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Home My WebLink About0296 OCEAN STREET - Health 296 Ocean Street Hvannis A= 325 049 e No. "S en Fee U� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for ]Biopooal *p5tem Con6truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon(;X) ❑Complete System El Individual Components Location Address or Lot No. Owner's Name Addres's-and Tejj�No. �rj(o t]�n 3} k��chr�s ✓ltv 0-1-4-0 ) e�.a.l C Wo iK- Assessor's Maplarcel SU�`7'� 3a; v Y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 2 Lot Size 3 sq.ft. Garbage Grinder(* ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) i 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. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Gin CrU. f Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been ssued by this Bo of He lth. Signed _, r �^ Date 7-23 —o I Application Approved by _ Date Application Disapproved for the following reasons Permit No. 'Z elv Date Issued Z Y THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY at the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned�� ir (Y�— at SOZ— has been constructeq in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ?ZtZ)I—S 3-7 dated Z 3 o Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector d PTo�� "_ �•;,,r 'S ; Fee a. -• ro t� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Miopozar *pztem (Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon(�O ,-QComplet@ System ❑Individual Components Location Addressor Lot No. _ Owner's Name Address end Te.No. �y� Occa.� Sf �nh s ttit� � �b M .f. .L a c o f' Assessor's Map/Parcel 3a; o y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. V0 � � EQ�v � Type of Building: • Dwelling$-{ No.of Bedrooms '2 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. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ab qu Date last inspected: �! Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been ssued y this Board of He lth. Signed Date �'d.3 - Application Approved by Date Application Disapproved for the following reasons, Permit No. men I—S 1 Date Issued ZZ Z 1 01 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned - by i vc, at 2�& f has been constructe in ac ordance with the provisions of Title 5 and the for Disposal System Construction Permit No.2ff�/_S 3 dated 7 Z 3 d Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector 7-- ------- -------------- _. No. 8 f FeeJ / "...-- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS wie;pogal *pztem (ton5truction Perml Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( System located at z 1?6 0�t�J�1 IS ya-41t 11A, /(//tf- 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 this •-t. (' Date: Approved by INETati Town of Barnstable Regulatory Services BARNSrABLE, * Thomas F. Geiler,Director 639• Public Health Division ptFD MA'�A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Criscello Luzroque 296 Ocean Street Hyannis,Ma. 02601 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The Y septic sy stem owned b you located at 296 Ocean St. Hyannis was inspected on, 6/28/2001 by John Graci a Massachusetts licensed septic inspector. The inspection of your septic system showed :that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Our records show that the system has been in a failed state for more than two years. You are ordered to hire a professional engineer or registered sanitarian to prepare a-plan of proposed replacement septic system .component(s). This plan i is to be submitted to the Town of Public Health Division Office (Regulatory Services Barnstable Publ , 200 Main Street,Hyannis),within (90) days receipt of this letter. The plan will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title V. You are a lso o rdered t o u pgrade o r r eplace t he s eptic s ystem w ithin s ix months (180) days o f y our receipt of this letter. Any person aggrieved by any order issued by the local approval authority may appeal to any c ourt o f competent jurisdiction as provided for by the laws of the Commonwealth. You have the option of requesting an adjudicatory hearing pursuant to 310 CMR 15.422 Failure to comply with this order will automatically result in a public hearing scheduled before the Board of Health. E BOARD OF HEALTH o as A.McKean,R.S., C.H.O. Agent of the Board of Health I I CC: Board of Health 1/failed_septic_lettm Barnstable Assessing Search Results Pagel of 2 .y E.�6€Stet 9EsL « a Home: Departments:Assessors Division: Property Assessment Search Results .. in 1 296 OCEAN T -HET Owner: Property Sketch Legend LUZROQUE, CRISCELLO B& AINOM-7 Map/Parcel/Parcel Extension ".' "' 325 /049/ Mailing Address `3'' — LUZROQUE,CRISCELLO B& k `f k � 9 DIAZ, MICHELLE E3 296 OCEAN ST v HYANNIS, MA.02601 �r 2005 Assessed Values: 11 Appraised Value Assessed Value Building Value: $ 118,100 $ 118,100 Extra Features: $0 $0 Outbuildings: $300 $300 Land Value: $212,200 $212,200 Interactive Property Map: ap requires Plug in: Totals:$330,600 $330,600 1 have visited the maps before t Show Me The Map � y April 2001 photos available ;;; Sales History: Owner: Sale Date Book/Page: Sale Price: SOUZA, PHILLIP R&MARIE M 1/15/1985 4384/147 $64,000 MACDONALD, RICHARD T JR 1/15/1982 3424/159 $0 LUZROQUE, CRISCELLO B& 7/27/2001 14079/171 $ 170,000 ROLFE, MICHAEL C 4/15/1995 9648/165 $69,500 CITIZENS BANK OF MASS 2/15/1995 9562/314 $88,000 2005 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Land Bank Tax $60 Town Fire District Rates Other I $6.05 Barnstable-Residential $2.12 Land B. Barnstable-Commercial $2.80 Hyannis FD Tax(Residential) $502.51 C.O.M.M.-All Classes $1.01 Cotuit FD-All Classes $1.28 Town Tax(Residential) $2,000.13 Hyannis-Residential $1.52 Hyannis-Commercial $2.39 http://vvww.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 2/2/2005 i Barnstable Assessing Search Results Page 2 of 2 W Barnstable-Residential $1.44 W Barnstable-Commercial $2.10 Total: $2,562.64 Due to rounding differences these values may vary I Land and Building Information Land Building Lot Size(Acres) 0.12 I Year Built 1921 Appraised Value $212,200 Living Area 1376 Assessed Value $212,200 Replacement Cost$ 157,411 Depreciation 25 1 Building Value 118,100 Construction Details I Style Colonial Interior Floors CarpetHardwood Model Residential Interior Walls Plastered Grade Average Heat Fuel Gas i Stories 2 Stories Heat Type Hot Water Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 2 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 2 Bathrooms Total Rooms 5 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value SHED Shed 112 $300 $300 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area (Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story (Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 2/2/2005 i Septic Inspection Information Data Entryy[1ateF 7/31/2001 Septic Inspect No: "Assessors�Map 325 Parcel 049 F_of Bus►ne"""ss" ' mb 296 address Ocean Street ° /illage Hyannis I ;^inspector,; John Grad ; Imspec date' 6/28/2001 System Status F Comment:; Permit;# 20015371 NRepair®ate EITTI otcfrcat�on hate �— g/nstaNe ,;, Repay eaelline Date i i i i! I I i I f i I i i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS s DEPARTMENT OF ENVIRONMENTAL PROTECTION FAILED INS— ` %ANN syOv TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 296 OCEAN STREET HYANNIS,MA 02601 Owner's Name: MIKE ROLFE Owner's Address: BOX 864,HYANNIS;MA.02601 Date of Inspection: 6/28/01 Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.:13OX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT 1 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 _ Needs Fui he aluation by the Local Approving Authority X Fails r Inspector's Signature: Date: 6/28/01 't r The system inspector shall submit a opy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspecti : If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments THE SYSTEM FAILS TITLE V INSPECTION.THE SEPTIC TANK IS FULL. LIQUID IS OVER THE PIPES. THE SYSTEM IS IN HYDRAULIC FAILURE.': ****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. i Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 'CERTIFICATION (continued) Property Address: 296 OCEAN STREET HYANNIS,MA 02601 Owner: MIKE ROLFE Date of Inspection: 6/28/01 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: THE SYSTEM FAILS TITLE V INSPECTION.THE SEPTIC TANK IS FULL. LIQUID IS OVER THE PIPES.THE SYSTEM IS IN HYDRAULIC FAILURE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and ovee20 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: n/a 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 pipes)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is'removed ND explain: n/a I W Page 3 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE,SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 296 OCEAN STREET HYANNIS, MA 02601 Owner: MIKE ROLFE Date of Inspection: 6/28/01 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order io determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within.50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SA8�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 n/a "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 fro-n that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this.form. 3. Other: n/a 1 Page 4 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 296 OCEAN STREET HYANNIS,MA 02601 P Y Owner: MIKE ROLFE Date of Inspection: 6/28/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow _ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is.within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. . _ X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma X _ (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large 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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply _ X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen'sensitive area(Interim Wellhead Protection Area—1 W PA)or a mapped Zone It 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 "ye§" in Section D above the I01-ge§y§tell)lin failed:The owner or oper§tor of any large§y§teal con§idcrcd § §igni(icnnt 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. . 1 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 296 OCEAN STREET HYANNIS, MA 02601 Owner: MIKE ROLFE Date of Inspection: 6/28/01 Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period'? X Have large volumes of water been introduced to the system recently or as part of this inspection ? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up'? i; X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS, located on site'? X _ 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? X _ 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 X Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 296 OCEAN STREET HYANNIS,MA 02601 Owner: MIKE ROLFE Date of Inspection: 6/28/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):220 Number of current residents: 0 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or'no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use:(yes or no): NO ` Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: 6/1/01 COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CM 15.203): n/agpd Basis of design flow(seats/persons%sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons:- How was'quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy - _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1933 Were sewage odors detected when arriving at the site(yes or no): NO 4 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 296 OCEAN STREET HYANNIS,MA 02601 Owner: MIKE ROLFE Date of Inspection: 6/28/01 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 12" Material of construction: Xconcrete,_metal ,fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: IOOOG L 8' 6" H 5' 7" W 4' 10"" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle:32" Scum thickness:2" Distance from top of scum to top of outlei tee or baffle: 0" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK IS FULL AND OVER PIPES.SYSTEM IS IN HYDRAULIC FAILURE. GREASE TRAP:_(locate on site plan). Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,,-etc.): n/a •>e " Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 296 OCEAN STREET HYANNIS,MA 02601 Owner: MIKE ROLFE Date of Inspection: 6/28/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:OVER PIPE 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.): n/a PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO ✓ Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a i e Page 9 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 296 OCEAN STREET HYANNIS, MA 02601 Owner: MIKE ROLFE Date of Inspection: 6/28/01 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: n/a FLOW DIFFUSERS leaching chambers, number: 2 n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,sighs of;hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): SYSTEM IS IN HYDRAULIC FAILURE. LIQUID IS OVER PIPES IN SEPTIC TANK.THERE IS NO EFFECTIVE LEACHING CAPACITY LEFT CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a . 1 , PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): n/a r .. Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 296 OCEAN STREET HYANNIS,MA 02601 Owner: MIKE ROLFE Date of Inspection: 6/28/01 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. G�,R k , PoC�h 1 oA � j 13 � 3`I n Page I 1 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 296 OCEAN STREET HYANNIS, MA 02601 Owner: MIKE ROLFE Date of Inspection: 6/28/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 10 feet Please indicate(check)all methods used to determine the high groundwater elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain; n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS-10 FEET it