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HomeMy WebLinkAbout0060 OLD TOWN ROAD - Health 60.0Id Town Road Hyannis P A = 267 062 - i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppliLation for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System XIndividual Components Location Address or Lot No. � /i i �/��,j � Owner's Name,Address,and Tel.No. Assessor's Map/Parcel A6 7--er U(p l� V fl , ' Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. F Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd 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) 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 provisionAB�,U�d�' nviro tal Code and not to place the system in operation until a Certificate of Compliance has been issued b alth. DateAl-1,ln Application Approved by Date Application Disapproved by Date for the following reasons 064 Permit No. --- Date Issued FK /f, No Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:` Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppYication for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair 4 Upgrade( ) Abandon( ) ❑Complete System AIndividual Components Location Address or Lot No. 'r p, i / Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ;A6 (peg Installer's Name,Address,and Tel.No. a �� 4 Designer's Name,Address,and Tel.No. rvAIIh11, tXthV(MtV) M11U 2,c12,fi-M f F , Type of Building: , / Dwelling No.of Bedrooms A Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) 1 Other Fixtures _-�' r Design Flow(min.required) / //} gpd Design flow provided gpd *"N Plan Date I i Number of sheets Revision Date r, 4- Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) / Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 1'5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed ' . Date Application Approved by L N _-u_�_'�.. Date � j(! C i Application Disapproved by Date f for the following reasons Permit No. ��� Date Issued / 0 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS 56 Certificate of Compliance THIS IS TO C,ERttTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired,O Upgraded( ) Abandoned( .)by at i t ;1 � �1�1� pl_ lif •6 o has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NoQ,^�,'�'' --/�1 /dated Installer 111V,ki( Tnaff tfff"1,hl,�w Designer #bedrooms Approved design flow��'14- gpd t The issuance of this permit shall not be construed as a guarantee that the system will {�tf�inccti alas designe/d! Date ����(�.0 Inspector - — No. c -- � Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS �+ Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(e Upgrade( ) Abandon( ) System located at r t I and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 pe it. Date ,/ l )/ Approved bye I , Town of Barnstable " Inspectional Services Department B" A1� `MSS. Public Health Division � Mass. �, h 200 Main Street, Hyannis MA 02601 Office: 508-862.4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 1517 March 12, 2020 GREENBLATT, ANDREW& BOVEY, JENNIFER B 505 MAIN STREET CHATHAM, MA 02633 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 60 Old Town Road,Hyannis was inspected on 03/06/2020 by Michael T Bisienere, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Needs Further Evaluation by the Local Approving Authority" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • The distribution box has root infestation and decay. You are ordered to repair or replace the distribution box 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. P ER OF THE BOARD OF HEALTH t Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\60 Old Town Road Hyannis.doc THE P` ~� Town of Barnstable � L1AW15TABLE, 6 9 Inspectional Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An 'Y' 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 ❑ 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 ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static 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 facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTMER Repair deadline: Q C/, f 0:1SEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc t i Commonwealth of Massachusetts �� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments5 rJ 60 Old Town Road Property Address t47 Andrew Greenblatt&Jennifer Bovey f3 Owner Owner's Name t information is required for every Hyannis MA 02601 03/06/2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road � Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ® Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 03/06/2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ' i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 60 Old Town Road Property Address Andrew Greenblatt&Jennifer Bovey Owner Owner's Name information is required for every Hyannis MA 02601 03/06/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: 2) 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 1 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .� 60 Old Town Road Property Address Andrew Greenblatt&Jennifer Bovey Owner Owner's Name information is required for every Hyannis MA 02601 03/06/2020 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u!� 60 Old Town Road Property Address Andrew Greenblatt&Jennifer Bovey Owner Owner's Name information is required for every Hyannis MA 02601 03/06/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: This home has an H-10 D-Box that has root infestation and decay. (Photos attached) No visisble failure criteria was found in the rest of the system. 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u� 60 Old Town Road Property Address Andrew Greenblatt&Jennifer Bovey Owner Owner's Name information is Hyannis MA 02601 03/06/2020 required for every —y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 ❑ 0 the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone Il of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u— 60 Old Town Road Property Address Andrew Greenblatt&Jennifer Bovey Owner Owner's Name information is required for every Hyannis MA 02601 03/06/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)) t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 i Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Old Town Road Property Address Andrew Greenblatt&Jennifer Bovey Owner Owner's Name information is required for every Hyannis MA 02601 03/06/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 plus GPD Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): town water Detail: In 2019-1800 cubic feet were used and in 2018-1600 cubic feet was used Sump Pum ? Yes No P ❑ Last date of occupancy: Sept 2019 Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 i_ Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 60 Old Town Road Property Address Andrew Greenblatt&Jennifer Bovey Owner Owner's Name information is required for every Hyannis MA 02601 03/06/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 60 Old Town Road Property Address Andrew Greenblatt&Jennifer Bovey Owner Owner's Name information is required for every Hyannis MA 02601 03/06/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: New leacing installed 10/6/97 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 15" 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Old Town Road V Property Address Andrew Greenblatt&Jennifer Bovey Owner Owner's Name information is required for every Hyannis MA 02601 03/06/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 6"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: H-10 1000 gallon Sludge depth: 31- Distance from top of sludge to bottom of outlet tee or baffle 33" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 60 Old Town Road Property Address Andrew Greenblatt&Jennifer Bovey Owner Owner's Name information is required for every Hyannis MA 02601 03/06/2020 - page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 ( Commonwealth of Massachusetts Title 5 Official Inspection Form �b Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 60 Old Town Road Property Address Andrew Greenblatt&Jennifer Bovey Owner Owner's Name information is required for every Hyannis MA 02601 03/06/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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.): 1 *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. 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.): At the time of the inspection there was root infestation and decay. The liquid level was below the outlet pipes. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 f i it I Commonwealth of Massachusetts Title 5 Official Inspection Form <iI Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 60 Old Town Road V Property Address Andrew Greenblatt&Jennifer Bovey Owner Owner's Name information is Hyannis MA 02601 03/06/2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: one ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: w X 11 X 2 /infiltrators ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 1 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 60 Old Town Road Property Address Andrew Greenblatt&Jennifer Bovey Owner Owner's Name information is required for every Hyannis MA 02601 03/06/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.). 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection both the leaching pit and the infiltrator trench were dry and no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Old Town Road Property Address Andrew Greenblatt&Jennifer Bovey Owner Owner's Name information is Hyannis MA 02601 03/06/2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Old Town Road Property Address Andrew Greenblatt_&Jennifer Bove Owner Owner's Name information is required for every Hyannis MA 02601 03/06/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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: l hand-sketch in the area below ❑ drawing attached separately Rear Driveway A B O A B 0 1 22' 1T3" 2 26'4" 2176" 3 3 31'6" 25' 4 4 32' a 4 "6 t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 16 of 18 L c� Commonwealth of Massachusetts �= p Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 60 Old Town Road V� Property Address Andrew Greenblatt&Jennifer Bovey Owner Owner's Name information is Hyannis MA 02601 03/06/2020 required for every y page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 14 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date - ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered a hole at a lower elevation and shot it with a transit to show four feet of seperation Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form <1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 60 Old Town Road Property Address Andrew Greenblatt&Jennifer Bovey Owner Owner's Name information is required for every Hyannis MA 02601 03/06/2020 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 I tY T�41 �(`yj♦,!W}r� Y r �. ,d "T�l !=rt. @� ey!'•' x � I ljyk/ ` k ��tg#S' J'y-�`E } "�N� � � '•4e1yi� ,�lt q &^ ! �,3 � f 9 .a, M1x L4 �N � �tr.-r,SFr il�� �4 +�•.� y,� g"n'� � �� �' S �- �'E' Y; ,�"�l�jt�}�j hf�' �y't�� -`e • ;a� .� b,��'i���- j\o �ir elf � � �T2 i it c -h "IT � �ti$3 31�S I�>. 4 � 52 I erq✓ i Lyw� v1 ��y� ? adri {�L 3ti /y�lr '�> TER } - 4 'KYy¢r#�C - z�a "`k � .,x��t' j��fit` �r• � t= ji �"� �h�4�{•E I � tt}� � �. "e'�3� -'�°',�~r'�e �"ay''a,,s .�' - r v-,�f` '.-{ �; "�y t'�y S•4� '�u � t '� ; 4 K,_ ggg�����''YY ♦� Lab'(x���-.��,>� � w• r. ,>r' -.' ��.oR�Tc►,y,� ��.p _drl 'a .��� :. Y`. �L.f""frie �Y'��`. a." "' E�".,ks��'�+�+� y, �fJ i-r � tf`• ,fir, 74 rN irj It; l� -ill l:kyL`rt a •yw�.. �, �� ems+ ♦.h ,. �r ��.� 'm.�t a *� ' r_ ems;- 9 ,"`r �•°'{ ,., :, j't t ay� oj4., ' + ;L '�'v9 '� tSL,h��.� s•�'`ylpaw�Y••: -y�'�„ •• 1� �.L� �x h �y ear rr � a91" 4,M��.�. � i �1 � nc�•�Rv.�.'.� 1�a: % �.g� M� ` ,��05r aas� •' } gam' ° ' l`� A-, -" ��:� r •ea ~/^/ N�.4 ff sue\ ti • S ' _W R t Commonwealth of Massachusetts au _ � Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments \es #60 Old Town Road Property Address Richard Trull Owner Owner's Name information isf9stRialp d��I S MA 02632 1/27/09 required for every page. City/Town I State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. , Important: A. General Information When filling out forms on the computer, use 1. Inspector: I 53Z4 only the tab key to move your Carmen E Shay cursor-do not Name of Inspector use the return key. Shay Environmental Services, Inc. Company Name rab 185 Ashumet Road Company Address Mashpee MA 02649 etma City/Town State Zip Code 508-539-7966 3080 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes .i. ❑ ❑ Needs Further Evaluation by the Local Approving Authority ..:iE p. _ 1/27/09 I . Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Appro:V,I.Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. [A 2-10 60 Old Town Road Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Se�Disposal System•Page 1 of 15 Y P 9 P Y 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments #60 Old Town Road Property Address Richard Trull Owner Owner's Name information is required for Barnstable MA 02632 1/27/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 1" of liquid in SAS installed in 1997- by probing stone, Leach pit has stain line from failure in 1997 B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 60 Old Town Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ea''�• #60 Old Town Road Property Address Richard Trull Owner Owner's Name information is Barnstable MA 02632 1/27/09 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain.- The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 60 Old Town Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments #60 Old Town Road Property Address Richard Trull Owner Owner's Name information is required for Barnstable MA 02632 1/27/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 60 Old Town Road,Hyannis•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments _ #60 Old Town Road Property Address Richard Trull Owner Owner's Name information is required for Barnstable MA 02632 1/27/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 60 Old Town Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form =� Subsurface Sewage Disposal System.Form - Not for Voluntary Assessments �,e. #60 Old Town Road Property Address Richard Trull Owner Owner's Name information is required for Barnstable MA 02632 1/27/09 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 60 Old Town Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 j Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments #60 Old Town Road Property Address Richard Trull Owner Owner's Name information is required for Barnstable MA 02632 1/27/09 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: September-2008 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: Last date of occupancy/use: Date Other(describe): 60 Old Town Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts _ Title 5 Official Inspection Form 1= Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a / #60 Old Town Road Property Address Richard Trull Owner Owner's Name information is required for Barnstable MA 02632 1/27/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Board of Health Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: October 6, 1997 Were sewage odors detected when arriving at the site? ❑ Yes ® No 60 Old Town Road,Hyannis•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments #60 Old Town Road Property Address Richard Trull Owner Owner's Name information is required for Barnstable MA 02632 1/27/09 every page. City/Town State Zip Code Date of Inspection D. System Information cont. Y (cont.) Building Sewer (locate on site plan): Depth below grade: 4 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): No evidence of leaks, plumbing properly vented Septic Tank (locate on site plan): Depth below grade: 4 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1,000 Gallon Capacity If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ------------------------------------------------- ------------------------------------------------------------------------ Dimensions: 8' x 5' x 5' Sludge depth: 38" below inlet Distance from top of sludge to bottom of outlet tee or baffle 22 Scum thickness 1/4" Distance from top of scum to top of outlet tee or baffle 8 Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured 60 Old Town Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts _W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments #60 Old Town Road Property Address Richard Trull Owner Owner's Name information is required for Barnstable MA 02632 1/27/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet baffle present and in good condition. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank tank must be pumped at time of inspection) locate on site plan): 9 9 ( P p p ) ( P ) Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 60 Old Town Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts �6 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments #60 Old Town Road Property Address Richard Trull Owner Owner's Name information is required fdr Barnstable MA 02632 1/27/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day ' Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): 0 *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Equal with all two outlet inverts. Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No evidence of leak or cracks Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 60 Old Town Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments \apt #60 Old Town Road Property Address Richard Trull Owner Owner's Name information is required for Barnstable MA 02632 1/27/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1-6 x6 diam ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 1-26' x 11' x 2' ❑ 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.): SAS fuctioning properly, 1" liquid around SAS by probing stone - no evidence of hydraulic failure. Located cover and opened Pit. 4' liquid in pit-stain line present from failure of pit in 1997. New SAS added at the time. 60 Old Town Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form = Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a V�� #60 Old Town Road Property Address Richard Trull Owner Owner's Name information is required for Barnstable MA 02632 1/27/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 60 Old Town Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts ) � Title 5 Official Inspection Form =l l 1' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments tea ` #60 Old Town Road — -_ ------------.___-_-, -- Property Address Richard Trull Owner Owner's Name information is required for Barnstable MA 02632 1/27/09 _.— every page. City/Town -_ .__--..............__-- State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 7 21 ' +3 33 2 S- AF = 41 I 1�C=�t� �3& = 3r ' `f` 5f-on� o-130>< or, r, 60 Old Town Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 ! f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments #60 Old Town Road Property Address Richard Trull Owner Owner's Name information is required for Barnstable MA 02632 1/27/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 19.7 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ® Accessed USGS database -explain: refer to attached You must describe how you established the high ground water elevation: GIS MAPS - performed groundwater adjustment-see attached. 60 Old Town Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Permit Number: T Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: CICA TCLI�n —k-\1014 Lot No, Owner: ;C�u 4l ����� Address: � r4� Contractor:__ 0, 2tAE s S"\W-e Address:_ MA54Ilpc, Ho Notes: STEP i Measure depth to water table r to nearest 1/10 ft. ................ .Date d �d mo th/day/Year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine. OAppropriate index well.................................................... I�fv3 `j OWater-level range zone ..................................................... C STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well 1 ;fv mont /year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) determine water level adjustment ................. `.......................................... STEP 5 Estimate depth to high water by subtracting the water. level adjustment (STEP 4) from measured depth to water levelat site (STEP 1) ..................................................:..............................: .� f; Figure 13.--Reproduclble computation form. 15 TROY WILLIAMS 3 SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508 3&5-1300 19 Hummel Drive FNOV IVED South Dennis, MA 02660 -` COMMONWEALTH OF NIASSACHUSETTS 8 Z003 EXECUTIVE, OFFICE OF ENVIRONMENTAL AFFAIrRSF BARNSTABLE HEALTH,CREPT. DEPARTMENT OF ENVIRONMENTAL PROTFCTfiO"1�7 f ) TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A [VIAP '-(Ol CERTIFICATION PARCEL 'tZ� (o pZ r.x Property Address: 60 Old Town Road LOT Cp Hyannis,MA Owner's Name: Eduardo&Kelly Almeida Owner's Address: 60 Old Town Road O Date of Inspection: Hyannis,MA 02601 . November 12,2003 O Name of Inspector: "troy M.. Williams 0 Company Name: Troy Williams Septic Inspections Mailing Address: 19 Hummel Drive South Dennis,MA 02660 Telephone Number: (508)385-1300 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system• Passes Conditionally Passes Needs Further [:valuation by the Local Approving Authority 'Fails Inspector's Signature: S�.o-y Date: /1 11 Z /0 3 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I lealth or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This Inspection represents the conditions of the system on the Date of Inspection noted above. ****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 saute or different conditions of use. Title 5 Inspection Form 6/15/2000 pace 1 of It Page 2 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 60 Old Town Road Owner: Hyannis,MA Date of Inspection: Eduardo&Kelly Almeida November 12,2003 Inspection Summary: Check A,B,C,D or E/A WAY 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 Ch4R 15.303 or im310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be r laced or repaired.The system,upon completion of the replacement or repair,as approved by the Board o eaIth,will pass. Answer yes.no or nordetermined(Y,N,ND)in the for the following statements. I not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank:(whe r metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is im rnent. Svstem will pass inspection if the existing tank:is replaced with a complying septic tank as approved by t oard of Health. •A metal septic tank.will pass inspection if it is structurally sound,n eaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out igh static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or yen distribution box.System will pass inspection if(with approval of Board of Health): , broke ipe(s)are replaced ob . ction is removed tstribution box is leveled or replaced ND explain: The system to ed pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if ah approval of the Board of Health): broken pipe(s)are replaced. obstruction is'removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: ' 60 Old Town Road Owner: Hyannis,MA of Inspection: Eduardo&Kelly Almeida C. Further Evaluations 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. I. S)•stem will pass unless Board of Health determines in accordance with 310 CMR 15.30 1)(b)that the system is not functioning in a manner which will protect public health,safety and th 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 s marsh 2. System will fail unless the Board of Health(and Public W er Supplier,if any)determines that the system is functioning in a manner that protects the public alth,safety and environment: _ The system has a septic tank and soil absorptio ystem(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface wat supply. — The system has a septic tank and SA d the SAS is within a Zone I of a public water supply. — The s)•stem has a septic tank a SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic t k and SAS and the SAS is less than 100 feet but 50 feet or more froM a private water supply well". ethod used to determine distance "This system pass if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and vol 'e organic compounds indicates that the well is free from pollution from that facility and the presence . ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure cd ria are triggered.A copy of the analysis must be attached to this form. 3. Other: M1 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 60 Old Town Road Hyannis,MA Owner: Eduardo&Kelly Almeida Date of Inspection: November 12,2003 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 town 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 NA .Liquid depth in cesspool is less than 6"below invert or available volume is less than%:day flow ✓ Required pumping more than 4 times in.the last year NOT due to clogged or obstructed pipe(s).Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. h13 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. N►,4 Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ NO 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 form.) 140 (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 desi 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 criteri ove) yes no — _ the system is within 400 feet of a surface drinkin ater supply the system is within 200 feet of a tribu o a surface drinking water supply the system is located in a nitroge nsitive area(Interim Wellhead Protection Area—I WPA)or a mapped Zone 11 of a public water sup well If you have answered"yes"to question in Section E the system is considered a significant threat,or answered "yes"in Section D above the , ge system has failed.The owner or operator of any large system considered a significant threat under S . .ton E or failed under Section D shal`.upgrade the system in accordance with 310 CMR 15.304.The system o, er should contact thq appropriate regio tal office of the Departcrlent. 4 Page 5 of l l OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 60 Old Town Road Owner: Hyannis,MA Date of Inspection: Eduardo&Kelly Almeida. November 12,2003 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No (':::::ping information was provided by the owner,occupant,or Board of I iealth 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: Yes no ✓ _ 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(3)(b)) n � • Page 6 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 60 Old Town Road Owner: Hyannis,MA Date of inspection: Eduardo&Kelly Ahneida RESIDENTIAL November 12,2aMOW CONDITIONS Number of bedrooms(design): Nwnbcr of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x k of bedrooms): 3 3 o Number of current residents: -3 Does residence have a garbage grinder(yes or no): /o Is laundn on a separate sewage system (yes or no) n�� (if yes separate inspection required] Laundry system inspected(yes or no):�� Seasonal use: (yes or no):.—o Water meter readings,if available(last 2 yearsltsage(gpd)): _o¢-o Z: y 2vo 3 = 29', Sump pump(yes or no): No Last date of occupancy: 0� COM M ERCIAL/INDUSTRIA L Type of establishment: Design flow(based on 310 CMR 15.203): —gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(y or no): Water meter readings, if available: Last date of occupancy/use: -- OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: No ,,,, Was system pumped as pan of the inspection(yes or no)`.Rio 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/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 installed(if known)and source of information: el-bow CL—A lf.•4, -lv �D.,.� S/�3/$ 3 li /fVq.�►rl ww ��sh.It . r �ti to4Q ? Pw cAt.., pt:e C­L Were sewage odors detected when arriving at the site(yes or no): At- 6 Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: . 60 Old Town Road Owner: Hyannis,MA Date of Inspection: Eduardo&Kelly Almeida November 12,2003 BUILDING SEWER(locate on site plan] Depth belo%ti grade: 16 "} Materials of construction:_cast iron Z40 PVC_/other(explain):_/, L,o'd T /ou C- Dkiance fron, private water supply well or suction line: /ql g Comments(on condition of joints, venting,evidence of leakage,etc.): N!1%e a l..,. S u C u,r J+- 1 ►. S c, �.. SEPTIC TANK: ✓(locate on site plan) Depth below grade: /D" Material of construction: ,, concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: o0o s w�l o . Sludge depth: 9 Distance from top of sludge to bottom of outlet tee or baffle: c;2 '8 Scum thickness: 11, Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: / 3 How were dimensions determined: Drab.. • _ Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): �.�r �vt•�..�a.t.S Wiv+ h v+9✓h .... oic:.t,.r. . .�`•�O—�Shc at.5�-L��._.� C-w11. V �-G�W.c�c.,.• w 0.S TP y N GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polye ene 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 affle: Date of last pumping: Comments(on pumping recommendations,in and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of le e,etc.): 7. 1 Page 8 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 60 Old Town Road Owner: gym,MA Date of Inspection: Eduardo&Kelly Ahneida November 12,2003 TIGHT or HOLDING TANK: (tank must be pumped at timXinsion)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass__polyethylene other(explain): Dimensions: Capacity: ftallons Design Flo%%: gallons/day Alarm present(yes or no): Alarm level: Alarm in working er(yes or no): Date of last pumping: Comments(condition of alarm an oat switches,etc.): DISTRIBUTION BOX: (if present 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 carrygver,any evidence of leakage into or out of box,etc.): D-3a)o wus ( ,-, j ' wa✓( ��a.,� w ; t'w �. -Fro ou�l� f I' ►, �S . /�/c� a�1. 1 •�, c �_ v�i2►+► PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Cop ments(note condition of pump chamber,conditio pumps and appurtenances,etc.): 3A{`i 1- S 3 �"fi � S f 4 +p: J, Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE AISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 60 Old Town Road Owner: Hyannis,MA Date of Inspection: Eduardo&Kelly Almeida November 12,2003 SOIL ABSORPTION SYSTEM(SAS): ve' (locate on site plan,excavation not required) If SAS not located explain why Type ,' leaching pits.number: t1, 'Z 's fV h ✓ 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.): t C�c ✓., *h �S rS n Nl dr G L./�u� Vl0 CESSPOOLS: (cesspool must be pumped as part of inspection) cate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth ofseum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or r Comments(note condition of soil,sig , of hydraulic failure,level of ponding,condition of vegetation,.etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Con l,Ments(note condition of soil,signs of hydraul ilure,.level of ponding,condition of vegetation,etc.): h v } M M. Page 10 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 60 Old Town Road Hyannis,MA Owner: Eduardo&Kelly Almeida Date or Inspection: November 12,2003 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. Ac- = 18 6 ► � ' rap 17` qv) : 21 ' 3Cc4 G = y 7 ' I � Iouuy�l(�ti O A A o-13--lx E - O - ` .'Page 1 I of I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 60 Old Town Road Owner: Hyannis,MA Date of inspection: Eduardo&Kelly Almeida SITE EXAM November 12,2003 Slope Surface water Check cellar ✓ Shallow wells Estimated depth to ground water 3_I_1S feet Adjuslcd high ground water cicvation 27.y_'feel Please indicate(check)all methods used to determine the high ground %%ater 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 I lealth-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain:,_ Z L y y You must describe how you established the high ground water elevation: G( ln►si. • b t t'..cam• •`'� -- J u - yy ' This report has been prepared and the system inspected as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,written or implied, relating to the system,the inspection and/or this report. I In accordance with Massachusetts General Laws C. 111 § in CMR stet and her Clot accessible notice the following of the date and methods(s) of removal or covering of paint, plaster or other accessible materials to be rovided and must persons,natdleastotonl(10)s of lead d&VO 2riorsto beginning of deleadingbe received by 1. occupants of the dwelling unit 2. All other occupants of the residential premises, if any Fax (617) 753-8436 3. Director, Childhood Leading Poisoning Prevention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Fax (617) 727-7568 4. Director, Asbestos & Lead Program Department of Labor.& Industries Room 11006, 100 Cambridge Stree; Boston, MA 02202 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission (If premises is listed on the State Register 220 Morrissey Blvd. of Historic Places, this notification must be Boston, MA 02125 . made upon receipt of an Order to Correct Violations or 'at least 30 days prior to initiating preventive deleading)Fax (617) 727-5128 Doleadina COntr&Ctor pains and penalties of perjury, that The undersigned hereby states, under the p he/she has read and understood the COMM poisonin nwealth of Massachusetts Regulations, 454 CMR 22.00 and Leading g ... Regulations, . 105 CMR and'correct000, dtohtheat tbestnofrh is/her mation cknowledge land hbelief. notification is true g Date 2 -- 9 7 Signed: ' Title: _ �"�,�`� Company: property owner (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealth of Massachusetsaiow-poising Prevention n riskabatementandcontainmented Control gulations, 10.5 CMR 460.175, for owner/agent further certify that I or my agent will be performing the following low-risk activities (I have circled all that, apply) : capping baseboards applying liquid_encapsulant applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters tide .�n�l c��r�ert to the I certify that all `the' information contained in this notification is best Of my knowledge and belief. Date: _ KEV 10/12/95 +•ar�srna*ice-ca�a+se'*raTce^ t=��€++aua� ._ _ -_ , ,. �a�. _ ,.,u_.._• .:. p;�y,_.. . ._ _ ,.._.....,.�..---.� CCHWNWEALTH OF MASSACHUSETTS Department of Labor i Industries and Department of Public Health NOTIFICATION OF DELEADING WORK All sections of this form must be completed in order to comply with the notification requirements of M.G.L. c.111 § 197, 454 CHR 22.00 and 105 CKR 460.000 as most recently amended FILE NUM)ER: (AGENCY USE). Contractor perforrning project Accurate Deleading Company License # 000053 Exp.date 1/98 Lead Paint Inspector Fred H mm;1a License # Date of Inspection 5/27/97 If low-risk deleading work is being performed, complete the following line: Property owner Agent(s) Address of Project Building Name (if any) Floor Street Addddr-e-sss^-' 60 Old T� own��o`add Apt. No. City �G� Hyann_i_G-=nrt Nra ! Zip 02672 Deleading Method: Wet/Dry Scraping Heat Gun Caustics Liquid Encapsulant Covering Demolition Replacement Other If "Other" selected, please explain RPmnuni A, -rl can ii xgrnT .4prlozxr, & deers w/al coil stock (white) Remove windows only, Check One: dwelling is multi-family single family XXXXX Start date 9/15/97 Completion date 11/ 5/97 When will work be done: A.M. XXXXX P.M. XXXXX Weekends? if necessary Project Supervisor's name. Robert T. Beauregard License # 00053 Property Owner Dennis Corners Address P.O. Box 85 City W. Hyannisport State Ma. Zip 02672 j Telephone (508) 790-2303 Ext. 30 In case of emergency contact Robert T. Beauregard Phone: day (508) 996-1205 evening (over) TOWN OFBARNSTABLE LOCATION too M#.�c RA SEWAGE# 91-54;L VILLAGE "gegg�ai5�OfNk- ASSESSOR'S MAP&PARCEL o�Co' ®Coa INSTALLERS NAME&PHONE NO. r tZ U C SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ���c�— y�n� \Nm"size) NO.OF BEDROOMS OWNER PERMIT DATE: 0t,,, C?3: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist �,,^^ on site or within 200 feet of leaching facility) N Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachiNXIA'EA cility) I Feet FURNISHED BY "AN I.{t i A _ TOWN OF BARNSTABLE ,"LOCATION 140 0,1,0-r lelkl &70 SEWAGE # VILLAGE S/b/Zr ASSESSOR'S MAP&LOT ME INSTALLER'S NA &PHONE NOS,o c.--21Ae 'S SEPTIC TANK CAPACITY St CM0 LEACHING FACILITY: (type) 1" °S®� �'�sGi�-- (size) f� '��X NO.OF BEDROOMS 73 BUILDER OR OWNEReovn:%S PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist . within 300 feet of leaching facility) Feet Furnished by O O V4 1 -- No. � `� / � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE.,MASSACHUSETTS pplicatton for Migpo al 6pztem Cow5trurtton Verna Application for a Permit to Construct( )Repair(�.Agrade( )Abandon( ) 0 Complete System O Individual Components Location Address or Lot No.Zao ©C TQ,,'" Owner's Name,Address and Tel.No. '�-�..�t�,atsrts PprT Assessor's Map/Parcel f 6�p'�{!�.*e V5 Installer's Name,Address,and Tel.No. 1� '-7'7�'� y Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms -� �LoLSiz_e sq.ft. Garbage Grinder( ) Other Type of Building e_Sj cLeA,+'1�0. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow .3 3O gallons per day. Calculated daily flow 3 gallons. Plan Date Number of sheets Revision Da e Title Oi,—,hV'S ��lr��• �`C"S Size of Septic Tank 15�?cj 5 NIVO Type of S.A.S. Description of Soil51 6 Nature of Repairs or Alterations(Answer when applicable) /V a N De 1 141 S tK-a a c,. Ij 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 issue 's S' Date Application Approved b Date % S7 Application Disapproved for the following reasons Permit No. Date Issued ., .. pr No. le� Fee-=��1 Entered in computer:- t� THE COMMONWEALTH OF M4ASSACHUSETT$Z,; _4 yes._. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS } 01p pYicatiouJor Mte;pogar *poteut Con6tructiou Permit Application fora Permit to Construct( )Repair grade,'( )Abandon( ) El Complete System ElIndividual Components Location Address or Lot No. (00 O 1� `G�i VIJ ` F` Owner's Name,Address and Tel.No. Assessor's Map/Parcel X6 n 0 `Lh"V`dt'�5 V,3 Installer's Name,Address,and Tel No. '7 7 `06?�/ Designer's Name,Address and Tel.No. �� �d- -e-- 11 2-0 �a--qc acl'_ I N rh 1\ Type of Building: Dwelling No.of Bedrooms 3 LLo Size sq. ft. Garbage Grinder( ) Other\ Type of Building -.Si �T"I�o. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 30 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date' Title �rs�� �•, • Size of Septic Tank 15Qi �t 1L2y Type of S.A.S. a' Description of Soil �Ar� Nature of Ikepairs or Alterations(Answer when applicable) ti�"Ka�� n� �� Cu� C I ►+� ��-- Date last inspected: ._ Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued ar Date Application Approved by Date 57 Application Disapproved or the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS r" BARNSTABLE, MASSACH'USETTS Certificate of, ompliauce THIS IS TO CERTIFY that the On-site Sewage DisposalfSystem'Constructed( )Repaired ( )Upgraded Vill Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for ilsposa System Construction Permit No. dated Installer _ Cr4i Designer. t The issuance of this perms :hall not 4 construed a'a guaranteetthat the'., will function s&s ned.._ Date �^ �"`�. /� au"` Inspecto.• " -- ^ter. --------r-� ----------- No. Fee J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 1=i2;poga1,*p!5tem Construction Permit Permission is hereby granted to Construct( `)#Repair( )Upgrade Abandon System located at r,�o �► ` a�1n` ,�T/ �,J u �V,V\ 41S and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to F comply with Title 5 and the following local provisions or special conditions. r Provjded:Construc 'on m st be completed within three years of the date of�thisspemut. ___ Approved by r �l NOTICE:: This Form is to I)c used for the Repair of Failed y'" • � •r" Scl)(ic Systems Only h CEIt'I'1FICKFION OF SKETCH ANU APPLICATION FORA DISPOSAL 1V0I116 C'ON S'I*ItUC-I-ION 1-1110111• OVITI1UU'1• DESIGNED PLANS \ , hereby certify that the application for disposal works construction permit signed by me dated '>`—c)*--7J concerning the property located at &-0 O ko *r 0e,rr mess all of the following criteria: v. There arc no wetlands within 3oo feet or the proposed septic system There are no private wells within I So feet of the proposed septic system ,/The observed groundwater 161e is 14 feet or greater below the bottom or the leaching Willy 'here is no increase in now and/or change In use proposed There are no variances requested or needed. STONED: DATB: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER .K IAUach a sketch plan of the proposed system. Also if the licensed Installer posesses a certified plot plan, this plan should be submitted). I s. •� oc ._ t .. d SENDER: I also wish to receive the v ■Complete items 1 and/or 2 for additional services. „ ■Complete items 3,4a,and 4b. following services(for an ■Print your name and address on the reverse of this foam so that we can return this extra fee): card to you. ■Attach this form to the front of the mailpiece,or on the back if space does not Permit. 1. ❑ Addressee's Address � � m ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2, ❑ Restricted Delivery W ■The Return Receipt will show to whom the article was delivered and the date .. delivered. Consult postmaster for fee. v 3.Artigie Addressed to: 4a.Article Number d d P ac203 �ZgdOPdlC c � 4b.Service Type ❑ Registered . W7 Certified c ❑ Express Mail _ ❑ Insured Q �4 0 ❑ Return Receipt Me dli 0 COD a ✓ 7.Date of Delli.VM4 z i OCT) z 5.Received By:(Print Name) 8.Addressee's:° drQd Only#requested w and fee isiai. ! t g 6.Sig ture:(Add,e ee or Agent) ��1P0 iSkiii Is i PS Form 3811, December 1994 102595-97-B-0179 Domestic Return Receipt I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 ® Print your name,address, and ZIP Code in this box Public Health Division Town of Barnstable P.O.Box 534 Hyannis,Massachusetts,02601 Z 203 498 869 4 US Postal Service ,e Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International M l See reverse Sent & mber r P ce,Sta I C Postage $ Certified Fee .Special Delivery Fee Restricted Delivery Fee Lo c Return Receipt Showing to Whom&Date Delivered Q Return Receipt Showing to Whom, Q Date,&Addressee's Address cDTOTAL Postage&Fees $ M Postmark or Date to a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). i` 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service y window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach,and retain the receipt,and mail the article. L- uz 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Forth 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article Q RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. 0 0 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. r`o 6. Save this receipt and present it if you make an inquiry. t 02595-97-B-01 a5 d Z 203 498 861 a US Postal Service . Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail(See reverse Sent t01 Streetmbe Post e,State, IP 72 Postage 717 60 Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom&Date Delivered Q Return Receipt Showing to whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ Cq Postmark or Date U) Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service m window or hand it to your rural carrier(no extra charge). ai 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Z cc return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address OR on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article Q RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agentof the . addressee,endorse RESTRICTED DELIVERY on the front of the article. CD 5. Enter fees for the services requested in the appropriate spaces on the front of this € - receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. li 6. Save this receipt and present it if you make an inquiry. 102595,97-8-0145 a t Town of Barnstable = Department of Health, Safety, and Environmental Services MAN. Public Health Division i639. eop 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health October 8, 1997 U.S. Dept. of Agriculture Rural Development 451 West Street Amherst, MA 01002 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 60 Old Town Road, Hyannis, MA was inspected on April 2, 1997 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: • "Distribution box is rotting... must be replaced." Also, the leaching pit was full of wastewater effluent, "past the effective depth of leaching." You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within(60) days of receipt of this notice. You are also directed to bring the septic system into compliance within ninety (90) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued.by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE B ARD OF HEALTH G Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health q\health\dbfiles\titles i.doc SHE Town of Barnstable y� �7 pn • Department of Health, Safety, and Environmental Services BARNffrA; ' MA99. Public Health Division 1639• ArFD�a 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health T0: fts, ��' DATE: ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located t 60 b Lt -� as inspected on � D, 097 by �Ic � 6��ci , 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: n /� ``` huh P' lv-x i s , mnt 6. refJacaa ti G t? ��{�GS� You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within n days of receipt of this notice. You are also directed to bring the septic system into compliance within 4'�= -days of receipt of this order letter. ✓)I^V�j (:-'D You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health gV WM&filaVitl4i.dm COmmorweatth of MOSSOChusettS .John Grad Exea tNe Office of EnWomwiritai Affairs D.E.P. Title V Septic Inspector 1�e2119 partnlent of P.O. Box A 02 Environmental Protection Te 5108) 5 MA 0 - � (508) 5G Q SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM A V IBA PART A CERTIFICATION lg9) o Property Address: 60 Old Town Rd. Hyannis Address of Owner: Date of Inspection:3129197 (If different) Q Name of Inspector John Gracl USDA Rural Development Service A Company Name,Address and Telephone Number: B 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes This Inspection is based on criteria defined In Title y _ code 310 CMR 15.303.My findings are of how the system is Conditionally P855e5 _ performing at the time of the Inspection.My Inspection does Needs F her E luation By the Local Approving Authority not Imply any warranty or quarantee of the longevity of the i_Fail septic system and any of its components useful life. Inspector's Signature: fi Date: 412197 i The System Inspector shall lubmit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A,B,C, or D: A] SYSTEM PASSES: _I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: _One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not.) _ The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiitration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11115195) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 60 Old Town Rd.Hyannis Owner: USDA Rural Development Service Date of inspection:3129197 _ Sewage backup or breakout or high static water level observed in the distribution box is due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four 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 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well: The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER D] SYSTEM FAILS: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage in facility or system component due to an 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 cesspool. X SAS is in hydraulic failure. (revised 11115195) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 60 old Town Rd.Hyannis Owner: USDA Rural Development Service Date of Inspection:3120197 D] SYSTEM FAILS(continued) Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further Information. (revised 11/15195) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 60 Old Town Rd.Hyannis Owner: USDA Rural Development Service Date of Inspection:3129197 Check if the following have been done: _X_Pumping information was requested of the owner,occupant,and Board of Health. X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. NaAs built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. x All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the Interior of the septic tank was Inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge, depth of scum. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/15195) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 60 Old Town Rd.Hyannls Owner: USDA Rural Development Service Date of Inspection:3129197 FLOW CONDITIONS RESIDENTIAL. Design flow: "0 gallons Number of bedrooms: 4 Number of current residents: 0 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available: nla Last date of occupancy: 6.7 months ago. COMMERCIAL/INDUSTRIAL: Type of establishment: Na Design flow:0 gallons/day 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: nla Last date of occupancy: n1& OTHER:(Describe) Na Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped in the last year. System pumped as part of inspection:(yes or no)No If yes,volume pumped: 0 gallons Reason for pumping: n1a TYPE OF SYSTEM X Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source information: Approximately 10 years. Sewage odors detected when arriving at the site:(yes or no) No (revised 11115195) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 60 Old ToWn Rd.Hyannis Owner: USDA Rural Development Service Date of Inspection:3129197 SEPTIC TANK: X (locate on site plan) Depth below grade:4' Material of construction:X concreate_metal_FRP_other(explain) Dimensions: L g'6"H 5'7"W 4'10- Sludge depth:4' Distance from top of sludge to bottom of outlet tee or baffle: 23" Scum thickness:5" Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 13• Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) Septic tank and all components are structurally sound.Recommend pumping system every two years for maintenance. GREASE TRAP: (locate on site plan) Depth below grade: Na Material of construction: _concrete_metal_FRP_other(explain) Dimensions: n<a Scum thickness:nla Distance from top of scum to top of outlet tee or baffle:n1a Distance from bottom of scum to bottom of outlet tee or baffle:n1a Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) nla (revised 11115195) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 60 Old Town Rd.Hyannis Owner: USDA Rural Development Service Date of Inspection:3129197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: n1a Material of con struction:_concrete_metal_FRP_other(explain) Dimensions: n1a Capacity: n1a gallons Design flow: n/a gallons/day Alarm level: n1a Comments: (condition of inlet tee, condition of alarm and float switches,etc.) rda DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert: n1a Comments: (note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box etc.) Distribution box is rotting.Distribution box must be replaced. PUMP CHAMBER: (I' (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) n1a (revised 11115195) 7 SUBSURFACE SEW_ AGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 60 old Town Rd.Hyannis Owner: USDA Rural Development Service Date of Inspection:3120197 SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: nla Type: leaching pits,number: 1,000 gallon leach pit leaching chambers,number:n1a leaching galleries,number: n1a leaching trenches,number, length: nla leaching fields,number,dimensions:nfa overflow cesspool,number:n1a Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) The leach pit is past the effective depth or leaching.The sas is in hydraulic failure. CESSPOOLS: (locate on site plan) Number and configuration: n1a Depth-top of liquid to inlet invert: n1a Depth of solids layer: n1a Depth of scum layer: n1a Dimensions of cesspool: n1a Materials of construction: n1a Indication of groundwater: nfa inflow(cesspool must be pumped as part of inspection) Na Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) Na PRIVY: (locate on site plan) Materials of construction: nla Dimensions: n1a Depth of solids: rya Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) nla (revised 11115195) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 60 Old Town Rd.Hyannis Owner: USDA Rural Development Service Date of Inspection:3129197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' Fo IA g it AA At 11 31 DEPTH TO GROUNDWATER Depth to groundwater: 12 feet method of determination or approximation: USGS Maps and Charts (revised 11115195) 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 Green Acre Rd.Falmouth Owner: Mayes Date of Inspection:3129197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' R � A f5 O �t Q6 yo �A �7 DEPTH TO GROUNDWATER Depth to groundwater:12 feet method of determination or approximation: USGS Maps and Charts (revised 11115195) 9 PAR Real Estate System General Property Inquiry Help Parcel Id: 267 062- - Account No: 168749 Parent: Location: 60 OLD TOWN RD HY Neighborhood: 55BC Fire Dist: HY Devel Lot: 36 Lot Size: .28 Acres Current Own US DEFT OF AGRICULTURE State Class: 101 RURAL DEVELOPMENT No. Bldgs: 1 Area: 130-3 (joy 451 WEST STREET Year Added' AMHERST MA 1002 Deed Date: 110196 Reference: 1047506'.., January 1st: US DEPT OF AGRICULTURE Deed MMDD: 1196 Deed Ref: 10475069 Comments: Values: Land: 22400 Buildings: 55000 Extra Features: 600 Road System: 60 Index: 1177 (OLD TOWN ROAD ) Frntg: 102 Index: 1566 (SUNSET TERRACE ) Frntg: 130 Control Info: Last Auto Upd: 020997 Statusg C Last TACS Update: 010697 Land Reviewed By: Date: 0000 Bldgs Reviewed By: ML Date: 0791 Tax Title: Account: 313 Taken: 062388 Account Status: PO Hold Status: PO Cancel Press XMT for more data Next screen PAR Action Owners Name Road Index Road Name Parcel Number 267 063 ai SENDER: 1 alfd�wish tc receive e ■Complete items t and/or 2 for additional services. % ,. �- H EComplete items 3,4a,and 4b. following servtces(for-an 0 ■Print your name and address on the reverse of this form so that we can return this extra-fee)- card to you. / 41 „ ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address permit. y ■Write'Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery rn ■The Return Receipt will show to whom the article was delivered and the date a ° delivered. Consult postmaster for fee. .L 0 v 3.Article Addressed to: 4a.Article Number d z d3 E �'!' — r 4b.Service Type ° 4-d", i r Certified C c���� ❑ Reg Registered ed � ❑ Express Mail ❑ Insured I c ❑ Return Receipt for Merchandise ❑ COD w 3 oa J 7.Date D liqAdVess 0 / a. 3 =ceived (Print Na � 8.Add e 's (Ohly if requested Y and fee is paid) t Sig'' ture: (Addressee or Agent 0 '— PS Form 3811, December 1994 Domestic Return Receipt +G First-Class=Mail UNITED STATES POSTAL SERVICE gg`e, �_- Po`stag &Fees Pad USPS pm f Permit No'G-10 • Print your name', address, and ZIP Code in this box • /991 I I I i Bard of 011I 'Town of BamstablO P.O.Box 534 Hyannis,Massachusetts 02501 af�I •!:33 3.31iiiI 133.11sS13°:3!�e�t ;.� United States Rural 451 West Street Department of Development Amherst, MA 01002 Agriculture (413) 253-4300 TDD (413) 253-7068 "rasa'• '" FAX (413) 253-4347 October 20, 1997 Subject :Septic System 60 Old town Rd Hyannis, Ma. To:Town of Barnstable Public Health Division Please be advised that the owner of record responsible for any necessary repairs to the septic system located at the above-mentioned property is Dennis J. Conners II whose mailing address is P.O. Box 85, W. Hyannisport, Ma. 02672 . Mr. Conners has been forwarded the correspondence dated Oct . 8, 1997 and sent by the Town of Barnstable to the USDA/Rural Development in Amherst, Ma. . Please correct your records to reflect the true owner of the property so that all future correspondence can reach the owner in a timely manner. Thank you for your cooperation and prompt attention to this matter. If you have any further questions, please do not hesitate to call our office at (413) 253-4315 . Peter P. Laurenza Rural Housing Specialist Rural Development is an Equal Opportunity Lender. 1. OoCATION SEWAGE PERMIT NO. VILLAGE /,,,�eg-745 Zk 01 " doe'.-rf M-a I N S T A LLER'S NAME & ADDRESS J• CRAIG MEDEI S Trucking & !Bulb:ig 142 Ctrpomfon Feet Hyannis; Mass. 775-0828 - 0*, OWNER a-a d [7) DATE PERMIT ISSUED / /� DAT E COMPLIANCE ISSUED - � — f. r F 0 r THE COMMONWEAL:+H OF MASSACHUSETTS Appliration for MiltosaK Works Tonstrurtion ramit Application is hereby made for u Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System Installer Address Dwelling—No. of Bedrooms......^3--------------------------------Expansion Attic ( ) Garbage Grinder ( � Other—Type of Building ------------- No. of persons............................ Sbm~c,x ( ) -- Cafeteria ( ) `4 Other fixtures -.-----_---.------.-.---_----'-.--.---.---..--__---------_-----________ Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity --- Length................ Width................ Diameter................ Depth................ Disposal Trench--0o..................... Width.................... Total Loogtb-------..- Totalkacbiogurca....................sq. ft. Seepage Pit No--_-.-- D�oetoc_---._- Depth below inlet.................... Total �uc6�gur��--_-_-ag ft. �o Other D�tr�n��nnbox (' ) Dosing tank ( ) ~" Percolation Test Results Performed bn-----'--.------.--_.-------_--'---- [ate........................................ Test Pit No. l-----.mioutcayerinc6 Z)eyt6 of Test Pit.................... Depth to ground water........................ fZ4 Test Pit No. per inch Depth of Test Depth mground wuter''_'__-' P4 ----------;e.................................................................................................................................... 0 Description of ...............................................................~ ...................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicabl ............. .. The undersigned u&ccee to install the uforcdexcribcd Individual Sewage Disposal System-in accordance with the provisionsof TITLE 5 of the State Sanitary Codo—Thennderoigoed further agrees not to place the system in operation until a Certificate of Compliance !�igne -----.---' ~_ --_'--- Appl�utoo Approved D --------'................................... _�� _______ Date Application Disapproved reasons:..................................................... ----'-`----'-----'-----'----`----'------------`---`'--''--'--`---------`----'-------- ~^= Permit Date |-- - -- - � - ' - -� - � — - - - � THE COMMONWEALTH opMAssAoHussrrs / � BOARD OF HEALTH ..........-'..-----���F�'J� ------------------' �� ���rt«��ua4e Qu Tou4tplia4ua ��w-,i e has been installed in accordance with the provisions of TI1 5of The State Sanitary Code depribed in the application for Disposal Works Construction Permit No.... ............... -------- is V osal System constructed or Repaired THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM /FkTION SATISFACTORY. .................................................................... Inspector....... ---/:�--------------------------------------------------------------- - ................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEALTH ApplirFation for Disp.aii al Worse Tnnatrurtuan "truth Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: LoeatMon.. dress ATn .. ..- ----- - •... ...._._..._ - - ---...... ner r r.+r w IT) , .. ...... ........ -G� . ... ... Installer Address Build Size Lot............................Sq. feet (;) aDwelling—No. of Bedrooms___. ................................Expansion Attic ( ) Garbage Grinder ( ) p, 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. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... a ............................................... O Description of Soil...... ' U .-•----•---------------------------------•-------------------------------------------•----•-----------------------------••......----- W ••-•----••••----------------••---•••-• •--•••------------•-•--••--••--------------•••••-•...•. U Nature of Repairs or Alterations Answer when applicabl _ ... . : j Agreement: � / The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TILTIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Complianc as been issu y the board of hea th f -� gne ....... !-. .... Application Approved BYE'b � - ---••--•--•--- Date Application Disapproved f t e.following reasons:------•------------------•------------------------------------------------------•--------------------......•---- -•-•------•-......--•-•------------•--------------------------•---------...-_................----------------••-•----•--•--••-•--•-------•-•------.---- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD „ F HEALTH / ..L ...........OF... .............................................. %antif irttft, of Toutplianrr T IS 0,CER rFiY. T t the Itidivid wa Disposal System constructed ( ) or Repaired ( ) b "........ ............... ............................... - ----------- Y . a stall at . ................................... l - ---- --- ........................................................... has been installed in accordance with the provisions of mZ + 5 of h State Sanitary Code de r' ed in the application for Disposal Works Construction Permit No____ __________ ........... dated--_ ___,. _'------------_-------_--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS y G 1! 1l BOARD F" HEALTH ..d Via ..................OF....... ...... ._..................................... No..... ..#. .. FEE..t�............. Ropla at pmb Tv"iAration, rranit Permission is hereby granted... ••-• .-• •-...•....."-`9 ------------------------------------------------------------- to ConstruuS "( ) or epair rr-.i:; ival SP. V.. spo st ol at No..._.t� � .....Zated... • -- '�' -- S ..- as shown on the application for Disposal Works Construction Peri No............... f'_:...........�_............ PP P <� .... .............................. _ Boa of Health DATE................................................................................ 101, FORM 1255 HOBBS &, WARREN. INC.. PUBLISHERS