HomeMy WebLinkAbout0017 FRESH HOLES ROAD - Health " �17 Fresh, Holes 'Rd
aka,17"19 Fresh Hbke5 Rd
292452 Hyannis
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YOU WISH TO OPEN A BUSINESS?
j For Your Information: Business certificates.(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do.by M.G.L.-It dogs.not give you.permission to operate.) You must first obtain the necessary signatures on this format 200 Main St., Hyannis.
Take the completed form to,the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, M-A 026.01 Clown Hall) and get the Business Certificate that is
required by law.
DATE. �1 Fill in please:
_ F'[ s,_ t ,i APPLICANT'S YOUR NAMS: 1 R L A
j u' 1 ) L� E/BUSINE55 IN
HOME ADDRESS- to F�e � S�_!tl � �
ss a,I Lily III TELEPHONE .# Home Telephone Number -s
E—MAIL: 10 O /�� 1• �01'1�
NAME OF CORPORATION: o i oil Q
NAME OF NEW BUSINESS TYPE OF BUSINESS n �J C Gore S�>vG �tOY)
IS THIS A'HOME OCCUPATION? YES NO
ADDRESS OF BUSINESS. G S G O MAP/PARCEL NUMBER (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you In obtaining the information you may need. You MUST GO TO 200 Main St. - [corner of Yarmouth '
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDaGs oFF MUST COMPLY WITH HOME OCCUPATION
Thf rp d ny r it ire eri that pe ain to this type of business. RULES AND REGULATIONS, FAILURE TO
et r COMPLY MAY RESULT IN FINES.
M N
'� G 3 ' -
2. BOARD O HE . H
This individual has been infDr ed of the permit r quiremen that pertain to this.type of business.
,, Authorzed Signature** MUS�� COMPLY�INI`I`KAL :
COMMENTS: U l._i �
,r, HAZARD01 IS MATFRIAt.0,REGUS
3. CONSUMER AFFAIRS (LICENSING AUTHORITY) .
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
Date: 6 /Z?
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: ��>'� "S POOZ v �C�✓) U<�s<.�/Jr /��S/ r�� xnC
BUSINESS LOCATION: res A �CLr0 //4 1I0"ENTORY
MAILING ADDRESS: . /6o.)c Seri-/l, vvAZ,,j d TOTAL AMOUNT'
TELEPHONE NUMBER: __ 37.>2 4?5 a/ e.� � �J— /0
CONTACT PERSON: 3 "'0 F y
EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE?
TYPE OF BUSINESS: lt�oJL1 Con t y/v®cA-o- -e 4j i al's ejzo e
INFORMATION / RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic or
hazardous characteristics and must be registered regardless of volume.
Observed / Maximum Observed / Maximum
Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive
❑ NEW ❑ USED Cesspool cleaners '
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides z
❑ NEW ❑ USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel,Aviation gas
Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED
Miscellaneous petroleum products: grease,
Photochemicals (Developer)
lubricants, gear oil ❑ NEW ❑ USED
Degreasers for engines and metal Printing ink
Degreasers for driveways&garages Wood preservatives (creosote)
Caulk/Grout _ (� • Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Miscellaneous Combustible ..
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt& roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (including carbon tetrachloride)
❑ NEW ❑ USED Any other products with "poison" labels
(including chloroform,formaldehyde,
Paint&varnish removers, deglossers hydrochloric acid, other acids)
Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers may be toxic or hazardous(please list):
Metal polishes
Laundry soil &stain removers
(including bleach)
Spot removers&cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash ��� _
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials
10/31/2011 14:14 FAX 5084283928 CAPEWIDE R 002/002
75
.Ca ewide
ENTERPRISES, LLC
J.P. MACOMBER& SON•S►.nee 1928
153 Commercial Street
Mashpee, MA 02649
October 31,2011 O
Barnstable Health Department V
200 Main Street
Hyannis,MA 02601
Re: 17-19 Fresh HoRHyaz
To Whom It May Concern:'
Maria Moniz,owner of the property at 17-19 Fresh Holes Road,Hyannis, has contracted with
Capewide Enterprises,LLC to complete an upgrade of the Title V Septic System. An engineering
plan has been drawn for such property by Eagle Surveying,Inc, dated July 21,2009.
Capewide intends is to obtain a permit for this job within two weeks and intends to g9WW fl=:,:.. .
work within four weeks or no later than t
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If you have any questions you may contact me at{508)4'7T.88 '7. - -�
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Sincerely, v. .
en Ric Cap �....... . r
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Co-Owner -_....._..-.....-_ .. .,-,s...,... -
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Phone: 508.477.8877
Fax: 508.477.4977
Rich@CapewideFnterpnses.com
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Barnstable
±
i tHE Town of Barnstable �
Bp Tp�
P � Regulatory Services Department 1 ericaC-j
• RARNS`rABLE. I
679. ��� Public Health Division
$AreO MAt a 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 # 7011 0470 0001 4525 5440
(October 20 2011 6' "7) 4- -?3 - e1 /7
_
. to C'�.,,o<•�_ -
Mr. & Mrs. Joseph Moniz 'L/
33 Franklin Street '
Somerville, MA 02145
YOU ARE SCHEDULED TO APPEAR BEFORE THE BOARD on Tuesday,
November 81h 2011 at 3 pm in the Town Hall, Hearing Room, 2nd Floor 367 Main Street,
Hyannis, MA due to your failure to repair or replace the failed septic system at 17-19
Fresh Holes Road, Hyannis, MA
The State Environmental Code Title V requires all failed septic systems to be repaired or
replaced within two years. The Town of Barnstable Board of Health has more stringent
deadlines dependent upon the type of failure identified. In this case, the septic system
has been in failure beyond the established deadline.
You will be given the opportunity to testify, present witnesses, documentary evidence,
and other official information regarding this case.
PER ORDER OF THE BOARD OF HEALTH
Wayne Miller, M.D.
Chairman
Q:\SEPTIC\Letters Septic Inspection Failures\l7-19 Fresh Holes Rd.,Hy.doc
°F1HE T�
Town of Barnstable Barnstable
Regulatory Services Department "'edCe '
MAC'
9q, 1639. ,4 Public Health Division
0 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL# 70081830000205008468
4/15/2009
Franklin Credit Union
c/o Karen Bates, Cape Coastal Realty
4 Barlows Landing Suite 1
Pocasset, MA 02559
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 17-19 Fresh Holes Road Hyannis,MA was last inspected
on March 30, 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
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
17-19 Fresh Holes Rd
M
Property Address
Franklin Credit Union (Contact Karen Bates @ Cape Coastal Realty 1-508-221-4442)
Owner Owner's Name
information is required for Hyannis MA 02601 3-23-09
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
A. General Information
1. Inspector:
Shawn Mcelroy
Name of Inspector
Upper Cape Septic Services
Company Name
29 Atwater Dr
Company Address
E. Falmouth MA 02536
City/Town State Zip Code
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 Fu r Ev uatio y the Local Approving Authority
3-30-09
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.
Ll � /0 �
t5insp official document-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM 17-19 Fresh Holes Rd
Property Address
Franklin Credit Union (Contact Karen Bates @ Cape Coastal'Realty 1-508-221-4442)-
Owner Owner's Name
information is required for Hyannis MA 02601 3-23-09
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ 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 structu'rally'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 breakout 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
• t • pass inspection if(with approval of Board of Health):'
❑ broken pipe(s) are replaced
❑ obstruction is removed
t5insp official document-03/08 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not-for Voluntary Assessments
M
17-19 Fresh Holes Rd
Property Address
Franklin Credit Union (Contact Karen Bates @ Cape Coastal Realty 1-508-221-4442)
Owner Owner's Name
information is required for Hyannis MA 02601 3-23-09
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.
t5insp official document•03108 Trite 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
K�_
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 17-19 Fresh Holes Rd
Property Address
Franklin Credit Union (Contact Karen Bates.@ Cape Coastal Realty.1-508-221-4442)
Owner Owner's Name
information is H required for annis MA 02601 3-23-09
—�
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to.All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
® ❑ Backup of sewage into facility or system component due to overloaded or
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 '/ day flow
® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
w„ 17-19 Fresh Holes Rd
Property Address
Franklin Credit Union (Contact Karen Bates @ Cape Coastal Realty 1-508-221-4442)
Owner Owner's Name
information is required for Hyannis i MA 02601 3-23-09
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.)
EJ
® 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.
t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
w 17-19 Fresh Holes Rd
Property Address
Franklin Credit Union (Contact Karen Bates .@ Cape Coastal Realty 1-508-221-4442)
Owner Owner's Name
information is required for Hyannis MA 02601 3-23-09
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes"or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example,a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp official document•0=8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15
Commonwealth of Massachusetts
Title 5 Official ,inspection - Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
17-19 Fresh Holes Rd
Property Address
Franklin.Credit Union (Contact Karen Bates.@ Cape Coastal'Realty 1-508-221-4442)
Owner Owner's Name
information is -
required for Hyannis -. MA 02601 3-23-09.
every page. City/Town. State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions: I
Number of bedrooms(design): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 440
Number of current residents: `s. r 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 ears usage d 453gpd/2yrs
9 ( Y 9 (gpd)): -
Sump pump? ❑ Yes ® No
Last date of occupancy: _ 2-09
Date
Commerciallindustrial Flow Conditions:
Type of Establishment: :.t,
Design,flow(based on 310,CMR>15.203). Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? El 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):
t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15
Commonwealth of Massachusetts - +
W Title 5 Official .Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1-
17-19 Fresh Holes Rd
' M
Property Address r
Franklin Credit Union (Contact Karen Bates•@ Cape Coastal Realty 1-508-221-4442)
Owner' Owner's Name
information is required for Hyannis MA 02601 3-23-09
every page. City/Town + State Zip Code Date of Inspection
D. System Information (cont_) ,
General Information
Pumping Records:
N/A
Source.of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons,
How was quantity pumped determined?
Reason for pumping:
I
Type of System:
® Septic tank, distribution box, soil absorption system
+. ❑ Single cesspool
❑ Overflow cesspool
❑ Privy t.
❑ 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:
1997
Were sewage odors detected when arriving at the site? ❑ Yes ® No
t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
17-19 Fresh Holes Rd
Property Address
Franklin Credit Union (Contact Karen Bates @ Cape Coastal Realty 1-508-221-4442)
Owner Owner's Name
information is required for Hyannis MA 02601 3-23-09 .
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
Depth below grade: 36"
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: 30"
feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
--------------------------------------------------------------------------------------------------------------------------
Dimensions:
1500 Gal
Sludge depth:
y 24"
Distance from top of sludge to bottom of outlet tee or baffle 8
Scum thickness 12
Distance from top of scum to top of outlet tee or baffle 2
• Distance from bottom of scum to bottom of outlet tee or baffle 3"
How were dimensions determined? Tape
t5insp official document•03M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
C�
M 17-19 Fresh Holes Rd
Property Address
Franklin Credit Union (Contact Karen Bates @ Cape Coastal Realty 1-508-221-4442)
Owner Owner's Name
information is Hyannis MA 02601 3-23-09
required for H y I
every page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank is in need of pumping for solids. Outlet baffle is missing. Tank is in good condition with no sign
of leakage.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of.scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping:
Date
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 ofinspection)(locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
t5insp official document•0=8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
17-19 Fresh Holes Rd
Property Address
Franklin Credit Union (Contact Karen Bates @ Cape Coastal Realty 1-508-221-4442)
Owner Owner's Name
information is
required for Hyannis MA 02601 3-23-09
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank (cont.)
r r• c i
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 Stain line above outlet invert.
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D-box is in bad condition and crumbling and in need of replacement.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes; ❑ No
Alarms in working order: ❑ Yes ❑ No
I
t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15
Commonwealth of Massachusetts r
Title 5 Official Inspection Form
Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments
M 17-19 Fresh Holes Rd
Property Address
Franklin Credit Union (Contact Karen Bates @ Cape Coastal Realty 1-508-221-4442)
Owner Owner's Name
information is Hyannis MA 02601 3-23-09
required for H y j
every page. City/Town State Zip Code Date of Inspection
D. System Information (cant.)
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS)(locate on site plan, excavation not required):.
If SAS not located, explain why:
Type:
❑ leaching pits number:
® leaching chambers number: 6-infiltrators
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Iq
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leach field has signs of failure with back-up into d-box and surrounding stone.
t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15
Commonwealth of Massachusetts
Title 5 OfficialInspection..Fo:rm
Subsurface Sewage Disposal System Form =Not for•Voluntary'Assessments
17-19 Fresh Holes Rd
Property Address
Franklin,Credit Union (Contact Karen Bates @ Cape'Coastal Realty 1-508-221=4442)
Owner Owner's Name
information is Hyannis
required for +t '. MA 02601 3-23-09 -
every page. City/Town i State Zip Code Date of Inspection
D. System Information (cont.)
r 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.):
t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal Systern Form -Not for Voluntary Assessments,
17-19 Fresh Holes Rd
Property Address
Franklin Credit Union '(Contact Karen Bates.@ Cape-Coastal'Realty 1-508-221-4442)
Owner Owner's Name
information is required for Hyannis MA 02601 3-23-09
every page. City/Town State Zip Code Date of Inspection
D. System Information (cone)
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. '
6ctc� I
/ 4
L
p D
0
I-
0 ;
A- 9-F- 5Y '
t5lnsp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systerr•Page 14 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
17-19 Fresh Holes Rd
Property Address
Franklin Credit Union (Contact Karen Bates @ Cape Coastal Realty 1-508-221-4442)
Owner Owner's Name
information is required for Hyannis MA 02601 3-23-09
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: 12'
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed:
Date
® Observed site(abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
® Checked with local excavators, installers- (attach documentation)
® Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
Original design plans show groundwater at greater than 12'.
t5insp official document•03108 Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System-Page 15 of 15
Town ofBarnstable Barnstable
%Y Regulatory Services DepartmentBARNWABM
9� "AW
9, ,0� Public Health Division
ArFDh11D,�p 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geder,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL# 70081830000205008468
4/15/2009
Franklin Credit Union
c/o Karen Bates, Cape Coastal Realty
4 Barlows Landing Suite 1
Pocasset, MA 02559
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The'septic system'located at-17-19 Fresh Holes Road Hyannis,MA was last inspected
on March`30;,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 M'cK6ari;�.-R°:S'.;CHO
Agenf.of-tlie Board"of Health
Town of Barnstable Barnstable
Regulatory Services Department !ericaC4
BARM.Traot.e, I I
MASS. ON
i679• Public Health Division
�O �0
Arf0 MAt 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHd
February 5, 2008 00FT
Thomas & Jennifer Rooney
59 Norwell Avenue 1
Scituate, MA 02066
As of October 1, 2006 a new rental registration ordinance was put into affect
requiring all property owners of rental units to register their rental units with the Town of
Barnstable Health Division. According to our records, you own the rental property at
17/19 Fresh Holes Road, Hyannis.
Enclosed are applications. Please use a separate application for each rental unit
you own. Should you need more applications, they are available online at
www.town.barnstable.ma.us. Go to the Health Division page by looking in the
Department Menu. There is a link to the Rental Registration information on the Health
Division page. You may print out as many as you need, and return them to the Health
Division with the appropriate 2008 fees included.
Failure to comply with this ordinance may result in the issuance of a non-criminal
ticket citation in the amount of$100. Each day of non-compliance is considered a
separate offense.
Should you have any questions, please feel free to call 508-862-4644. Thank you
in advance for your cooperation.
CERTIFIED MAIL # 7006 2150 0002 1038 6520
JALetter to Homeowner to Register.doc
No. / 7 ` "`"r Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION !-TOWN OF BARNSTABLE., MASSACHUSETTS
Zipplication for Mitpozal *pgtem Construction Permit `
Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor's Map/ParcelSa-
V��GtJ i
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building: /
Dwelling No.of Bedrooms L Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.'of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank % S6V Type of S.A.S. -77'kwt_—,L Tr t7-6 W--S
Description of Soil ✓k C 0 SW
Nature of Repairs or Alterations(Answer when applicable)
Lt.64 Gi c,,/ 4 srav Q_-
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued b this lth.
Signed Date 17
Application Approved by. Date
Application Disapproved for the following reasons
Permit No. -1 l (p Fi Date Issued
TOWN OF BARNSTABLE
:LOCATIONS
SE WAGE #
VILLAGE
ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO,
SEPTIC TANK CAPACITY�� „
LEACHING FACILITY:(type)
(size) 1,✓, Csr
NO. OF BEDROOMS—y--PRIVATE WELL OR PUBLIC WATER Ci,,Ii./c
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes
No
o YY
No. ....— Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ZIpprication for Migoga[ *pgtem Congtruction Permit
Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) O Complete System O Individual Components
Location Address or Lot No. 1-1 F�-CS1N e tz(? Owner's Name,Address and Tel.No.
Assessor'sMap/Parcel �ya_ Sep- Olt woG(tic
L-k-1-w i(_
Installer's Name;Address,and Tel.No. Designer's Name,Address and Tel.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 1140 gallons per day. Calculated daily flow Y&' gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank / S_6V Type of S.A.S. 47*P-f--,4— T",t 7`6 1e-�
Description of Soil yi1 F 6 SA"^
1 "1'ogs..Vz
Nature of Repairs or Alterations(Answer when applicable)�llD 5 D t C.� Q" 6 oy_ o ►� S n s ,/ V
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until.arertifi-
cate of Compliance has been issued by this B• d oLH alth.
Signed Date
Application Approved by - Date
Application Disapproved for the following reasons
I
Permit No. �'1 "� _ / G, Date Issued
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (tompriance
k THIS IS TO CER�Y, that the 011 * e Sewage Disposal System Constructed ( )Repaired ( )Upgraded (P-i
Abandoned( )by yy —C yk-P- S F_k-A t C
at 1'-7--t- 1 S has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. l t dated Y ` S — 9 7 .
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date Inspector
7
------------------------------------- - -
No. % 7- 1606 Fee SU
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Migpogaf *pgtem (Congtruction Permit
i Permission is hereby granted to Construct( )Repair( Upgrade( )Abandon( )
52
System located at T °1 ✓ h ��U�e K�
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Constructions must be completed within three years of the date of this permit.
Date: Approved by '/41
:Y
NOTICE: This I+��rm ;is t"o Uc'usal for the Repair of Failed
Septic Systems Only
CCIt I IFICA TION OF SKC'TCII ANU APPLICATION FOR A DILnOSAL
W0 1ZICS CONSTRUCTION I'lgzml,I' (wluiOU r DESIGNED
[,
,hereby certify that the application for disposal works
construction permit signed by the dated
4—ci 7 , concerning the
property located at /7�-1 e7 ���5k1 hd�r�°� — meets all of the
following criteria:
• There are no wetlands within 300 feet of the proposed septic system
• There are no private wells within 150 feet of the proposed septic system
• The observed groundwater table is 14 feet or greater below the bottom of the leaching facility
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
NEU : DATE:
SIG
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
[Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan,
this plan should be submitted].
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