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0003 ELAINE ROAD - Health
3 Flaine Road Hyannis, A= 72 r a k t i� i w f 4 6 r - k H L ' q TOWN OF ABARNSTABLE LOCATION L l ®i�1� SEWAGE# A016 A 30 5 VILLAGE RYANN.15 ASSESSOR'S MAP&PARCEL;2 41 INSTALLER'S NAME&PHONE NO.CAP&&i0t 6N?&RQ(ses(LC SEPTIC TANK CAPACITY I, 0 6o G,41-(,OAJ LEACHING FACILITY: e L� ) ®� (h'P ��+� ��� (size) K °] NO.OF BEDROOMS OWNER IY�C6 94UAV 5 7AN,5'6 POWELL, PERMIT DATE: ��.�4 oZ®/ COMPLIANCE DATE: 9 I(p 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) N Feet Edge of Wetland and Leaching Facility(If any wetlands exist within A 300 feet of leaching facility) A/ A Feet FURNISHED BY I S ct lb i A-1 + ".to 3t� ® - 4 0 8p3 e C) S A- t� A_ ^ 44,C` P 5 ; 5 Is Town df Barnstable Pit Department of Regulatory Services s n�rwar�eta k . Public Health Division Date 3 (� MA9a �,, teJ9• 200 Main Street,Hyannis MA 02601 , . rfll!Alit� Date Scheduled f G Time /d`—AJ Fee Pd.__ � x Soil Suitability Assessment for SZe Disposa W Performed•By:-M)G hAf l Amerlgl, k r Ty S E Wimessed By: L G.� _d J LOCATION&.GENERAL INFORMATION Location Address 3 f LNA. �m.t Owner's Name 14.14 l4 Cppa S p W v- • �'tllJ O N S Y , tairflSt� O LC- Address 3 C-LA(a)E; P ) HY*A)&)f,S' Assessor's Map/Parcel: �`rg/�el 7 Engineer's Name SC, �—��`�� 2� 50�-Z]3-03]7 NBW CONS rRUC7YON REPAIR ._- Telephone# Z5019-477— g�� . Land Use- Sj-41/e. FGO �/ L!>Nelli'tM Slopes(96) _ Surface Stones Distances from: Open Water Body ft Possible Wet•Area!!!!' ft Drinking Water Well P(.A ft Draihage Way Z*>/O ft Property Line 7 ft Other ft SI{ETCH:(Street name,dimensions of lot,exact locations of test holes&pare tests,locate wetlands-In proximity to holes) See i9t ��he� 54f— pr�� Parent material(geologic) /A lA 10 c,/A r �' Depth to Bedrock Depth to Groundwater. Standing Water In Hole: 7 Weeping from Plt Pnca 7 13 Z */ Estimated Seasonal High Oroundwater F-3 DETERMINATION FOR SEASONAL'HIGH WATER TA13LE Method Used: DifecfA* DbSenlojPn Depth Observed standing in obs.hole: /.S Z In, Depth to soil mottles: ./3 LL ,/ ►n, Deilth to weeping from side of obs.hole: >/ Z in, Groundwater Adjuettrlent ft. lndex Well-#1 Reading Date: Index Well level — Adj4actor,,,,,r�Adj.Groundwater1evei,,,_, PERCOLATION TEST Baie Thno Observation Hole# Time at 9" Depth of Pero Time at 6" Start Pre-soak Time 0 Time(9"41 _ End Pro-soak Ji per'c �Cst done by Don-ell M2y, Rate'Min./htch . 2MP On 6-D1-09;perl Reference#JZ5610 Sltc Suitability Assesament: Site Passed Site Failed: Additional Testing Needed(Y/N) d" Original: Public Health Division Observation Hole Data To Be Coinpleted on Back----------- ***If percolation testis to be conducted within 100'of wetland,you must first notify the Barnstable Conseirvation Division at least one (1)week prior to beginning. Q:ISBPTICIPBRCPORM.DOC /C DEEP.OBSERVATION HOLE LOG Hole# 1 +Z ' Depth from Sail Horizon Sail Texture Sdil Color Soil. Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,Valiyall Fi I ' _.;t �- 12 _ 2 . A I-Oamy sowd 1 Oer /, 2 P"^y2' O -, 5 6 J32 C lhed-ca�r,�s 2-5X 616 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sall Color Soil •Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. Consintanch DEEP OBSERVATION HOLE LOG Hole# Depth from Soil horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,SRopes;Boulders. Flood Insurance Rate Map: Above Soo year flood boundary No— Yes Within 500 year boundary Nod + 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 thrpughout the area proposed for the soil absorption system? . 'Ye( _._ If not,what is the depth of naturally occurring pervious material?,._., .. Certification I certify that on ��-Z�'99 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise experience described in 10 CN R 15.017. Signature Date Q:WEpTICWfl11CPORM.DOC Town of B instable. r# oF� • ` Department of Regulatory Services () I ' �� i Public Health Division . Date ems$ 200 Main Stree4 Hyannis MA.02601 s h I �1fD IA►( . Date Scheduled � Time'.Ll AM 'l Szritability Assessment for Sewage Disposal Performed By: `1 witnessed By; i M r f . LOCATION& GENERAL INFORMATION �.LC Location.Address'3 SLk--6�G . . Owner's Namc �� _ .. _ _... L/O WTrna GDIIr4..56010.0. fn1- �Y�nl,�5,-P2oRT Address 4828 won Geurtt�n•pa• /� I [ r17D� Assessor's Map/P4rce1: Engineer's Name b JW-�(f NEW CONSIRU�'I ION REPAIRI Telephone#k 5A 2 ZZ 1 done ' Land Use ._Slopes('%)• ' 0+1�'. •_ , Surface Stones - 0 >�Od ft Drinking Water Well :L ft Distances from: Open Water Body ft Possible Wet Area r y l d6 y l v ft Otter ft Drainage Way ft Property unc - 'I SKETCH:(Street name,•din ensiodi%f 1ot,exact locations of test holes&perc.tests,locate wetlands in proximity to holes) / 1 1 � I 1 , 1 t � GG 11 1 ` ♦ D // 1 ..�...- 130.79 14 �0 O P EDGE l �+titU / � C y R L T Tq MENT�__ - %/ yore�)ep�h501t \�/ CL( �{I�� Depth to Bedrock ,LLG�t Parent material(gedlogic) '/ I N )� • Depth to Groundwakdr: Standing Water in Hole Wceping from.Pit Face / -------- Estimated Seasonaliljigh Groundwater �'Q 11- DI ' TION FOR SEASONAL HIGH WATER TALE Method Used: in. Depth to 5011 mottles: Jn. Depth C1bserved standinglin obs.hole: I ins ©roundmater Adjustment Depth toiwceping from side of obs.hole: A�,{actor.,._...r Adj.troundwater Level,,,,_, Index Well# Reading Date index Well level PERCOLATION TEST Date_._____. '>t' Observation I I Tittle at 9" Hole# Time at 6" ---- Depth of Pere l D$ Time(9".6") ' Start Pre-soak Time.( -- �l End Pre-soak ,. Rate MinJlnch � ' site Suitability Assessment: Situ Passed x Site Bailed:_ Additional Testing Needed(YIN) — Observation Hole Data To Be Completed on Back Original:.Public Heal lth Division I. ***If ercola•ion test is to be conducted within 100' of wetland,you must first notify the P _. ...1-,__- rno.ric;nn at least one(1)wedk prior to beginning- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. nsistenc %Gravel it 16y 2.s 7/ DEEP OBSERVATION HOLE LOG Hole# Depth from• Soil Horizon Soil Texture Soil Color Soil Other Surface(in.)- (USDA) (Munsell) Mottling .(Structure,Stones,Boulders. Consist nc Gravel) 14`'- 1 8 an 1 GYM- s 2,5 y 71 DEEP OBSERVATION HOLE LOG Hole# Depth from• Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) ( SDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, o Gravel I I � 1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil F07the, Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cons stency. Orayel) 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 material? Certification p I certify that on v ` (date)I have passed the soil evaluator examination approved by the Department of Enviro ental Protection and that the above analysis was performed by me consistent with the required train expertise a d experie ce described in 3.10 CMR 15.017. Signature Date 1p 1 Q:ISEPTIC\PERCFORM.DOC J. TOWN OF OWNOF BAAR�N,SSTABLE SEWAGE# LOCATION VILLAGE .��/ S� ASSESSOR'S MAP&PARCEL °- INSTALLER'S NAME&PHONE NO. U AL4•41 JQ//(�'� SEPTIC TANK CAPACITY S ld LEACHING FACILITY:(type) 7agwkt � (size) NO.OF BEDROOMS OWNER. A V O t.^^- PERMIT DATE: — COMPLIANCE DATE: 3 0 1 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 L l/ - 17 9�2 - 143 -53 B3 _3p Q 2- s�, �,3 No. � � a l 3 Fee 160 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer; PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MA SACHUSETTS Yes Rpplicotion for ;Digoaf *p5tem Cougtructiou Permit Application for a Permit to Construct( ) Repair�rade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or No. z/,*//VZZ �D Owner's Name,Address,and Tel.No. Assessors Map/Parcel Installer's Na Address *Tel o. //„gym ,✓ ` e Desi ner's Name,Address andl.No Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures / Design Flow(min.required) 330 gpd Design flow provided ��i gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank � �T ��� Type of S.A.S/�O 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 andmot to place the system in operation until a Certificate of Compliance has been issued by this Board of .ealth. tgned G� Date D Application Approved b X, Date Application Disapproved by: Date for the following reasons Permit No. 171 Date Issued -t JNo. ^ Fee, V� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,`'M, �S- USETTS Yes fj Application for &goal 6p.5tem Construction Permit Application for a Permit to Construct( ) Repair(yr-up grade( ) Abandon( ) ❑Complete System ❑Individual Components t L //lJ �'� fl Location Address//or��Lot No. -Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 92 _. 02 Installer's Name,Address and Tel.No. //AO m /✓ n. e Designer's Name,Address and_el.No. 02�, jvU7%i JG S7' .✓l1r/c> D, i�X ' v A5iv Type of Building: Dwelling No.of Bedrooms Lot Size/ �J sq. ft. Garbage Grinder ( ) Other Type of Buildings No.of Persons ` Showers( ) Cafeteria( ) Other Fixtures \ /� `' —- Design Flow(min.required) �y gpd Design flow provided �`' gpd Plan Date Number of sheets Revision Date Title �' u Size of Septic Tank P Type\oflS.A.S/lam Description of Soil \ j Z/, J,-Z y Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: J " \ 1 l✓ 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.t�ot to place the system in operation until a Certificate of Compliance has been issued by this Board oHealth. 0 tgned Date ` Application Approved b Date Application Disapproved by: Date for the following reasons Permit No. �� "`Date Issued 4 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 at /j/ j J has been constructed in accordance with the provisions of Title 5 and the Jffs_Disposal System Construction Permit No� '` 5 3 / dated Installer /, '�J /. �/`�1� Designer / #bedrooms Approved design flow -3 gpd The issuance of this permit shall not be construed as a guarantee that the system wi)1�fu c 'on as designed. Date �j���0 Inspector ;A/_ konc ryallo. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS &5po5al *pgtem Construction Permit Permission is hereby granted to Construct ( ) Re air ( Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditio s. Provided: Construction must be completed within three years of the date o this p t t. Date h �� Approved by Town of Barnstable '"E' Regulatory Services Thomas F. Geiler, Director M&YSTABL$ MAC Public Health Division 7� 1639. °' Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 503-362-4644 Fax: 503-790-6304 Installer & Designer Certification Form p, �S d Date: I Sewage Permit S Assessor's Map\Parcel U Designer: II T w\, Installer: " Address: c7 V U Address: c On �P 1-' �" �t �' '1 t-'® was issued a permit to install a dat ) (installer)' tic system at � t/A✓po ole, T 1� based on a design drawn by (address) - ' '1 f tv� K dated 0 (designer) JC I certify that the septic system referenced above was installed substantially'according to the design, which may include minor approved charges such as lateral relocationf y of" distribution box and/or septic tank. I certifv that the septic system referenced above was installed with major changes (i.e. greater than I lateral relocation of the SAS or anv 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. OF MAssc' &(Installer's D AR Signature) No_1140 SAN I TAR�P� '1 (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BA STABLE 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: Health/Septic/Designer Certification Form 3-26-04:1doc r Town of Barnstable Barnstable Regulatory Services Department BAIMSTABM O '""W s634. Public Health Division , °"1°�• 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# 70081830000205008505 4/15/2009 Avelo Mortgage LLC 4828 Loop Central Drive#600 Houston, TX 77056 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 3 Elaine Road Hyannis, MA was last inspected on March 18, 2009, by Shawn McElroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS. 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 4. f1 ZoO� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Elaine Rd Property Address Litton Loan Servicing ( Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 3-18-09 every page. CitylTown State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection.forms may not be altered in any way. A. General Information I . 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 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 maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Ev luation by the Local Approving Authority 3-20-09 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the 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. 3 Elaine Rd Hyannis•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 3 Elaine Rd Property Address Litton Loan Servicing ( Contact David Holi @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 3-18-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,C 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 3 Elaine Rd Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Elaine Rd Property Address Litton Loan Servicing ( Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 3-18-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced _. ND Explain: ❑ The.system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a'surface water ❑ 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. 3 Elaine Rd Hyannis-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4'M 3 Elaine Rd Property Address Litton Loan Servicing ( Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Hyannis MA 02601 3-18-09 required for y every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: * This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/ day flow ❑ ® 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. 3 Elaine Rd Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 3 Elaine Rd Property Address Litton Loan Servicing ( Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 3-18-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No . ' ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® '° Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within-400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone 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. 3 Elaine Rd Hyannis•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Tine 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 3 Elaine Rd Property Address Litton Loan Servicing ( Contact David Halt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 3-18-09 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no"as to each of the fo'lowing: 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 p`,ans 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? W® El Was the site inspected for signs of break out. P 9 ® ❑ 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)] 3 Elaine Rd Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 16 I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 3 Elaine Rd Property Address Litton Loan Servicing ( Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 3-18-09 every page. City/Town State Zip Code Date of Inspection D. System Information t 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 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)): 210gpd/2 yrs Sump pump? ❑ Yes ® No Last date of occupancy: 8-08 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? _ ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 3 Elaine Rd Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 I Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 3 Elaine Rd Property Address Litton Loan Servicing ( Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 3-18-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1980's Were sewage odors detected when arriving at the site? ❑ Yes ® No 3 Elaine Rd Hyannis•03/08 1 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Elaine Rd Property Address Litton Loan Servicing ( Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 3-18-09 every page. City/Town State Zip Code Date,of Inspection D. System Information (cont.) Building Sewer(locate'on site plan): Depth below grade: 18' 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: ® 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 Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 20 Scum thickness 3 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 13" How were dimensions determined? Tape 3 Elaine Rd Hyannis•03/08 Tittle 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form a a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Elaine Rd Property Address Litton Loan Servicing ( Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is H required for annis MA 02601 3-18-09 y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank in good condition with baffles installed and no sign of leakage. Recommended pumping for solids. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) locate on site plan): p P P )( p ) Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 3 Elaine Rd Hyannis-03/08 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 3 Elaine Rd Property Address Litton Loan Servicing ( Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 3-18-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ .No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with stain lines above outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 3 Elaine Rd Hyannis-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Elaine Rd Property Address Litton Loan Servicing ( Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 3-18-09 - every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ 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 has signs of hydrolic failure with stain lines above inlet invert. 3 Elaine Rd Hyannis-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 M 3 Elaine Rd - Property Address Litton Loan Servicing (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 3-18-09 - every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 3 Elaine Rd Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Elaine Rd Property Address Litton Loan Servicing ( Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is H required for y annis MA 02601 3-18-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. v i G 30 i 3 Elaine Rd Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 N Commonwealth of Massachusetts Title 5 official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 3 Elaine Rd Property Address Litton Loan Servicing ( Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 3-18-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.)' Site Exam: - ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to 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 9 you established the high round water elevation: Y 9 USGS and town maps show groundwater at greater than 20'. 3 Elaine Rd Hyannis-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 - ....._:,,,--..:.�...W..........,,,i.�..-,...- _. ,,... ,.....w. �.«v.�.,,.--.•w.---..,,�r.....x.,..,,,,�,,•.F- ..;.sy,..,..-«..r-"�a7�•V..,,t-•,^rw-n.,,'--.�,..v`..�i-..M.w..,,-...w.-...air-.,...--«..n...----- ;" . TOWN OF SARNSTABLE BAR-W 5817 a Ordinance or Regulation WARNING. NOTICE Name of Offender/Manager �' .� fi . . Address of Offender Lo A MV/MB Reg.# r Village/State/Zip 1 Business Name ' -iam/m; on k�o 045 Business Address Signature of .En.forcing Officer Village/State/ZipAle L_7/4 Location of Offense ,7' / t�• i '' �s ' .r" ' w�,f Enforcingy Dire�ptF/,ADiv_iyps+ion ,, Offense f]te44 tA` ►5` * "K �'4t 4-Ti `1 l `t Facts ' '� �# : 1, w- ' a�= # This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. T NAME OF OFFENDER ' r D n D D 7 0 8 7f TOWN OF ADDRESS OFFENDER t f f BARNSTABLE CITY,ST TE.ZIP CODE it OIF7ME�Y MV/MB BEG19WCIO B OFFENS{E� f W y`y p r /��/y} ! i679• C t LU LU TIME A D OATE`OF V-10_LATIO�,,� - � � LOCATION OF VIOLATION Z NOTICE OF 4 ' LLJ (' P.M ONE '� - f 20 Q "� L/ 1Nf ' `(CA yS NIS SIGNATURE ENFORCING'P�IMSON ENFORCING DEP 1 BADGE N0. W VIOLATION �'' -- (/ _� 0 OF TOWN I HEREBY ACKNOWLEDGE RECEIPT OF CITATION X ��-�- ~ ❑j W d ORDINANCE ' Unable to obtain signature of offender. THE NONCRIMINAL FINE FOR THIS OFFENSE IS S Date mailed LU W OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. W REGULATION (1)You may elect to pay the above fine,either by appearinX in person between or by mailing 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, Q Hyannbefore:is, ,MA 0260Barnst1,WITHIble N TWEN 200 TY-ONE(in 2)Hyannis, AYS OF THE DATE OF THIS NOTICE.money order or postal note to Barnstable Clerk,P.O.Box 2430, CL Tyou desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT.COURT DEPARTMENT,FIRST If UNSTABLE DIVISION,COURT COMPOUND,MAIN STREET ARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation fora hearing. t a (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the ,y hearing to be due,criminal complaint may be issued against you. ❑1,:HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature k Q1 ct Zko Bk 23237 Pa 194- ;55476 10-28--2008 a 12=1390 MASSACHUSETTS STATE EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS Date: 10-28-2008 a 12:09pm CtI*: 783 DocT: 55476 Fee: $1,097.82 Cons: $320:986.03 BARNSTABLE COUNTY EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS Date: 10-28-2008 & 12:09pm Ctlt: 783 Doct: 55476 Fee: $731.88 Cons: $320P986.03 FORECLOSURE DEED Avelo Mortgage, L.L.C., a limited liability company duly established under the laws of the State of Delaware and having its usual place of business at 250 John W. Carpenter Freeway, Suite 300, Irving, TX 75062, holder of a mortgage from Alzize D. Valle to Novastar Mortgage, Inc., dated June 30, 2006, and recorded with Barnstable County Registry of Deeds at Book 21154, Page 22;the undersigned being the present holder of said mortgage via Assignment recorded at Book 22954,Page 53,the original of which Mortgage is located at Avelo Mortgage,L.L.C., 250 John W. Carpenter Freeway, Suite 300, Irving, TX 75062, by the power conferred by said mortgage and every other power, for Three Hundred Twenty Thousand Nine Hundred Eight-Six and 03/100 3" Dollars ($320,986.03f paid, grants to the said Avelo Mortgage, L.L.C.with a mailing address of .0 c/o Litton Loan Servicing, LP, 4828 Loop Central Drive#600, Houston, TX 77056, the premises 0 conveyed by said mortgage. Said premises are conveyed subject to all municipal real estate taxes, assessments,liens and .14 claims in the nature of liens now unpaid or hereafter becoming due and to all encumbrances of record,to which said mortgage was subject and subordinate. x WITNESS the execution of the said Avelo Mortgage, L.L.C. this day of a OCT 0 9 2008 ,2008. AVELO MORTGAG C. LITTON LOAN SERVICING LP W Attorney in Fact n, y r see POA @ Book 23209, Page 65 STATEOF TEXAS Vice Pry ent County of Harris OCT 0 9 20�,2008 r Then personally appeared the above-named and acknowledged the foregoing instrument to be the free act d deed of said Avelo Mortgage,L.L.C., before me, Notary Public My commission expires: Doc#281985 (Seal) BRENDA MCKINZY CUNNINGHAM,MACHANIC,CETLIN,JOHNSON Notary Public,State of Texas ► AND HARNEY LLP ;1 !.` y Commission Expires ' '„`,: DeCember 05,2010 220 NORTH MAIN STREET NATICK,MA 01760.... .. Certified Mail#7006 2150 0002 1041 8795 Town of Barnstable { Regulatory Services ? pAitNSt'A�L�, MASS. Thomas F. Geiler, Director Public Health Division COPY Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 31, 2008 Alzize D Valle 390 Mitchell's Way Hyannis, MA 02601 NOTI_C_E_ 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 3.Elaine Road,Hyannis, MA was inspected on March 27, 2008 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 five (5) bedrooms observed in this dwelling; three (3) were observed on the first floor, (2) two were observed within the basement. However, the existing septic system (permit # 91-385) was not designed for five bedrooms. It was designed for three (3) bedrooms. 105 CMR 410.451: Egress Obstruction: Observed large amount of trash impeding egress from lower level back exit. 105 CMR 410.450: Means of Egress: Observed that two said rooms in basement did not have second means of egress as stated in above code. 105 CMR 410.482: Smoke Detectors: Observed that there was not operating smoke detectors and CO detectors within home. QAOrder letters\Housing violations\Rental ordinance\3 elaine hyannis You are ordered to correct the violations listed above within sixty(60) days of your receipt of this notice-by pulling any required building permits (it applicable); You are ordered to remove the two bedrooms from the basement by removing entrance doors and by opening all door-way entrances to each room in the basement to minimum of five feet wide openings. This will bring the total bedroom count down from (5) five to the appropriate (3) three as designated by your septic permit. You are ordered to correct the violations listed above within twenty four (24) hours.of your receipt of this notice by installing smoke detectors and CO detectors in accordance with state fire codes; by removing all trash which is impeding any egress from said building; by removing beds from two rooms in basement and not using them for sleeping purposes. 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 ORDER OF THE B IARD OF HEALTH T omas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Timothy O'Connell, Health Inspector Q:\Order letters\Housing violations\Rental ordinance\3 elaine hyannis i AQ1fizen Web Request Page 1 of 3 r' r. i 4. P kxc.' eit 1 - 3$5 Request Information r2 I Request ID: 21660 Created: 3/10/2008 1:54:57 PM Status: Assigned To Staff Assigned To: O'Connell,Timothy Health Office Section 353-1 Garbage and Rubbish Anonymous: Yes Request Category: Chapter 170 : Housing Overcrowding Chapter. 170 : Housing Overcrowding - Night Only edit Estimated 3/12/2008 Change Estimated Feb March 2008 Air Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 24 25 26 27 28 29 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 ( Created By: Barrett, Caitlin Priority: Medium edit ( Health Office Citation Numbers: � edit e _dit f Requestor Information �Requestor Request DETAILS: LOCATION: 3 ELAINE ROAD Hyannis, Ma 02601 j Request Parcel Number i 1 Map: ,248 Block: 097 Lot: 1000 Serious overcrowding of people ------ -° -" and cars. Also, there is I garbage/trash/junk in back of http://issql2/IntemalWRS/WRequest.aspx?ID=21660 3/10/2008 r �izen Web Request Page 2 of 3 ,� q g property. Parcel...Lookup Email: Ed_it._Re..qu,estor_Information ......._...............................---.._............._..............__..............._....................._................_......_....._...._......_.............._............__........_..._....._..._......._........_...................._............................................_._......._...._......._.............._e...__........_..............__...................... ......._..._ "Track Request Progress .....................................................-._.......-...._...._ _....._....................._......._...._._....._. l Request Work History: Internal Note History: ............ ........_........__......_... __.._......_......................_.__......_..._..._........_......___--....._.._....._.....__..........__......_.........................._......_............._.............._.............._......._........-............._..................._................_..........._..__..... r .......... ...,... „ System entry on 3/10/2008 1:54:57 PM: s I Assigned to O'Connell,Timothy 1 t Enter work progress: Enter internal note: (dewed by everybody) (dewed internally only) , k3hYs 11 Spell�Check .; Sp'ellCfeck ,, Add document or image link: s.� 9 I NNBrowse < You can also type in =a 1alder- narne to sae even),,,thing in the lder Current Links: Time worked on request 10 Response time: 0 r f time s"� i YYIr?1�c'-^lrgi����yyt� [� are 1f�#L:�I-'�.��I S Examples ^���¢�(,��p��p .si��:t'I�¢:-�y� iy>�,�.i�^ij ��>�?� tI 1�r q,¢��1.p����> � �.C�`s, ,§-;.�. � Response time: °S`_a:7':..�F�d, from the cr`C'L9[iop i'�t'�e- to ��0.-'u first actions on the request. Do not include nights, weekends, and holidays in rl-sponse time for Most departments, Save Changes Check to notify town employee below to review this request. Save changes and notify i Health Office citizen* _ Barrett, Caitlin -� Close request _ Brief message to reviewer: http://issgl2/lntemalWRS/WRequest.aspx?ID=21660 3/10/2008 f a Parcel Detail Page 1 of 3 J' y r x � Ar"A fi Logged I f As: iy3C t'Ic�;?. r e I Detail Parcel Info ...... ...... _... Parcel ID 248-097 DeveloLott FLOT36 Lot ,�.,. Location;3 ELAINE ROAD Pri Frontage j50 Se Sec Road CARLOTTA AVENUE Frontage`86 Village;HYAN N IS Fire.District'HYANNIS __ ... __._ Sewer Acct 484 _. _ _ _.___.._ ____._.. Road Index 10 ___ ._..e..... ........_ .__.__.._ .__. ....___._�._..___.. s . Interactive "T Owner Info `10 VV _ nf..... _.. .._..__. _. _ . _.m..._._3_ _.._.. Owner,VALLE, ALZIZE D Co-Owner ........ ...... ... ......... ............. Streetl 1,3.ELAINE RD Street2 _._..__ ._. ....... ....... .... _.. City iHYANNIS State MA zip 02601 Country Land Info ....... ......... - .. Acres L0.27 Use ISingleFarn MDL-01 zoning RB Nghbd 0106 Topography Road ; Utilities Location Construction Info Elludtg I of I Year'1964_.._ Roof,, p Ext Vinyl Siding Built Struct Wall Effect r` ,,_ _ __ Roof ._. TAC Area 11585- Cover Asph/F GlS' TP TypeI None ........ ..... ..... Style,Split-LeveliNe�» »,M„»e wall£Drywall Rooms 3 Bedrooms » Int Bath Model j Residential Floor Rooms;2 Full Heat -- Total Grade=Average Hot Water 8 Rooms Type• Rooms http://issgl/Intranet/propdata/ParcelDetail.aspx?ID=17690 3/10/2008 y Parcel Detail Page 2 of 3 Y e i s Heat _ Found- n a Stories! Story Fuel Gas ation€TypEcal3 Permit History . .......... . _._. Issue Date Purpose Permit# Amount I asp Date comments 10/25/2001 Out Building 57177 $1,000 AM 2002 12:00:00 SHED 10/22/2001 New Addition 56597 $26,400 1/1/2002 12:00:00 SUNROOM, AM WOODDECK 4/4/1997 New Roof 22174 $900 7/22/1998 12:00:00 AM 5/1/1990 New Addition B33706 $8,000 3/15/1991 12:00:00 AM Visit History.._.. ...___ Date W h 0 Purpose 11/29/2001 12:00:00 AM Paul Talbot Meas/Listed Sales History Line Sale Date owner Ookf'paee Sage P 1 7/3/2006 VALLE, ALZIZE D 21154/19 2 7/9/2003 COLE, KIMYON R &TERESA M TRS 17225/339 3 10/18/2002 COLE, KIMYON R&TERESA M 15760/061 4 7/12/1974 COLE, KIMYON R &TERESA M 2106/256 - Assessment History Save Year Buildim Val"'le, XF Vale OB Valuo Land Va'ue- Total Parc# 1 2008 $150,300 $14,500 $800 $164,000 3 2007 $149,600 $14,500 $800 $164,000 4 2006 $127,900 $14,500 $800 $164,000 5 2005 $119,400 $14,300 $800 $150,200 6 2004 $97,000 $14,300 $800 $130,600 7 2003 $87,200 $14,300 $800 $42,800 8 2002 $77,700 $14,300 $0 $42,800 9 2001 $77,700 $14,300 $0 $42,800 http://issgl/intranet/propdata/ParcelDetail.aspx?ID=l 7690 3/10/2008 r Pfircel Detail Page 3 of 3 10 2000 $59,700 $13,500 $0 $32,000 11 1999 $59,700 $13,500 $0 $32,000 12 1998 $55,900 $12,700 $0 $32,000 13 1997 $78,600 $0 $0 $25,600 14 1996 $78,600 $0 $0 $25,600 15 1995 $78,600 $0 $0 $25,600 16 1994 $73,000 $0 $0 $28,800 17 1993 $73,000 $0 $0 $28,800 18 1992 $83,000 $0 $0 $32,000 19 1991 $89,600 $0 $0 $51,200 20 1990 $89,600 $0 $0 $51,200 21 1989 $89,600 $0 $0 $51,200 22 1988 $50,100 $0 $0 $21,200 23 1987 $50,100 $0 $0 $21,200 24 1986 $50,100 $0 -$0 $21,200. Photos http://issql/Intranet/propdata/ParcelDetail.aspx?ID=17690 3/10/2008 —Parcel Detail Page 1 of 3 10 m Logged In As: Parcel Detail Wednesday, Marc Parcel Lookup Parcel Info Parcel ID 291-045 —__ I Developeer iLo LOT 28 Location 1390 MITCHELL'S WAY I Pri Frontage r157 Sec Sec Road rPHILLIPS ROAD —' I Frontage,111 Village 1HYANNIS Fire District(-HYANNIS Sewer Acct� —� �—� I Road Index InteracMavp u_ - Owner Info Owner iVALLE, ALZIZE �_I Co-owner -- Streetl 390 MITCHELLS WAY J Street2 City IHYANNIS ) state�MA Zip 02601 — Country L - Land Info Acres�0.28 Use (Single Fan MDL-01 ( Zoning RB I Nghbd �0105~� Topography&e7vJ Road Paved Utilities[Septic,Gas,Public Water I Location Construction Info Building 1 of 1 Year Roof Gable/Hip Ext Built f ; n _.._ - i1986--------------� Struct r ����p._ -I Wall IWood Shingle 9 I Effect 1468 Roof Ash/F GIs/Cm AC Area �— Cover( p p I None Type I l Int - Bed c��____-___..__.____ Style(Ranch I wall jDrywall I Rooms►3 Bedrooms I Int( `._ Bath -- Model Residential _ Floor i Hardwood _ I Rooms 13 Full I V Heat( — Total Grade Average Type,Hot Air Rooms 116 Rooms http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=22605 3/12/2008 4�arcel Detail Page 2 of 3 I Found- Stories 1 Story Heat Oil Found- Poured Conc. I Fuel ation JBz I :4S 11 it Permit History Issue Date Purpose Permit# Amount Insp Date Comm 12/1/1986 B30342 1$45,000 1/15/1988 12:00:00 AM HY 1 8 Visit History Date Who Purpose 10/18/2004 12:00:00 AM Paul Talbot Meas/Est 3/25/2003 12:00:00 AM Paul Talbot Meas/Est 4/18/2001 12:00:00 AM SM 3rd Visit-2nd Notice Left 3/23/2001 12:00:00 AM SM 2nd Visit-1st Notice Left 2/14/2001 12:00:00 AM SM Meas/Est 6/15/1987 12:00:00 AM Andrew Machado - Sales History Line Sale Date Owner Book/Page Sale P 1 7/19/2006 VALLE, ALZIZE 21198/231 2 3/1/2005 DEFREITAS, GERALDO F ET AL 19573/183 3 12/6/2004 DEOLIVEIRA, EDILSON M &ALLESSANDRA 19314/028 4 7/1/2004 DEOLIVEIRA, MARCIO 18785/347 5 10/24/2003 CECILIO, EDSON V&JANAINA 17842/128 6 9/26/2002 CECILIO, EDSON V& 15654/086 7 9/15/1987 FRANCIS,'ANTONIA I & 5923/067 8 10/15/1985 FRANCO, NICHOLAS D TRS 4762/139 9 ROSARIO,IJOHN J JR 1613/189 Assessment Histo Save# Year Building Values XF Value OB Value Land Value Total Parc( 1 2008 $144,900 $28,700 $0 $145,500 3 2007 $144,100 $28,700 $0 $145,500 4 2006 1139,900 $28,700 $0 $145,000 5 2005 $125,006 $28,700 $0 $131,200 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=22605 3/12/2008 parcel Detail Page 3 of 3 6 2004 $101,600 $28,700 $0 $111,500 7 2003 $92,000 $28,700 $0 $29,800 8 2002 $92,000 $28,700 $0 $29,800 9 2001 $91,600 $2,700 $0 $29,800 10 2000 $72,500 $2,700 $0 $19,200 11 1999 $72,500 $2,700 $0 $19,200 12 1998 $70,300 $2,700 $0 $19,200 13 1997 $69,400 $0 $0 $19,200 14 1996 $69,400 $0 $0 $19,200 15 1995 $69,400 $0 $0 $19,200 16 1994 $67,200 $0 $0 $23,100 17 1993 $67,200 $0 $0 $23,100 18 1992 $76,600 $0 $0 $25,600 19 1991 $83,600 $0 $0 $41,700 20 1990 $83,600 $0 $0 $41,700 21 1989 $83,600 $0 $0 $41,700 22 1988 $0 $0 $0 $18,900 23 1987 $0 $0 $0 $16,100 24 1986 $0 $0 $0 $16,100 Photos Sw 1,I http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=22605 3/12/2008 f i Certified mail#7006 2150 0002 1041 8771 Town of Barnstable 04 trte r� P4 Regulatory Services Thomas F. Geiler, Director BARNSCA 3 F4 Public Health Division OprE�MA'S b Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 12, 2008 Alzize D. Valle 390 Mitchell's Way Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE CODE The property owned by you located at- 3 Elaine Road, Hyannis was inspected on March 11, 2008 by Town of Barnstable Health Inspector Timothy B. O'Connell because of a complaint. i The following violation of the Town of Barnstable Board Code was observed: 4 353-1 Responsibilities of Owners: Garbage and rubbish observed in the back yard not within proper receptacles. 4 170-4 Certificate of Registration: Failure to register rental with Health Division. You are directed to remove the garbage and rubbish from your property and dispose of it properly; you are direct to register above address with Health Division. Both of theses violations 'must be corrected within 7 days of your receipt of this notice. i You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) daays after the date the order is served. i Failure to comply with an order will result in a fine of$100.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH f mas A. McKean, R.S., CHO Director of Public Health Town of Barnstable ; i QAOrder letters\Refuse\3 Elaine,Hyannis 2.doc i i Town of Barnstable Regulatory Services nnt3ttsmsriw Thomas F. Geiler,Director 9 ;MASS. �. $� 1�39- Public Health Division tfp pAA�a, Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 31, 2008 Attn: Hyannis Fire Health Inspector Timothy B. O'Connell conducted an inspection. In accordance with the State Sanitary Code, 105 CMR 410.482, the Health Department is required to notify the Fire Department if there is a smoke detector violation, or possible smoke detector violation. The following property had possible smoke detector (and\or CO detector)violation(s): 8 Elaine Road, Assessors Map-Parcel: (248-097): -No CO's or Smoke Detectors operating within home. Timot B. O'Connell-Health Inspector QAOrder letters\Housing violations\Rental ordinance\\Pire ViolationsTIRE TEMPLATE.doc NAME OF Of¢�NDEER „.., a IV , �.. - _ BAR? a 6 ADDRESS tS01 NDE(�i,/ 1i '� z TOWN OF _dam �c,,.� �''� � �' � �`._ �� a BARNSTABLE CITY,STATE,ZIP COD A IV p k f( r 1 "� �SNE►p� MVIMB REGISTRATION NUMBER PAa.�$ OFFENS Cn..l 1r C .1 s t r " e hf'� - 52'J "trU�. -� a MASS. (+ryr i_ ��J _ 'y � FD M1N r y t It G 1'0 —1 j— Y�. 0 '�%'L 'y. W TIME Ng DATE F VIDLATI�M t } LOCAIJ. OF VIOI��AiIONi i r �(�t�' ,f LLJ J NOTICE OF A00 ( ./ P.M.)ON 1 ,20 c;. d. �y SIGNAT F'ENFORCING P_ ON 'I ENFQ,R61N ��P�. } g 4 t y !(/ BADGE N0. LLI VIOLATION ��4 t [ f i0 OF TOWN o ACKNOWLEDGE RECEIPT OF CITATION X a I H EBY A N ORDINANCE 11 Unable to obtain signature of offender. THE NONCRIMINAL FINE FOR THIS OFFENSE IS S J Date mailed W W R YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. W REGULATION a (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, < before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P. Box 2430, —j Hyannis,MA 02601 WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. 2 (2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST BARNS TABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21D Noncriminal Hearings and enclose a copy of this ' citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or If you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature I _ FORM%O C&W HOBBS&WARREN'M THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ITY/TOWN W EPARTMENT e ADDRESS—� GSM SVeyw TELEPHONE Address__ Occupant Floor Apartment N. . No. of Occupant _ No.of Habitable Rcoms_ 9 No.Sleeping Rooms_ No.dwelling or rooming units kp4tones,,_. Name and address of owner G J� - ! 0 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: Chimne : BASEMENT Gen.Sanitation: Dampness: Stairs: U ' Liq htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceilin : Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Suo I Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 A Bedroom 3 (J Bedroom 4 Hot Water Facil. Sup,Ten.,Gas, Oil, Elect!.- Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION R ORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PER " < � INSPECTOR C TITLE Qf�� � DATE ��— TIME �U Ef 0 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 tfis 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 crder 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 410.20' 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 Corrrol, 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 main_ain 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. PROPOSED 50 CFM VENTILATION FAN'"TOWN OF SAe A7% c❑ sD PROPOSED COMBO SMOKE CO DEtfUC Fj � N? BEDROOM 1 sD PROPOSED SMOKE DETECTOR* BATH " O C❑ SD \ J � LL BEDROOM 2 SD w KITCHEN W J. a ❑ a ❑ BATH SD � C❑ SD BEDROOM 3 I( LIVING ROOM REMOVE II WALL TO \ CREATE ONE II ROOMt!!71 II MECH. OFFICE WASH/ z BATH DRYER w cn SD C❑ CL. SD m CLOSET DEN c 0 C❑ SD c REMOVE----- in o ui DOORS \ O FLOOR PLAN #3 ELAINE ROAD, HYANNIS, MA Scale: 1/8 =1' 0 4 8 12 16 20 FEET t ' tar.. ;i�'�`1 arm (�' Slx•f;,';It'�'-E..� t ' 35 .- DATE s/� 2/0 5., �__�.._.-_W _m k•�r���ij,:•--____.__. PROPERTY ADDRESS 3 -pi a; „t- Rd West Hyannis Port MA 02672 On the above date, the;aieptic system at the address above was Inspected. This system consists of the following:. rY 10 1-1000 ga Uon .3ept.ic tank.1' 2., 1- Diataigut.ion. Box.i 3., 1-1000 gaiion ieach.ing pit., Based on lnspectlon, I certify,the following conditions: 4., 7h:iz' .ins a 7.itee Five Septic .system (78code) 5., The zept-ic system tz .in paopea wozk.ing o/zdea at the /22eZent time. SIGNATURE Name: Robert A. Paolinl Company: �e�eeh P• h��r.mhpr 3< Son Inc_. Address: P. O. Box VI Centetvtile. Mass 023 Phone:j 508-775:3338 or 608: 412 . . joSEPH P. MACOMBER & SONv.INC.- Tanks-Cesspoola"lechfieWs •PUMP44 &..Installed Town Sewer.donneotlons P.O. Box 66 Centerville, MA 2- - 32-0066 •776+33$6 .' 77.5.641 COMMONWEALTH OF 1VIASSACHU SE TTS• EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS �. DEPARTMENT OF ENVIRONMENTAL PROTECTION t TITLE 5 OFFICIAL INSPECTION FORM-�N�OT.FOR VOLUNTARY ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART•A CERTIFICATION Property Address- • +•+i Pnrfi MA .n2672 Owner's Name:`o�, rt Cc A Owner's Address: Date of Inspection: Name of Inspector: (please print) Company Name: mae^mien _Son Inc. Mailing.Address:' .aat3,.0 2 6 3 2 Telephone Number: 5 0 8 7 7 5 3 3 3 CERTIFICATION STATEMENT that I have personally inspected the sewage disposal system.at this address wash performed based on my I certify P below is true,accurate and complete as of the time of the inspection.The.sewn P training and experience in the proper function and maintenance of-on-site.sewage disposal systems.I am a DEP . Title 5(310 EN R 15:000). The system: approved system inspector pursuant to:Section.0 340 of Passes- conditionally Passes Needs Further Evaluation by the Local Approving Authority al � Date: Inspector's Signature: inspector shall,submit a.copy of this inspection report to the.Appro4ing Authority(Board of Health or , The systemP em or has-a design flow of.10,900 DEP)within 30 days of completing this inspection.If the system;is a port t i syst regional office of the gpd or greater,the inspector and the system owner.shall submit the report to the appropriate DEP.The original should be.sent to the system owner and copies sent to the buyer,if applicable,and the approviAg. authority. Notes and Comments i v tions of use'at **** only describes conditions at the time of inspection and under re underhe ithe same or different Thls report y ^ time:This inspection does not address how the system will perform in the utu conditions of use. T:., r T~"Prtinn rnrm 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTIONYORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: -4 Elaine Rd W Hyan�=Port MA 02672 Owner: RnhPrt rnl P Date of Inspection: R f /cl Inspection Summary: .Check:A;B,C,D or.E/ALWAYSompaete all of Section;D A. System Passesgeh n° 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. CQmm nts: JeR7.ic -6y-6tem .i.a .in. /2a0e/2ae woitk.ing . o/ide2 at the P/Zezen .cem.� B. System Conditionally Passes: no 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. n o 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: no 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: no The system required um in .more than 4 times a year due to broken or obstructedpipe(s).The s stem will Y q P P g Y Y 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: 3 Elaine Rd W Hyannis Port MA 02672 Owner:. Rnhart- Cnl P Date of Inspection: 9 f 12 j n S C. Further Evaluation is Required by the Board of Health: no 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: -moo 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: no The system has aseptic 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. no The system has a.septic tank and SAS and the,SAS is within a Zone 1 of a public water supply. no _ The system has a septic tank and.SA&and the SAS is.within 50 feet of a private water supply well. no The system has a septic tank and SAS and the SAS is less than 10Q feet b�t 50 feet or.more from a private water supply well".Method used to determine distance VzZu¢ "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: • z I Page 4 of 11 • a OFFICIAL INSPECTION FORM—NOT'FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE:.DISPOSAL SYSTEM.INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 'i ri ; ^' Rd W HyanniGPnrt 'MA 02672 Owner: RnbPrt rnliz Date of Inspection: D. System Failure Criteria applicable to all systems:. You must indicate"yes":or"no to.each of the following:for all inspections: Yes Xo _ Backup of sewage into facility or.system component due:to overloaded.or.clogged SAS or cesspool _ 7- Discharge:ouponding of effluent to the surface of the.ground or surface waters due to an overloaded or X clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or X cesspool _ Liquid depth in-cesspool is less than 6"below invert or availablesvolume is less than'�4.day flow _ 7- Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number X of tunes pumped' Any portion of the SAS,'cesspool or privy is below high ground water elevation. _ 7_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion:of a cesspool or privy is'withina-Zone.1.of a:public well... supply _ X Any portion of a cesspool or privy is within.50 feet of i private water well. Any portion ofa cesspool or privy is less than 100 feet but greater than 5.0 feet from a private water supply well with no acceptable water quality analysis..]This'system passes if the well water.analysis, bacteria and volatile or anic compounds �. performed at a DEP certified laboratory,for coliform g 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.] NO (Yes/No)The system fails.I have determined that:one or.more�nf the above.failurc...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. { L Large Systems: To be considered a large system the:system must serve atacility with a design flow of 10,000 gpd to 15,000. gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) i yes go — the system is within 400 feet of a surface drinking water supply — X the system i.s within 200 feet of a tributary.to a surface drinking water supply _ X 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 signif cant.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 i ' I Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS E'I AGE DISPOSAIJ SYSTEM INSPECTION FORM r—. SL$SURFACE S PART CIIECIajST Property Address: i ' -Rd W Hyannisport MA 02672 owner: RohPrt• C Date of Inspection: Check if the following have been done You must indicate"yes or"no'!alto each of the following: Yes No _ . X Pumping information was provided by the Owner,occupant,or Board-0 f Health _ X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? _ X Have large volumes of water been introduced to the system recently or as-part of thisinspection? X Were as built plans of-be system'obtained and examined?(If they were not availabie4iote as N/A) X Was the facility or-dwelling inspected for signs of sewage back up? X — Was the site inspected for signs of break out? X . _ Were all isystem components,excluding the SAS',located on site.?- X _ Were the,septic tank manholes uncovered;Dpened,and the interioL of the tank inspected for the condition of the baffles or tees,material U construction,dimensions,depth of liquid,depth of sludge and depth of scum? X Was the facility owner an occupants if different from owner)provided with information oft thoproper maintenance of subsurface sewage disposal systems? The size and location of the Soil,Absorption System(SAS)onthe site.has been deternilrted based on: Yeso — Existing,information.For example,a plan at the Board of hiealth. I x Determined in the field(if any of the failure criteria related to Part C is-at issue approxirriation-of distance . is unac_ceptable)[310 CMR 15.302(3.)(b)) Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS .SUBSURFACE,SEWAGE DISPOSAL SYSTEMINSPECTION FORM � PART C SYSTEM_INFORMATION Property Address: 3 Elaine Rd W HyannisPort MA 02672 Owner: Robert Cole' Date of Inspection: g f 1 I n S FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design) 3 Number of bedrooms(actual):3 330 DESIGN flow based on 310 CMR 15:203(for example: 110 gpd x#of bedroomsy. Number of current residents: Z Does,residence have a garbage grinder(yes or no): no Is laundry on a separate sewage system(yes or no):n� [if yes separate inspection required] Laundry system inspected(yes or no)n o Seasonal use,(yes or no): n0 2003=73, 500gaiionz G%[7_Z01. 36. Water meter readings,if available(last 2 years usage(gpd)):Z 0 0 4 6 8 2 5 0 ya 2 o n �%[7_ 8 6 9 8 Sump pump(yes or no): no Last date of occupancy: h e n.t COMMERCIAL/PhDUSTRIAL N/ Type of establ bhp ont: Design flow(liasEd on310 CMR 15.203): gpd Basis of desip"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): GENERAV INFORMATION Pumping Records . 8/15/0 5 Source of information: Was system pumped as p.�o�the inspection(yes or no): e m e a h u 2 e d If yes,volume.pumped:7_gallons--How was quantity—pumped determined? Reason for pumping: main . TYPE OF SYSTEM X Septic tank,distribution box,soil absorption:system . _Single cesspool _Overflow cesspool —Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval T Other(describe): Approximate age of all components,date installed(if known)and source of information: 1019191 Bo)ttoio.t.t.i Were sewage odors detected when arriving at the site(yes or no): n o 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR.VOLUNTA.RY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3 Elaine R W .Hr nni -,part-_MA 02672 Owner' Anhcri- C`nl P .Date of Inspection: R/1 2/ 5 BUILDING.SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron X 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of'oints,venting,evidence of leakage,etc.): fight., No .64ng6 o� .eeakage., Vented thaouyh home SEPTIC TANK:y e'locate on site plan) 1000 ga i i o n Depth below grade: 1 2" Material of construction:X 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) 8, " , " , " Dimensions: 6 X 5 8 X 4 10 Sludge depth. 2 a Ce to a c e Distance from top of sludge to bottom of outlet tee or.baffle: Scum thickness: taace taace. Distance from top of scum to top of outlet tee or baffle:L a ce Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: m e a z u2 ed Comments(on pumping recommendations,inlet and outlet tee or.baffle condition;structural integrity,liquid-levels as related to outlet invert,evidence of.leakage,etc.): Iaiet & out eet tees at .gi e n /zeace., Tank j. .6t/tuctu2a eh/ 60und n. o 3tgnz o ea age.l GREASE TRAP:n°(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 yaeazeut aI2 4 6 nocto/2 gent:). Page 8 of I 1 OFFICIAL INS•PFCI'I ON FORM—NOT FQR VOLUNTARY ASSESSMENTS .;��W.I F GE SEWAGE DISPOSAJ,SYSTEM INSPECTION FORM • PART C SYSTEM INFORMATION(continued) Property/tddress: 1 mine VA ru �uicPnrt MA 02672 Owner, Date of Itspection: TIGHT or HQI,,DING TANK n o (tank must be pumped at time of inspcction)(locate on site plats) Depth below grade: Materiel of construction: concrete metal fiberglass____polyethylene other(explain): Dimensions: Capacity:' gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm'in wort n&order(yes or no): Date.of last pumping: Comments condition of alarm and float-switches,etc,): fight oa ho 2ciing tanks ayte no4 z2ay. aal ` BOX: if present must be o ened)(locate on site plan) DISTRIBUTION ( present p Depth of liquid level above outlet divert: 6 Comments(note if box is level aitd distribution to outlets equal,any evidence of solids carryover,any evidence of le4age into or out of box, etc.): oz .ins eeve e., No h.i nos o Leakage in--Oa u o zo-f7d caaaq ove.1L., PUMP CHAMBER: no (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,ett;.): Pump chan29ea .iz no.t Raezent., 8 . Page 9 of 11 OFFICIAL.INS.PECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 P.1 a i nP _Rd W HyannisPort MA 02672 Owner: Robert Cole Date of Inspection: R f 1 2/n SOIL ABSORPTION SYSTEM(SAS): {locate on site plan,excavation not required) If SAS not located explain why: Located see /gage 10 Type leaching pits,number: 1 X leaching chambers,number: leaching galleries,number:_ leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): Loamy to medium dine sand., No .s.i rz s o� �a-iiu ze onL ond.in o.¢m¢ o.L h ante nty., CESSPOOLS:n° (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:Dimen • Materials of construction: . Indication of groundwater inflow(yes nr no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): ce z12o..o 2.6 ate not 12ae sent PRIVY: n° (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.): l nL.ytl -ib not ant p-AP-I n 9 i Page to of ll Cys 3tV:ASSESSMENTS oMCIA- SA YNSPEC2q0N--V0 �Vi-NOT ,S 'V Q 3ON�FOM , 5tBR `SYMA(�rL•�; RPAR' 'ErM 1NSPE Sy STRM r.MM1�'�'L' OY'!1(�c©ntht>ted�' property Address'. W H ann gr MA. 02672 Date of Inspection: I SYSTEM 1pmd�narks or - 2 cc f re OSA, eiit erg 1 OF sE'�►AG�•DISP tics to at least two penman provide a sketch of the sewage disposal system including, •Locate all wells within }00 feet.Locate where publicw8;tcr supply Cnt4rs.the building. I Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.0 SYSTEM INFORMATION(continued) Property Address: 3 C e a i n e Road Ide-.6t HyannZ,3/20/LT Owner:Roge/tt o e Date of Inspection: 5 STTE EXAM . Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: -N 0 Obtained from system design plans on record-If checked,date of design plan reviewed: u e�s Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: a a.D t r a n d no . Checked4ith local excavators,installers-(attach documentation) Accessed USGSdatabase-explainhtt/a:town.,&a/tn.6ta&ie_.,ma. ups �--.. You must describe how you established the high ground water elevation: 11,3ed. : Ca Re Cod Comm.is.i:on 1date2 7aaie Coritou.¢z And l ugtic 1Jate2 Su/2p.2y Oeii head 2oteetion :a/te¢.s mal2., Se t 1995 Natea aes0u2eeh o .ice cane eo comm.i.s.iono Top of Groun Leaching Pit ;eet Groundwater. X�_eet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frlmpter Method Therefore,the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table is feet. 11 nTTIR�.1I�:'.T• •RRRTM rR17><P'I�r•q!!-J,RIR*Rl�'•RR'•T71��,IV7P������y��� TOWN OF BAR�"T�TT_ARr.F- I30AIiU OF li)rAL�'ll gUI)SURFACH SEWAGE DISPO, SYSTEM INSPECTION FORM — PART D CERTIFICATION , ..ate.T•:-t:.-+v„s,rr,uR,RR•nl+mr..el. .. a.,.,..,.�.,�„ �.,...1.,•.. _,.� -TYPE OA PAINT CI,EARLY- ERTY I NSPECTFD PROP ,. , STREET ADDRESS 3 Elaine Rd ASSESSORS MAP, BLOCK AND PARCEL # /-J4 0' V, 1 OWNER's NAME Robert PART` D CERTIFICATION . NAME -OF INSPECTOR Ro&eat /'a.o$wn i. COMPANY NAME oae h ':P.� Macom�e Son Inc Box 66 •• Cen�eaviiie Plaza' 02632 ' COMPANY ADDRESS Town-or City. state tip SLroot' COMPANY TEGCPHONE ( 508 Y � 7.5 ' 3338 FAX (' 508' )790 - f 578 CER'rI•FICATION STATEMENT I .certify that. I have personally .inspected ..the sewage dieposa�l system at this address and that t}%e ir�formatioon'rT�erin�gectionewasopsrPormed and and any • omplete as of the time a:f, inspecti n. recommgr endations regardent •Xn�:riencedin the nproper te nano efunction- and maintenance ofon- with my training and Pq site sewage disposal systems Check one: ' 14 System PASS*D The inspection whicF -I have .-conducted has ..nvt found any information . which indicates that the system fails to adeduaately protect .publi-c health or the enviropment as defined in .310 CMR. 15. 30.3 , Any failure criteria sot evaluated are as stated in the FAILURE CRI•T•ZR•IA sieetion o.f this, form. System FAILED* r ' 1 The inspection which I have 'can environmentnintaccoirda•nceh-at -the swithtem fTitleto protect the public health 61 310 CMR 16 . 303, and as - specifically noted on PART FAILURE CRITERIA of this inspect ko. f o Inspector Signature* Date e Copy of this cent. fioat.i'o•n must •be provided :to : the .QWNER-j t•hle. BUYEROwn here appli•.ca•ble) and th!a E3QAEiD 08' HEAL-kit .. * If the inspection FAIL•Eb., th'e .owne'r• .or operator whall upg.r.ade'.the system. within o'ne year of the date of the inspection, unless. allowed or required - otherwise as provided in �JO CMR 16 ,305 , 3 gS No...........A..?_.X.R 0 V E ID ...........:. Barnstable Conservation Commis"Effli1COMMONWEALTH OF MASSACHUSETTS POARD OF HEALTH Signed Date TOWN OF BARNSTABLE ,Apure#ion for Uiopoii ai Workii Tonotrnrtion runfit Application is hereby made for a Permit to Construct ( ) or Repair (A4 an Individual Sewage Disposal System at: ....... .._.� ' ?�J g ......................�:.� ��s! ' .............•----- ...---------••--••------................. Location-Address or Lot No. ......�4y ......... �a�--------------------�-------- ----.-•---•--. ....... , --........- n_J Owner Address Q --------------- ._ ... _f_4 Z ems........a Pq Installer Address d Type of Building Size Lot /dCYS_f._Sq. feet U Dwelling—No. of Bedrooms................... ...._...........--..Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ............................ No. of persons............................. Showers ( ) '— Cafeteria ( ) Other fixtures W Design Flow__________________�:: ...............gallons per person per day. Total daily flow............#. 10...................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter...--------.____ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter..............--.... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by................-......................................................... Date....................................... a Test Pit No. 1................minutes per inch Depth of Test Pit.-..---.____.------- Depth to ground water...--....--............. fs, Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water................... -.... ------------ •------------ ---- •-------------------------- -----------•--------_----- 0 Description of Soil......................................................................................................................................................................... x V ------------------•••---.....----------•----------...---------------------•------------......--------------•----------------•--------•------------=.................................................... x -----------------------•------- U Nature of Repairs or Alterations— swer when applicable-.--o.44 ----.-.-�'eA_...�/�....7D.--...!5.6e Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance as een issue by the board of health. Signed -------- --- ---- ---------- ------- ..--- ...-------.------- ------ Application Approved By --.^- ------Z :A-�- - ---- ------------- ------------............ ---------- ......... Date Application Disapproved for the following reasons- ..................................................................................................................................... ---------------- ------ -- --........................................................------------ ------------ --- ------------------- -- ---- - ---------------------- -- -------------- .................................... -- c. Dace PermitNo. ........ ----------.. ------------ ------ Issued ............................................. Date E F�a... THE COMMONWEALTH OF MASSACHUSETTS _)jP0AR® OF HEALTH TOWN OF BARNSTABLE Appliration for Uiipnsal Works Tomitrurtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ....................... •-•-- --------....---•--•-•--.......------- -•._.............---•----••••------•------- ---•---•---........------........._------ tior �L/H�y(J + Cca -�ddress �/C�I of No. .......... ........._..-.,.V.............................------------_____v____---_- ------------- ...................��. ........_......................-- Address Installer Address U Type of Building Size Lot ! ._._S feet Dwelling—No. of Bedrooms.................... ........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures .._:.._.. ............. W Design Flow__________________ .................gallons per person per day. Total daily flow__._.._........3...................gallons. WSeptic.Tank—Liquid capacity............gallons Length._,........... Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.--___-•_-_---__--_ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) IH. Percolation Test Results Performed by........................................-................................. Date........................................ a Test Pit No. I.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -...... ------------------------------------------------------------------------- -------------------- --------------------- 0 Description of Soil......................................................................................................................................................................... x U w U Nature of Repairs or Alterations— swer when applicable.____X G� '� 1-7 7-0 Cx'�57 •- -------- - - ------•• •- ••. - - Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the y p Certificate of Compliance as een issue by the board of health. system in operation until a Certi i Signed --.:.... ...--- . - - ;� s :. Date Application Approved By ..... .��,,<,�.-.. .. -.. ....... c7 / ..ems..-,�t.r,-�- ......................... ........ .. .. ................. � ��_Due. ... -. Application Disapproved for the following reasons- ......................--------------------- - -------------------------------- -__............... .--.--- ---....----- ------------------------------------------------------------------------------------- ........... ..---..-------------.......----------- ........................................ Date PermitNo. ....... 3.. ...j_-------------------- Issued .............. .................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cerrtifira to of Cfomplinure t THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ------- ........................................... 0/7, �. C'O�S` ........................................... � ,�� Installer /�J Aj SP� at ......................................................... has been installed in accordance with the provisions of TITLE 5 of The tate Environmental Code as described in the application for Disposal Works Construction Permit No. ..... ---,I--?..s"..--- dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE' SYSTEM WILL FUNCTION SATISFACTORY. �'. / DATE.......................... Vf-, /1 ..... .............................. ------ .........-----...... Inspector -------------- --- .---........................................... -----_--_--_- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �U--- No. /- / �. FEE..._-_..... .... Disposal Vorkv Tonitrnr$ilan rrntit e o A ,�' Permissionis hereby granted.......................I.............----•••..-----•--••--•--•-•--••-•---------------•-•----••-•-••••-•................•....._........----••. to Construct ( ) or Repair (�<) an Individua Sewage Disposal System at No. .................................14 ..........................................t1. `' r�/il/.cS ----••. --------••-•-••-•--------------------•------•••••••---............. Street / ���/' as shown on the application for Disposal Works Construction Permit No__ ____ ____________ Dated.....__....._....._..._.._......._....._.. ................................. '-Board of Health - ....................................................... O _DATE............... ��------- --�-•---------------------------- FORM 36508 HOBBS Q WARREN,INC.,PUBLISHERS ` TOWN OF BARNSTABLE LOCKTION .3 C/9, e V SEWAGE # VELLAGE AA/4 o p!_{,S ASSESSOR'S itifAP& LOT LNStALPWS NAME&PHONE NO. $EPTlC TANI{ CAPACITY LEACHNG lE^ACILITY: (tyke) (sine) l a NO.OF'BEDROOMS— DIJELDER 3 .. .. � ��OWNER -��-ai red I v�� ec�►�►� E PERMITDATE:--,.,,.,..._. ,,.00KPLI,4JgCE DATE: 4 Sepuaition Dismnce Betweep tbe: Maximum Adjusted Groundwater Table to the Bottom of Leaching Pacili ty Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility). Edge of Weiland and Leaching Facility(if any wetlands exist within 300 fa et ..f lcaching facility) Funt3$hcd by .0 m ' � n 1 i d V� R oc A' TOWN OF BARNSTABLE Lc-_,ATION F44e JL 0 SEWAGE # VILLAGE, � 4S - ASSESSOR'S MAP & LOT,4W-6,97 INSTALLER'S NAME & PHONE NO. 2�pwl SEPTIC TANKCAPACITY ®O LEACHING FACILITY:(type) ��% �O� (size) NO. OF BEDROOMS .a PRIVATE WELL OR BLIC WATE BUILDER OR OWNER lzfA1t�aly) clif DATE PERMIT ISSUED: ' P L DATE COMPLIANCE ISSUED: ( ql VARIANCE GRANTED: Yes No� r -1 rj IX/ TOWN OF BARNSTABLE L7wATION,q SEWAGE # �Z- VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. Q SEPTIC TANK CAPACITY 10 r-O 4,7 fiS/`iw TLEACHING FACILITY:(type) (size) 4`4 NO. OF BEDROOMS_3 PRIVATE WELL OR PUBLIC WATER 4��J4 e BUILDER OR OWNER DATE PERMIT ISSUED: DATE COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes No 4 W Q V G V A " y ' , t SURVEY REFERENCE: PLAN OF LAND BY: ED KELLOGG DATED: SEPTEMBER 1961 l L !- ` BENCH MARK ti 42 \ PAINT SPOT CONC PAD* � � ELEVATION = 40. 02 f -24.48' '� ao `��%' �\ BARNSTABLE GIS DATUM 35.77 pwt `s/. - 1 ••\•\ � �� ��� ill 1 j o TH-2 �� \\ 1M1j� �• Q y I 4 LEGEND 20.73' II 1\ a �deb / Y, �� \ \\ f---- 32,05 ------� PROPOSED CONTOUR \\' PROPOSED SPOT GRADE SOIL ABSORPTION SYSTEM (SECTION —— 98 —— EXISTING CONTOUR + 96.52 EXISTING SPOT GRADE 36Jr\\\ \20 ft �O \ \F \•\ W— EXISTING WATER SERVICE 34� \ N'\ \\ \ \ 1 TEST PIT \ \ \ \ \ \ o LOCUS MAP N.T.S. O \\ \ \ 1 t�G \\ �I \\ %%N2 I `7a , 10 tt i All- ON \ 3� 40 >_oarH4�'i AR A = 1 7C�\5 �sf +\� I �`' 1 \ \ \ \ P I _ / u. O 1 ' I _ illsan R� `38 I EK sting Leochpit (Mote 10)36 — 32 34 / \ i%/ v LOT-097 } , Carlcitia�v DEED BOOK 23237 _ — DEED PAGE 184 t�, —— c ';p�v pF-pA\/F- NT J �a OF NUE O T T A DA�R N M. PROPOSED SEPTIC SYSTEM UPGRADE PLAN . C R �- N '1Y4d 3 ELAINE ROAD HYANNIS MA IG/ p� Prepared for: William Dinger sl��r l•lt�\a Engineering by: Surveying by: SCALE DRAWN DARRENM.MEYER,R.S. Boo-TeeA Environmental 1"=20' DMM I PO BOX9Bf (508) 364-0894 CHECKED SHEET N0. EAST SANDWICH,MA 02637 DATE: sos-V2-2922 06/01/09 DMM 1 of 2 I , NOTE: JTO PREVENT BREAKOUT, THE PROPOSED DESIGN CRITERIA NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS ,FINISH GRADE SHALL NOT BE < EL:32.0 FOR A DISTANCE OF 15' AROUND THE NUMBER OF BEDROOMS: 3 BR DWELLING (PROP IS IN ZONE IQ SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. PERIMETER OF THE S.A.S. SOIL TEXTURAL DESIGN PERCOLATION CLASS: CLASS 2 M N/IN ( ������ OF ` oo INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER DAILY FLOW: 330 G.P.D. 1 DAM. ✓� OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. oESIGN Flow: 33o c.P.o. M YER F.G. EL. F.G. EL.=38.0(MIN.) F.G. EL: 38.0t FG. EL: 38.0(MAX.) GARBAGE GRINDER: NO No. 1140 PROPOSED SEPTIC TANK: USE EXISTING 1.000 GALLON SEPTIC TANKAwiamoza=us �R LEACHING AREA REQUIRED: (330) = 445.94 S.F. .74 �+aITAM L - 10't L = 20' L - 10'(MAX INSTALL TWO INSPECTION PORTS (MIN.) DISTRIBUTION BOX: 3 OUTLETS (MINIMUM) O S-IX (MIN.) O S=1x (MIN.) �E O S-ix (MIN.) 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC PRIMARY S.A.S. USE 2 TRENCHES_(10 TOTAL UNITS) OF 16" INFILTRATOR HI-CAP H-20 UNITS-NO STONE 10" 14• tt 11.3" TO BOTH TRENCHES 5 UNITS EACH = 31 25' LONG INV.=35.93 4B" JOUID INVERT BOTTOM & SIDE AREA LEVEL INV.=35.68 (GENERAL USE APPROVAL FOR 7.9 SF/LF OF BIODUFFUSER) 1 PROPOSED (INFILTRATOR UNITS): 10 UNITS x 6.25 LF x 7.79 SF/LF = 466.88 SF GAS BAFFLEINV.=32.30 2-TRENCHES (5 UNITSIEACH(10 TOTAL) AT 6.25'/UNIT= 31.25' DESIGN FLOW PROVIDED: • �=B-� 0.74(486.88 SF) � 360 GPD > 330 GPD req'd INV.=32.5 D8-3 INV.=31.61 SOIL ABSORPTION SYSTEM (PROFILE) EXISTING 1.000 GALLON SEPTIC TANK (1-120 LOADING) RESTORE VEGETATIVE COVER EXISTING SEWER OUTLET �� 1 r. 75" NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING ;i°' '''! EwsnNc su1TABLE ;•. PIPE INVERTS PRIOR TO CONSTRUCTION BREAKOUT=TOP ELEV.--32.0 MATERIAL INV. ELEV.= 31.61 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE ON A MECHANICALL COMPACTED SIX BOTTOM ELEV.= 30.67 1111011111111 "lull! INCH CRUSHED STONE BASE, AS SPECIFIED IN I 2.83 5.66 2.83 11 310 CMR 15.221(2) 5' MIN. ABOVE BOTTOM OF r , T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH 11.23 3) REPLACE EXISTING 1,000 GALLON SEPTIC � ., _ TANK WITH 1500 GALLON SEPTIC TANK (5.92' PROVIDED) F2-TRENCHES (5 UNITS EACH (10 TOTAL)) �� 76 IF FAILED, DAMAGED, OR UNDERSIZED. ADJUSTED GW EL.=24.75 = 4 6.25' PER UNIT= 31.25'/TRENCH PROFILE 4) INSTALL INLET & OUTLET TEES AS REQUIRED 5) PLACE SANITARY TEE IN D-BOX. SEPTIC SYSTEM PROFILE TYPICAL TRENCH SECTION KLl. N.T.S. 17N I GENERAL NOTES: 1( 1s" 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOG P#: 12580 BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS ��--34" OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DATE: JUKE 1 2009 LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: SOIL EVALUATOR: DARREN MEYER, R.S., CSE SECTION END CAP -310 CMR 15.405 (1) (8): 1) A 3 Fr. VARIANCE FROM 310 CMR 15.221(7) TO ALLOW LEACHING TO BE WITNESS: DAVID STANTON, RS 6 FT. BELOW GRADE VS. REO'D 3 Fr. (H26/VENT PROVIDED) HEALTH AGENT 16"„ HIGH CAPACITY (H-20)INFILTRATOR UNIT 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE TH-1 Depth Elev. TH-2 Depth DESIGN ENGINEER. Elev. - MODEL 16" HICAP 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 38.0 0" 39.0 0' FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT ENGINEER BEFORE CONSTRUCTION CONTINUES. FILL FILL TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. EFFECTIVE LENGTH 75" 34.0 48" 38.33 8" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF A LOAMY SAND A LOAMY SAND SIDE WALL HEIGHT 10" THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 10YR 4/1 10YR 4 2 OVERALL HEIGHT 16" HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 33.5 54" 37.83 / 14" 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. B LOAMY SAND B LOAMY SAND OVERALL WIDTH 34" 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 10YR 5/8 1OYR 5/8 14.3 CF ,7 TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 32.5 66" �37.0 24" CAPACITY (110 GAL) 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. MEDIUM I. MEDIUM PERC ®34.5 PROPOSED SEPTIC SYSTEM/SITE PLAN h� 10. EXISTING LEACHING TO BE PUMPED. CRUSHED AND REMOVED. SAND SAND REPLACE WITH CLEAN MEDIUM SAND PER TITLE V. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 2.5Y 7/4 2.5Y 7/4 3 ELAI N E ROAD HYAN N I S MA 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY 24.75 159" 25.75 159" Prepared for: William Dinger AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY i PERC RATE <2 MIN/IN. ("C" HORIZON) Engineering by: Surveying by: SCALE DRAWN JOB. NO. 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. NO GROUNDWATER OBSERVED DARRENM.MEYER,)ZS. Bco-Tech BovkonmenW NTS D.M.M. 14. NO WETLANDS WITHIN 1 POBOX881 50' OF PROPOSED LEACHING. I • I. Darren M. Meyer, R.S.. CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 (508) 364-0894 DATE CHECKED SHEET NO. 15. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPECIFIED) to conduct coil evaluations and that the above analysis EAST SANU1MCJl02537 yo has been performed by me consistent with the 16. PROPERTY IS LOCATED WITHIN A ZONE II. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October. 1999. 508-362-2= 06/01/09 D.M.M. 2 Of 2 i I , }