 18'+/-to ground water at this site. This report has been prepared and the system inspected and failed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,written or implied,relating to the system, the inspection and/or this report. 11 i '3 C0N1�I%1O\ \`EALTH OF MASSACkSETTS EXECUTIVE OFFICE OF E?�1%1R0N�1E\TAL AFFA��IRccS�� ; DEPARTMENT OF ENVIRONME\TAL T£t��YO� 3 a� ONE WINTER STREET. BOSTON. SIA 0210F c1"•_s: tc,t, rolyy 199, 1 HFq TH� �ge�f 4A W'ILLIAN'F WELD a1 RL'Dl 170'�l Govemc• 6 9 Sccrc:ar% ARGEO PAUL CELLL'CCI DAVID B STRURS Lt.Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commission: PART A CERTIFICATION 1 / Property Address: alO Cc%—PASS Cn<.r 1+-AMNFVG Address of Owner:�4tUr.�t s a �NNC�2tnX 1P�2. Date of Inspection. Cj 1 n\di-) (If difierent) CIt f_o_ _- j 1371 Name of Inspector: H.LA a o I am a DEP ap rot.ed system inspector pursuant to Section 15.340 of Title S (310 CMR 15.000) Company Name:A/(a h4-g'c rEit Io'r'rrj.s .-q P.#,7.0L_/ Mailing Address: Re!) Ap K a 3;0?U H/9S'N4_e.Q- H I'- v 0-C4-q Telephone Number: e-SO*) C�¢�- /(� Zp CERTIFICATIO\ STATEME-0 I cenih, that I have pe,sonalis irspeced the se%age disposal system at this address and tha: the information reported beloM is true, accurate and co^tolete as o'the time of inspec.o- The inspection Nas penormed basec on m% training and experience in the proper function and maintenance or on-sae ses.age d,sposa iN-stems The system- Pafae� _ Conc•t.o':a:;. Passes ♦eec= Furtne• Eva!uat-on 9% the LOUT Approving A;ltnorft% Fa a Inspector's Signature. �UVtCJ�Oi�VI t�t4 y;�;CQ., Date: ` The St Se^ Insoecto- sna'' s;ubmf: a cop% of this inspection report to the Approving Authority within thfm- 130, days of completing this fnspec,or. It the system is a shape;: system o- has a design floN of 10.000 god or greater, the mspenor and the system owner siali submit the repo Ic the a oroonaie reg•ona• cr:fce of the Department of Environmental Protector The ong:naf should be sent to the system owner and copes sen: to the buve•. c applicable. and the approving authont\ I►rSPECTIO% SUMMARI: Check A, B, C, Or D a A) SYSTEM PASSES: :a I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 C.titR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS BI SYSTEM CONDITIONALLY PASSES: One or more system components as described in the 'Conditional Pass' section need to be replaced or repaired. The systern, upon completion of the replacement or repair, as approved by the Board of Health, will W. Indicate yes, no. or not determined (Y. N. or ND� Describe basis of determination in all instances If'not determined`, explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance lanachedi indicating that the tank was installed within twenty (20) years prior to the date of the inspection, or the septic tank• whether or not metal, is cracked, Structurally unsound, shows substantial infiltration or exffltratton, or tank failure is imminent The system will pass inspection if the existing septic tank is replaced with a conforming septic tank w approved by the Board of Health. t:..•:..a o�;is�s,t Iraq. 3 of io DEo o-the wono woe weo httc 4www Riagnet state ma woec Pnntec on Retyped Papa' r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:', OM ner; Date of Inspection; `B)11,SYSTEM CO NOITIONAIIY PASSES (contin,od f Selvage backup or breakout o•high B state, water level observed ; the distribution box is due to broken or obstructed Pipets) or due to a broken, settled or uneven distribution box.Board of Health;. Describe observations he system will pass inspection if(with approva! of the broken Pipe($) are replaced obstruction is removed distribution box is levelled or replac _ The system required pumping more o e than four times a a►due to broken or s inspection ,i(with approval of the Board of Health)• obstruct Pipe'petsl. The'system M;II pass broken P'pe(s; are replace, `t Obstruction ,s removed a" w C) FURTHER R'ALUATIO,% IS REQUIRED 61 THE BOARD F HEALTH: s� Conditions et,st wh,ch re°j,re further evaluation the Board °f Health in Public heath, sates and the environment order to determine if t ° ment a he system is failing to protect the 1) SYSTEM WILL Pg55 l'N1E55 BOARD OF H TH DETERMINES THAT THE SYSTEM 15 NOT FUNCTIONING (% A MANNEI WHICH WILL PROTECT THE PUBLIC HEA H AND SAFETY AND THE ENVIRONMENT: � Cesspoo: or p•,%-% ,s wuh,n SO i w — Cesspoo: o of a surface water p „� ,} M rth,n 5Q : Of a borde',nB vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BO RD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROP THE SYSTEM IS Fl1NCT1pN1NG IN A htAtihER THAT PROTECTS THE PUBLIC HEATH AN THE SY tiME%T: RIATE) DETER.�tItiES THAT D SAFETY AND THE _ Tne $vs:eT has a Sept, .i The $%-! to a surface t,,ate^�Pp`soil absorption system (SAS, and the SAS is within 1 00 feet to a surface Water supply or _ Tne systerr, has a septic tan{, and soil absorption system and the $A5 is within a Zone I Of a-- The syste-n has a septic tank and soil absorption system and the SA5 is within So feet of a p,ivate water _ The s!•stem has a septic task Public Muter sup�'v well. and soil absorption system and the SAS is less than 100 feet but SO feet or more DP�� well Private Mater suppl%. well, unless a well water analysis for col,form the well ,s free.irom pollution from that facil,t,• and the bacteria and volatile organic Compounds from a less than 5 pp ' Method used to determine distance pence Of ammonia nitrogen indicates dw and nitrate nitrogen is equal to« 3) OTHER �(Wf011nution not valid). (rovisfe vote 2 of 10 I f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATIO% (continuedi Propert-. Address: Owner: Date of Inspection: D) SYSTEM FAILS: You must indicate either -Yes" or "%o' as to each of the following 1 have determined that the system violates one or more of the following failure cn ria as defined in 310 CMR 15.303 The oasis for this determination is identified below The Board of Health should be conta ed to determine what will be necessary to cortex the failure Yes No Backyp of se%age into facility or system component due to an ov loaded or clogged SAS or cesspool. Discharge or'ponding of effluent to the surface of the ground or surface waters due to an ove•loaded or clogged S-AS or cesspool X S:a:fc !reufd leve` in the dis:ribj:,or. box above outle: tnven ue to an overtoaaed or cloggec SAS or cesspoo' Lic:,+d deprh it ceispoo! is less than 6" beloN invert or av ilable volume is less than 112 da% f civ. Recu,rec pumping more tha-• 4 times in the last year N T due to clogged.or obstructe4 pipe s N.Jr.nDer c' times pumped_ An. Do^.o^+ o`the So:! Ano•pt,or% S�steT. cesspool r privy is below the hrgrs groundA re, a;eva•.fe-. ^,• po,7:on o'a cesspool or is Aithin 100 i : of a surface wale, suvo�%- o• rrrbu:a-\ to a sunace Ovate, supp!N An\ oo,::bn of a cesspoo' or prn� is N d!fr a Z e I of a public wea t pc-�,c- c' a cesspoo: o' p!i%% is N i:hin 5 fee: of a private water suppi% we!1 An% po".or 0.1 a cesspoo! or prr\N• is less th 100 fee: but greater than 50 fee' from a Drivate -Aare' supDi%- well with no accexabie Nare• q;:a!ir\ anal\s.s h me w I has been analyzed to be acceptable. anach cop% o• well %a:e- analysis for colftorr. bacte•-a %o!a:,1e organic co-po ds, ammonia nitrogen and nitrate nitrogen Ej LARGE SYSTEM FAILS: Nou must indicate e--e• 'yes' or "%o" as to each of the (lowing The io:.oM:rg c•f:e•,a anp-% to ;arge syste•ms in doftfon to the criteria above The systern sen•es a facilm with a design flo of 10,000 gpd or greater (Large System: and the system is a signi6can: threat to public health and safety and the envrronmen because one or more of the following conditions exist Yes No the system is within 400 feet of surface drinking water supply the system is within 200 feet o a tributary to a surface drinking water supply the system is located in a nitr en sensitive area (Interim Wellhead Protection Area • IWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of an) such system shay bring the system and facility into full compliance with the groundwater treatment program requirements of 31a CNiR 5.00 and 6 00 PleAse consult the local regional office of the Department for further information. lrevxsed 04/25/V) page 3 of 10 f t SL-'BSLAFACE SEWAGE DISPOSAL SYSTEM INSPECTIOti�FOR.M PART B CHECKLIST Propert% Address: �aL t o &M()rrS" Owner:TeINC.1PL Date of Inspection: Check if the following have been done You must indicate either 'Yes' or 'No'as to each of the following. Y � do .Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving norma flow rates during that period Large volumes of water have not been introduced into the system recentl% or as part of this +nspec+on t ^s bua: plains have been oo:a:ned and evaT•+ned Note if they are not available with N;A The fac:ljn or d-etimg %%as +nspeced to, signs o;sewage back-up — Tne system does not rece,%e non-sanity% or industr+a•' waste flow — Tne site %%as inspected for signs )t breakou: — A'l c�Ste•T' c0•'npcme't}. excloc+ne the 50-: ADSorpUon Svstem• have been located on the site Tne sep:,c tank rnammo;es were unco%ve•d. openec and the interior of the septic unk was inspected to, cond•l.om of` ba^ies or tees. ma:e•.a, o• cor•s:rucoon d,mensions. oeo m of liquid. depth of sludge. depth of scum Tne s,re a^c !oca:.on o'the So.' •.!:s m — o x:o S v ster- on tine site has been determinedbased on me tacaa-� o%%�e, T .anc Occupants if d.neren: 1torr• oNneh were provided with Iniormat+on on the proper maintenance of Sut-S,;r:ace 0,sposal Svsterr. Ex+s:,r.¢ ,r.ip•Tat+O^ Ex Pram a: B O H. De:e•mt.-ec me i,elc v am% e: the fa!!ure trite-;a rezed to Par, C is at issue• approxrma:+om of distance is umaccexaD•e I 13 302 3• b t (revamed 04;25/9', lraq• 4 of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Properh Address: coom fis Owner:�Q tNCb QLL Date of Inspection:C1 1 RESIDENTIAL: FLOW CONDITIONS Design flo» 32U a D.d.lbedroom for Number of becrooms OS Number o`current residents Q Garbage g•. der (yes or no-,f Laundry co-•nected to system (yes or no: Seasonal use Ives or no- Water meter readings. if a%a,lable (last rwo i2 vear usage tgpd,. t'J Sump Pump Ives or not t1 Las: dare o;occuDanc,. t,,ao -e-ll."f,-i, W.t..Gr.2" j COn1.MERCI4,L'INDL'STRIAL Type o+ es:ablrshme-: Design fio%, alionsca% Crease tract present ryes or no_ Ind.,s:r,a' k%aste 1-olding Tani. oresen: -yes or no Non-san.ta,% Haste d,scna•gec to the T,:,e S sys:e n ses or no_ eater meter reac:ngs if a%a,lab,e Las:Fa:e o: o OTHER. De:c%be Las: case o• occ.:canc• GENERAL INFORMATION PUMPING RECORDS and source of rniorma:,on N011t¢ —A Tlki'� ow�zc_ ; L►Kas Sic tfcM SL.ovtc� be P�'uh,tlr�a „„ I S\ste pumper as Dar, pt tnsDect,on. Ives or no .. If ves. %o;ume pumped itallons Reason for pump,nE TYPE OF SYSTEM _ 7)(N Sea:+; tanl�.'a,s»rer"e-be,,,.soil absorption system Sing-e cesspool Ove,low cesspool Pr,%) Shared system (yes or no; (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components. date installed (if known) and source of information: olcx(c� Sewage odors detected when arriving at the site Ives or not 1--k) (revised 04/25/711 page 5 of 10 r- 1 ' 1 7 i SLBSURFACF SMAGE DISPOSAL SYSTEM N'SPECTlO% FORM PART C . SYSTEM INFORMATIO% (continued) Proper , Address: Ai0-(2QW,,iPWSS Owner: feif-)Oeks' Date of Inspection: BUILDING SEWER.- (Locate on site plans Depth below grade Material of construction _cast iron _40 PVC _other (explain, Distance from private water supple well or suLi,on (,- Diameter Comments (condition of joints, venting, evidence of leakage. etc.) SEPTIC TA%K:V�0S tlocate on site p;an - -- Dep:h below grade," material or consu,,a,o- 1conc•e:e _me:o _c,oe-grass _Polvechvlene _other,explain It to^� IS me-.a: I,$: age _ 1> age cori.rmec c, Cen-:ica:e o: Corrviance �-Res%o Dimens,ors i(lbO R A` Sludge dep:r; 2 x 4 D,siance frorr. toc c• sioeee to bono- o'ou:;e: tee o• ba'-e -3 l Scum thickness _ �n „ Distance from tec c• scum to tec c• ou:le: tee er ba'.e 1� D,uance iron oono-. o• sc.;— to oocc'n o• oxw tee c• oa".e \Sit ho% dimensions Ae,e ee:e-r-i,nec IMketALV I Commen:s trecor rnendaaor icr pu-pmg cond,t-on o' rn;e! and o.;:let tees or baffles. depth of liquid level to relation to outlet invert. structural ,ntegr,ty, e„dence of teat.aee. e:c NLL k0 Vh,A to T . . v` ► L "'f I c ' : v T i Q rV GREASE TRAP:—,—Jj (locate on site plan Depth below grade Material of construction. _concrete _metal _Fiberglass _Polyethylene _-other(expla,n) Dimensions Scum thickness Distance from top of scum to top of outlet tee or baffle. Distance from bonom of scum to bonom of outlet tee or barite Date of last pumping Comments: (recommendation for pumping, condition of t•ilet and outlet tees or baffle3., depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage. etc ; tre,ipea 04,15.17) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO% FOR.m PART C SYSTEM INFORMATIO% (c/ind Propert% Address: OM ner: Date of Inspection: TIGHT OR HOLDI%G TANK: -rank must be pumped prior to. or at timeion(locate on site plan, Depth below grade Material of construction _concrete _metal _Fiberglass _Polyethylene n) Dimensions. Capacir gallons Desig- floe gako^s=da. Alarm level A.a•m in Nora:ng o•de• _ 'res. _ no Date of prey sous pumo.ng Comments (condition: of inlet tee cond;;ior. o• a'a•r*. and fioat sNnches. etc DISTRIBUT10% BOV ooca:e on s,te C a Dec:^. a licu•d lee' aoo�e o:ale: l-e Co*�Te-ts Incite le e' a-d is er:,a ev-cence o' sol-cs ca/o%,,e,. eN dence o' leakage into or out of box. etc PUMP CHAMBER:_ (locate on site plan - Pumps in working order. (Yes or No Alarms in working order flies or No Comments Incite condition of pump chamber, condition of pum and appurtenances, etc.( I (revised 04/25/V) Palo f of 10 1 { . t . y t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORtit PART C SYSTEM INFORMATION (continued) Property Address:a'10 (9M(41Z `'tV Owner:'Felt-cau- Date of Inspection: ( d� SOIL ABSORPTION SYSTEM (SAS):_J S (locate on srte.plan. rf possible, exca. :,or. not required, but may be approximated by non-intrusive methods, If not determined to be present, explain Type leaching pits. number A b leaching chambers. number_ leaching galleries, number leaching trenches. numbe•,Iength { leas-�,ng f-eids. nun. De.. over;�ov, cesspool, numoe- Al►ernanve systerr, Name ci Tecnrorog% Comments inorq on jIrOn ' C' SO s -s Of h%dra,l,c fail,,re. eye i pond:ng condition or v ( egetatron, etc r CESSPOOLS: noca;e on site p:a- %-;- e, and Deom-tor o: lic-i1c to mret inter. Deptn of solids lave Depth of scum la%-e- Drmensions of cesspoo. Materials of construc,D^ Indication of g•ound..a:e• rnflOv, (cesspoo' m De p mpec a$ par or inspeaion Comments. (note condition of soil, signs of hydraulic failure, level of pondmg, condition of vegetation, etc.) PRIVY: (locate on site plan; Materials of construction Depth of solids. Dimensions Comments (note condition of soil, signs of hvdraulrc failure, level of pond,ng. condition of vegetation, etc.) (revised 04/2s/!`.) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATIO% (continued: Proper1% ddress: poo �,n,Q>x5S Ct2 Owner: (�(LImc%o ,Q, Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 (Locate where public water supply comes into house) � R (rwaaad 04•1s!f') traye 9 of 10 f 3 r. ! SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO% FORM PART C SYSTE,41 INFORMATION (continued) Property Address: Owner: Date of Inspection: Depth to GroundAate• Fee; Please indicate all the methods used to determine High Groundwater Elevation: Obtained irorn Design Plans on record Observation o;Site tAbuning proper;. obsena:jor hole. basement sump etc I Determine it from local conditions Cnec. „an local 5,sarc o• nea-:r Chec. F:%tA n;aDs Y Crieck pur,p-nF recoros Check :cca' e,ca•.a:o; ms:a''•e•s Lse r. :-ie ":¢- C o,r.ewa a Ele.ation tMst be completed P•go 1C of 1C o �09 LOCATION � 2L � SEWAGE PER T NO. 123 �11` V leiLAGE 4 yx INSTALLER'S NAIVE & ADDRESS t U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� t' � � �� A� � � � � � �� ` � � � �� `1\ � �� ® � No..........lkk_.. Fizs.......lp?s...... ... THE COMMONWEALTH OF MASSACHUSETTS .v BOARD OE !-HEALTH .. ..............OF...... ............................. App i ation for Bigpaiia1 Works Tomotrnrtion ramit Application is hereby made for a Permit to Construct (>}-or Repair ( ) an Individual Sewage Disposal System at: -- ---•- ----• ....... L ca'on- ress 40 or O ner Address W -•-•---------•----•------•-•----•-•-... .--------•----••--•.-•-•---•-------------- a Installer4 Address UType of Building Size Lot.....�Q�..,l6.Q..Sq. feet ,., Dwelling—No. of Bedrooms....pZ______________________............Expansion Attic ( ) Garbage Grinder ( ) PL, Other—T e of Building AV4.N 9X_ No. of persons.........�-_ Showers — Cafeteria � Other fixtures ---------------------------------•-•------------•------•-•--•--••----------------•----• .._......_.------------••-- W Design Flow.......$_4.....................:.......gallons per person Ver day. Total daily �,ow...... M__v.____.._.............gallons. WSeptic Tank—Liquid capacity....1__O�llons Length_8........__.. Width_�__._�._.__ Diameter________________ Depth_______................ x Disposal Trench—No..................... Width......-............. Total Length.................... Total leaching area_____4� ...sq. ft. Seepage Pit No...../............ Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing Ve7-1/oof ( ) aPercolation Test Results Performed by.._5 l_... Date.... ,.a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----Af�p�e Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x ---- - --------------------••-•-------- O Description of Soil---.a�' �` L-----='` U .----------------------------------------------------••..••--•-•.--:::_::��... ................................. -.-_----__._..__._....----------.-.--.-.--------- W UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ •-------------------------------------------------•••_••---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'1ITIL 5 of the.State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the ar of h alth. !/ Signed`%_ ----• .................. y--• ............. Application Approved B _______ �/ ate Date Application Disapproved for the following reasons-------------•----------------------------------------------------------------__...----•---....-•-:.... ...........................................•----._...-----------..__.._..------------........--------•---------•----•-------------•--•-••.._.__..:---•------••--•-••-------------••--•-•-•--------•••-- Permit No.........7�..e.................................... Issued.... ..... Date L'. ....•--•------------... ..._. ----- Date No........... Pam... FEB....... 5........_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................OF........ ;: ✓ ,� ,... �.�L-"( ApplirFation for Disposal Works Tonotrn.rtion Vanti# Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ti JJ� Location ddress /`` �. o ner Address - Installer Address Type of Building Size Lot...... r_��..Sq. feet 1-4 Dwelling—No. of Bedrooms__•..C...................................Expansion Attic ( ) Garbage Grinder ( ) 44 Other—Type of Building _ i. C_'_°_ ...... No. of persons............................ Showers ( i) — Cafeteria ( ) a' Other fixtures ------•--•--------•------------- . W Design Flow_._____::-_ ...............................gallons per person per day. Total daily flow........ '....._...............gallons. WSeptic Tank—Liquid capacity....L:.L.gAllons Lengths:....`....... Width.!...... Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.....`�.L_.Lsq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing t�r}k ( ) 4"r 7i/r c Percolation Test Results Performed bY--- 4" C,- ------ -_ Date_... Wa Test Pit No. I................minutes per inch Depth of.Test Pit._..._.............. Depth to ground water.._._./. P Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ..................•--••--•••---•---•--•----------------............•---------.................-•-.--..................... O Description of Soil_. : 'ham`' :_ � �'�%��__.:.: ff _......................................... ....... . x �......--- r W --•----------------------------•---•--------------------------------------------------..........-----------------------------------------------------------•----.............--------•----------------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... •---------------------------------------------------------•----------_..._.....---.._......._..................----•--••-•----•-----•-----.....••-•------------•-------•--------------------........... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of L i:IE p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed �.�-/' -._... ---------------•• --/.'---- /�. . Application Approved B ate r Date Application Disapproved for the following reasons:................................................. ................................. . .................•--------•------•--------------.....--------------------•----------------•-•------------••-•--•-•--------------•---------------------------••------------------------•--•--------•----- Date PermitNo..........2�'•'---------•-------••---•------••--- Issued....................................................... Date THE.COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................OF......... ............................ TnrtifiraIr of Tompliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) r Installer i at...... .......... .-- ---------=-------------------------------- -- -= ..... r has been installed in accordance with the provisions of TITLE' j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.........�. . ....................... dated-------- __ _R-----/ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILLJLUNCTIQN SATISFACTORY. ,r ......_... 7 ----------DATE............. Inspector COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �....r.`.....................OF.. /� "`','.✓ _ /l No......................... FEE.......--............... Disposal orko �ono#rnr##ion �erutii Permission is hereby granted- _:,.`" .:.-..__... %��.: ..��...... __..!... . ..................................................................•--.-•--- to Construct ( 'y') or,Repair ( ) an Individual Sewage Disposal System atNo............• ' r............ - ..... ...., . .. . .. .._.. ............................................ Street ~ as shown on the application for Disposal Works Construction Permit No..__.� ......... Dated....... ..................... Board of Health ' DATE.................................................................. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ,� �..r�+ s.'"1r:`..', i_ _r _ .•^.'.'�r•'.' -_ -. +may^.. '"r,r,�+�.,+ ?' .f "'siP .., ,.,>1�:.� c,kt,f'4yrr'."i,'�,t "::,�t�•T i.:'�•..t•. 4::+�.- _ - �i''9��tti.. .. 3,.;'� .... a. c.��,s_,.�'•�.•�s`. ._. ry :.. `��;1`•.f,.- 7':rt',.. ,r, ,fit`a: a' - _-ss.. .F `ram" - .3 �Y 4,`' �"."a..{ �• � 4 _ .`-'tt,'.zil ;.3.yf` ..•S•c, _ ., , t�'. h_.. 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MINIMUM FROM SLAB OR CRAWL SPACE CLEAN SAND OILETEST DONE OF SOIL EBY SWEET ��iEEf311YG WITNESSED BY _j,QQMA3 (ASSUMED) CONCRETE r-INSPECTION PORT j COVERS 4" SCHEDULE 40 PVC PIPE 7LOAM AND SEED OBSERVATION HOLE 1 ELEV.= 98.90 MIN. PITCH 1/8" PER FT. 2" LAYER OF PERJOLA ION RATE _ < 2 MIN./INCH AT __ 60 -_ INCHES DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 1/8" TO 1/2" WASHED STONE " M — 99.00 MAX. I VENT 0-12 A/P LOAM` SAND 10YR2/1 &00 4" CAST IRON PIPE Q \ 9&98 Mm. NOT REQUIRED (OR EQUAL) MINIMUM -� +- ' 12-30 B LOAMY SAND 10YR5 6 PITCH 1/4" PER FT. i I ' z GEN � / 307� COBBLES I 1 I EXISTING SPOT ELEVATION x0.0 FLOW LINE m+!-� EXISTING CONTOUR ----00---- 30-120 C MEDIUM/ 10YR6/6 ELEV. = g7.00_ / 96.00 10" FINAL SPOT ELEVATIO�O7p COURSE SAND I MIN. I - - o o -V-- _ FINAL CONTOUR ELEV. _ 30 20"LEVEL e � , �, I 10 �b7 SOIL TEST LOCATION y � o ELEV. = ^l ELEV. _ ._9_ _ GAS ELEV. _ _ 0 - 6„ SUMP -ELEV _ _ _ `�L I TOWN WATER —A�W BAFFLE DISTRIBUTION f _ CATCH BASIN �� LIQUID OUTLET BOX `LEV = 4 HIGH CAPACITY INFILTRATORS JVIIH GAS LINE CESSPOOL CP G ` DEATH TEE X -��- STONE IN AN (''C BE PLACED ON FIRM BASES TO BE WATER TESTED � � `4 FEET 14 INCHES 11' X 36' X 100 TRENCH FORMATION 'n CLEANOUT --s�C.0. 5 FEET 19 INCHES24 INCHES GALLON ON F MORE THAN ONE OUTLET - - 17 FEET 24 INCHES ( TO BE PLACED ON FIRM BASE) NO WATER ENCOUNTERED AT _ ELEV. 18 FEET 29 INCHES �JE TI DTANK ,T^ SOIL ABSORP110N ONE 3/4" TO 1/2" CLEAN -�� STEM SAS) INDEX DOUBLE WASHED STONE ADJUST n� FREE of FINES & SILT a DESIGN CALCULATIONS t I JSGS PROBABLE WATER TABLE ELEV. = NUMBER 'U� BEDROOMS 3 \ SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( / / ) ELEV. = GARBAGE DISPOSAL UNIT NO ® TO SCALE BOTTOM OF TEST HOLE ELEV. - _ _ TOTAL ESTIMATED FLOW ( 110 GAL/bR./bAY X _•,3 _ 81t.) Q_ GAL./DAY REQUIRED SEPTIC TANK CAPACITY _§§Q_ GAL. ACTUAL SIZE OF SEPTIC TANK _1_500_ GAL. SOIL CLASSIFICATION I DESIGN PERCOLATION RATE <_ - _ _ MIN./IN. EFFLUENT LOADING RATE QJ4_ GAL./DAY/S.F. LEACHING AREA 474_33 SO. FT. (11 X36)+(47X2X10/12) LEACHING CAPACITY (AREA X RATE) ''1. 4 GAL./DAY 474.33 X 0.74 RESERVE LEACHING CAPACITY QQ GAL./DAY / NOTES: 1 ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN'S RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO LOT 2JA B°0p. WITHIN 6" OF FINISHED GRADE. AREA 10,160.Dt S.F 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE gyp, USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE i MORTARED IN PLACE. N10 E3ETE€W41ATION; HAS BEEP. MADE AS TC COMIPLIA,':CE WITH DEEDED OR ZONING !REGULATONS. OWNER ; APPLICANT IS TO _ OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR IS TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE. 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION IS TO BE BROUGHT TO THE ATTENTION OF Q THE DESIGN ENGINEER IMMEDIATEL`. 8. PARCEL IS IN FLOOD ZONE p &&v C3 9. LOT IS SHOWN ON ASSESSORS MAP -Mk-- AS PARCEL _14�__. CLEAa Q 10. EXISTING SEPTIC IS TO BE PUMPED AND REMOVED. j OU u 11. PIPING IS TO BE REPLUMBED TO EXIT AS SHOWN. I 7 Q- . � .� Nu ►v A 0`�/FD: B ARD OF HEALTH c, o o 3a; L__) G ej CE4 oely T *44 T o,Qlkz- A _NT PROPOSED SEPTIC DESIGN 00,'' so FOR T JAC UES SYLVESTRE R0E 20 LOT 23A, COMPASS CIRCLE Boon. BARNSTABLE (HYANNIS)-, MASS rn � �`r Locus SWJrM M MNGLNJZRJNG 235 GREAT WESTERN ROAD ® P. 0. BOX 713 QP 39808922 SOUTH MASS. 02660 i DATEFEB. 12, 2003 Sc�E," " = 20' REVISED JOB No. 5616-000 j LOCATION MAP J I REVISED SHEET 1 OF 1 C.• TSB`PRO✓�5616-00,dwg�5616-OO.OW(, CrcOU—' SWEETSER ENGINEEY '