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0299 OAKLAND ROAD - Health
299-0akiand;Road Hyannis. P 271- .091 V i i r I v -i TOWN OF BARNSTABLE ,,LOCATIONq � � �� SEWAGE # VILLAGE AN f )tt!& _ ASSESSOR'S AP & LOT � % -"T jjf INSTALLER'S NAME 6z PHONE NO.f 11 42 ` SEPTIC TANK CAPACITY �L LEACHING FACILITYAt o j � (size) NO. OF BEDROOMS PRIVATE WELL OR LIC WATER BUILDER ER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED• VARIANCE GRANTED: Yes No .ke 1/ 1 P IVN cP -rl � � ,1 it ►� 6` IrLinj N I cD Certified Mail Fee If I $ Extra Services&Fees(check box,add fee as approp ate.1- 1 ❑Retum Receipt(hardcopy) L`�'6'n O [}Return Receipt(electronic) fit$ �& ostmark C3 Certified Mail Restricted Deliveryl,$ V.�� �� Here O ❑Adult Signature'Required/(' $ r-1CAnIt.SinnatureR-trirte Oelivery_$� OERQUEIRA, N1A R,CtLO T� ui q P."O:BOX �1913 o # _�Fi`,YANNIS;,MA 0260tG>'� �' Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides _ for a specified period, delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders: Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®;First-Class Package Service®, available at retail). or Priority Mail®service, Adult signature restricted delivery service,which' ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age. international mail. �•, and provides delivery to the addressee specified ■Insurapce coverage is notavailable for purchase by name,or to the addressee's authorized agent 1-with Certified Mail service.However,the purchase (not available at retaiQ. of Cerfifled Mail service does not change the t ■To ensure that your Certified Mail receipt is f _+- insurance coverage automatically included with accepted as legal proof of mailing,it shoulg bear a j certain Priority Mail items: USPS postmark.if you would like a postmark on-r, ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this _ Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply • You Can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy retum receipt, mplete PS Form 3811,Domestic Return I itch PS Form 3811 to your mailpiece; IMPORTAM Save this—110ittor Year records -- - s(Reverse)PSN 7530-02-000.9047 COMPLETE • COMPLETE • ON DELIVERY. I ■ Completd if .1.*.2,and 3. A. Signa e ■ Print your". nd•address on the reverse X [I Agent so that we can rthe card to you. ---�❑Addressee B. R by(Printed Name) 11+1.tkbaie of Delivery ■ Attach this.'AnWthe back of the mailpiece, —,—or on the front-if soace perm-its. Idress;different from ite 118-SP Yes delivery addre to p No y.3 CERQPUOEI O MARCELO T X 1913 HYANNIS, MA 02601 y 4SeNdA� �v i - A�> (I I IIII�I I II I�I I�II II II IIII II I) III(I I�I(I I III 3. Service Type ❑Priority'ad M it ess§ II ❑Adult Signature �O Registered MailrM +!I �❑�Adult Signature Restricted Delivery 0 Registered Mail Restrictedy 9590 9402 5225 9122 7024 41 Certified Mail® slivery II (]Certified Ma l Restricted Delivery eturn Receipt for ❑Collect on Delivery Merchandise —�- T.nefer_from Bemice label). ❑Collect on Delivery Restricted Delivery Signature I firmationTM 7 015 I c( r K i I7'•j p a, _1nsured Mail ❑Signature Confirmation-,. 17 3 0'O 01 4 9 8 8 t 1 t?7 2 t t t 'ail Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return;Receipt First-Class Mail Postage&Fees Paid USPS Permit No.G-10 9590 9402 5225 9122 7024 41 i United States Sender:Please print your name,address,and ZIP+4®in this box* Postal Service Town of Barnstable O Health Division ` .o 200 Main Street Hyannis,MA 02601 I .�_ _ } 1J11��'i1+1111rf1l;jiijljjlllllill�Il��ll7�,itl: ljljl 'i�llt Town of Barnstable Inspectional Services MASS Public Health Division ses9•Mpt 200 Main Street, Hyannis MA 02601 D l� Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO FINAL NOTICE CERTIFIED MAIL#7015 1730 0001 4988 1272 August 16, 2019, CERQUEIRA, MARCELO T P.O. BOX 1913 HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 299 Oakland Road, Hyannis, MA was inspected on 03/15/2017 by Jason Haskell, a certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You were originally ordered to repair or replace the septic system before March 30, 2018. However, this system was not repaired or replaced as ordered. You are ordered to repair or replace the system within 6 months. <, o Failure to repair/replace the septic system within six month period will result in scheduling this issue before the Board of Health at a public meeting. PER ORDER OF TH BOARD OF HEALTH limas° cKean, R.S.; CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\299 Oakland Road Hyannis Final Notice BOH.doc Town of Barnstable Barnstable ti y RHlmeicaC�y Regulatory Services Department i snxaysra>31a�, ; 1619. Public Health Division µ;•�a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1730 0001 4990 6913 October 11, 2018—THIRD NOTICE CERQUEIR.A,MARCELO T P.O. BOX 1913 HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 299 Oakland Road, Hyannis,MA was inspected on 03/15/2017 by Jason Haskell, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution bog above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within six (6) months 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 Z OF HEALTH as McKean, R.S.,THE Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\299 Oakland Road Hyannis Third Notice.doc t °F`"E'°w Town of Barnstable - -— — Public Health Division �`, U.S.POSTAGE>>PITNEYBOWES "a"5r"A`e. 200 Main Street —"t:;7.�® o p+'�00 Hyannis,MA 02601 ~�i a 0ZIP 2 02601 $ 006.6/ 0 < 7015 1730. 0001 4990 6913 0000336455OCT, 11, 2018. CERQUEIRA, MARCELO.T ti ydETIIR a TO SENDER \ " lDpj':c 8C;;.,..D2809.4 020a * 1669-00826-08-21 Qi,11 11.1 .:;�a` yjjjs'•gL Jil9:1.�:�'1I11'11111v.'�� �rlii ... f. 'I 1 A. l ✓-.�' le Complete items 1,2,and 3. Signature ❑Agent i le Print your name and address on the reverse X ❑Addressee i so that we can return the card to you. ■ Attach this card to the back of the mailpiece, B• Received by(Printed Name) C. Date of Delivery i or on the front if space permits. I 1. Articl w Y ^�" --� D. Is delivery address different from item 17 ❑Yes If YES,enter delivery address below: p No z_ CERQUEIRA, MARCELO T - P.O. BOX 1913— i HYANNIS, MA 02601 i I 3. Service Type ❑Priority Mail Express® I - I I IIIIII III III I II II I II I I I III II II IIII II I I III ❑AAdultdult SSignature 0ignature Restricted Delivery ❑RRegisteredegistered Mail Restricted; 9590 9402 3759 8032 3746 92 ❑Certified Mail® Delivery 4. Certified(Nail Restrtcted Delivery 6�Metu h Ra eeipt for 1 ❑Collect on Delivery I i 2, Article_NtimhPr_CTransfar_irnm mnd�o��hen -p cnnertr,o_nalivery Restricted Delivery 11 Signature Confirmation" I Signature Confirmation —-•7 015 17 3 0 0001 4990 6 913 Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt I� f i .. , q • 41 ra •. • _ Ln Ln co � �� � t _ ft U a co Postage $ L ru Certified Fee ti O ReturnReceipt Fee Ln PostWrk p (Endorsement Required) -- f1ew Jt7 C3 Restricted Delivery Fee (Endorsement Required)rq 6- O Total Postage&Fees Sem DEUTSCHE BANK NATIONAL TRUST TR. ti C/O OCWEN LOAN SERVICING LLC ------- o Sven 1661 WORTHINGTON RD STE 100 or A �;�y WEST PALM BEACH,FL_33409 �' Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: n Certified Mail may ONLY be combined with First-Class Mails or Priority Mails. o Certified Mail is not available for any class of international mail. e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. L o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ® For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". _ e If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 i o . o Er C3 11:0 0 F F I C I A L U,&E, co Certified Mail Fee Er $ ,y _-r Extra ServiCes&Fees(check box,add fee as appropriate) 1`a• ❑Return Receipt(hardcopy) $ 1 El Return Receipt(electronic) $ p 'mark C .❑Certified Mail Restricted Delivery $ 0 ❑Adult Signature Required $ []Adult Signature Restricted Delivery$ O Post —— Total DEUTSCHE BANK NATIONAL TRUST TR $ sari' C/O OCWEN LOAN SERVICING LLC Siiee, 1661 WORTHINGTON RD STE 100 I cty - WEST PALM BEACH, FL 33409 l ... , r r r,r•r• Certified Allaii service provides the following benefits: ■A receipt.(this portion of the Certified Mail label). for an electronic return receipt,see a retail n A unique identifier for your mailpiece. associate for assistance.To receive a duplicate u Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the- n A record of delivery(including the recipient's retail associate. - signature)that is retained by the Postal Service' Restricted delivery service,which provides ; for a specified period. delivery to the addressee specified by name,or- to the addressee's authorized agent C1 Important Reminders: Adult signature service,which requires the ■You may purchase Certified Mail service with u Y P signee to be at least 21 years of age(not _ First-Class Wife,First-Class Package Service®, available at retail). " or Priority Mail®service: Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age International mail. and provides delivery to the addressee specked 1 ■Insurance coverage is notavallable for purchase by name,or to the addressee's authorized agent. with Certified Mail service.However,the purchase (not available at retail). :7 of Certified Mail service does not change the s To ensure that your Certified Mail receipt is insurance.ceverage automatically included with accepted as legal proof of mailing,it should beaz aj certain Priority Mail items: USPS postmark If you would like a postmark on—n ■For an additional fee,and with a proper this Certified Mail receipt,please present your . endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for �. the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion_, of delivery(Including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.:-� electronic version.For a hardcepy return receipt, _T complete PS Form 3811,Domesbc Return Receipt attach PS Form 3811 to your mailpiece; iMPORTAUr Save this receipt for your records. PS Form 3800,April 2015(Reverse)PSN 7530-o2-000-9o47 1 e Complete items 1,2,and 3. A sig tur e Print your name and address on the reverse X O Agent so that we can return the card to you. [3 Addressee 0 Attach this card to the back of the mailpiece, B• Received by(Printed Name) C. Date of Delivery or on the front if space permits. address different from item 1? El Yes enter delivery address below: ❑No DEUTSCHE BANK NATIONAL TRUST TR C/O OCWEN LOAN SERVICING LLC 1661 WORTHINGTON RD STE 100 II WEST PALM BEACH, FL 33409 3. Service Type ❑Priority Mail Express® II I�IIIBI I�I IBI I II II II I I I 'II I II I�I II I II I I I ❑Adult Signature ❑Registered MallTM ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted 9590 9402 1933 6123 1781 01 Certified Mail® Delivery ❑Certified Mail Restricted Delivery VDRetum Receipt for ❑Collect on Delivery Merchandise ❑Collect on Delivery Restricted Delivery ❑Signature ConfinnationT 2 `-`^^�-oandr..q label). -I--2—mtLMail ❑Signature Confirmation 1 7 015 17 3 0 0001 4988 0190 Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 bomestic Return Receipt USPS TRACKING# First-Class Mail Postage&Fees Paid USPS Permit No.G-10 I I I 9590 9402 1933 6123 1781 01 United States •Sender:Please print your name,address,and ZIP+4®in this box• Postal Service Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 I I I I Town of Barnstable Barnstable AlAmed Regulatory Services Department eaC j s lAi2NS1ASLL MASS& Public Health Division m 200 Main Street, Hyannis MA 02601 2007 * Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1730 0001 4988 0190 March 22, 2018 — SECOND NOTICE DEUTSCHE BANK NATIONAL TRUST TR C/O OCWEN LOAN SERVICING LLC 1661 WORTHINGTON RD STE 100 WEST PALM BEACH, FL 33409 ORDER TO COMPLY,WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 299 Oakland Road,Hyannis, MA was inspected on 03/15/2017 by Jason Haskell, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within six (6) months from the date you receive this notification. Failure to repair/replace the septic system within the,deadline period will result in future enforcement action. PER ORDER O BOARD OF HEALTH omas cKean, R.S., Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\299 Oakland Road Hyannis- Second Notice.doc r . Ty Town of Barnstable Barnstable °s Regulatory Services Department AlAmm`CeC j BARNSTA$1�, 4q, Public Health Division i° aMr►�A' 200 Main Street, Hyannis MA 02604 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010. 0000 2847 8551 March 23, 2017 DEUTSCHE BANK NATIONAL TRUST TR f C/O OCWEN LOAN SERVICING LLC 1661 WORTHINGTON RD STE 100. WEST PALM BEACH, FL 33409 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at299 Oakland Road,Hyannis, MA was inspected on 03/15/2017 by Jason Haskell, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH BOARD OF HEALTH o as c ean, R.S., CHO Agent of the Board of Health f Q:ISEPTIC\Letters Septic Inspection Failures or Future Ev11299 Oakland Road Hyannis.doc I - ~� Town of Barnstable t�xxsrear.E, . XAS& Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA'02601 Office:.508-862-4644 Richard Scali,Director FAX: 508-790-6304 y Thomas A McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR.15.000) _ An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA. ❑ Discharge or ponding of effluent to the surface of the ground o Pumping more than 4 times during the last year not due to clogged or obstructed Pipe ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool O 1 YEAR DEADLINE CRITERIA tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc a7i-L Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M. ,M 299 Oakland Road I7 Property Address Deutsche Bank National Trust Owner Owner's Name information is Hyannis MA 02601 3/15/2017 required for every H—Y n 7 page. City/Town State Zip Code Date of Inspection CID 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 Sj on the computer, use only the tab 1. Inspector: key to move your cursor-do not Jason Haskell use the return Name of Inspector key. All Clear Septic&Wastewater Services ,%y Company Name 102 West Main Street Company Address Norton MA 02766 City/Town State Zip Code 508-763-4431 SI 13520 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 494o-,- 1'0�141 3/17/2017 Inspe or's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 299 Oakland Road Property Address Deutsche Bank National Trust Owner Owner's Name information is required for every Hyannis MA 02601 3/15/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Septic tank, distribution box, SAS. System has signs of previous overload. SYSTEM FAILS B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old`or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 299 Oakland Road Property Address Deutsche Bank National Trust Owner Owner's Name information is required for every Hyannis MA 02601 3/15/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 299 Oakland Road Property Address Deutsche Bank National Trust Owner Owner's Name information is required for every Hyannis MA 02601 3/15/2017 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 112 day flow t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 299 Oakland Road Property Address Deutsche Bank National Trust Owner Owner's Name information is required for every Hyannis MA 02601 3/15/2017 page. Citylrown 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.] ❑ ® 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. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System°Page 5 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments r 299 Oakland Road Property Address Deutsche Bank National Trust Owner Owner's Name information is required for every Hyannis MA 02601 3/15/2017 page. Cityrrown 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 GPD t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 299 Oakland Road Property Address Deutsche Bank National Trust Owner Owner's Name information is required for every Hyannis MA 02601 3/15/2017 page. City/Town State Zip Code Date of Inspection D. System Infdrmation Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Unknown 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 299 Oakland Road Property Address Deutsche Bank National Trust Owner Owner's Name information is required for every Hyannis MA 02601 3/15/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 2016 per BOH Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �M 299 Oakland Road Property Address Deutsche Bank National Trust Owner Owner's Name information is required for every Hyannis MA 02601 3/15/2017 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: 1992 per BOH paperwork Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 0 33" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line. town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints good, no leaks, vented. Septic Tank(locate on site plan): Depth below grade: 30feet 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: 8'3"x 4'3"x 4'9" (1000 gallons) Sludge depth: 4 t5ins.doc•rev.616 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 f Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 299 Oakland Road Property Address Deutsche Bank National Trust Owner Owner's Name information is required for every Hyannis MA 02601 3/15/2017 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 25" Scum thickness 0 11 Distance from top of scum to top of outlet tee or baffle 5 Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Rod&Tape measure Comments (on purpping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not required at time of inspection, 2 inlet pipes, 1 has tee, 1 doesn't have tee, evidence of previous overload above outlet invert. 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.doc-rev.6/16 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 -� 299 Oakland Road Property Address Deutsche Bank National Trust Owner Owner's Name information is required for every Hyannis MA 02601 3/15/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 f ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 299 Oakland Road Property Address Deutsche Bank National Trust Owner Owner's Name information is required for every Hyannis MA 02601 3/15/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note.if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Signs of previous overload. e Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working'order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 299 Oakland Road Property Address Deutsche Bank National Trust Owner Owner's Name information is required for every Hyannis MA 02601 3/15/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil and vegetation normal, signs of hydraulic failure. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth 'of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 299 Oakland Road Property Address Deutsche Bank National Trust Owner Owner's Name information is required for every y H annis MA 02601 3/15/2017 „ 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form- Not for Voluntary Assessments 299 Oakland Road Property Address Deutsche Bank National Trust Owner Owner's Name information is required for every Hyannis MA 02601 3/15/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water-supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately 15ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 299 Oakland Road Property Address Deutsche Bank National Trust Owner Owner's Name information is required for every Hyannis MA 02601 3/15/2017 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 groundwater: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date D ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health- explain: Previous T5 done 2/1/03 ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: High ground water elevation to be obtained during system replacement. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 299 Oakland Road Property Address Deutsche Bank National Trust Owner Owner's Name information is required for every Hyannis MA 02601 3/15/2017 page. CitylTown 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 V All-Clear Septic, & Wastewater Services o ► fir, , tLET � 5 (n TF JI °� � �a(�:p� �� •'ems � � a �� . . �. • _ 102 W. Main St. Norton, MA 02766 Office: (508) 763-4431 Fax: (508) 763-4168 www.aliclearseptic.com COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF:-ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTEC ri'M D FEB 13 2003 TOWN OFl3ARNSTABLE"; _. HEALTH DEPT. TITLE 5 I S OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEN9RM 11, Z °' PART A CERTIFICATION PARCEL. ;. �. LOT . Property Address: 299 Oakland Rd Hyannis REQ_ �E Owner's Name: Dave Langf ield Owner's Address: Date of Inspection: ,'. /� FE6 1 .2DD3 TOWN OF BARNSTA13LE Name of Inspector:(please print) W i 11 i am _ • Robi nson Sr. HEALTH gEPT-.' Company Name: . William E. Robinson Septic Service Mailing Address: P 'O Box 1 089 Centerville, MA Telephone Number: (508) 775-8776 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and.that the information reported; below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am,.a DEP approved system inspector.pursuant to Sec ion 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails r - Inspector's Signiature: - Date:• The system inspector shall submit a copy of this inspection.report to the Approving Authority'(Board of Healtlror 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 shalt submit.the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 t i Page 2 of l l SSM OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASS FORMS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT PART A CERTIFICATION (continued) Property Address Owner. ® field Date of Inspection: Inspection Summary:;Chgk A,B,C,D or E/ALWAYS complete all of Section D A. Sy'ste __Passes: d any. information which indicates that any of the failure criteria described in 310 CMR t have not fours y exist.Any failure criteria not evaluated are indicated below. 15.303 or in 310 CMR 15304 Comments: B. stem Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaire .The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass: Answer es,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, xhibits substantial infiltration or exfiltration or tank failure'is imminent.System will pass inspection if the existing t 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 expl in: bservation of sewage backup or break out or high static water level in the distribution box due to broken or obstru ed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with appro t of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced explain. The system required pumping more than 4 tunes a year due to broken or obstructed pipe(s).The system will pas inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is ramovod D explain: Page 3 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS _ SUBSURFACE SEWAGE DISPOSALSYSTEM INSPECTION FORM PART'A CERTIFICATION(continued) Property Address: 299 Oakland Rd . Hyannis Owner: Dave Lgmgfield Date of Inspection: 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 fail'n to protect public health,safety or the environment. 1. stem will pass unless Board of Health determines in'accordance with'310,CMR,1S,303(1)(b).that the-, - s stem is not functioning,in a manner which will protect public health safe 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. S3 stem will fail unless the Board of Health(and Public Water Supplier,if any)determines:that.the syste is.funt boning 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 s rface 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 frond 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 acteria and volatile organic compounds indicates that the well is free from pollution from that facility and.. e presence of ammonia nitrogen and nitrate nitrogen is equal to or.less than 5 ppm,provided that no other allure criteria are triggered.A copy of the analysis must be attached to this form. 3. ther. 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM 'PART A: CERTIFICATION(continued) Property Address: Dave LanQf; P� 299 Oakland Dd_ Owner. Hyannis Date of Inspection: D. System Failure Criteria applicable to all systems:. You ust 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 �. ;" loa _ Disctiarge or ponding of effluent to the aurface of the ound 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 67,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 p�pe(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. Pp y Any portion of a cesspool or privy is within 50 feet of a private vrater sup 1 well _ Any portion of a cesspool or privy is less than 100 feet.but greater than 50 feet from a private water supply well with no acceptable water quality analysis.[This.system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to.orless than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.j (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. " E. La a Systems: To be con idered a large system the system must serve a facility with a,design now of 10000 gpd to 15,000 gpd- You must• icate either"yes"or"no"to each of the following: (The follow' g criteria apply to large systems in addition to the criteria above) yes no — — the ystem is within 400 feet of a surface drinking water supply the stem is within 200 feet of a tributary.to a surface drinking water supply the s stem is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zon II of a public water supply well . Z. If you have wered"yes"to any question in Section E the system is cainsuiered a significant threat, answered "yes"in Secti n D above the large system has fai kd.The owner or operator of arty large system considcred a significant t eat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The ystem owner should contact the appropriate regional office of the Department. 4 Page 5 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART W. CHECKLIST Property Address: 299, Oakland Rd Hyannis _ Owner: Da uP La of ield Date of Inspection:- -;L-/— Check if the following have been done.You must indicate-ycs"or"no"as to each of the following: Yes o Pumping information was provided by the owner,occupant,or Board of Health v/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? . i �I Have large volumes of water been introduced to the system recently or as pail of this inspection?._ Were as built plans of the system obtained and examined?(If they were not available note as N/A) v Was the facility or dwelling inspected for signs of sewage back up? ✓ — Was'the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? Were the septic tank;manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on:, Yes no ✓Existing information.For example,a plan at the Board of Health. —L11— Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)13 10 CMR 15.302(3)(b)j 5 Page 6 of I OFFICIAL INSPECTION FORM-,NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 299 Oakland Rd Hyannis Owner: Dave L anaf field Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_4r Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x N of bedrooms): ( o Number of current residents: / -- Does residence have a garbage grinder(yes or no):.+1iiS' Is laundry on a separate sewage system(yes or no):70[if yes separate inspection required] Laundry system inspected(yes or no):,!j,o Seasonal use:(yes or no):/=C) Water meter readings,if available(last 2 years usage(gpd)): -fromAua 2DM1 to Oct 2002 22, 500 g 1 s Sump pump(yes or no): Last date of occupancy: COMMERC IJINDUSTRIAL Type otestablis ent: Design flow(b ed on 310 CUR 15.203): 9pd Basis of design o.viw(seats/persons/sgft,etc.): Grease trap pr ent(yes or no):_ Industrial wa a holding tank present(yes or no):— Non-sani waste discharged to the Title 5 system(yes or no):— Water me er readings,if available: Last dat of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped:_ Qallons--How was quantity pumped determined? Reason for pumping: TY F 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/Altemative 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 utstalled(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): .6 Page 7 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM '-` PART C SYSTEM INFORMATION{continued),. Property Address•• 299 Oakland Rd Hyannis Owner: Dave Langf ield ` Date of Inspection: p BUILDING SEW R(locate on site plan) Depth below gra Materials of con ction `_cast iron _40 PVC_other(explain): Distance from p vate water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_ locate on site plan) Depth below grade: _ Material of construction: ✓concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:— is age confu-mcd•by a Certificate of Compliance(yes or no):_.(attach a copy of certificate) Dimensions: "Z Sludge depth: e-1 i/�JJ, t Distance from top of sludfe to bottom of outlet tee or baffle:i / Scum thickness: Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom9f outlet tee or baffle: How were dimensions determined: d 'L- Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): , GREASE T P:_(locate on site plan). Depth below ade:_ Material of co struction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickn s: Distance fro top of scum to top of outlet tee or baffle: Distance fro bottom of scum to bottom of outlet tee or baffle: Date of last umping: Comments n pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related t outlet invert,evidence of leakage,etc.): 7 pages of I I _ LUNTARY ASSESSMENTS , , - OFFICIAL INSPECTION FORM NOT FOR vo SUBSURFACE SEWAGE DI5POSAL SYSTEM INSPECTION FORM , PART C SYSTEM-INFORMATION(continued):. Property Address: 2 9 ^a Rd Owner: field Date of Inspection: —t TIGH or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth be w grade: _�. y Y Material f construction: concrete- metal fiberglass of eth lene other(explatn): Dimensio s: allons Capacity. Design Fl Dw: gallons/day Alarm pr sent(yes or no): Alarm le el: Alarm in working order(yes or no): Date of I st pumping: Comore is(condition of alarm and float switches,etc.): DISTRIBUTIONZCfP BOX: resent must be opened)(locate on site plan) , Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): 1< PUMTi (locate on site plan) Pum (yes or no): Alarr(yes or no): Comon pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 299 Oakland Rd Hyannis Owner: Dave Lang 1e Date of Inspection: --�—�� SOIL ABSORPTION SYSTEM (SAS): G�Iocate on site plan,excavation'not required) If SAS not located explain why: Ty leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOO (cesspool must be pumped as part of inspect ion)(locate on site plan) Number and c nfiguration: Depth—top o liquid to inlet invert: Depth of solid layer: Depth of scum ayer. Dimensions of csspool: Materials of co struction: Indication of gr undwater inflow(yes or no): Comments(not condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (I cafe on site plan) Materials of co struction: Dimensions: Depth of solid Comments(n a condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTAR SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ASSESSMENTS FORM PART C SYSTEM INFORMATION(continued) Property Address: Oakland Rd 29 annis Owner: �av Langfie Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch o f.the dis osa sewage benchmarks.Locate al g p 1 system including ties to at least two I wellreference s within 100 feet.Locate where public water supplynente spemtthe building.landmarks or J� , �C1 Gx s s ,f G "s, � U 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 299 Oakland Rd HWanniS - Owner. nee T angfield Date of Inspection: f- SITE EXAM Slope Surface water Check cellar Shallow wells x , Estimated depth to ground water,;Z feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: 6 6 I4,6 w., Checked with local excavators,installers-(attac documentation) Accessed USGS database-explain: You must deyibe how you a tablished the high ground water elevation: / �-s 1 1�0 ✓3Z5 -j � .y 11 TOWN OF BARNSTABLE LOCATION 2- e o -o ,(L,jb ^zvl k.C/ SEWAGE # I VILLAGE� ASSESSOR'S MAP LOT�"J/.- 0 V INSTALLER'S NAME PHONE NO. 1 O,h l k--S 6 SEPTIC TANK CAPACITY l b 6 LEACHING FACILITY:(type) 16 O (size) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER/ BUILDER OR OWNER DATE PERMIT ISSUED: ,S'GI'' 's DATE COMPL�ANCE ISSUED: :5 VARIANCE GRANTED: Yes No �� i \ � . 1 . � , 1 / © r ••� i Or � l_ � !' .-s-+- /, g '� � J MMy \'-J , /� '' VJ 1 J J � � .. 30 00 VFEz .... .......... . . ............. THE COMMONWEALTH OF MASSACHUSETTS a- RD OF HEALTH / �v OF BARNSTABLE Appliratiun for Ui_npuittl Wurkri Tuntrurtiun rantit Application is hereby made for a Permit to Coristruct ( ) or Repair ( X) an Individual Sewage Disposal System at: ....299 Oakland R_d Hyannis Location-:%ddress or Lot No. D. Langf eld-------------------------------------•--------•-- ----------------•------------..........--•-=--------•--•--------..._.....-•----................-- Owner Address a .... ..E...___RObinson. Septic---- P_.O_.-___Box....1 089._Centerville................._._..... Installer Address Type of Building Size Lot............... .........Sq. feet .-� Dwelling— No. of Bedrooms----------3--------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures --------------------------------------------------------------------------------------- -------------------------------------------------•-•--------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity...--......gallons Length................ Width....-..-.._...-- Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY--------------............................................................ Date........................................ W Test Pit No. 1................minutes per inch Depth of Test Pit.........-.--.._...- Depth to ground water....-.-------._......... �T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ---------------------------------------------------------------------------------------•------............................................................... 0 Description of Soil..............sand............................................................................................................................................... U •-•--------- -----------------------------------------------------------------•----------------....----------------------------------------------------------------•----•------•-••------•-•--------•--- W UNature of Repairs or Alterations—Answer when applicable...-..._..ins_tall___a---1_.000gal_--tan]c................. ..D-Box...and- stonepacked_._precast__.leachpit___________________ _ ____ _ _____ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance-with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees nor to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ------------ ................................................................................ .....--. ...........:------ Dare Application Approved BY ... ... ................................................................ .......................................... .. . ...... `S -1111 tY...... Dare Application Disapproved for the following reasonr: --------------------------.............................................................................................................. ---------------------------------------------------------------------------------------------------------------------------------------- ----------------- -------------------------------------------- .... . .. ............. qDace Permit No. ...... --/ -- ------dam- - - --------- ----------- Issued ----------------------------------------------------------- ------ Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE \. ertifi ate of Tontla iattrE THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( x ) WE Robinson Sevt c._S.xv.ic.e--------------------------------------- --------------...----- ----------------------_- --------------------...------- by 299 Oakland Rd Hyannis ----------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ----- a....f.... ..... dated ------------------------------------....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. .. -- -------DATE..._.. � : Inspectd .r tom` ------- ------------- ------------------------------------------------------------- THE - COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH qq TOWN OF BARNSTABLE No..(.°�.'...�,./._��_._ FEE....30...".00..._.......... �t��n��tl �xk� ��a�t����#ilan �rrnti� ,• Permission is hereby granted W.E. Robinson Septic Service-•-----•----------•----•--•---•-------•-----------•-•---------•-•-•--------- to Construct ( ) or Repair ( X) an Individual Sewage Disposal System atNo.•---2.99---.Gakland_-Rc?----- ..H 5................................... --------- --------------•------------------------------------------......_....._ Street q !j as shown on the application for Disposal Works Construction Permit N�o.JWY ..... Dated.-;�—`n.��_---.p�............ ------•--•------•---------- - ------------------------------------------------------- DATE......... ............................................ Board of Health •�-.._�.�--�--��--��' FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS No.. 9.Y .� / Fx$..3 0 ..0.......... r f '..• THE COMMONWEALTH OF MASSACHUSETTS c2.2/ z5KI/ BOARD OF HEALTH i �m41T�OWN OF BARNSTABLE Appliratiou for Diupuiittl Wurk,i Towitrurtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: ....299...Oakland,•Rd.--........HXaa is------•................ .................................................................................................. Location-Address or Lot No. ....n......Lana ield..---•••---•-•••-•---------------------------•-•••-•--...... ---••--•---------------------•--•-._.......---•----•--..........----------.....----------......... Owner Address a W-._E....Robinson Septic Service_ P.O._ _Box 1089Centerville_ Installer Address UType of Building Size Lot........................Sq. feet ,� Dwelling—No. of Bedrooms.......... --------------------------------Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) p" Other fixtures ------------------------------------------------------ W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width...--.-.-------- Diameter...-..-----.---- Depth................ x Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter................-.-- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by------------ ............................................................. Date........................................ ,.� Test Pit No. 1................minutes per inch Depth of Test Pit---_----.---------- Depth to ground water.-------------.._....... fi Test Pit No. 2................minutes per inch Depth of Test Pit.--------------.---- Depth to ground water........................ a --------------------- --•-----------•------•-------•------•-•----•-------••---•---•-----•---.....-------------•---•-•........•-----------................---. 0 Description of Soil..............sand U - ----------------------------------- W Nature of Repairs or Alterations—Answer when applicable-----.----ins_tall__a___1_,000 gal_.-t3nk_�______________ x U P ..............................................Box tonepacked_-precast...leachpit----------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ------------------------------------------------- ----------------------.-..--------- .................................:...... Dare Application Approved By ------ -----}}��-J--. .��.. �� ,-.= ------------------------- -----------.------------------ -----�,�:.... v Dace Application Disapproved for the following reasons: -------------- ...... . ... . .................. . . .....-. .. . . ................--............ .. ...................................................-- . ........................................ q Dace Permit No. `.. - Issued :.:-._--------------------- ---( �' Dace AsBuilt Page 1 of 2 TOWN OF BARNSTABLE r LOCATION Pq �{� ]� (�� SEWAGE V VILLAGE\,t)tllS ASSESSOR'S AP & LOT INSTALLER'S NAME & PHONE NO.LAPZA 2 ' Qc^mt SEPTIC TANK CAPACITY LEACHING FACILITY:(t l j � (Size) NO. OF BEDROOMS PRIVATE WELL O LIC WATER BUILDER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No s ' �Aous� A e A= �a http://issgl2/intranet/propdata/prebuilt.aspx?mappar=271091&seq=1 3/15/2017