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HomeMy WebLinkAbout0073 ORR'S AVENUE - Health 73 ORRS AVE. HYANNIS A,—� A = 291 194 o 91 IJ I 9, k i o E t TOWyri Or BARNSTABLE U,'CnTION -73 ap-,s li�fs e SEWAGE # 01CW I 3�S VILLAGE "S ASSESSOR'S MAP & LOT -2 91- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /,aag 64lL LEACHING FACILITY: (type)',Iw 7�'�i 4 k) [ )) (size)0X 3e,sz11 NO.OF BEDROOMS BUILDER O OWNER C-e6Ler PERMITDATE: J Z o I COMPLIANCE DATE: Separation Distance Between the: 'LL 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 3 • -1 "� �---r _� o �� �.. _ � a ��-� w �� �'� ®- } P 1 ` � �, - '\. � qu, Commonwealth of Massachusetts Title 5 Official Inspection Form p. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Orrs Avenue Property Address i i' Dennis Kerkado Owner Owner's Name information is ✓ MA 02601 3/16/20 ~ required for every Hyannis 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 S! HL103 on the computer, use only the tab Richard T. Johnson key to move your Name of Inspector cursor-do not D &J Environmental Services use the return Company Name key. 10 Mt. Pleasant Street 40Q Company Address Plymouth MA 02360 City/Town State Zip Code Qr 508-735-8740 S113545 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 3/16/20 n ctors Sig ure 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 c Commonwealth of Massachusetts �M Title 5 Official Inspection Form °I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . � 73 Orrs Avenue Property Address Dennis Kerkado Owner Owner's Name information is required for every Hyannis MA 02601 3/16/20 page. City/Town 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 r - c Commonwealth of Massachusetts �m ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 73 Orrs Avenue Property Address Dennis Kerkado Owner Owner's Name information is required for every Hyannis MA 02601 3/16/20 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 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Orrs Avenue v Property Address Dennis Kerkado Owner Owner's Name information is required for every Hyannis MA 02601 3/16/20 page. Cityrrown 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: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El ® 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 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Orrs Avenue Property Address Dennis Kerkado Owner Owner's Name information is required for every Hyannis MA 02601 3/16/20 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 '/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. ❑ ® 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 ❑ ❑ 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 73 Orrs Avenue Property Address Dennis Kerkado Owner Owner's Name information is required for every Hyannis MA 02601 3/16/20 page. Citylrown 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)] t5ins .doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 P P 9 Commonwealth of Massachusetts +n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 73 Orrs Avenue Property Address Dennis Kerkado Owner Owner's Name information is required for every Hyannis MA 02601 3/16/20 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220GPD Description: r 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: not available Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts �ry ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 73 Orrs Avenue Property Address Dennis Kerkado Owner Owner's Name information is Hyannis MA 02601 3116/20 required for every y ate page. CityrTown St 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: owner 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 Commonwealth of Massachusetts �n Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c � 73 Orrs Avenue Property Address Dennis Kerkado Owner Owner's Name information is required for every Hyannis MA 02601 3/16/20 page. Cityrrown 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: 2001 per as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: <1feet 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.): joints structurally sound, no signs of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts +r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Orrs Avenue v Property Address Dennis Kerkado Owner Owners Name information is required for every Hyannis MA 02601 3/16/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: <1feet 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: 1000 Gal. Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 34" <1„ Scum thickness 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? Field Measurement/Mfg. Specs. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Sanitary tees in good condition, tank structurally sound, no evidence of leakage. It is recommended that system be pumped regularly to extend life of components. This report does not guarantee that system will operate properly in the future. l5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Orrs Avenue Property Address Dennis Kerkado Owner Owner's Name information is required for every Hyannis MA 02601 3/16/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: fe et Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): _ 'NI 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 73 Orrs Avenue v Property Address Dennis Kerkado Owner Owner's Name information is required for every Hyannis MA 02601 3/16/20 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 I Date of last pumping: Date Iv Comments (condition of alarm and float switches, etc.): *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.): Box level, distribution equal, no evidence of solids carryover, no evidence of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Orrs Avenue Property Address Dennis Kerkado Owner Owner's Name information is required for every Hyannis MA 02601 3/16/20 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: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 1 x 20' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: I ❑ 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Orrs Avenue Property Address Dennis Kerkado Owner Owner's Name information is Hyannis MA 02601 3/16/20 required for every y ate page. Cityrrown St 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.): no evidence of hydraulic failure, no no damp soil, normal vegetation. 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 c Commonwealth of Massachusetts Title 5 Official Inspection Form TI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 73 Orrs Avenue Property Address Dennis Kerkado Owner Owner's Name information is Hyannis MA 02601 3/16/20 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 Commonwealth of Massachusetts 992 Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System_Form-Not for Voluntary Assessments 73 Orrs Avenue Property Address Dennis Kerkado Owner Owner's Name information is Hyannis MA 02601 3/16/20 required for every y 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: ® hand-sketch in the area below ❑ drawing attached separately Sketch is not to scale A=Inlet cover to Septic Tank XA=25'9" YA=17'9" B=Outlet cover to Septic Tank XB=31'4" YB=15'6" C=Distribution Box XC=51'6" YC=28'0" WA j J pump A C . 3 0rr,5 A Yen ue 15itrep doe•rev.7/i81�018 Title 5 ORMW kgmc ion Form:S Sewage Disposal Syamm•Page 16 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 73 Orrs Avenue v� Property Address Dennis Kerkado Owner Owner's Name information is required for every Hyannis MA 02601 3/16/20 page. Cityrrown 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: NGWE at 120" per soil logs 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: 2001 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: Obtained from site observation, visual elevation, soil logs on file at BOH dated 2001 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Orrs Avenue Property Address Dennis Kerkado Owner Owner's Name information is Hyannis MA 02601 3/16/20 required for every y page. Citylrown 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 Z� No. 7AV L3 C/J Fee �) < THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OFF BARNSTABLE., MASSACHUSETTS Yes Application for INgogal *pttem Construction i3ermit Application for a Pemut to Construct( )Repair(-/)Upgrade( )Abandon( ) O Complete System Y Individual Components Location Address or Lot No. Owner's Name,Add ss and Tel.No. )3 prr,5 -f� Gym -1j� Assessor's Map/Parcel �t�Cyn �l fl Installer's Name,Address,and Tel.No. �¢ Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(YO Other Type of Building % No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow ci© gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 'z Description of Soil ell Nature of Repairs or Alterations(Answer when applicable) �11�- /4 . '/�� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b his Bo I of Jgealth. Signed Date D/ Application Approved by Date �ZS_ 0 Application Disapproved for the following r asons Permit No. Date Issued S' Zs- 0 r» �- No. Oev/-3 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: r?t '4_4, Yes PUBLIC HEALTH DIVISION - TOIW"F BARNSTABLE., MASSACHUSETTS ZIppfication for Mfi6pogar *p.5tem (tongtruction Permit Application for a Permit to Construct( )Repair( ✓)Upgrade( )Abandon( ) ❑Complefe»System Y Individual Components » Location Address or Lot No. 3 Owner's Name,Address and Tel.No. � 0 ors Q� Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ,Qpt I"d10 Co�s7` � 7/-939� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(/00 Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow ,�J�O gallons. Plan Date Number of sheets Recision Date Title Size of Septic Tank IMP 9P -Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) X­1 '9 Date last inspected: Agreement: The undersigned agrees to ensure the construction atd'maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b pis BoaFd of Health. Signed -!' 4r ;22 - Date /d> Application Approved by a Date =Zr 0 Application Disapproved for.the following r asons Permit No. 100 - 32r" Date Issued Y ZS 0 i THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (tompliance THIS IS TO CERTI�Y, that th/-On-s to Sewage Disposal System Constructed( )Repaired (!" ) Upgraded( ) Abandoned( )by ll y`�Hof C ®��5�• at 7 3 el/-lS has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No 2-V/-.3 Z-r dated Installer Designer The issuance of this 1 not be construed as a guarantee that the syste unc signed. Date �t G Inspector No.2ad �'" �Z� ------—---------------- Z < l— // �/ Fee THE,COMMONWEALT.H OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS Miopooal *pttem Construction Permit Permission is hereby granted to Construct( )Repair(�)Upgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructio must be completed within three years of the date of this p t. Date: Z� Dl Approved b Y I NOTICE: This ForM Is To Be'Used For the Repair Of Failed so tic Systems. Only: - - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONMUCTION PERMIT(WFIgOUT DESIGNED PLAN hereby ce that the anolication for disposal w. r'�' / �-lal ... p sal orics construction permit sired by me dated !Z,i concerning the property located:at 7.3 01/',3 !� � ��.� meets all or the iollowinz Criteria:. !Y 7ae Lailed S,'sCeIn is conned to a residential dwe��� ina on iv. there a� no coinmer c::al or bt'SL1es5 es assocated with the dwel t--g. ;ae scil.is classified c:ied as CLASS I and the_ -oiation mm is .e^s man or eauai :o_ minis Ies Der :IIC:1 ne:e are.'o wetlands within I00 eet of me:,ron_os=s.-o_uc s.stem 4r "ae ;i _ .....,e no p,�. e weys wi':h.n.l:0 ___.of file proposed s=tic 1/7he—T.is no inc:ease in flow'and/or g-- ;or.c:an7_,n _e proxy,-d /7-ne:,e--re no v-sances.,^us-Ltd or tilt i iRe bottom of the proposed leaching aeiity will not be-located es- • '— xated less �tian nve.__.above the ::,aemum a#zted,o-oundwater able elevation. (Adjust the?*oundwater.table.using the.=rimptor /ethod when applicable], Lf-theS.A.S. wtll be looted with_50 i.._,of any vegtated wetlands. the bottom or the propose leachng facility will not be located less than iourte_n(14)feet above the m2--durum adi•usted oundv ester table elevation, Please complete the foilowinb A) Top of Ground Surface EIevation(using GIS information) 1. 53 B) G.-W.Elevation =the MAx Fugh G.W.'Adju meat. D rrrRENCE BETWEEN A and B 6 SIGNED : DATE: (Sketch proposed Pl2n of system on back]. ¢ NAM-=1 .�. T/ �d j���,���� �-��� 3 ��X�� � ��^�� �� , ILI Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 73 0rr's Avenue qq 9/ Property Address Claudio Coelho 9 y Owner Owner's Name information is Hyannis MA 02601 April 16, 2008 required for H Y p every page. Cityrrown 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: only the tab key to move your David D. Coughanowr cursor-do not Name of Inspector use the return key. Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and t*,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 mai,htenance-of on-site sewage disposal systems. I am a DEP approved system inspector pursuant to2sectionA.5.34"f Title 5 (310 CMR 15.000). The system: ' "_ ® Passes ❑ Conditionally Passes ❑ Fail' i t�9a ❑ Needs Further Evaluation by the Local Approving Authority f � �. �S April 16, 2008 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5-2912.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 73 Orr's Avenue Property Address Claudio Coelho Owner Owner's Name information is Hyannis MA 02601 Aril 16 2008 required for Y p every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E I always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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 ass inspection if it is structural) sound, not leaking and if a Certificate P P P Y 9 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 t5-2912.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 73 Orr's Avenue Property Address Claudio Coelho Owner Owner's Name information is Hyannis MA 02601 April 16 2008 required for Y p , 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. t5-2912.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts ' W Title 5 Official Inspection Form z Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Orr's Avenue G„M SVay`e. Property Address Claudio Coelho Owner Owner's Name information is Hyannis MA 02601 Aril 16, 2008 required for Y P 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 '/2 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. t5-2912.doc-06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 73 Orr's Avenue Property Address Claudio Coelho Owner Owner's Name information is Hyannis MA 02601 April 16, 2008 required for Y p every page. Cityrrown 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. t5-2912.doc-08/06 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 °M 73 Orr's Avenue Property Address Claudio Coelho Owner Owner's Name information is required for Hyannis MA 02601 April 16 2008 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? SAS also located ® ❑ 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. Location confirmed Determined in the field (if any of the failure criteria related to Part C is at issue ® ® size not approximation of distance is unacceptable) [310 CMR 15.302(5)] 15-2912.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 73 Orr's Avenue Property Address Claudio Coelho Owner Owner's Name information is i H anns MA 02601 April 16 2008 required for y p every page. Cityrrown 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 gpd Number of current residents: 5 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)): 293 gpd Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5-2912.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Orr's Avenue Property Address Claudio Coelho Owner Owner's Name information is required for y H annis MA 02601 April 16, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Owner Was system pumped as part of the inspection? ❑ Yes ® No 1f yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool P Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Age: 6+years. Certificate of Compliance issued 611912001 (Board of Health permit#2001-325) Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-2912.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 73 Orr's Avenue Property Address Claudio Coelho Owner Owner's Name information is Hyannis MA 02601 April 16, 2008 required for H Y p every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): No evidence of leakage or backup into dwelling was observed. Septic Tank(locate on site plan): Depth below grade: 1 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: 8.5 ft x 5 ft x 5 ft(1000 gallon) Sludge depth: 8 in Distance from top of sludge to bottom of outlet tee or baffle 26 in Scum thickness 6 in Distance from top of scum to top of outlet tee or baffle 7 in Distance from bottom of scum to bottom of outlet tee or baffle 11 in How were dimensions determined? As built card t5-2912.doc•08/06 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 ° M 73 Orr's Avenue Property Address Claudio Coelho Owner Owner's Name information is Hyannis MA 02601 April 16, 2008 required for Y p 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.): Pumping is recommended at this time and maintenance pumping is recommended every two years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): t5-2912.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 73 Orr's Avenue Property Address Claudio Coelho Owner Owner's Name information is Hyannis MA 02601 Aril 16 2008 required for Y p , every page. Cityrrown 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.): *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 At outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box appears structurally sound with no evidence of leakage in or out. Some solids in sump. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-2912.doc-08106 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 M 73 Orr's Avenue Property Address Claudio Coelho Owner Owner's Name information is Hyannis MA 02601 April 16 2008 required for y p 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: ❑ leaching chambers number: ® leaching galleries number: 1 � ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soils above leaching gallery appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. A bucket of water was poured into the distribution box and was observed to pass through in an unobstructed manner, and could be heard splashing down into the leaching gallery. 15-2912.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M 73 Orr's Avenue Property Address Claudio Coelho Owner Owner's Name information is Hyannis MA 02601 April 16, 2008 required for Y p every page. Cityrrown 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.): t5-2912.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Orr's Avenue Property Address Claudio Coelho Owner Owner's Name information is Hyannis MA 02601 April 16 2008 required for Y P every page. Cityrrown 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. LOCATIONS A B EXISTING 1 17.5 Ft 25 Ft DWELLING 2 26 FL 51.5 Ft # 73 B A W Z 1 0 o J SEPTIC TANK w 3I 2 o D-BOX LEACHING GALLERY NOT TO SCALE ORR ' S AVENUE t5-2912.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 I Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 73 Orr's Avenue Property Address Claudio Coelho Owner Owner's Name information is April Hyannis MA 02601 A 16 2008 required for Y p � , every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: 15 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As built card on file ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: Barnstable GIS Department records You must describe how you established the high ground water elevation: Town of Barnstable GIS Department records indicate that the property is 15 feet above groundwater table. As built card on file at the Barnstable Board of Health shows bottom of leaching facility to be over 5 feet above the maximum adjusted groundwater table. t5-2912.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form Not for Voluntary Assessments °M 73 Orrs Avenue Property Address HUD/Cityside Management Corp., 22 Medallion Center, Greely St., Suit 5, Merrimack, NH 03054 Owner Owner's Name information is Hyannis MA 02601 August 24 2009 required for _ Y 9 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information I forms on the computer,use 1. Inspector: only the tab key to move your Michael McDowell r cursor-do not Name of Inspector use the return key. The Building Inspector of America Company Name t — Q 2 Brookside Circle ° Company Address Z Wilbraham. MA 11095 City/Town State —Alb Code 3> 800-626-4408 156 Telephone Number License Number W B. Certification I certify that I have personally inspected the sewage.disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper.function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ -Fails ❑ Needs Further Evaluation by the Local Approving Authority • August 24, 2009 Inspector's Signature,Michael McDowell,MM/jm Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system.owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes'conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. L� 73 Orrs Avenue,Hyannis,MA HUD.doc•08/06 Title 5 Official Inspection Form:Subsurface S age Disposal System•Pa e 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 0 73 Orrs Avenue Property Address HUD/Cityside Management Corp., 22 Medallion Center, Greely St., Suit 5, Merrimack, NH 03054 Owner Owner's Name information is Hyannis MA 02601 Au ust 2009 24 required for y g , every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: N/A _ ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20,years old is available. ND Explain: ❑ 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 . 73 Orrs Avenue,Hyannis,MA HUD.doc•06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °M 73 Orrs Avenue Property Address HUD/Cityside Management Corp., 22 Medallion Center, Greely St., Suit 5, Merrimack, NH 03054 Owner Owner's Name information is Hyannis MA 02601 August 24, 2009 required for y 9 every page. Citylfown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): N/A ❑ 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: N/A ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and 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. 73 Orrs Avenue,Hyannis,MA HUD.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form- Not for Voluntary Assessments � M 73 Orrs Avenue Property Address HUD/Cityside Management Corp., 22 Medallion Center, Greely St., Suit 5, Merrimack, NH 03054 Owner Owner's Name. information is Hyannis MA 02601 August 24, 2009 required for y 9 every page.. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): N/A . ❑ 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 ❑ N/A 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). 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.N/A tributary to a surface water supply. 73 Orrs Avenue,Hyannis,MA HUD.doc•08/06 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 4M 73 Orrs Avenue Property Address HUD/Cityside Management Corp., 22 Medallion Center, Greely St., Suit 5, Merrimack, NH 03054 Owner Owner's Name information is Hyannis MA 02601 August 24 required for Y 9 , 2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ N/A Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. El N/A Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. 0 ® 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. N/A For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section.D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ Elthe 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. 73 Orrs Avenue,Hyannis,MA HUD.doc•08/06 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 73 Orrs Avenue Property Address HUD/Cityside Management Corp., 22 Medallion Center, Greely St., Suit 5, Merrimack, NH 03054 Owner Owner's Name information is H annis MA 02601 August 24 2009 required for Y g , 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 CM 15.302(5)]. 73 Orrs Avenue,Hyannis,MA HUD.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal.System•Page 6 of 15 " I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ,M 73 Orrs Avenue Property Address HUD/Cityside Management Corp., 22 Medallion Center, Greely St., Suit 5, Merrimack, NH 03054 Owner Owner's Name information is Hyannis MA 02601 August 24 2009 required for Y 9 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 gpd 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? N/A ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 285 gpd 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Unknown Last date of occupancy: Date Commercial/Industrial Flow Conditions: WA 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: gate Other(describe): 73 Orrs Avenue,Hyannis,MA HUD.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ,M 73 Orrs Avenue Property Address HUD/Cityside Management Corp., 22 Medallion Center, Greely St., Suit 5, Merrimack, NH 03054 Owner Owner's Name information is Hyannis MA 02601 August 24 2009 required for Y 9 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) General Information Pumping Records: Source of information: Unknown, HUD owned house 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 ET Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: _ Septic tank appears to be original with house, approximately 19 years old, based on materials used and their condition. Distribution box and SAS are 9 years old per Board of Health records. Were sewage odors detected when arriving at the site? ❑ Yes ® No I 73 Orrs Avenue,Hyannis,MA HUD.doc•OB/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form. _ Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °M 73 Orrs Avenue Property Address HUD/Cityside Management Corp., 22 Medallion Center, Greely St., Suit 5, Merrimack, NH 03054 Owner Owner's Name information is H annis MA 02601 August 24, 2009 required for Y 9 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer (locate on site plan): Depth below grade: 18 inchesfeet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line:. 6 feet 6 inches feet Comments (on condition of joints, venting, evidence of leakage, etc.): Building sewer exits front foundation wall 9 feet 6 inches in from left front corner. Cleanout is blocked by a framed in box. Recommend making cleanout accessible. Septic Tank(locate on site plan): 12 inches - Depth below,grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 8'L x 5'W x 5'D, approx. 1000 gals. Sludge depth: 0-1 inch Distance from top of sludge to bottom of outlet tee or baffle 30 inches Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 5 inches Distance from bottom of scum to bottom of outlet tee or baffle 18 inches How were dimensions determined? With a tape measure and pole 73 Orrs Avenue,Hyannis,MA HUD.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 5 73 Orrs Avenue Property Address HUD/Cityside Management Corp., 22 Medallion Center, Greely St., Suit 5, Merrimack, NH 03054 Owner Owner's Name information is Hyannis MA 02601 August 24, 2009 required for y 9 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.): Fluid level was correct, that is, equal with outlet invert. Septic tank and tees appear to be sound. Observed blackening above fluid level and on bottom of covers. This is an indication of previous backups. Suspect this was reason for new SAS. Recommend pumping every 3 years. Grease Trap (locate on site plan): N/A 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): N/A Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): I 73 Orrs Avenue,Hyannis,MA HUD.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 73 Cirrs Avenue 40 Property Address HUD/Cityside Management Corp., 22 Medallion Center, Greely St., Suit 5, Merrimack, NH 03054 Owner Owner's Name information is August 24, 2009 Hyannis MA 02601 Au required for y 9 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) WA Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box ) ( plan): present resent must be op locate on site : ( 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.): Fluid level was correct,that is, equal with outlet invert (1). There is a riser over the distribution box cover. There was no evidence of solids carryover. Pump Chamber(locate on site plan): WA PumpS in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No I 73 Orrs Avenue,Hyannis,MA HUD.doc•08/06 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 M 73 Orrs Avenue Property Address HUD/Cityside Management Corp., 22 Medallion Center, Greely St., Suit 5, Merrimack, NH 03054 Owner Owner's Name information is Hyannis MA 02601 August 24, 2009 required for y g every page. CityrFown State Zip Code Date of Inspection D. System Information (cost.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 1 @ 30 feet ❑ 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.): There was no evidence of hydraulic failure. Leaching trench consists of 4 infiltrators. Note: House is vacant. The septic system has not been receiving normal daily flows for an unknown length of time. 73 Orrs Avenue,Hyannis,MA HUD.doc•08/06 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 ;M •''r 73 Orrs Avenue Property Address HUD/Cityside Management Corp., 22 Medallion Center, Greely St., Suit 5, Merrimack, NH 03054 Owner Owner's Name information is Hyannis MA 02601 August 24 required for y g , 2009 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): N/A Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy.(locate on site plan): N/A Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 73 Orrs Avenue,Hyannis,MA HUD.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °M 7;Orrs Avenue Property Address, HUD/Cityside Management Corp., 22 Medallion Center, Greely St., Suit 5, Merrimack, NH 03054 Owner Owner's Name information is August 24, 2009 Hyannis MA 02601 Au required for Y 9 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. Sketch is not to scale A= Inlet cover to Septic Tank XA=25' 9" YA= 17' 9" B=Outlet cover to Septic Tank XB=31' 4" YB= 15 6 C= Distribution Box XC=51' 6" YC=28' 0" be.M 1 , se P,in j ec tnr purA p x Y A � . C �3 Drr� AYzv�ue 73 Orrs Avenue,Hyannis,MA HUD.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ,M 73 Orrs Avenue Property Address HUD/Cityside Management Corp., 22 Medallion Center, Greely St., Suit 5, Merrimack, NH 03054 Owner Owner's Name information is Hyannis MA 02601 August 24 required for Y g , 2009 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 ground water: 10 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: 6-19-01 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 groundwater elevation: As per Board of Health records dated 6-19-01 no groundwater was found at 10 feet Grade falls off to rear of house. SAS is located in the front of house. 73 Orrs Avenue,Hyannis,MA HUD.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 ` M VILLAGE ASSESSOR'S MAP & LOT_,P?, 9/-11Z/' INSTALLER'S NAME&PHONE'NO. SEPTIC TANK CAPACITY A aeV 64 LEACHING FACILITY (type) (size),V54 3-6-ea NO.OF BEDROOMS BUILDER.0 e— L PERMITDATE: COMPLIANCE DATE 57�- D�-Cl I CO : Separation Distance Between the: Maximum Ad justed-Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Faqi4.ty, -it q any wells exist on site or within 200 feet of leaching.fatility'Y. Feet Edge of Wetland and Leaching:Facility r(If any Wetlands exist r within 300 feet:of leaching leac,hin* facility A1,14 i Feet 7.: turni she,d�b y 4, cep -7e SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTI10N,ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signatu '0 item 4 i!YRestricted Delivery is desired. ❑!Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. R (P C.Date of Delivery Attach this card to the back of the mailpiece, or on the front if space permits. j — 1 D.Is delivery address different-f ni item:t?p Yes II 1. Article Addressed to: - If YES,enter delivery address bed U�o i V— 6 I CA /CMG /� I 1 L PA�� �LR/b 3. Service Type certified Mail ❑Express Mail V— LA H U 1`1 G i?�{ L< 9 Registered ❑Return Receipt for Merchandise. 1 t) ElInsured Mail ❑C.O.D. I` 1 13 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (transfer from service label) ;17 0 0 7! 3 0 2 0 0 0 01 3 4 2 9} 8 0 0 4 j PS Form 3811,February 2004 i' ; Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS h Permit No.G-10 I! Y • Sender.,Please nt your name, address, and ZIP+4 in this box• Town of Barnstable Health Division 200 Main Street j Hyannis,MA 02601 a�n11111111jilIriI,I 111 13.1 11,11ai luldill 1111DIJ1111111 9a @RROMM , p MEw . C3 occ rrl .- OFFICIAL USE ru Postage $ Certified Fee Postmark ®� O Return Receipt Fee t� APR He C3 (Endorsement Required) ?00 O Restricted Delivery Fee 9 (Endorsement Required) ru O Total Postage&Fees t� m ent Pg O Street Apt NZjIo., '',, ll ^ /� t� max. �--f- f�. ----------- ----- rytAP+� ��7 U , f ll0 Certified Mail Provides: a A mailing receipt o A unique identifier for your mallpiece o A record of delivery kept by the Postal Service for two years Important Reminders: to Certified Mall may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mallpiece"Return Receipt Requested'.To receive a fee waiver for a duplicate return receipt,.a LISPS®postmark on your Certified Mail receipt Is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mallpiece with the endorsement'Restricted-Delivery. o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed;detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000.9047 Town of Barnstable Barnstable A"mer ca CRY TAftEl.�;I Regulatory Services Department E \.va�`6�9 ,� Public Health Division \fb MAI - 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geller,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL 7007 3020 0001 3429 8004 April 1, 2009 Midfirst Bank C/O Midland Mtg. Company 99 NW Grand Blvd. Oklahoma City, OK 73118 Attention : Foreclosure Department NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II—MINIMUM STANDARDS OF.FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 73 Orr's Ave., Hyannis was inspected On March 11, 2009 by Jaime Cabot, R.S. Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received by the Town of Barnstable. The following violations of the State Sanitary Code were.observed: 105 CMR 410.300 & 310 CMR 15.00— Sanitary Drainage System Required. Disposal Works Permit# (2001- 325) Septic tank is not approved for other than single family use. 105 CMR 410.482- Smoke Detectors: No Carbon Monoxide Detector Provided for dwelling. 105 CMR 410.500- Owner's Responsibility to Maintain Structural Elements: Hole in Bedroom Wall. The following violations of the Town of Barnstable Code were observed: 170-4— Certificate of Registration. Rental property is not registered with Town of Barnstable Health Department. _ The following violations of the Town of Barnstable Code were observed: 170-4— Certificate of Registration. Property is not registered with Town of Barnstable Health Department. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by removing the illegal apartment and correcting all other violations. You may request a hearing before the Board of Health if written petition'requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations,please contact the Town Health Division an sk to speak with the inspector who performed the inspection. PE O ER OF T E BOARD OF HEALTH o c ean, ,CHO Director of Public Health Town of Barnstable I, dads --' er•� r•y� (pP„;Iq' h4 rC .. ,asi ,t i- ` h- �{,�'µy„5, 3��J.r. '4 1 �,i �4+.-;, F r:r. T�.r".",�C� + '`''i S.,�' ,e`'/1`4 r' " ,. vn 77ly" "g�yr6r.�Fp�.;•�'� r °4 TOWN OF E STABLE gAg- , 0=dinan'ce` or -Regulation AS' WARNING 'NOTICE r a' tName,Fof Offeiidfiar/Minager L o `� ! `,''� �✓ f/a dob 7 t/ r i} Address of-;,"Of f eh-der ': OP. MV/MB Reg. Village/State/Zip )- 4f- ' i .tii ; `�. .` . �. SS. f }/, ,Business Name �! , am/pm, on 200 ! . ` Business Address - ,� ��• � , � *y ,Signature of Enforcing: Officer G Village/State/Zip ��� I Ni I I t s Location'. of dffense �- �1i? ��'/'.y; �'"! a.•� � {'� . Enforcing Dept Division, `0ffen'se 5u l() � 41 ��L:q.l.i �`yf,,vl ff,1.d$� �11* �►d�4 ! ? �� 1 - �L'1':Ii-:���`'] �6 Facts � �� iS1 { C:: : .,„L°.�( - 3,' i ri �..,� .r` a i ; 1 'c.; E-;� 1.� rr,► Ta, j .n0 AJ - - - - J a.. � as a warning, g has been taken. i' , y {Thi is 1 the, a oa1� f Town' a encies: to At' this t�.me no le al action , g g r,achieve voluntary_ compliance of Town Ord�.nances, Rules and Regulwatioris: ; Education of forts and.,-warning .notices are i� attempts .to gain voluntary ',^compliance: Subsequent violations will�re ult in .'�app'ropria a legal action by_:•ahe Town WHITE' OFFENDER; CANARY CORD/REG PRONG; PINKI iENFORCINGOFFICER ++GOLD,,ENF.ORCING DEBT:.% �. �' ;.'''R _-.wrri+?.;v� '�'dv. .._._¢.�'.,.,,:3;4VZ`@Ir:J�'7^ic•.,...;�'„o5 Olaf F.i1:I-2t.:.,V�'t�i;'r:W4 .. `�.+r:."�1^.�'+'lGyi`.'.�;.��`'a�v�S�v.'�cr�yl�.4b:?w-r�h�e.0 n:�.2<.SW`+css.wt uS��..'"...4�.;sxxr�`.xfd-ode-4�'�+r�nei(1t;<..t.�-e`�w: HOBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS FORM 30C BOARD OF HEALTH �4IZq SZn,(�,Lf-- CITY/TOWN DEPARTMENT P' 41 U'ZC.C1� A ADDRE S �M SVe v g If 7 � O PI?S TELEPHONE Address Alv4i4-1 S f Occupant 4 o L v4- c.P rjgrez S Floor Apartment No. No. of Occupants 3 No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units_ I No.Stories I Name and address of//owner A\ O A 0160 Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: ,._, 1'2-uc) P-, e4lo 5bo Chimney: AoiA L_I✓ BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: C, Or Z e�Z 0 0 Z Obst'n.: v k V)CO Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: CA1F- Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: , PLUMBING: Supply Line: 1�r i 711w iv��� I 0 ❑ MS ❑ ST ❑ P Waste Line: J !Gv v d H.W.Tanks Safety and Vents lL ELECTRICAL Panels, Meters,Cir.: b4;7G ❑ 110 ❑ 220 Fusing,Grnd.: O ry L ar,'V c_ AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 �- Bedroom 2 T Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: AL Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: 0 ��(` ru General Building Posted I I II�b Locks on Doors: a I Sgfi EV ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF ERJURY." INSPECTOR S TITLE DATE 2oO TIMET11 If A.M. THE NEXT SCHEDULED REINSPECTION 7 / A P.M. • 4 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of Ieadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or.safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. , (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. 1 I (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through(0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. _ /� 1F'"v1'. �,,.4wMt.aK'"�„'�^.'•R`' �^^t^.�'�'""ry-�',�v.vrnfx,,,,.rt,�'.ro.....�,.•"..,•,. „—.., -<�. FORM30 H&W Hoeesa WARREN TI THE COMMONWEALTH OF MASSACHUSETTS �� BOARD OF HEALTH L"L CITY/TOWN DEPARTMENT 2-GY� N to2 CaUI ADDRE§S .. �M . l> >Z<z5 A TELEPHONE Address /LA+-1.1,.\i S _ Occupant s c C- lA..a D/ S /L v4 (a fd2 S Floor Apartment No. No.of Occupants No. of Habitable Rooms No.Sleeping Rooms _3 No.dwelling or rooming units___ 1 No.Stories l // Name and address of owner A e 1 A,0 — '/� t 3. V ��I( A\I� I 1�4'� C C'v't �c.(�Q Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: i Dual Egress:and Obst'n.: 111 B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: _ Foundation: ,� , ¢z(n r2(jo r-A /0 S bo Chimney: ' BASEMENT Gen.Sanitation: Dampness: ,Stairs: + Li' htin - STRUCTURE INT. Hall,Sterirwa : (,� C,. 7 -t z-e-1 U 0 10 6 Z Obst'n.: (Zov Y71:4 Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: V�fZ t' `. r 7G HEATING Chimneys: p-,/cio Central -❑ Y . ❑ N -E ui . Repair TYPE: Stacks, Flues,Vents: 3 PLUMBING: Supply Line: j 10 j 14 l�rl''�/ a i 9 G f- 4116 v ❑ MS LIST ❑ P Waste Line: H.W..Tanks Safety a_nd,Vent s ELECTRICAL P_,anels, Meters,Cir.: 7, Win%,", .• ❑ 110 El220 Fusin ,.Grnd.:"'r ' �V 6 4, e e- e- U Jc C.- AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen ^� I Bathroom Pantry Den Living Room,'1,f., e, m Bedroo ..i`_r.^1 - n Bedroom 2 / i- Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove - =-Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: r ' Wash Basin,Shower-or Tub: k: ram; (. Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: U ,.,7 ►��(.. r..a ("a 7 W -�- _..� General uilding Posted I I-M -►- ° Locks on Doors: \(-f-Gf i 1C n E Al tr4 L.:T Q ,:S.tG, ONE OR MORE OF THE. VIOLATIONS.CHECKED ABOVE IS A CONDITION WHICH ..,1 MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE*�CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES�;ERJUAY." INSPECTOR . �• � • 'TITLE AM. DATE /l � TIME t . �1 A.M. THE NEXT SCHEDULED REINSPECTION / )0>4 P.M. t 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to'always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190.through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with'accepted,plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. THE T � Town of Barnstable Barnstable OF ° Regulatory.Services Department A& "'wicaCffy ��•i nA RNISTA nLE. f� - \9�"69:� Public Health Division m =F� ` 200 Main Street 026 MA Hyannis 1 2007 Y 0 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL 7007 3020 0001 3429 8004 April 1, 2009 Midfirst Bank C/O Midland Mtg. Company 99 NW Grand Blvd. Oklahoma City, OK 73118_ Attention : Foreclosure Department NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 73 Orr's Ave., Hyannis was inspected On March 11, 2009 by Jaime Cabot, R.S. Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received by the Town of Barnstable. The following violations of the State Sanitary Code were observed: 105 CMR 410.300 & 310 CMR 15.00— Sanitary Drainage System Required." Disposal Works Permit# (2001- 325) Septic tank is not approved for other than single. family use. F. 105 CMR 410.482- Smoke Detectors: No Carbon Monoxide Detector Provided for dwelling. 105 CMR 410.500- Owner's Responsibility to Maintain Structural..Elements: Hole in Bedroom Wall. The following violations of the Town of Barnstable Code were observed: 170-4—Certificate of Registration. Rental property is not registered with Town of Barnstable_Health Department. The following violations of the Town of Barnstable Code were observed: 170-4-Certificate of Registration. Property is not registered with Town of Barnstable Health Department. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by removing the illegal apartment and correcting all other violations. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's-failure to comply with an order shall constitute a separate violation-. Should you have any questions regarding the above violations,please contact the Town Health Division an sk to speak with the inspector who performed the 'inspection. PE O ER OF T E BOARD OF HEALTH o c can, , CHO Director of Public Health Town of Barnstable �o !�3 TOWN OF BARNSTABLE LOCATION )/7- 2k4 SEWAGE # VILLAGE ASSESSOR'S MAP & LOT �OINSTALLER' NAME & PHONE NO. c�E��,, yam" S�7g 000 SEPTIC TANK CAPACITY OZA LEACHING FACILITY:(type) , �>'/T 3f)V'L� (size) 66V �NO. OFBEDROOMS PRIVATE WELL OR PUBLIC WATERA)iLcl BUILDER OR OWNER DATE PERMIT ISSUED: DATE COZiPLIANCE ISSUED-- VARIANCE GRANTED: Yes No !!,v i FEB....... ............ THE COMMONWEALTH OF MASSACHUSETTS 3 /;1 BOAR® OF HEALTH �I / ff1 ^�ir.........--OF..... ��� � t aq 1 Apphratiun for Diupuuttl Works Tonutrnrtiun thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal RSystem at ... .�. ....✓e- ..............•------........ ................------t-....�_�:. ...................................................... Loc t' n- duress or- t No.,/ C �aF�¢-s " /�� �i�� ��o,Y,�ijy of h'��w<e ®df ��i -...._...... ............................••----• ------ .._.. 1 ........................ - �'•rdi rOwner Address ............................................•-••-•--•-•-...............••-•-- Installer Address �� �30 ype of Building Size Lot..-_.�____________________Sq. feet V Dwelling` No. of Bedrooms........3................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a YP g ---•---••••----------•------ P ( ) — Cafeteria ( ) POther fixtures .......................... ---•--•--•------•--•--••---'-•---•-•-----••--•-------••--------•----••--......--•-••-----•--•-••-••-•------•............... w Design Flow.................... ...............gallons per person pgr day. Total da y flow..__..3. .�.........................gallons. WSeptic Tank—Liquid'capacity��q!?.gallons Length�_�6.-.. Width.'y"��..- 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......L e � .C� y'� „��-_...____.._. ���� a Date Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ f%4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-----.--------.-----.-. a ••---•-------------•-------•----•- Description of Soil------.Coa-F-r=� Sa,wr� o� sotvef coeds e Sart� x . . ---..�..... ;� -------------------••-•------------•--------------- -----------•••---------------- w U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ....................................._.................................................................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been yll e a health. �� - Signed.............. -------e------ - -----------•------.. Date Application Approved By----•-•---- )IIII&I-N� •. t,r. --,� ----•-•. -. .�(." Date Application Disapproved for the following reasons:---- ----•---------------------•----•--------------------------------------------•----•-•--•••-••------•-•------ ----•---•--••.....-•-----•----•--------•--------------•---••••------•----•.....---•--•••----•-••••••-----'--••-••••--•---------•-•-•------•••--•••••---•-••-•---•--•------•------•-------•••------------- Date Permit No......... �_.J..1..�... Issued------••--------•--•--------•-------•-•--•--- u--....iQ Date No.. �:... y Fmc .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. ...........OF..... Appliratiun for Uiupuaal Workg Tunitrurtiun ratnit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: , J .................................................................................................. ----•-•-••---••--•--•---...------••-••••••-•...........•-•-•--••-.................----•-.......... , Location-Ages' or Lot No. -- u l.....E.........................:`�j----------------------------...... ..............................................._.................................................. , Owner Address 4/ZInstaller Address d Type of Building Size Lot.......... ...............Sq. feet Dwelling No. of Bedrooms........ ................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -----------•--•-•--•-----------•.......................---------------------------------------------•••- W Design Flow....................�.�-a...............gallons per person r day. Total dail flow...... �....�............._..........gallons. WSeptic Tank—Liquid'capacity��..ctJ.gallons Length-' '.'.Width..='r::� 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.-___-_ _.:. '.y.....................................................� � r.' ~' a Date----------- -- •-------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-.-_____________--_____. r3. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-.--._____-___---___._. a '" 7to v e/ c" ,� s-t OwD Description of Soil--------C - -r -----5 . -••---e..................................-•----••-----••---•--•--•-•----••-------•--•-•-------•- xU --------------------•--------------•-•---------•---.........---...---••--------•----..........----•-•--•----------------------------•---•-----•-•-----------------------....-------••----•-•------•-.... ------------------------------------------------•----------------------.........-------•-------------------------------------------------....---------------------------------------------.....-•------- U Nature of Repairs or Alterations—Answer when applicable..___........................................................................................... ----------------------------•-------------------•---------•----•----•---------------.....-----------•---•--•-•••••-•••---••-••---•-•••--•-----------•-•-••••-••-•••---•••--••-••--•--•-••-•--••....-•.-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by fl/ie/board- of health. Ale Signed. -• •...-j-••-•-----••---•-•...---•-••--•-••....-----•-••-------••••-••-•-•- ............D...... ate Application Approved BY............... .=--1 ..t�.:.:.w` '-` - ........... U Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ....---•--•-•----------------•--•-----------•------•-•-------------------------•-----.....------------••.I----------------------------------------------------------------------------------------------- _t/ Date PermitNo. ............_..Y..........•--•••----.•.... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH] �r L/r?rt..........O F........... r, .<'c-t.;u! a [!!C. .............. .................................... C�rrtifirtt#r of TampliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.................................................................................................................................................................................................... Installer at.................................................................................................................•••-------••----••••••-•------•-------------•••-•----••--•--•---.....--------------•- has been installed in accordance with the provisions of TI h Z 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........ ---------- dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHAD NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........................•---------...............................•-•--•...... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH rr .f4f kj..............O F........ -•-• ............� FBE.....s ... ..... DiupuuFa1 fur � uraiun rranti Permission is hereby granted--------- = -aQ..... --- ---•-------•-------------------:.........----------...------•--•---•-•----- to Construct Q116 or Repair ( ) an In ividual Sewage Disposal System at No............4,z -7.......2_t......-•-••••-. .....cwK......•� = Street r,r as shown on the application for Disposal Works Construction Permit No------ Dated.......................................... ------------------------------------* ................................................. Board of Health DATE............... FORM 1255 /HOBBS & WARREN. INC.. PUBLISHERS .. - .. � � a�+ — �� -;7/ 2 20 FT. MIN. ' TOP OF FOUND. SOIL TEST EL. _ %S y 10 FT MIN. XP DATE OF SOIL TEST -'."�'�;- ',' - ' '`� WITNESSED BY T pt1^1fVeNG CONCRETE 4 SCH. 40 PYC PIPE I GLEAN SAND PERCOLATION RATE e- MIN INCH COVERS MIN. PITCH 1/8 PER FT. OBSERVATION HOLE I OBSERVATION HOLE 2 CONCRETE 2" LAYER OF ELEV. = 9y --5- ELEV.= , 4" CAST IR N PIPE 12 COVERS 1/8"- 1/2" WASHED FOR EQUAL, MIN. - PITCH 1/4 PER FT STONE FLAW LINE EL MIN. i EL. 2'p' EL = LEVEL E L x EL. 40.E 3 DIST. EL = 9c 5 v o w Abc, WATER AT J EL.= 0 WATER AT EL.= BOX z r , 3/4"- 1 1/2" �� c •o w GALLON WASHED STONE 0 0 0 1 c po • w ° DESIGN CALCULATIONS SEPTIC TANK 0,010 EL.= NUMBER OF BEDROOMS PRECAST LEACHING BASIN OR EQUIV. GARBAGE DISPOSAL UNIT /✓G% , 6 DIAM. TOTAL ESTIMATED FLOW GAL./BR /DAY z BR.) j3T GAL./DAY SEWAGE DISPOSAL SYSTEM PROFILE REQUIRED SEPTIC TANK CAPACITY y9> GAL. NOT TO SCALE r - \ ACTUAL SIZE OF SEPTIC TANK GAL. -- LEACHING AREA REQUIREMENTS \, BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE EL.= ga S OBSERVED WATER TABLE / / ) EL.= SIDEWALL AREA r IbAL./S.F. BOTTOM AREA / GAL./S.F /LEACHING CAPAGITY 80TTOM SIDEWALL) C) GAL. LEGEND � RESERVE LEACHING CAPACITY GAL \ `- -- EXISTING SPOT ELEVATION OOXO EXISTING CONTOUR — —— - 00— --— _ FINAL SPOT ELEVATION NOTES FINAL CONTOUR I. ALL WORKMANSH;P AND MATERIALS SHALL CONFORM TO D.E.O.E. \ SOIL TEST LOCATION TITLE 5 ;r!E TOWN OF ,,n,4,0,,,,�, _ RULES AND `/I d REGULATIONS FOR THE SUBSURFACE UiSPOSAL OF SEWAGE . v 1 ILI I Y ►'OLE -�- TOWN WATER W—��=W____ - 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO �0; CATCH BASIN ® ) 1. WITHIN 12 OF FINISHED GRADE . p 3. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME.a� �E � r � C �- ��� �Uv?�, �' 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H- 10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT OF DRIVES OR PARKING AREAS. H-20 LOADING p % I MIN. FRONT SETBACK SHALL BE USED UNDER OR WITHIN 10 FT OF DRIVES OR PARKING. MIN REAR SETBACK 5. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE 32 4 5 D/ 0o MIN. SIDE SETBACK le. SHALL BE MORTARED IN PLACE. Qo5 ` 6. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH 0 �F�' rjfT � DEEDED OR ZONING REGULATIONS. OWNER /APPLICANT IS TO A OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. o . 106 t LO -, APPROVED : BOARD OF HEALTH DATE AGENT f 16 3 ^^ 1 PROJECT LOCATION, V L APPLICANT r ROB/lV W. WILCOX d PROFESSIONAL LAND SURVEYOR 203 SET UCKET ROAD 385-6478 SOUTH DEWS, MASS. 02660 o � 126%4/c o r r Sod 1 _ �„ .w OATS` 7 REV. REV. ' �/c� /f2 e-sA�<o� T �i ��i-1 G✓`. ,,,. f',?<.•.s^'t l�nJ ID'' ,/"�� � `O/2.. l4 L�/�c-✓�-,e- 1�'�7- LOCATION MAP Jos No.�; SHEET OF