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HomeMy WebLinkAbout0006 HIRAMAR ROAD - Health 8 ' 'in Ku� , � Y I NNIS _ 145 `__.. 292 � s ;. TOWN OF BARNSTABLE LOCATION U h' f 16 M SEWAGE# VILLAGE � � ASSSESSOR'S MAP&PARCEL /NAP-Fe oR ✓7 �� (�%/�Co 1149TA-b�S NAME&PHONE NO. SEPTIC TANK CAPACITY -s� ��� /�5.4 T/ LEACHING FACILITY: (type), (size) NO. OF BEDROOMS OWNER PERMff DATE: COMPLIANCE DATE: i Separation Distance Between the: Maximum Adjusted Groundwater Table ty 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 � � � w �_ 4 . . � o 9 ". e 7 i \ �_`A- �. ®� / � ,� f YOU WISH TO OPEN A BUSINESS? 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 does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 36.7 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE:QZk161 6zl b Fill in please: APPLICANT'S YOUR NAME/S: SO - �' � BUSINESS YOUR HOME ADDRESS: (ram N tR-An�l �. 2� , i-1YF1r�Jry�S M © �( " TELEPHONE # Home Telephone Number MIS 2_: cS S 1 NAME OF CORPORATION: 3 ru NAME OF NEW BUSINESS TYPE OF BUSINESS 3�)eRa S�(r IS THIS A HOME OCCUPATION? YES NO - ADDRESS OF BUSINESS MAP/PARCEL NUMBER Z _G3�� (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. BUILDING COMMISSIONER'p OFFICE ' MUST COMPLY WITH HOME OCCUPATION This individual has been ' for of any er requirements that pertain to this type of business.RULES AND REGULATIONS. FAILURE"TO COMP .Y MAY RESULT IN FINES. uthorized Si a ur COMMENTS: vim- a 2. BOARD OF HEALTH This individual has been informe of rmit requirements that pertain to this type of business. MUST"COMPLYWITH ALL HAZARDOUS MATERIALS REGULATIONS Authorized Signature COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: TOWN OF BARNSTABLE Date O TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: �rGT�I S 1� i�J,k n BUSINESS LOCATION: _ran r.,h n Avc Oy6d 1 QZ ®I INVENTORY MAILING ADDRESS: S ne TOTAL AMOUNT: TELEPHONE NUMBER: O 3�5 — ©S S --)- CONTACT PERSON: �a Z EMERGENCY CONTACT TEL PHONE NUMBER: �SC3O 14 b&- �-45 Z MSDS ON SITE? TYPE OF BUSINESS: '-pa6 V')-�1 /,a ns CCA Y-N INFORMATION / RECOMMENDATIO S: 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 1 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 ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Photochemicals (Fixers)5 Gasoline,.Jet fuel,Aviation gas Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) 1 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 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 6-8 Hiramar Road Property Address Andrew Lindera Owner Owner's Name information is Hyannis MA 02601 February 7 2013 required for every Y ry page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not David D. Cou hanowr R.S. 11U� use the return Name of Inspector key. Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 Cityrrown State Zip Code 508 364-0894 1328 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 � ;E ❑ Conditionally Passes ❑ Fads ❑ Needs Further Evaluation by the Local Approving Authority . February 7, 2013 Inspector's Signature Date rx� rn 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. b I 19 1- I� t5ins-11/10 Title 5 Official Inspect o F r Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6-8 Hiramar Road Property Address Andrew Lindera Owner Owner's Name information is Hyannis MA 02601 February 7 2013 required for every y ry 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: Inspector's Note==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4-5. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. Inspector was unabe to access inside of building at time of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally t 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. ft. *A metal septic tank will pass inspection if:it is structurally sound, not leaking,and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. . ❑ Y ❑ N ❑ ND (Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 'Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM ' 6-8 Hiramar Road Property Address Andrew Lindera Owner Owner's Name information is Hyannis MA 02601 February 7 2013 required for every y ry page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 6-8 Hiramar Road Property Address Andrew Lindera Owner Owner's Name information is Hyannis MA 02601 February 7 2013 required for every y ry page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from,a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I \ Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6-8 Hiramar Road Property Address Andrew Lindera Owner Owner's Name information is Hyannis MA 02601 February 7, 2013 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis:[This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ 0 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. l 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 ❑ El system is within 400 feet of a surface drinking water supply .❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ E] the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 6-8 Hiramar Road M Property Address Andrew Lindera Owner Owner's Name information is Hyannis MA 02601 February 7 2013 required for every y ry + 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? ® El Were all system components, excluding the SAS, located on site? E ❑ 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? ® T] Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® :❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6-8 Hiramar Road Property Address Andrew Lindera Owner Owner's Name information is Hyannis MA 02601 February 7, 2013 required for every - Y rY page. Cityrrown State Zip Code Date of Inspection D. System Information Description: ' Number of current residents: 2 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 247 gpd 9 ( Y 9 (gpd)): Detail: 2011, 2012 - both units Sump pump? ❑ Yes ❑ No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 6-8 Hiramar Road Property Address Andrew Lindera Owner Owner's Name information is Hyannis MA 02601 February 7 2013 required for every y rY page. City/Town State Zip Code a Date of Inspection D. System Information (cont.) i Last date of occupancy/use: Dater Other(describe below): I i General Information Pumping Records: Source of information: agent 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 El 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): l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 6-8 Hiramar Road Property Address Andrew Lindera Owner Owner's Name information is required for every Hyannis' MA 02601 February 7, 2013 page. City/Town ` State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed'(if known) and source of information: Age: 12+ years. Certificate of Compliance issued 3/30/2000. (permit#2000-189). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 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.): Sewer lines are under slab and not accessible for inspection. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) if tank is metal,list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5 x 5 x 6- 1500 gallon tank Sludge depth: 6 in l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 117 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 6-8 Hiramar Road Property Address Andrew Lindera Owner Owner's Name information is Hyannis MA 02601 February 7 2013 required for every y rY page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28 in Scum thickness 4 in Distance from top of scum to top of outlet tee or baffle 8 in Distance from bottom of scum to bottom of outlet tee or baffle 12 in How were dimensions determined? Disposal Works permit Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Maintenance pumping is recommended within 2 years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 6-8 Hiramar Road Property Address Andrew Lindera Owner Owner's Name information is Hyannis x MA 02601 February 7 2013 required for every ry page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level.' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): III "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 6-8 Hiramar Road Property Address Andrew Lindera Owner Owner's Name information is required for every Hyannis MA 02601 February 7, 2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at outlet inverts 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 appears structurally sound and functioning as intended. No evidence of leakage in or out was observed. Some solids in sump. A bucket of water was poured into the distribution box and was observed to pass through in a rapid and unobstructed manner and could be heard splashing down into the SAS. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 6-8 Hiramar Road Property Address Andrew Lindera Owner Owner's Name information is required for every Hyannis MA 02601 February 7, 2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 2 ❑ 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.): Soils above leaching galleries appear unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. A bucket of water was poured into the distribution box and was observed to pass through in a rapid and unobstructed manner and could be heard splashing down into the SAS. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 6 Commonwealth of Massachusetts W Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments <c 6-8 Hiramar Road Property Address Andrew Lindera Owner Owner's Name information is MA 02601 required for every Hyannis February 7, 2013 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 _ Commonwealth of Massachusetts° Ti_t'le Official Inspection Form �, Su6surface�Sewage Disposal<S`yst'em:Form-=Not for Voluntary Assessments;: 6 8,sHirdthb-tRoad`:_ Property Address,, - Andrew Lrndera_ - . Owners-tVame` - information Is [egw�ed`foreye.ry Hyannis MA,.. 02601 February 7,,201;3 page. cityffown State; Zip Code Date'offnspecton D, Sys#em 'li~ forma#ionG (cone-:) Sketch Of Sewage'Disposal:System: Proiiide awiew of`the.sewage disposal system,lncluding fies to at leasYtwo permanent reference landmarks or benchmarks Locate all`wells:within f, feet '.Locate where pubUc water supply enters?the building: Check one;of the boxes below .. _Y . hand sketch rn the;area t%elow drawing attached separately 3 All 90 Sox 4 jr, IT� l5in's•1.1+11.10. The 5 Oifival'Inspec6omForm Sutisudace Sewage D(sposal Syslem=Page 15 0117' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments O w it r M 6-8 H ama Road Property Address Andrew Lindera Owner Owner's Name information is Hyannis MA 02601 February 7 2013 required for every ry page. Cityrrown 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: 15+ 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: Previous inspection report ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: - You must describe how you established the high ground water elevation: Previous inspection report indicates high groundwater is more than 15 feet below the surface. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r. 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •'' 6-8 Hiramar Road Property Address Andrew Lindera Owner Owner's Name information is Hyannis MA 02601 February 7, 2013 required for every Y rY page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 f COMMONWEALTH OF MASSACHUSETTS a Title 5 Official Inspection Form Not for Voluntary Assessments y0 . Subsurface Sewage Disposal System Form Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Property Information: MAP 292—PARC 145 6 & 8 HIRAMIR ROAD - HYANNIS, .MA 02601 p a" Property Address LINDERA, ANDREW Owner's Name 6 & 8 HIRAMIR ROAD Owner's Address HYANNIS MA 02601 City/Town State Zip Code OCROBER 13, 2006 Date 2. Inspector: JAMES D. SEARS Name of Inspector A & B CANCO Company Name 350 MAIN STREET Company Address WEST YARMOUTH MA 02673 City/Town State Zip Code 508-775-2800 Telephone Number =-ti B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported �'µ1 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. 1 am a DEP appri4ved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000). The System: •c). ® Passes ® Conditionally Passes ❑ FailsNje j c � eds Further Evaluation by e Local Approving Authority ector'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. I ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page I of 16 COMMONWEALTH OF MASSACHUSETTS W Title 5 Official Inspection Form 7 C Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. Certification (cont.) 6 & 8 HIRAMIR ROAD Owner's Address HYAN N I S MA 02601 City/Town State Zip Code LINDERA, ANDREW Owner's Name OCTOBER 13, 2006 Date of inspection 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: N/A 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: Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 COMMONWEALTH OF MASSACHUSETTS Y Title 5 Official Inspection Form 9 C Not for Voluntary Assessments �v Subsurface Sewage Disposal System Form B. Certification (cont.) 6 & 8 HIRAMIR ROAD Owner's Address HYAN N IS MA 02601 City/Town State Zip Code LINDERA, ANDREW Owner's Name OCTOBER 13, 2006 Date of inspection B) System Conditionally Passes (cont.): N/A ® Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ® broken pipe(s)are replaced ® obstruction is removed distribution box is leveled or replaced ND Explain: ® The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ® broken pipe(s)are replaced I ® obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: N/A 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 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 COMMONWEALTH OF MASSACHUSETTS w Title 5 Official Inspection Form 9 C Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 6 & 8 HIRAMIR ROAD Owner's Address HYAN N I S MA 02601 City/Town State Zip Code LINDERA, ANDREW Owner's Name OCTOBER 13, 2006 Date of inspection C) Further evaluation is required by the Board of Health (cont.): N/A 2.System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health,safety and environment: ® The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ® The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ® The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well" Method used to determine distance: "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less that 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: I Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments ^M Jeo Subsurface Sewage Disposal System Form B. Certification (cont.) 6 & 8 HIRAMIR ROAD Owner's Address HYANNIS MA 02601 City/Town State Zip Code LINDERA, ANDREW Owner's Name OCTOBER 13, 2006 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 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 leaching is less than 6" below invert or available volume is less than '/z day flow ® ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: . ® ® Any portion of the SAS, cesspool or privy is below high ground surface water elevation. ® N/A Any portion of cesspool or privy is within 100 feet of a surface water supply ortributary to a surface water supply. ® r N/A Any portion of a cesspool or privy is within a Zone 1 of a public well. ® N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. N/A 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.] YES No The system is a cesspool serving a facility with a design flow of 2000 gpd—10,000 gpd. Yes No ® ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 COMMONWEALTH OF MASSACHUSETTS n Title 5 Official Inspection Form d Not for Voluntary Assessments p1 Je. Subsurface Sewage Disposal System Form B. Certification (cont.) 6 & 8 HIRAMIR ROAD Property Address HYAN N I S MA 02601 City/Town State Zip Code LINDERA, ANDREW Owner's Name OCTOBER 13, 2006 Date of inspection 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: N/A 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. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Checklist 6 HIRAMIR ROAD Property Address WEST YARMOUTH MA 02601 City/Town State Zip Code LINDERA, ANDREW Owner's Name OCTOBER 13, 2006 Date of inspection 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? ® Q 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, including 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)]. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 COMMONWEALTH OF MASSACHUSETTS a w Title 5 Official Inspection Form i 7 tl Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information 6 & 8 HIRIMAR ROAD Property Address HYAN N IS MA 02601 City/Town State Zip Code LINDERA, ANDREW Owner's Name OCTOBER 13, 2006 Date of inspection Residential Flow Conditions: ✓ Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Number of current residents: N/A Does residence have a garbage grinder? ® Yes 0 No Is laundry on a separate sewage system?[if yes separate inspection is required] ❑ Yes NA Laundry system inspected? ❑ Yes NA Seasonaluse? ® Yes Q No Water meter readings, if available(last 2 years usage(gpd)): N/A Sump pump? ® Yes No Last date of occupancy: UNKNOWN Commercial/Industrial Flow Conditions: N/A Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.) Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ® Yes ® No Non-sanitary waste discharged to the Title 5 system? ® Yes ® No Water meter readings if available: Last date of occupancy/use: Date Other(describe): Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 COMMONWEALTH OF MASSACHUSETTS v Title 5 Official Inspection Form r Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 6 & 8 HIRAMIR ROAD Property Address HYAN N I S MA 02601 City/Town State Zip Code LINDERA, ANDREW OWNERS NAME OCTOBER 13, 2006 Date of inspection General Information Pumping Records: ✓ Source of Information: N/A Was system pumped as part of the inspection? ❑ Yes 0 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) ® Tight tank. Attach a copy of the DEP approval. Other(describe): Approximate age of all components, date installed(if known)and source of information: 2002 Were sewage odors detected when arriving at the site? ® Yes No Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 COMMONWEALTH OF MASSACHUSETTS A Title 5 Official Inspection Form d Not for Voluntary Assessments VBv` Subsurface Sewage Disposal System Form D. System Information (cont.) 6 & 8 HIRAMIR ROAD Property Address HYANNIS MA 02601 City/Town State Zip Code LINDERA, ANDREW Owner's Name OCTOBER 13, 2006 Date of inspection Building Sewer(locate on site plan): ✓ Depth below grade: 8" feet Material of construction: ® cast iron [3 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 - CLEAN Septic Tank(locate on site plan): ✓ Depth below grade: 101, feet Material of construction: 0 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) El Yes No -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Dimensions: 1500-GAL PRE CAST Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 18" Scum Thickness 3" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? ASBUILT, TAPE&SLUDGE JUDGE Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 COMMONWEALTH OF MASSACHUSETTS r Title 5 Official Inspection Form d Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 6 & 8 HIRAMIR ROAD Property Address HYAN N IS MA 02601 City/Town State Zip Code LINDERA, ANDREW Owner's Name OCTOBER 13, 2006 Date of inspection 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 AT WORKING LEVEL, TANK & COVERS AT 10". INLET TEE — OUTLET TEE. NO SIGN OF OVERLOADING OR LEAKAGE. Grease Trap (locate on site plan): N/A Depth below grade: feet Material of construction: EDconcrete ❑ 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): N/A Depth below grade: Material of construction: ® concrete ® metal ® fiberglass ® polyethylene ® other(explain) Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 1 COMMONWEALTH OF MASSACHUSETTS u Title 5 official Inspection Form d Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 6 & 8 HIRAMIR ROAD Property Address HYANNIS MA 02601 City/Town State Zip Code' LINDERA, ANDREW Owner's Name OCTOBER 13, 2006 Date of inspection Tight or Holding Tank (cont.) N/A 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 a 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 14" 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 16"X 16"- 14" BELOW GRADE, ONE LINE IN -TWO LINES OUT. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. Pump Chamber(locate on site plan): N/A Pumps in working order: ® Yes No Alarms in working order: ® Yes ❑ No Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form e� Not for Voluntary Assessments 41 Vey. Subsurface Sewage Disposal System Form D. System Information (cont.) 6 & 8 HIRAMIR ROAD Property Address HYANNIS MA 02601 City/Town State Zip Code LINDERA, ANDREW Owner's Name OCTOBER 13, 2006 Date of inspection 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: 5 ® 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.)- LEACHING IS FIVE (5) INFILTRATORS. CHECKED LEACHING WITH CAMERA, NO SIGN OF OVERLOADING OR SOLID CARRY OVER. LEACHING UNDER BLACK TOP PARKING LOT. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 COMMONWEALTH OF MASSACHUSETTS r Title 5 Official Inspection Form a e` Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 6 & 8 HIRAMIR ROAD Property Address HYAN N I S MA 02601 City/Town State Zip Code LINDERA, ANDREW Owner's Name OCTOBER 13, 2006 Date of inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): N/A 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, damp soil, condition of vegetation, etc.)-. Privy (locate on site plan): N/A Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): COMMONWEALTH OF MASSACHUSETTS 4 Title 5 Official Inspection Form 0 Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 6 & 8 HIRAMIR ROAD Property Address HYANNIS MA 02601 City/Town State Zip Code LINDERA, ANDREW Owner's Name OCTOBER 13, 2006 Date of inspection 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. 3 � c y I 1 S i i Title 5 Official Inspecu,n Form �uhsurcux Sewage Disposal SY tom Pwe 1 or 16 COMMONWEALTH OF MASSACHUSETTS tl Title 5 Official Inspection Form o` Not for Voluntary Assessments Subsurface Sewage Disposal System Form + 1 D. System Information (cont.) 6 & 8 HIRAMIR ROAD Property Address HYAN N IS MA 02601 City/Town State Zip Code LINDERA, ANDREW Owner's Name OCTOBER 13, 2006 Date of inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to NO ground water: 15' 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: GROUND WATER OFF PLAN 15' NO WATER. BOTTOM LEACHING AT 3' BELOW GRADE. t .,.M..e.., '^,roti�...,.,{3�z'+*,.�...:^`•�•�.,,.r•+^ -+r'.r"....� i.n,�p..«f..y.r�.r,,,,n^7'kr's:"r`u '�f,,+r,A�"-.�n`yfTN>^s.�-!rr,r+�.,srq'ri.^^+vn�ari;.'+.,�Aro 'e+a ..r` +w.t+:rti'±.'��.�.r.. TOWN OF .BARNSTABLE sit-W 5264 Ordinance or Regulation WARNING NOTICE G� � dobName of Offender/ManagerP �J�,..) � � R&AMA MA PAddress of Offender 69 J A (L,- f j-.I P6 MV/MB Reg.# Al7: Village/State/Zip A( �� P4 � 6 �� / r v ., Business NamePm. .o 120(.� Business Address S 'nature of Epnforc �ng, Offices"r Village/State/Zip J An Location of Offense �O _ J �! il(/Ill !( J r � � � J E orcing Dept/Division Offense I-SA 0-C l A'fl /�! 1 Facts UYMY p OP lbl-pyn V Or This will serve only as a wa ning. jAt .this time ri.© 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. ".""� •-4- ,..,-.w..,, •Yr.--.� .-_�-.-,...... nr:�>-. -.+i.r-^.,;t-•�,.,.,�ny_ •.,..rr�ys.K+ierra...R+i,,.rk.-,-.,..:-�7.,,..•^-.!'R.:+"!-r,,.....es.;y.,,."-r.�.z..r...-,�,nR-,..w .r<^3, _ TOWN OF BARNSTABLE BAR-W Ordinance or Regulation `" WARNING NOTICE Name of Offender/Mans errrrI A t O� / Address of Offender A lC,._ i .MV- MB ,Re Village/State/Zip N V A Al Al I ()9*�_/ Business Name6?m on �/ 20.L_er Business Address s{ r�WAlt- Signature of/Rfiforb ng` Officer' M Village/State/Zip Location of Offense Enforcing Dept%Division Offense 1�# .`>1 t lC •1 )Le f_A Facts i� /Y� 4 / �1 � (_,. ► . �/ T �`! �( " ,,( r,!��, t)(�,f 01A01 Al OP �Gv' �� o Yn fn&v ar /n� 1V/iV46- This will serve"only as a warning. tAt 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. rw TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE ; d ^ , tt Name of Of f ender/Manager, f : / ' . ,, r r' _, { Address of Offender '" t=' �a I i e f f MV/MB Reg.# f Village/State/Zip ; r1i ,{_ .w..,. .- �/ Business Name am/pm one ' 1 --?120r/ Business Address Signature of(Enforcing Officer Village/State/Zip ` -- Location of Offense r ' i Enforcing Dept/Division Offense1 Facts Vro:,�, f r��`'! ; I re ti �� / ��� � , /` f•` � ��a ,r '�J e '��- 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. Health Complaints 14-Sep-04 Time: 9:18:00 AM Date: 9/13/2004 Complaint Number: 17715 Referred To: DONNA MIORANDI Taken By: DENISE WITTER Complaint Type: GENERAL Article X Detail: ILLEGAL OPERATIONS Business Name: Number: Street: Hiramar Rd Village: HYANNIS Assessors Map_Parcel: Complainant's Name: 4 Address: Telephone Number: r Complaint Description: Caller said most of the duplexes have 6-10 people living in them. The duplexes in question are numbers: 5&7; 4; 8&10; 12; 17&19; 25&27; and a yellow house that the caller is not sure of number but its at the end of the street closest to Bearse's Way. The person in#5 is running a hair salon and building dept has already been notified. Caller said there is trash from these houses and it blows around the neighborhood and ends up in caller's yard. Actions Taken/Results: DZM responded and spent the morning going around to all these houses. Issued a couple of warning to occupants not knowing the owners at the time and the tenants claim to"no speak English" Issued a warning to#12 and#6 Hiramar and ran out of warning notices. DZM returned at 4:30 pm and#9 &#11 as well as #13 &#15 were all cleaned up Shall send out warnings and/or tickets to#5 &#7 that are loaded with trash in the rear. #27 has mattresses in the rear. Investigation Date: 9/13/2004 Investigation Time: 10:30:00 AM 1 TOWN OF BARNSTABLE �a O LOCATION _d 14-i g A M-4 K Vd SEWAGE # - VILLAGE h V-X i S ASSESSOR'S MAP&LO INSTALLER'S NAME&PHONE NO. 5c.6`Tr F Q AM*1r-- 7'r 5 - ��9 SEPTIC TANK CAPACITY 5-202 LEACHING FACILITY: (type) i�i�IM 9W UF-/(AKL ze)W`1-h 11 W'NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: 3-3 - o COMPLIANCE DATE: 3 --3 G - 60 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 e Ri°o`er _ % Jt. -� �i `•ty � 5 No.2 sn--y- ''" �✓ ` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1 Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppCication for �Digogal *pgtem Congtruction Vermtt Application for a Permit to Construct( )Repair(). )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (R_ ne 's Nam ddress and Tel No Assessor's Map/Parcel �✓ / y w 1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel. o. a 71 9,'t - S-DcCX 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S.71A Qt1l3t'r1110E3� Description of Soil Nature of Repai or Alterations(Answer when applicable) "N tk w cc rYr or + /t/ 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 EnvirqWental Code and not to place the system in operation until a Certifi- cate of Compliance has bee ' ued by thi oard of Signed Date a d Application Approved by - t� Date' s Application Disapproved for the following reasons Permit No. _ l Date Issued Fee ✓ v �f� G THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: NZ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01pprication for ;igpoml 6pgtem Construction Permit Application for a Permit to Construct( )Repair(�//)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (_ V �� r�/�!1 G�f (Z (� ptner's Nam ddress and Tel No I� Assessor'sMap/Parcel Installer's Name,Address,and T No.el. Designer's Name,Address and Tel.No. o k a �► P;� "s l ! 77S S--D C1 CX QD Type of Building: i Dwelling No.!of Bedrooms�_ Lot Size sq.ft. Garbage Grinder V v Y Other Type of Building No.o Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow # gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title i Size of Septic Tank - Type of S.A.S. Description of Soil: -E c Nature of Repai or,,pilterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore de bed on-site sewage disposal system in accordance with the provisions of Title 5 of the EnvirqWental Code and not to place the system in operation until a Cert fi- cate of Compliance has bee ued by thi oard of Signed / Date O ApplicaCi'on Approved byt ' Date 3 Application Disapproved;for the following reasons Permit No.-,2 Ga..-� _ s�'3 Date Issued a- ---------------------------------------- -------------------------------------- - THE,COMMbN'VUE`ALI 6F,MASS•ACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of compliance THIS IS TO CERTIFY, that the On-site Sewage D' posal System Constructed( )Repaired(�Upgraded( ) Abandoned( )by -r� �,�C1 CC:��, '� / at� r-u'J"` d u\iG-^ t 1 has been constructed in accordance with the p vision of Title 5 and the for Disposal System Construction Permit TR.G�+� dated Installer U n^ �`�/' Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date ?, - r` - 110 fi Inspector h -------p--------------_ ---- ------------- Fee�!1 Fee 45 - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Dioozal *Pgtem Congtruction Permit Permission is hereby Fantedto Construct( )Repair(V )Upgrade( )Abandon( ) System located at GSM U.T and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of thit. Date: ��r� Approved b J 1/669 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AIND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, G rrin/�Vl� hereby ceniiy that the application for disposal works construction permit sinned by me dated V �a`3 (0 concerning the property located at 0-C ��C-UJ^W �() meets ail of the following criteria: _ Y -7 The failed system is tonne`ed to a residential dwelling only. There are no commercial or business uses associated with the dwelLng. The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. •/ There are no wetlands within 100 feet of the:proposed septic system •/There are no private wells within 1:0 feet of the proposed sepac's✓stem / —3 There is no increase in flow and/or change in use proposed , • There are no variances requested or needed. 3 7/The bottom of the proposed Leaching facliry,will fiat be located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] I • If the S.A.S. will be located with 2j0 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be Located less than founeea(14) feet above the maximum adjusted groundwater table elevation. Plesse complete the following: A) Too of Ground Surface Eievauon(using m CIS information) cl 1'0 B) G.W. Elevation Z]2• -the'vt-�.0 High G.W.Adjusunent .� D1F ERENCE BETWEEN a.and B SIGNED : DATE (Sketch pr000sed plan of system on backs. q:5ezl�h rower.c-t I l ����-� 0 X fb � � � �'� r=- � > t � � � � -_ o �� � G ._-. :�f������� � w�� t �. TOWN OF BARNSTABLE LOCATION "� + A�+�+ Z SEWAGE # VILLAGE ASSESSOR'S ASSESSOR'S MAP & LO - INSTALLER'S NAME&PHONE NO.. '7 5-- SEPTIC TANK CAPACITY qoa !' LEACHING FACILITY: (type) t4 jM � Uk ,((RNR�( ze)W '' I NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 3-t97- o J COMPLIANCE DATE: 73 -:3 v - Oo 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 I S • I LOT No. :_S6QN,,DREIS:_ 4 OWNERS NAME:SEWAGE PERMIT NO. : $t- Gt VNEW: REPAI DATE ISSUED: DATE INSTALLED. INSTALLERS NAME: 12A/,�Ti DU/ INSTALLATIOT; OF: WATER TABLE : FINAL INSPECTION BY: DRAWING OF INSTALLATION ON REVERSE SIDE : �C O �1 4 r TOWN OF BrARISiSTABLE LOCATION SEWAGE # .V 'VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: ICOMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by