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Home My WebLink About0007 QUAKER ROAD - Health 7 Quaker Road Hyannis A=292-017-002 a ,y r N TOWN OF B STABLE LOCATION I<.e,,— /l' SEWAGE # ------=. .� VJUAGE yarn i ASSESSOR'S MAP&LOT-_---_„_, — i RNSTALL,1E WS NAb0&PHONE NO. 1. SEPTIC TANK CAPACITY ��6� � � LEACHING 1 ACIL1W,. (type) �O SO �5 (size) 5' k !� '•Y ? bU LVER OR OWNER E PERMITDATI•a; --. —CONgI'I..I ICE DATE:— Separation l:Dismoce Between the; f Maximum Adjusted,Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any evens exist on site of within 200 feet of leaching faeiiity)'► ... Edge of Wetland and Leaching Facility(ti'any wt:tlands exist within 300 fee of leaching.facility) a Feel Furnished by_ k r ire 4�G T� W a VJ O o t4 . , t►J Su � � 9 r � j .. 1 , TOWN 0 BARNSTABLE "�:OC TION , G Ajo SEWAGE # ;J "5)� ,,y, I LLAGE Gt, d`S SSESSOR'S MAP & LOT 'e nINSTALLER'S NAME&PHONE SEPTIC TANK CAPACITY ) 5 7`2e 600 LEACHING FACILITY: (type), ® �i (size) NO.OF BEDROOMS BUILDER OR OWNER ✓'��t PERMITDATE:. COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) _ Feet Furnished by • � �� Yam.'...:-! f f �31. TOWN OF BARNSTABLE 4P� LOCATION / 0 SEWAGE# Q VILLAGE, /7 ASSESSOR'S MAP&LOT Ri8%i �ER'S NAME&PHONE NO._tJ SEPTIC TANK CAPACITY LEACHING FACILITY:(type) e) NO.OF BEDROOMS ---�d • " 0 BUILDER OR OWNER e� PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by G a � � O a W o S TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE I1:MINIMUM STANDARDS FOR HUMAN HABITATION Date Owner i, Tenant n C � V0 Address Address Complionce Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities V� 3. Bathroom Facilities V,/, 4. Water Supply 5. Hot Water Facilities � I 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation �; &`r' Scyv-,o e 071 ' Z-N 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use a 12. Exits , 13. Installation and Maintenance of Structural p' Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal Un0 16. Sewage Disposal 17. Temporary Housing PART 11 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Person(s) Interviewed In ector If Public Building such as Store or Hotel/Motel specify here Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments „R 7 Quaker Rd. w Property Address h+ Keith Carlson Owner Owner's Name/ l information is required for every t/ � Hyannis Ma 02601 5/24/2017 : 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 -XI way. Please see'completeness checklist at the end of the form. Important:When A. General Information / filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Jeffrey M Wall use the return Name of Inspector key. Wall Septic Service Company Name P. 0. Box 771 Company Address HafWichport Ma 02646 City/Town State Zip Code 508 432 4908 673 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (3 0 CMR 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority sp for Ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the :buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 ^v •V 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Quaker Rd. _ Property Address Keith Carlson Owner Owner's Name — information is Hyannis Ma 02601 5/24/2017 required for 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) Sys m Passes: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: One or more system components as described in the "Conditional Pass" section need to be laced or repaired. The system, upon completion of the replacement or repair, as approved by the and of Health, will pass. Check the bo r"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," plea explain. The septic tank is metal d over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantia ' filtration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is r laced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than ears old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 7 Quaker Rd. Property Address Keith Carlson Owner Owner's Name information is Hyannis Ma 02601 5/24/2017 required for every —_ page. City/Town State Zip Code Date of Inspection B. Certification (cont.) i Robstruction pumps/alarms not operational. System will pass with Board of Health approval if re repaired. ionally Passes (cont.): sewage backup or break out or high static water level in the distribution box due structed pipe(s) or due to a broken, settled or uneven distribution box. System will if(with approval of Board of Health): pip ) are replaced ❑ Y ❑ N ❑ ND (Explain below): tion is re oved ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is le ed or replaced ❑ Y ❑ N ❑ ND (Explain below): i a ❑ The system required pumping more than 4 times a ar due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Boa of Health): ❑ broken pipe(s) are replaced ❑ Y N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): i 4s-R.equifec�-by-4h"oard-of Neatth,,.- - ❑ Condit) - xixist which require further evaluation by the Board of Health in order to determine if the system is f i4mg tto protect public health, safety or the environment. 1. System will pass unle oaoard of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is-nbtfqnctioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface w ❑ Cesspool or privy is within 50 feet of a bordering vegetated we or a salt marsh l5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Quaker Rd. Property Address Keith Carlson Owner Owner's Name information is Hyannis Ma 02601 5/24/2017 required for every y _ page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) . System will fail unless the Board of Health and Public Water Supplier, if an ( pp t Yl ermines that the system is functioning in a manner that protects the public health, saf and environment: ❑ The stem has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet o surface water supply or tributary to a surface water supply. ❑ The syst has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system h a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septl tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water upply well". Method used to determine distance: This system passes if the well water a lysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the esence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other ilure criteria are triggered. A copy of the analysis must be attached to this form. l 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 El 2/ or clogged SAS or cesspool ❑ a�9- Liquid depth in cesspool is less than 6" below invert or available volume is less than /2 day flow t5ins.doc•rev.6/16 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Quaker Rd. _ Property Address Keith Carlson _ Owner Owner's Name information is required for every �__.H annis Ma 02601 5/24/2017 —. page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ �2/ 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. ❑ U/ '��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. ❑ L�N�� An portion of a cesspool or privy is less than 100 feet but greater than 50 feet Any P P Y 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. ❑ Q/ 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. de ' n flow of 10,000 gpd to 15,000 gpd. For large sy s, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Sec ' D. Yes No i ❑ ❑ the system I ithin 400 feet of a surface drinking water supply ❑ ❑ the system is within feet of a tributary to a surface drinking water'supply ❑ ❑ the system is located in a nit en sensitive area (interim Wellhead Protection Area— IWPA) or a mapped Zone f a public water supply well If you have answered "yes" to any question in Section E the sy is considered a significant threat, or answered "yes" in Section D above the large system has failed. owner or operator of any large system considered a significant threat under Section E or failed under on D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should cont the appropriate regional office of the Department. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts - - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Quaker Rd. Property Address Keith Carlson Owner Owner's Name information is required for every Hyannis annis Ma 02601 5/24/2017 __.._ page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No 2/ ❑ 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? ❑ B/ 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) y/ ❑ Was the facility or dwelling inspected for signs of sewage back up? Ly' ❑ 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 of4he 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)] (L,e4ro�11 o.^cy) D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): -- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts w : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Quaker Rd. _ Property Address Keith Carlson _ Owner Owner's Name information is required for every �H annis Ma 02601 5/24/2017 — — page. City/Town State Zip Code Date of Inspection D. System Information Description: /I — ate �-, fr��d�a.-� S^ �`'�'�'� 7` ��K . /1)i �T��'�Me _/Q!, Number of current residents: Does residence have a garbage grinder? ❑ Yes [9/No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes [g/No information in this report.) Laundry system inspected? ❑ Yes [g/No Seasonal use? ❑ Yes 2/'No Water meter readings, if available (last 2 years usage (gpd)): Detail: —12 Sump pump? ❑ Yes� No Last date of occupancy: � Dat Type tablishment: -- - - Design flow(based"on, 10, CMR 15.203): -- Gallons per day(gpd) Basis of design flow(seats/persons/ .ft., etc.): Grease trap present? ` ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: — t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Quaker Rd. _ Property Address Keith Carlson Owner Owner's Name information is Hyannis Ma 02601 5/24/2017 required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date ott "e ibe below): General Information Pumping Records: �uSravh.2� ��-G o Yc'oG� Source of information: — Was system pumped as part of the inspection? L Yes ❑ No If ,es volume pumped: � y p p gallons How was quantity pumped determined? Reason for pumping: �� - Type of ystem: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 i Commonwealth of Massachusetts : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Quaker Rd. Property Address Keith Carlson _ Owner Owner's Name information is Hyannis Ma 02601 5/24/2017 required for every � _ page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of ay components, d to installed (if known) and source of information: S ST c ram► i�s�Ai/ec� /4 ? 3� y e�de s of- aC \ /U'e e4) C,f, S /�S9�7 i/�G�io u a c" /✓ G e °/9 - �. _;1 t-17 05' 0 f.� ) _ Were sewage odors detected when arriving at the site? ❑ Yes LLY No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron 40 PVC El other(explain): - — Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): No Suer g !Y Ti�7,2 a1' -t"�2cToP7 . Septic Tank (locate on site plan): /, ,e-- Depth below grade: feet Material of construction: concrete El metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, listage! years _--.fie es�fiif ed-by-> ee �pfi�rteea-(attactra coprof-certi Dimensions: o oo o 91�1/,04.S f/� 5'-�r��y�C��a.�I,-(Qe3eL Sludge depth: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form M. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Quaker Rd. _ Property Address Keith Carlson Owner Owner's Name information is required for every Hyannis Ma 02601 5/24/2017 — page. City/Town State Zip Code Date of Inspection D. System Information (cont,) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evi e a of leakage, etc.): `C c? .-Id Ste' e t Gt� i elf e-G%/o✓�_a S' c � d�otc.'7�rt✓��- cif-'/a Pit'-..��'o u,-I o�. Gl�Gr� � G-2v�G /S c� Dep low grade: feet _ Material of cons ion: ❑ concrete ❑ me ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: — Scum thickness - Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Quaker Rd. _ Property Address Keith Carlson Owner Owner's Name information is Hyannis Ma 02601 5/24/2017 required for every - y _— page. Cityrrown State Zip Code Dale of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, fi4 ic}-le ,els as related to outlet invert, evidence of leakage, etc.): Mt -must-be-ptfmped-tit t De%hbelow grade: Material construction: ❑ concrete .� ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: -- Capacity: � — - -- — . \ gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 7 Quaker Rd. Property Address Keith Carlson Owner Owner's Name y information is Hyannis Ma 02601 5/24/2017 required for every _ _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont) Distribution Box (if present must be opened) (locate on site plan): To o,0�j/ gV-t2T3, f7 f Depth of liquid level above outlet invert V 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.): r Pump • working order: ❑ Yes ❑ No* Alarms in working er: ElYes ❑ No* Comments (note condition o �pchamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwea lth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Quaker Rd. Property Address — — Keith Carlson _ Owner Owner's Name information is H annis Ma 02601 5/24/2017 required for every �V_—__ __. _____.—_ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: leaching pits number: 17J leaching chambers number ) (A)$,7,A e107-A 'S e S, El leaching roMe o•13 S;) leaching galleries number: ,s �STv ovivs'. ❑ leaching trenches number, length:`-rPj x,5y L x a ❑ 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.): - '1e- — (faelz5..e .� tiu -Cesspools Numb' f-and configuration Depth-top Of liquid et invert — - Depth of solids layer Depth of scum layer Dimensions of cesspool , - - Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Quaker Rd. Property Address '— Keith Carlson Owner Owner's Name - information is Hyannis Ma 02601 5/24/2017 required for every Y page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of pond ing, condition of vegetation, c.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids — -- Comments (note condition of soil, signs of hydraulic failure, level onding, condition of vegetation, etc.): t5lns.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Quaker Rd. Property Address Keith Carlson Owner ..—_.- Owner's Name --� ---" information is annls Ma 02601 5/24/2017 required for every t.. . ..�_..___ - page. CitylTown State Zip Code Date of Inspection D. System Information (cont) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate 7wher public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately Foiled Failed Leach Plt Leach Plt 0 TEST HOLE 11 0 ELEV.= 99.50 _ D—Box _ \ 0 RFoundation �! T EXISTING a s' = t �-/ BEDROOMHOUSE07=R o ti7" / I LOT #1 �• --�Y' /.�� I \\\ 13,600 Square Feet------------- I EXISTING DRIVEWAY ' 1-5� 7-0 i t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .r+ 7 Quaker Rd. _ Property Address Keith Carlson Owner Owner's Name information is Hyannis Ma 02601 5/24/2017 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: [(Check Slope [Surface water [Check cellar [Shallow wells Estimated depth to high ground water: 16,-7O feet Pleas indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record io//-7 c _ If checked, date of design plan reviewed: pate ❑ 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: Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins.doc-rev.W6 Title 5 Official Inspection Form:Subswiace Sewage Disposal System-page 16 of 17 i Sep - 20-01 13 : 52 BARNSTABLE HEALTH OLPI Duo/ yQQa>V . - - . .X OTICE: 'Phis Form Is To Be Used For the Repair Of Failed Septic Systems Only. HRCOL,aTIO;N TEST AND SOIL EVALUATION EXEMPTION FORM _!LN cJ1�A� hereby certify that the engineered pian sip ec by r^,e concerning the property located at Q0gv:zeq— . ;4t,%0k!j_ meets all of the iCI!ow;n� .n!eria: This failed system.is connected to a residcmial dwelling only. There are no .ommerzia.1 or business uses associated with the dwelling, T'he soil is class:ced as.C`T.ASS I and the percolation rate is less than or equai to -ncnut:s per inch. The applicant may use histo-ncal data to conclude this f3c; or may •:onduct Prehrrwary tests at the site without a health agent present There :s no increase in flow and/or change in use proposed • There are no variances requested or needed. The bottom of the proposed leaching facility will not be located less than foutleen I;) lee: 300ve the maximum adjusted groundwater table elevation. tAdjust !hc nundwater table using the Fdmptor method when applicable Please complete the following; ,.A. "trip of Grouna Surface E!zvation (using GIS infor-mvion) g; G.W Elevator, _ ad;ustment for 'ugh G.W. _> FNt F BETWEFty A and B S'G..VED DATE, _ NOTICE 33sec iron !ne above ic.formation, a reotvr pemvt will be issued for 'xdr^orr.s Ta .,rr,ur. add!tional bedrooms :ue authorized to the future without engineerec syae^� plans. Puccam7 Le�� FcQ-- 9 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ,• 7 Quaker Rd. Property Address Keith Carlson Owner Owner's Name — --- information is required for eve t annis _ Ma 02 4 every 601 5/24/201 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Ly Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems) completed Yystem Information— Estimated depth to high groundwater ketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 r Table 3-2 Do's and Don'ts of Private Septic System Management DO... DONT... Do have the on-site system inspected and pumped by Do not use the toilet or sink as a trash can by a licensed professional approximately every 3 to 5 dumping non-biodegradable material(cigarette butts, years. Failure to pump out the septic tank can cause diapers,feminine products,etc.)or grease down the system failure. If the tank fills up with an excess of sink or toilet. Non-biodegradable material can clog solids,the wastewater will not have enough time to the pipes,while grease can thicken and clog the settle in the tank.These excess solids will then pass on pipes. Store cooking oils,fats, and grease in a can to the leach field, where they will clog the drain lines for disposal in the garbage. and soil. . Do know the location of the on-site system and drain Do not put paint thinner, polyurethane, anti-freeze, field, and keep a record of all inspections, pumping, pesticides, some dyes, disinfectants,water repairs, contract or engineering work for future softeners, and other strong chemicals into the references. Keep a sketch of it handy for service visits. system.These can cause major upsets in the septic tank by killing the biological part of the on-site system and polluting the groundwater. Small amounts of standard household cleaners, drain cleansers,detergents, etc.will be diluted in the tank and should cause no damage to the system. Do grow grass or small plants(not trees or shrubs) Do not use a garbage grinder or disposal,which above the on-site system to hold the drain field in feeds Into the on-site tank. If there is one, severely place.Water conservation through creative limit its use.Adding food wastes or other solids landscaping is a great way to control excess runoff. reduces the system's capacity and Increases the need to pump the on-site tank. If a grinder is used, the system must be pumped more often. Do install water-conserving devices in faucets, Do not plant trees within 30 feet of the system or showerheads and toilets to reduce the volume of water park/drive over any part of the system. Tree roots will running into the on-site system. Repair dripping faucets clog pipes, and heavy vehicles may cause the drain and leaking toilets, run washing machines and field to collapse. dishwashers only when full, and avoid long showers. Do divert roof drains and surface water from driveways Do not allow anyone to repair pr pump the system and hillsides away from the on-site system. Keep sump without first checking that they are licensed system pumps and house footing drains away from the on-site professionals. system as well. Do take leftover hazardous chemicals to an approved Do not perform excessive laundry loads with a hazardous waste collection center for disposal. Use washing machine. Doing load after load does not bleach, disinfectants, and drain and toilet bowl cleaners allow the on-site tank time to adequately treat wastes sparingly and in accordance with product labels. and overwhelms the entire on-site system with excess wastewater.This could flood the drain field without allowing sufficient recovery time. Consult with an on-site tank professional to determine the gallon capacity and number of loads per day that can safely go into the system, Do use only on-site system additives that have been Do not use chemical solvents to clean the plumbing allowed for usage in Massachusetts by MA DEP. or on-site system. "Miracle"chemicals will kill Additives that are allowed for use in Massachusetts microorganisms that consume harmful wastes. have been determined not to produce a harmful effect These products can also cause groundwater to the individual system or its components or to the contamination environment at large. Mtp:/M,*w.mast.gov/depWater/resoLnesNnpgulde.doc 3-17 July,M > - - -- - - _ vb C41- -. _ - --- --'- - .. Cr S, sQa��,,� - - - r : _ - e L ib L.gbE4� —` : - - - - r n6W t>ee lie: 13P - 1 _ e ice,._ Flaherty Associates SUBJECT PHOTO ADDENDUM File No. Carlson Case No. Carlson Borrower Carlson,Keith R.8 Dense J_ Property Address 7 Quaker Road City Hyannis -- County-....:_. Bamstable. State MA Zip Code. 02601-2728 Lender/Client TD Bank Address 32 Chestnut Street Lewiston'NfEU4240-`" Front i - c ` n3r t IK _ ft '3'may. ""-• - 1. .3i-�,jay 5-•?*+:."f-§....5 'Yy '-:��Rh.,..fi�s xi- �&lti-d e.i¢MC.%6. ( l -per Rear s ` y Q Rest-o�� +o i ! 4M, ME N, rs 'I I Kitchen q gg ;,�aw4ra► R .N K-gam Produced by ClickFORMS Software BradfordSoflware.com Page 5 of 19 5 S Its _ter c I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 7 Quaker Rd Property Address Contact Jason Smith of,JDS Realty Group @ 1-781-974-6465 Owner Owner's Name information is required for every Hyannis MA 02601 3-1-11 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. A. General Information !i 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Service Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification -- I certify that I have personally inspected the sewage disposal system at this address and that-the information reported below is true, accurate and complete as of the time of the inspection. T;h"e inspection was per Si 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 .i5.34"f Title 5 (310 CMR 15.000).The system`. ' ® Passes ❑ Conditionally Passes ❑ Fails M f` ❑ Needs Further Evaluation by the Local Approving Authority 3-1-11 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. t5ins°11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 1 Commonwealth of Massachusetts - Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 7 Quaker Rd Property Address Contact Jason Smith of JDS Realty Group a 1-781-974-6465 Owner Owner's Name information is required for every Hyannis MA 02601 3-1-11 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: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or mores stem components as described " y p bed in the Conditional Pass section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no" or"not determined" (Y, N,ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 7 Quaker Rd Property Address Contact Jason Smith of JDS Realty Group @ 1-781-974-6465 Owner Owner's Name information is required for every Hyannis MA 02601 3-1-11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 7 Quaker Rd Property Address Contact Jason Smith of JDS Realty Group @ 1-781-974-6465 Owner Owner's Name information is required for every Hyannis MA 02601 3-1-11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or Less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the followiing for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below,invert or available volume is less than day flow t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 7 Quaker Rd Property Address Contact Jason Smith of JDS Realty Group @ 1-781-974-6465 Owner Owner's Name information is required for every Hyannis MA 02601 3-1-11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,'cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water,supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water'supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 20006pd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the,system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Quaker Rd Property Address Contact Jason Smith of JDS Realty Group @ 1-781-974-6465 Owner Owner's Name information is required for every Hyannis MA 02601 3-1-11 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 6 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 660 4 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 7 Quaker Rd Property Address Contact Jason Smith of JDS Realty Group @ 1-781-974-6465 Owner Owner's Name information is required for every Hyannis MA 02601 3-1-11 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 8-2010 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 trapresent? Yes No p ❑ ❑ Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 7 Quaker Rd Property Address Contact Jason Smith of JDS Realty Group @ 1-781-974-6465 Owner Owner's Name information is required for every Hyannis MA 02601 3-1-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GM 7 Quaker Rd Property Address Contact Jason Smith of JDS Realty Group @ 1-781-974-6465 Owner Owner's Name information is required for every Hyannis MA 02601 3-1-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2005 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18 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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 12' 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: 2000 gal Sludge depth: 12" t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 7 Quaker Rd Property Address Contact Jason Smith of JDS Realty Group @ 1-781-974-6465 Owner Owner's Name information is required for every Hyannis MA 02601 3-1-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20 Scum thickness 0 6" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 16 How were dimensions determined? Tape Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 7 Quaker Rd Property Address Contact Jason Smith of JDS Realty Group @ 1-781-974-6465 Owner Owner's Name information is required for every Hyannis MA 02601 3-1-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: • gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Quaker Rd Property Address Contact Jason Smith of JDS Realty Group @ 1-781-974-6465 Owner Owner's Name information is required for every Hyannis MA 02601 3-1-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from chambers. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Quaker Rd Property Address Contact Jason Smith of JDS Realty Group @ 1-781-974-6465 Owner Owner's Name information is H annis MA 02601 3-1-11 required for every y - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3050's- 54'x121x2' ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach chambers in good condition with no sign of back-up into d-box or surrounding stone. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 7 Quaker Rd Property Address Contact Jason Smith of JDS Realty Group @ 1-781-974-6465 Owner Owner's Name information is required for every Hyannis MA 02601 3-1-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): � r t5ins-11/10 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Quaker Rd Property Address Contact Jason Smith of JDS Realty Group @ 1-781-974-6465 Owner Owner's Name information is required for every Hyannis MA 02601 3-1-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately L4,C J.- i v 0 a D a t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Quaker Rd Property Address Contact Jason Smith of JDS Realty Group @ 1-781-974-6465 Owner Owner's Name information is required for every Hyannis MA 02601 3-1-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water' ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 10'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/1D Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments 4'M 7 Quaker Rd Property Address Contact Jason Smith of JDS Realty Group @ 1-781-974-6465 Owner Owner's Name information is required for every Hyannis MA 02601 3-1-11 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 � y j Day_: 1 s 324 s 998 07-06-2017 12:39 BARNSTABL.E LAND COURT REGISTRY ., Town of Barnstable Zoning Board of appeals Decision and Notice Special Permit No.2017437-Bourgeois Section 240-11.C. (1)-Conditional Use Special Permit Allow a six.(6) bedroom lodging house with Managers unit in a single family dwelling Summary:. Granted with Conditions Applicant/Owner. 4 Ronald J. Bourgeois Property Address: 7 Quaker Road, Hyannis,MA Assessors Map/Parcel: 292/017-002 _017 SU,` 22rcl, Zoning District: Residence B (RB) wK Hearing Date: May 24,2017 Recording Information: Certificate 194285 Plan 21173-B �-r ^� ) Background Ronald J. Bourgeois applied for a Special Permit pursuant to Section 240-11.C(1)—Conditional Uses o in Residence B Zoning.District. The applicant sought,to reconfigure a single-family dwelling into a six v (6) bedroom lodging house with manager's unit. The subject property is located at 7 Quaker Road, p Hyannis, MA as shown on Assessor's'Map 292 as Parcel 017/0.02. If is located in the Residence B (RB)Zoning District. (n � Ip-I n dl The subject Lot is.located.at the comer of Quaker Road and Bearses Way, Hyannis. ,The lot size and ZI`n dwelling size appear typical for the area. According to the Assessors Records, the dwelling was constructed in 1985 and contains 2,832 gross square feet with four bedrooms. The dwelling is on a p �' private septic system and.connected to town water. The Assessors Records also indicate the dwelling (1 rf 3 was.restored to:a single family residence in late 2:011 but od inally constructed as:a lodging house. r I �f o According to the plan submitted, there are ,9 parking spaces available including one in an attached od r C J garage. �tl L cS PI-erocedural.&I-learing Summary Special Permit Application No:2417-037 for a Conditional Use Special Permit to reconfigure a single- family dwelling into a six(6) bedroom lodging house with manager's unit was.filed,at:the:Town Clerk's S ,f& office and office of the Zoning Board of Appeals on April 21,2017. A public hearing before the Zoning Board of Appeals was ,duly advertised and. notice sent to all-abutters and interested parties in accordance with MGL.Chapter 40. A.. The;heanng was opened. on May 24, 2-017, at which time the Board found to grant the Conditional Use Special Permit subject to conditions. Board members deciding on this application were Alex M. Rodolakis, Matt Levesque, Herbert Bodensiek, David Hirsch, and Robin Young. rZ The hearing was opened on May 24, 2017 with:Attorney MarkBoudreau representing the applicant. 1 � The Applicant, Ron Bourgeois, was also present. Attorney Boudreau reviewed the history of the property and stated that proper egress.from.the ground floor will be added along with interior changes. He stated there is a lodging house across the street owned by his client as well as others in the • neighborhood. The Applicant intends to lease these rooms long term. Attorney.Boudreau stated this use meets a.'need in the area, fits the spirit and intent of the Ordinance, and will not be a detriment to the neighborhood. The Board Chair asked for public.testimony and no one spoke. Findings of Fact At the hearing on May 24, 2017, the Board.unanimously made the following findings of fact in Special Permit Application No. 2017-037, a request for a Conditional Use Special Permit to reconfigure a (own of Barnstable Zoning Board of Appeals—Decision and Notice Special Permit No.2017-037 Bourgeois single-family dwelling into a six (6) bedroom lodging house with manager's unit addressed as 7 Quaker Road, Hyannis, MA: 1. In Application No. '2017-037, Ronald J. Bourgeois, has sought a Special Permit pursuant to f^� Section 240-11.C(1) —Conditional Uses in the Residence. B (RB) Zoning District. The applicant seeks to reconfigure a single_family dwelling to a lodging house for no. more than 6 lodgers with managers unit. 2. The property is located of 7 Quaker Road, Hyannis, MA, as shown on Assessor's Map 292 as Parcel 017-002. 3. The Applicant received Site Plan Review approval as evidenced by the letter dated April 11, 2017. 4. Section 240-11(C)(1) of the Zoning Ordinance allows the renting of rooms to no more than six lodgers in one. multiple-unit dwelling provided a Special Permit is"first obtained from the Zoning Board of Appeals subject to the provisions of Section 240-125 C. 5: After an evaluation of all the evidence.presented, the proposal fulfills the spirit and intent of the Zoning Ordinance and would not represent a substantial detriment to the public good or the neighborhood affected. 6. The proposed use of the property will not substantially adversely affect the public health, safety, welfare, comfort or convenience of the community. The vote to accept the findings was: AYE:Alex M.:Rodolakis, Matt Levesque, Herbert`Bodensiek, David Hirsch, and Robin Young NAY: None Decision 1. Special Permit No. 2017-037 is granted to Ronald J. Bourgeois, pursuant to Section 240- 11.C(1)- Conditional Uses in the Residence.B,(RB) Zoning District.. The Applicant seeks to petitioner seeks to reconfigure a single.family dwelling to a lodging house for no more than 6 lodgers with managers unit. The property is located at 7 Quaker Road, Hyannis, MA as shown on Assessor's Map 292 as Parcel 01.7-002. 2. The improvements shall be in substantial conformance with the site plan entitled "7 Quaker Road, Hyannis in Barnstable, Mass dated April 10, 2017.by Bass River Properties", sheets 1-4. 3. There shall be no expansion, including the living area,without prior approval of the Board. 4. The Applicant shall comply with all Licensing and Health regulations. 5. The.Applicant shall comply with all conditions of the April 11, 2017 Site Plan Approval; these conditions shall be incorporated as conditions of this Special Permit. 6. Evergreen vegetation shall be planted around the parking area for screening from Quaker Road and Bearses Way. 7. This Decision shall be recorded at the Barnstable.County Registry of Deeds and copies of the recorded decision shall be submitted to the Zoning Board of Appeals Office and.the Building Division prior to issuance building permit. The rights authorized by this special permit must be exercised within two years, unless.extended. The vote was: AYE:Alex M. Rodolakis, Matt.Levesque, Herbert Bodensiek, David Hirsch, and Robin Young NAY: None i Page 2 of 3 2 TOWN OF BARNSTABLE BAR-w 3134, Ordinance or Regulation WARNING NOTICE Name of Offender/Manager A 6"'." 4�*— _ ~" F . Address of Offender � � MV/MB Reg.# Village/State/Zip r' Business Name AI A am/p on 20 �. . Business Address Al Signatu�rd of Enforcing Officer Village/State/Zip Location of Offense . Enforcing Dept/Division Offense 10� r 1s alf t / � � ti '� -# tat> t r{g. t�tD. f .s� 3 This will serve only as a warning. ''-At this 'ti.me no legal action has beef taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF' BARNSTABLE BAR_W Q � Ordinance or Regulation WARNING NOTICE Name of Offender/Manager '"� � Address of Offender � MV/MB Reg.# Village/State/Zip i y ,�� Business Name :dT� am/�F; on •" Q- 20 ,, Business Address /J! ; Signatu of Enforcing Officer Village/State/Zip Location of Offense Enforcing Dept/Division Offense CM(L `lty.660 (A) E -t-s :Diii4 Al _ �.. This will serve only as a warning. VAt this time no legal action has bee,�ri taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. Certified Mail#7006 0810-�00000 3525 6795 �t►+�ra,,�� Town of Barnstable V o , Regulatory Services + BARNSPABM '* v MA8S. $ Thomas F. Geiler, Director a Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 7 Fax: 508-790-6304 ne 5, 2012 Q Adele Jacobs L .r 7 Quaker Road Hyannis, Ma 02601 ` NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE 11—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property" occupied by you located at 7 Quaker Road Hyannis was inspected on June 15, 2012 by Timothy O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint The following violations of the State Sanitary Code were observed: 105 CMR 410.550(A)—Extermination of Insects, Rodents and Skunks. Cockroaches observed throughout dwelling unit. 105 CMR 410.602(B)- Maintenance of Areas Free From Garbage and Rubbish. Large amount of debris and clutter observed within basement. You are directed to correct the violations listed above within twenty-four (24) hours of your receipt of this notice by hiring a licensed exterminator and exterminating all insects within said dwelling unit; by maintaining entire dwelling in a clean and sanitary manner. 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 and ask to speak with the inspect r ) who performed the inspection. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Keith Carlson; Owner QAOrder letterMousing violations\Rental ordinance\7 quaker rd 6-15-12 SENDER:�COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name andaddress on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. =` D. Is delivery address different from Rem 1? ❑Yes 1. Article Addressed to: If YES,enter delivery add e ❑No 2Adry � ' ele—�acobs - {�+ 3. Service Type ua Road )Certified Mail ®Express Man ldya�Pni :MA �2��1 �M ❑Registered ❑Return Receipt for Merchandise , r` i �_ y ❑ Insured Mail ❑C.O.D. V' 4. Restricted Delivery?(Extra Fee) ❑Yes -le Number 7006 0810 0000 3525 6795 01. ,nsfer from service!ab - 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • ' I g I 00 Town,of Barnstable I Health Division N 200 Main Street e _ Hyanni-:MA 02601 . M i i FORM30 C&w HOBBSBWARRENTM THE COMMONWEALTH OF MASSACHUSETTS BOARD O ALTH CITY TOWN a DEP' ARMMENT C tA GIN SVey`eW ADDRESS TE��ELE LEP ONE _ Address — Occupant " Floor Apartment No. No.of Occupants No.of Habitable Rooms No.Sleeping Rooms No. dwelling or rooming units N .St Name and address of owner •� L emarks Reg. Vio. YARD Out Bld s.: Fences: D 6 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: Chimney: BASEMENT Gen.Sanitation: — Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: 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 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 or Tub: Infestation _ " " — Rats,Mic Roach or Other: Egress Dual and 0 General Building Posted Locks on Doors: 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 J Y." INSPECTOR TITLE 4 DATE — TIME ' THE NEXT SCHEDULED REINSPECTION / P.M. 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. WL Fowler & Sons. Inc. Invoice Termite, Pest Control, and Tun`Management 358 West Main Street DATE INVOICE NO. . Hyannis, MA 02601 06/21/2012 430836 508-771-BUGS (2847) 508-771-TURF Service Date: 0612012012 BILL TO Address Serviced: ADELE JACOBS ADELE JACOBS 7 QUAKER RD 7 QUAKER RD HYANNIS, MA-02601 HYANNIS, MA 02601 { TERMS: j Net 30 Days DESCRIPTION AMOUNT Initial - Roaches ( $385.00 -Mist. - CC# IN OFFICE $0.00 Visa/MC/Disc - XXXX5320 ($385.00) TOTAL $0.00 i o ...........................................................................................................................................................................................................................................:........................... Please Return This Portion With Your Payment { f From: ADELE JACOBS Invoice Number: 430836 7 QUAKER RD Customer ID: 130731 HYANNIS, MA 02601 Prior Balance: $0.00 Invoice Total: j $0.00 To: Fowler& Sons, Inc. Amount Due: $0.00 358 West Main Street Hyannis, MA 02601 Payment Amount: Check Number: *Please include the Invoice Number with your payment. R*LE & S0 0N6i' � TERMITE AND PEST CONTROL Preparation list for Roaches Preparation is important to the success of your treatment:The more through the preparation the better the results of your treatment will be. cabinets- 1 Remove everything from all kitchen and bathroom d loose debris that may harbor 2) Throw away any loose grocery bags, cardboard, roaches. 3) Extinguish any open pilot lights on stoves. 4) Close all windows. a special attention to behind stoves 5) Clean up any food debris on counters and floors (p y P and refrigerators). e ay belongings around the perimeter of the floors. i.e. toys,cloths,shoes,etc. up g 7) Pick e feel free to call us prior to the treatment date. If you have any questions,pleas i YOUR TREATMENT IS SCHEDULED ON: � . P T A c c RLR 3 (508) 771-BUGS 2847 (508)240-BUGS 2847 58 West Main Street Hyannis. MA 0260 1 No. P��r� Fee TtIE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migool *p.5tem Construction Permit Application for a Permit to Construct( . )Repair(><)Upgrade( )Abandon( ) El Complete System Nbdividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. �a��S :/�JANc:�' � ��EHAnS rGQA�sicl Assessor's Map/Parcel Z9 2 6 I. OOP SUM Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. a �S `� E► U. +9coco Type of Building: Dwelling No. of Bedrooms _ Lot Size Lcfr�i_sq.ft. Garbage Grinder Other Type of Building � t>� No. of Persons 3- Showers( I/j Cafeteria( 1./) Other Fixtures kiTCKEnl 5QnSk AyNpRIB Design Flow (n gallons per day. Calculated daily flow (fit 4, Rs gallons. Plan Date 1611 ta5 Number of sheets I Revision Date '— Title Size of Septic Tank Type of HA.s. '71 — 2,05b lnlc'i L`T-RA IU2.S Description of Soil! —;>In QZC 47\ p t X Gk X a 1 'r Fm 4 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: 1 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 Envi mental Code and not to place the system in operation until a Certifi- Cate of Compliance has been i is o alth. Sig d Date ya Application Approved by Date Application Disapprove for the following r s s Permit No Date Issued 4 i y 1� � Mir No. w X "� Fee THE"CO.MMONW`EALTH OF MASSACHUSETTS Entered in computer: - Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS C Application for nigpogat *p!5tem - Congtru>rtion Permit re. Application for a Permit to Construct( )i Repair(><)Upgrade( )Abandon( ) O Complete System Individual Components Location Address or Lot No. �- ( tJAlct:�,'' Owner's Name,Ad ress and Tel.No. r �-_ N�Ar-1•St5 `:NAtJC�I 0 s��EE�1A�1 iCEASESi�1 Y Assessor's Map/Parcel 2-9 Z /01} f poa M I Installer's.Name,Address and Tel No. ' Designer's Name,Address and Tel.No. t. EQQ, SJCS, (o4eU �9(ao Type of Building: ,H Dwelling No.of Bedrooms Lot Size��,Aq.ft. Garbage Grinder(N� ✓ Other Type of Building No.of Persons Showers(�) Cafeteria( ) . Other Fixtures t--�yYaTGQY .k Tc K Ent �n1 1 I.tIUNp�1� Design Flow to gallons per day. Ca]culated daily flow (n_- � gallons. Plan Date b 1} ! Number of sheets ` Revision Date �- Title C s -�� y EC<* Size of Septic Tank tS'"P c)1�CU C 1 Type of S.A.S. �O �N 1 t- Ste}' X 1 a X Description of Soil Nature of Repairs or Alterations(Answer when applicable) 4z� Q�g� Date last inspected: k 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 • .. ed this Bo d of4lealth. DateSig a c 0 - Application Approved b ! a Date Application Disapproved for the following r aso/ns r / t�— Permit No. 111 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS �F . Certif irate of (Compliance THIS IS TO CE Y, hat th On^sit�'.Sewage Disposal System Constructed( )Repaired( )Upgraded (L ) Abandoned( )by `� �— t e r _ at W4.v� o`a . -- ,- H—t r" r` `~ h Vdated constructed in acc rdancewith the provisions of Title 5 and the for Disposal System Construction Permit N 10' 0 + Installer Designer The issuance of this permit shall not be construed as a guarantee that the s st-elli—f stio'` s designe Date No. —6FFee-/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwigpogar *pgtem (Congtructio permit Permission is hereby granted to Constjjjct( Repair( Upgrade( Abandon( ) System located at —7 , 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:ConstructiRL 4eted tthin three years of the date of tlt pe ` Date:_. L�J Approved by 1 ` 1 'z Sep - 20- 01 13 : 52 BARNSTABLE HEALTH DENI OVO/Wvvav -+ - - • srurol NOTICE: This Form Is To Be Used For tb.e Repair Of Failed Septic Systems Only. PERCOL,aTIO:N TEST AtYll SOIL EVALUATION EXEMPTION FORM hereby certify that the engineered pian signed by me uatec Jflk1Ak1DS-, concerning the property located at Q0AwEiL A. 4 t-4k meets all of the tcl,owmg, ::ntena� • This failed system is cornnecced to a residential dwelling only. There are no :orri.mtr.la! or business uses associated with the dwelling, Tie soil is ciass;;:ed as.CLASS l and the percolation rate is less than or equal to 5 -Ti.-)ut:s -per Inch. The applicant may use histoneal data to conclude this f3c: jr may f _onduce tests ac the site without a health agent present her: :s no Incrust In !low and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than fourtecn l,) ite: aoove the maximum adjusted groundwater table elevation. (Adiusc the oundwater table using the Edmplor.method when applicablel Please complete the following: 1 Trip .�i Ground Surface Elevation (using GIS information) _ 4— c.,.1-b' Elevator, 1155_ d;us(mcn( for 'nigh G.W. ....__.. _ ..� _I F1REt�t�F BETWEEN \ and B S'G,)[ED — DATA: 5 NOTICE 3asec �rc�n the a�.ove ir.formation, a repair permit wil! be issued for �edr^orrs T2.vimu-n NO :td:u:1nai bedrooms ue authorized to t`re future without engtncerec :tptic s_�ste^n plans. 11:11r)!r:0C1 PC1CC M2 1 g 01/23/2016 19:24 FAX IA 002/002 : .� Town of Barnstable tK° Regulatory Services Thomas F. Geller, Director + enrct+�grn�et.$, • MAC. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer_& Designer Certification Form Date: 10/26/05 Designer: Sha Environmental Services Inc. gn � . n Installer: Robert Septic Services. Address: P.O. Box 627 East Falmouth Address: 5 Trenton Street MA 02536 Yarmouth,MA On 10/21/05 Robert Septic Service was issued a permit to install a (date) (installer) septic system at 7 Quaker Road,Hyannis,MA based on a design drawn by (address) Shay Environmental Services Inc. dated October 20, 2005 (designer) XX I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i_e. . greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. l C/1RME:Pa { taller's Sig ature) SHAY ` No. 1181 (Designer's Signature) (Affix De p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION, THANK YOU. Q:Health/Scptic/Designer Certification Form Ln IggMTS MfYl�lffl Lrl a tr a C3 Postage $ o Certified Fee E3 Return Receipt Fee J Postmark (Endorsement Required) i �5 i DEC "1'�L0 t t3 Restricted Delivery Fee -0 (Endorsement Required) rl rq Total Postage&Fees u) p sent T C3 TU r k n e Q✓!a f_?_�_e� - ------ --- -----��_u R --- _.... _---- i N Street,Apt.No.; ii / /��"" or No...LT-4- Y1�1_a1_n--- y e e City,State,ZIF44 rn# oabo/ :rr �r Certified Mail Provides: nay)ZOOZ aunr'008E wood Sd e A mailing receipt (as�a o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. a 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. a For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe 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 mailpiece 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. Internet access to delivery information is not available on mail addressed to APO$and FPOs. COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signat / item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse ❑Addressee so that-we can return the card to you. " " Y B. Received'tiy(P,f .N me) Dat of elive ■ Attach this card to the back of the mailpiece, } f, r or on the front if-space permits. � D. Is'ftleli ft1ress different from item Ye 1. Article Addressed to: If YES,enter delivAry a'ddves?below: No I Park Square Management �Vls/ 156 Main Street Hyannis, MA 02601; 3. Service Type ❑Certified.Mail, ❑Express Mail L1& ❑Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number;(Transfer from service label) ,Jai j-•_ PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 I • Sender: Please print your name, address, and ZIP+4 in this box• I I PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE 200 MAIN STREET HYANNIS, MASSACHUSETTS 02601 I I {�1it1311�9lliil�ii!!l41�l�it�l�itt��!ltiilt�l�iftl�iit4 t i COMMONWEALTH OF MASSACHUSETTS Z F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROTECTION l�qM cVOy 350 MAIN STREET WEST YARMOUTH,MA U&N-ICD 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION ` MAP 292-PARC 017 Property Address: 7 QT TAKER ROAD l HY.,NNIS,MA 02601 C: Owner's Name: PAJ:-{SQUARE MANAGEMENT �N..- M .' Owner's Address: 156 MAIN STEEET > HYANNIS,MA 02601 Date of Inspection OC"Ce--)BER 27,2005 Name.of Inspector:(please print) JAWS D.SEARS '— r- Company Name: A&B-Cain. - Mailing Address: ' 356 Main Street u West-Yarmouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STA'CEMENT 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 p per function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _ Passes Conditionally Passes Needs Further Evaluation by the Local.approving Authority T Fails Inspector's Signature: Date: 10/27/05 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 approp-,.iate regional office of the DEP. The original should be sent to the system owner and copies sent tot he buyer,if applicable,and the approving authority. /Notes and Comments FAILED ****This report only describe::conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/1 3,%000 1 f Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 7 QUAKER ROAD HYANNIS,MA 02601 Owner: PARK SQUARE MANAGEMENT Date of Inspection: OCTOBER 27,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of.Section D A. System Passes: N/A 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 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 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: Title 5 Inspection Form 6/15/2000 2 } Page 3 of 11 OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A •CERTIFICATION(CONTINUED) Property Address: 7 QUAKER ROAD _ HYANNIS,MA 02601 Owner: PARK SQUARE MANAGEMENT Date of Inspection: OCTOBER 27,2005 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 pl ivy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or 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 public water supply. The system has a septic tank and SAS and the SAS is within 50 fe,t of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance " This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of zimmonia 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:- Title 5 Inspection Form 6/15/2000 3 5 � Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 7 QUAKER ROAD HYANNIS,MA 02601 Owner: PARK SQUARE MANAGEMENT Date of Inspection: OCTOBER 27,2005 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 pits is less than 6"below invert or available volume is less than%day flow —T 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 N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface watef supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis performed at a DEP certified laboratory,for cotiform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) YES (Yes/No)The'system fails. I have determined that one or more of the above failure criteria exist as described,ih 310 CNIR 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: N/A, To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No 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,Il•-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 is failed. The owner of operator of any large'system considered a significant threat under Section E or failed tinder Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 7 QUAKER ROAD HYANNIS,MA 02601 Owner: PARK SQUARE MANAGEMENT Date of Inspection: OCTOBER 27,2005 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 backup? ✓ Was the site inspected for signs of break out? ✓ Were all system components,including the SAS,located on site? ✓ Were the septic fank 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)has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part'C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3Xb)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 7 Ql. AKER ROAD HYANNIS.MA 02601 Owner: PARK SQUARE MANAGEMENT Date of Inspection: OCTOBER 27,2005 FLOW CONDITIONS RESIDENTIAL./ Number of Bedrooms(design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x 4 of bedrooms: 550 Number of current residents: _ N/A Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes br no): No Water meter readings,if available(last 2 years usage(gpd)): N/A Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attaeli copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1985 PERMIT#84-1087 Were sewage odors detected when arriving at the site(yes or no): NO Tide 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued): Property Address: 7 QUAKER ROAD HYANNIS,MA 02601 Owner: PARK SQUARE MANAGEMENT Date of Inspection: OCTOBER 27,2005 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 8" Materials of construction: Cast iron ✓ 40 PVC _ other.(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: Material of construction: concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yus or no): (attach a copy of certificate) Dimensions: 2000-6ALLON PRE CAST Sludge depth: 6" Distance from top of sludge to the bottom of outlet tee or baffle: 24" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 15" How were dimensions determined: ASBUILT&TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): TANK AT WORKING LEVEL;TANK&COVERS AT 10"INLET BAFFLE—OUTLET BAFFLE. GREASE TRAP located ousite plan) N/A ( P ) Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15i2000 7 i Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPIECTION FORM PART C SYSTEM INFORMATION(continued);. Property Address: 7 QL`'AKER ROAD HYANNIS,MA 02601 Owner: PARK SQUARE MANAGEMENT Date of Inspection: OCTOBER 27,2005 TIGHT or HOLDING TANK: N/A (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/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): ./ if'resent DISTRIBUTION BOX: ( p 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.,); D BOX IS 16"X 16"—30"BELOW GRADE,ONE LINE IN—TWO LINES OUT. BOX IS SOLID,BOX HAS BEEN OVER FULL AT ONE TIME. PUMP CHAMBER locate on site plan) N/A ( p ) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 f Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 QUAKER ROAD HYANNIS,MA 02601 Owner: PARK SQUARE MANAGEMENT Date of Inspection: OCTOBER 27,2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type J leaching pits,number: 2 leaching chambers,number: leaching galleries,number leaching trenches,number,length leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS TWO 1000-GALLON PRE CAST PITS,PITS ARE AT 42"BELOW GRADE WITH COVERS AT 1'. BOTH PITS ARE FULL,LEACHING NOT WORKING. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionxlocate 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (locate on site plan) Materials of Construction: _ Dimensions: Depth of solids: Continents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Title 5 Inspection Form 6/15/2000 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7.QUAKER ROAD HYANNIS,MA 02601 Owner: PARK SQUARE MANAGEMENT Date of Inspection: OCTOBER 27,2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two pennanent reference landmarks or benchmarks. Locate all wells within 100 teet. Locate where public water supply enters tlne buildin-. R C ,4 R J 30 � O i Title 5 Inspection Form 611.5,2 000 10 e { Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 QUAKER ROAD HYANNIS,MA 02601 Owner: PARK SQUARE MANAGEMENT Date of Inspection: OCTOBER 27.2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 15 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: �— Observation 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: TEST HOLE AT 15' NO WATER. TEST HOLE AT 5'—6"BELOW BOTTOM OF PIT. BOTTOM OF PIT AT 9'—6" BELOW GRADE i � o 17-, , t Title 5 Inspection Fonu 6/13 2000 11 _..:_�., � .y,,.r.. ,�f_�,• .....�r..�-,�.r..... e..- -n: ,.srfi..,.�...T.r-,..•y..,r -v_.i;;,- �;cry..;.*-.��-�M�r�-y+t�,p-:Tty"«-..-.-.-.•r+..._.y-.-.•.F!.-.-t.-.(-.•-.p..w"_.w.J'3'......rl}.....++.w.-..•...P—'T.^+,.....+^"."^_." - ,TOWN �OF BARNSTABLE BAR—W 814 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager ` ► r3 "C �� ` Address of Offender �?41 �n-- 1` MV/MB Reg.# Village/State/Zip �A -/ k to ra i 0 Z Business Name 1 ,�1" am%pm, oni� -' 20 Business Address ` Sign"ature of Enforcing Officer Village/State/Zip -t4 Location of Offense Enforcing Dept/Division �.) NS �;1* lr'��n,�� C.c�• % ,t Offense Facts �a�t,. - �» nay •5�..�� .. L t�tu � - F�t This will serve only as al warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. C4 WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. . .. - ...--.. . -i-s. 'r• - -'w u.s-. �....�ro"-.- r.S.fT+'+-"-"Fr'_b-nmµ: ...:h..nw.T.yh:.}•w:h'�N-ice.�"r'i`-i..r _�a+`)r.Y•!�"Ys:.w`...w+1�.!'irr+r•�14.^^"r� w�+^• .a+^'"'.'-'..-_. TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg.# Village/State/Zip -/ ' s t �' ''� �' �* ` Business Name �` "J � ` r Y am/pm, on /. 20 0- Business Addresses -- ` Signature of Enforcing Officer Village/State/Zip ��! ' - Location of Offense `° X.4 Enforcing Dept/Division '�e Offense y Facts •_r This will serve only as alwarning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent; violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. Town of Barnstable o� Regulatory Services HARNS'MABLE, Thomas F. Geiler,Director y MASS. i639. p Public Health Division TEO MA'S Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 26, 2009 Attn: Hyannis Fire On June 25, 2009 Health Inspector Donald Desmarais RS conducted a housing complaint investigation. The State Department of Public Health has not promulgated regulations for CO detectors into 105 CMR 410.000 the State Housing Code to date. It is the policy of the Town of Barnstable Health Division to take similar actions for CO detector violations as is currently required for smoke detector violations (under 105 CMR 410.482), which is to notify the Fire Department if there .is a violation, or possible violation observed. The following property had possible CO and smoke detector violations: 7 Quaker Rd,Hyannis, Assessors Map-Parcel: (292-017-002): -No CO detectors present at property. No smokes at property. Donald Desmarais RS, Health Inspector Q:\Order letters\Housing violations\Rental ordinanceUire Violations\CO TEMPLATE.doc TOWN OF BARNSTABLE BAR-W T5 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager -To C3 F Address of Offender 'I ev * MV/MB Reg.# Village/State/Zip � ,j &� -%A kLn 'N-IN Business Name Z'141-'> am/pm, on 200ef Business Address Signature of Enforcing Officer Village/State/Zip ANAA`b "A Location of Offense Ci!V--A0V(- Ae nj e-A4E i- Z, Eorcing Dept/Division lE <; Offense 6;� \A fALI V-t e64 U LKS k(.)AA VV't�- - FactsGk%zl�'�4 4. Picv, �j�D At,30 E �,j ri,>*NL A,�-)V) AT TPACT i W' LX C,&kJ�""-4A O ' f ve k-31 M This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. E a ,� tFtFtoy�Yo,+ Town of Barnstable Barnstable BARNSTABL& +w Al1A11t1811C3C11lI 9� M A QQ Board of Health 1 1 �fi4ye, 200 Main Street, Hyannis MA 02601 2007 Office: 508-862 4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff.D.M.D. .lunichi Sawayanagi Mr. Matthew Harris September 3, 2007 �,H,.�►,>�" 7 Quaker Road Hyannis, MA 02601 Dear Mr. Harris, You are granted additional time, until September 30, 2007, to either vacate the premises or to provide hot water and heat at 7 Quaker Road Hyannis. HISTORY On August 9, 2007 the property located at 7 Quaker Road, Hyannis was inspected by Health Inspector Donald Desmarais RS due to a complaint from the Police Department. During the inspection, it was determined that the dwelling was without the means to supply hot water in violation of 105CMR 410.190. It was determined that the gas was turned-off due to non- payment. The Health Inspector was informed that the owner of the property, Deassis Vagner, had vacated the premises and had left the United States. A hearing was held on August 21, 2007 at three (3) o'clock to provide the owner and the the occupants of the dwelling an opportunity to be heard, to present witnesses or documentary evidence and to show why the dwelling or portion thereof should or should not be found unfit for human habitation, and why an order to vacate and an order to close-up should or should not be issued. The owner, Deassis Vagner, failed to appear at that hearing. However, one of the occupants, Matthew Harris was present at the hearing. Mr. Harris requested permission to remain at this dwelling without any hot water until the end of September. The Board unanimously voted to allow you, Mr. Harris, to reside at this dwelling with the following conditions: 1) You shall vacate the premises as soon as possible; but in no case shall the occupant vacate the property any later than September 30, 2007. 2) Portable space heaters are not authorized. The occupant shall obtain written approval from the Fire Department prior to the installation or use of any portable heaters. 3) Ope tional smoke detectors and carbon monoxide detectors shall be provided within the i dwellin Since ; Wa e iller,M.D., Chairman BO OF HEALTH Q'\WIIIII.,ES\Harris7QuakerBoardDecision2007.doc j Excerpt from Board of Health Meeting on August 21, 2007: II. Hearings — Housing (New): Deassis Vagner, 7 Quaker Road, Hyannis - housing violation-no hot water. Donald Desmarais, Health Inspector, spoke of his inspection. The gas was turned off leaving no hot water. The owners have fled the property and the town, abandoned their property and left the tenants with the problem. The house is about to be foreclosed on. Matthew Harris, the tenant, has been there since 2001 (at the time, a different owner). The new owners collected two months advanced rent and have now left for Brazil. Mr. Harris (tenant) paid the light bill, and gas bill. There are only three tenants now. Mr. Harris (tenant) is asking the Board of Health to postpone the evacuation notice until September 15 or longer. They have checked with Keyspan and Keyspan requires the owner's name must be on it. The three tenants left have electric heat in their bedrooms. They could heat the water on electric stove. Upon a motion duly made by Dr. Canniff, seconded by Mr. Sawayanagi, the Board voted to approve an extension of stay until September 30, 2007. (Unanimously voted in favor.) f oF1HE T�,, Town of Barnstable Regulatory Services snat MBI.E, " v ass. Thomas F. Geiler, Director ► 39. ♦0 �ATEn +a Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Notice of Order to attend Show Cause Hearing according to 105CMR 410.831 C } On August 9, 2007 the residence at 7 Quaker Road, Hyannis was visited by Health Inspector Donald Desmarais RS. It was found that the dwelling was without the means to supply hot water in violation of 105CMR 410.190. Any or all Occupants of this dwelling shall be given the opportunity to be heard, to present witnesses or documentary evidence and to show why the dwelling or portion thereof should or should not be found unfit for human habitation, and why an order to vacate and an order to close-up should or should not be issued. The Show Cause Hearing will be held on August 21, 2007 at three (3) o'clock in the afternoon. The location of. the meeting will be in the Town Hall Conference Room at 367 Main St. Hyannis. Any questions can be answered by calling 508-862-4740. - Donald Desmarais RS Health Inspector Town of Barnstable Department of Public Health tip Town of Barnstable CF THE 1p� Regulatory Services * BAMSfABLE. 9 MASS. Thomas F. Geiler,Director 1639• �0 A'ED 19. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508 790-6304 Notice of Order to attend Show Cause Hearing according to 105CMR 410.831 C On August 9, 2007 the residence at 7 Quaker Road, Hyannis was visited by Health Inspector Donald Desmarais RS. It was found that the dwelling was without the means to supply hot water in violation of 105CMR 410.190. Any or all Occupants of this dwelling shall be given the opportunity to be heard, to present witnesses or documentary evidence and to show why the dwelling or portion thereof should or should not be found unfit for human habitation, and why an order to vacate and an order to close-up should or should not be issued. The Show Cause Hearing will be held on August 21, 2007 at three (3) o'clock in the afternoon. The location of the meeting will be in the Town Hall Conference Room at 367 Main St. Hyannis. Any. questions can be answered by calling 508-862-4740. Donald Desmarais RS Health Inspector Town of Barnstable Department of Public Health s )610 r7 TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE I1:MINIMUM STANDARDS FOR HUMAN HABITATION Date ZL 61z),7 Owner /L S to Q-xQ4-1 Tenant Address Address Compliance Remarks or Regulation k Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities , 6. Heating Facilities 7. Lighting and Electrical Facilities `! 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal l 16. Sewage Disposal �, f 17. Temporary Housing V PART 11 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition �9 Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here TOWN OF BARNSTABLE BOARD OF HEALTH n ARTICLE 11:MINIMUM STANDARDS FOR HUMAN HABITATION Date 1 � WC. Owner Tenant Address t - Address Compliance Remarks or Regulation# Yes o Recommendations Of 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. lighting and Electrical Faciliti 11 es 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects.and Rodents s 15. Garbage and Rubbish Storage and Disposal ✓ macmbw 16. Sewage Disposal ✓ ArIvItk %l 17. Temporary Housing N PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition IF Person(s)IntervieW-e0--W7< Inspector If Public Building such as Store or Hotel/Motel specify here HOBBB A WARREN.INC. .* TOWN OF BARNSTABLEG�� BOARD OF HEALTH-d7V Yj / - ARTICLE I1:MINIMUM STANDARDS FOR HUMAN HABITATION AV Date Owners IL`�'.f� t'! Tenant Address ! x-"r� Address Compliance Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities C—/V r'6y 3. Bathroom Facilities 4. Water Supply1-011 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities �� r� S 10. Curtailment of Service / J� 11. Space and Use �1 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents07 15. Garbage and Rubbish Storage and Disposal l/ ` 16. Sewage Disposal 17. Temporary Housing PART II 37. Placarding of Condemned Dwelling; J Removal of Occupants; Demolition G Person(s) Interview r' Inspecto If Public Building such as Store or Hotel/Motel specify here HOBBS&WARREN,INC. r— a ,f a W V N Lp ® W W � G G s Vf G W � W W � W t N V a v — � h oac d a W W O W S��r�zl9 i �- `�,�1 ^�' J J �3 �cP .� (+'� 0 <.. _ � i . �� r \ �' �� ` r �'p� . q� _ � ,J C� ,� © `�, � ,� � � �V Board of Health , Town of Barnstable d No.__ff /O,lg. P.O. Box 534 Fu$........:�...............'s .= Hyannlsp,. Y€; #yra "Qg'F MASSACHUSETT' BOAR® OF HEALTH ..----�444..............OF.......... ApplirFa#ion for BiopooFai Works Tonstratrtion Vautit Application is hereby made for a Permit to Construct K or Repair ( ) an Individual Sewage Disposal System at: LOT ................__.- .1 .. -'�' :.... n_s..� .._. .'1Y....------.... - .... - Location-Address or Lot No. ............ ......._... ---•-- ......• - W (!)J L bJ Owner, Address a ------------------------------- � •---..._.......{��1. !!1............................•.......... -----_....---•----•----^_____.....................--^---................................_..... Installer Address Type of Building Size Lot.... 3.60®____Sq. feet Dwelling—No. of Bedrooms..........7.............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers G� YP g ---------------------------- P ( ) — Cafeteria ( ) Ga .5�r...........--•-•-••••gallons -er--erson per d y Total. ..�iI flow.:..--------�................................................... W Design Flow--- ® ga P P Y• �--------------••------------. Ions. Other fixtures .. . _ W Septic Tank—Liquid capacity.._.®gallons Length....%__1.�._ Width.----_-_.... Diameter________________ Depth_.. _ i x Disposal Trench—N .__..__._ ..... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.._�..r.._ .. Diameter... Depth below inlet......6.......... Total leaching area6.e%�_ scT-ft.4s.f'�• Z Other Distribution box O Dosing tank ( ) 454,:fH Percolation Test Results Performed by.....Z-V ..4_...kfQEL'_L1CjZ.....14i;:. Date..../__o_-1,5_- f Test Pit No. 1....! Z__minutes per inch Depth of Test Pit---- Depth to ground waterAJV_7P._&—/J-" f=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water!*Q&p7_er.ga� ...................................................... ODescription of Soil------------------------------ < ----------------------------------------------------------------------------.-------- x W VNature 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 TI'i 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 the board of h lth. Si � ------ ------------------------- -------------------------- Da Application Approved By.......... `-- . 1/. 1� A ---------- Date Application Disapproved for the following reasons:......................... ----------------............................................... --------------------------•--- -----�-----------------� -----------------------------------------------...._...--------------------------I.J---�--------- -�------------------..... Date �' 1� Permit No.. --•----------------•- Issued._... -------I------'p a----•------------•-- te --------- ---- -- - Fina............ ... ......_ THE COMMON UTA-OF MASSACHUSETTS BOARD OF HEALTH l_ k '`............._OF.........5.F..�ti)S•7". _.......�L•�------._........------------ pphr�at n for Dispaii al larks Tonstrnrtion amit Application hereby made for;a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at: qc� � -' �2 Location-"Address or Lot No. ------•s------•---•---................e.........................,. ..._...----------•-•-• ---------------•------------••• --•---•--- ----•------------•----_ ............ Owner Aare M s Address W44S a 4 L InstallerF r4 Address Type of Building' Size Lot__ '�....___a=�_____Sq. feet;f Dwelling—No. of Bedroori�s, _,...................................._Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _______`___________________j4No. of persons._.____.___.____:' Showers ( ) — Cafeteria ( ) Otherxtures -----------------------------------°.-•--------------.-------------------._.__.._Ile" W Design Flow............ per person per day. Total daily flow..__.___7_..............................gallons. WSeptic Tank—Liquid capacity a�_gallons Length t._" Width/` -7._0_ Diameter________________ Depth�` x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area_._.____.._.__....__sq. ft. Seepage Pit No..j_.: _._`-_.._ Diameter__ZC.I:__5_'.._ Depth below inlet____ _'_._._._. Total leaching area,::L.4sq ft S• D Z Other Distribution box K) Dosing tank '-' Percolation Test Results, Performed by._ n fir_ __. ' t _?........Kn !�t__ Date___ ..............................�G Test Pit No. 1---C__•'�_-___.minutes per inch Depth of Test Pit___z_5?."___ Depth to ground water. (s, Test Pit No. 2_______________minutes per inch Depth of Test Pit.................... Depth to ground water_ ------------------------------------------ AJ. ---------------------€------•-------•--------•----••••-------•-----••••---•--...••---•--------._...........__. -------------------------------------------------------------------------------------------------------•-•-•• ....................._................. ............................................... U Nature of Repairs or Alterations—Answer when applicable._-_-__..________________________________________________________________________________________ M1 --------•---..-.--••--••------•---=---.....................-........................................t------------------••--•--------------_-•••. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with TL the provisions of TIE 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 the,board of health. Signed-- I : /• ---------------------• -•---- Date Application Approved BY ...�:. d .................. �, '- :=` " Date Application Disapproved for the following reasons----------------•---=---------•----------------------------------------- ----• -------- - ------------ ` Date PermitNo......................................................... Issued.....----------- --•-•-- -••••••-------- Date t ♦, �. tv y`ti. THe,,COMMONWEALTH OF,MASSACHUSETTS BOARD OF HEALTH .........................................:OF.............................................. ............. ...... :OF.............................................. ...........::......... Tatif iratr of in i nrr THIS IS TO CERTIFY, the Irlaila a is st ted or Repaired aller /1� . ,�,./1 \ has been installed in accordance with the provisions of TITIF 5 of The Sta�e Sa. itary Code as described in the PPDisposal ........ to ------ ----------------------------------• a lication for Works Construction Permit No THE ISSUANCE 0FTHIj CERTIFICATE SHALT. NOT BE CONSTRUED. G RAPTEE THAT THE SYSTEM WILL FUNCTI . S RY DATE.................................................•-...• Inspector r THE COMMONWEALTH OF MASSACHUSETTS __ BOARD OF `HEALTH i .........................................OF:....................._._......._........_..........:__......._......._..........._.. . No.��1.� FEE.f ................ f� �t��a��./- or� ��a�� nrtilan rrnttt Permission is herebyranted-------------`-"�'.__-•-•- ------- g ........................................................ to Construct ( ) orb Repair ( )Off-Individual Sewage Disposal System Street �1 7 r u t •' Z 7�`O as shown on the application for Disposal Works Construction Permit No_____________________ Dated:'___.................... r ................••--•--------- Board .. Heal ---------------------------- l:: DATE................. - -----•--- ._..-----•-•-------------------- i FORM 1255 A. M. SULKIN, INC., BOSTON J7 3 A( I 00, ; LOT I ' {h 13 500t S.F. 292 017 002. K. I >}' DECK EXISTING MULTI UNIT DWELLING I \ d � --=— --�-/ 25.8' 1 J'- � it p PROPOSED PARKING \9.0 I \ ® \� , «s 7. Q lJ A K_E.R ROAD . \ HYANNIS � I J / �j B'A R N S TA,B L:E �_,,, .• . r.. :.._,: _,:: _,t... __ .x,.,. �:, ,:.:,>::4=::, ._ <.,r --- _.ems_ — < �; � DATE MARCH 17 :2017, �Fk r �r C/�LKER. R. D � :r Wit-':. ., .,... 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E2. ►-I-,(A Q 15 ( B A P-S TA B L E B GOA1,4=0A-2- 1`•-7 TO 714E SU/GD/A/S -5E-7-- F.3 L.G_P. 21 t'73 e T c>LA,l!!r1 O F` A-fit T A JLE I 1787 ' 0. 00 e xlS-�-Inq e/eva-tIcan BL Z� 6 se-ra PI--OPoSed e 14e VC.tion i"? © �1 7-}-,l —— __ _.-_ _. __ �,x/S-f i n q c o rn i a u r_s s r de - j© ---o—o—a-- a __ P rpP O.S'e[� c o a-:-�•ca U r,� -_ ,C.i o,�?, 'Z� G?� f-L E,z?L.. T f-,' re' cxr G tO VENT PIPE (O Least 24 inches tall) SECTION A -A �ltJL4[1 NL'yAL1Y 10' min. from - 'NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. Schedule PVC w/Charcoal Odor Filter - ALI OUTLET PIPES FROM THE Existing Foundation house to septic tank PROFILE VIEW OF LEACHING SYSTEMSMALL 9 I- Septic tank covers must De SET L F BOX S BE --- 12• - P SET LEVEL FOR AT LEAST 2 FT. CONCRETE COVER HI S TOF = ELEV 100.25 within 6 in. of finished grade 7X.cover must be Not t0 Scale 6 of finished grads < _ eft -- --- �Gode over Septk Tank - 99.50Grade over D-Box - 99.50 Oda over SAS - ELEV 99.50 J'nJ 1/I' - 1/J' IeeAet/'seesaws I 3 - 5' OUTLET `Rdl n 1, J/I" to 1 1/2 Was"i Lrv&%vd sbwe /' ` KNOf](0U75 5.5• 12• INLET ", 1 4'PVC (GAPPED) RISPECTION PORT TO BE .n OUTLET I n `i S 0 02 3 HOLE H-20 4 NSTALLED AND TO BE NITM B' OF GRADE '•� I B' t ' 1` /��waes Si --- DIST. BOX 3' Max' ewer Top of SAS-Elev.=95r75 OO 15' EXIST. 5=0.01 or Greater S- 0.010' per foot : {` we vo EXISTPIPE 2.000 GAL. --1ss'- rn f` 50 ' Effective Depth 4" - SCH. 40 T ,.,,• .; tT; 1 „s�' �',� fRDt Exur. FwNnATwN / o, SEPTIC TANK cv Txxr //J " � N N s o -�' Effective Depth 24" Effective PLAN SECTION CROSS-SECTION > " H-10 .a.e.w. an N O �-- o -�Sideluall CONCRETE FLN1 FOUNDA n, " rn °' rn 4' 4' M 7 Units 2 7' = 49' v _ a " '-4 9' 3 HOLE H-20 DISTRIBUTION BOX - SYSTEM PROFILE 6 in.o"/'•-' ,/r 71 " 5' S' compacted stone _N 1 2, Not to Scale c > > o > c ' a+ 0 4 c 5 a> o NOT TO SCALE - Effective Vkdth sire i +++..-' n°' � •;,,.�^•..-..,...- o 4 tD 9i5 pa j M W11id Cseps y fll2tl MM�(EG F 6 l y f c c y u - $ Effective Length 6 in.of 3/4"-1 1/2' 0 m S❑IL ABSORPTION SYSTEM (SAS) GENERAL NOTES compacted •lane NOTE: ALL COMPONENTS MUST HAVE RISERS TO w/IN 6" OF GRADE w INFILTRAT❑R MODEL 3050 (H-20 LOADING)/ SUMNER & DUNBAR 1. Contractor is responsible for Digsafe notification - (OR EQUIVALENT) and protection of all underground utilities and pipes. Obs. Groundwater - Test Hole 1 Elev.= NONE OBSERVED 2. The septic tank and distribution box shall be set NOTE: OVERALL HEIGHT OF INFILTRATOR IS 30• /EFFECTIVE HEIGHT IS 24" level on 6" of 3/4"-1 1/2" stone. 3. Backfill should be clean sand or gravel with no r - - - - -- -- --- --- ------ - - -- -------- ----- - - stones over 3" in size. 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance with Title V of the Massachusetts state code, the approved plan and Local Regulations. 6. If, during installation the contractor encounters any t soil conditions or site conditions that are different from those shown on the soil log or in our design i installation must halt & immediate notification be made to Carmen E. Shay - Environmental Services, Inc. 1 7. No vehicle or heavy machinery shall drive over the LOT #2 septic system unless noted as H-20 septic components. P E R C 0 LATI 0 N TEST 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. 1 Date of Percolation Test: OCTOBER 13• 2005 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. I Test Performed By. Carmen E. Shay, R.S., C.S.E. i 10. All solid piping, tees & fittings shall be 4" diameter witnessed By. WAIVER (per Barnstable B.O.H) I TEST HOLE #2 Schedule 40 NSF PVC pipes with water tight joints. EXCAVATOR: Shay Environmental Srvcs., Inc. 96 Percolation Rate: 2 MPI 0 42" �35 ELEV.= 99.50 11. Municipal Water is Connected to The Residence and Abutting Properties Within 150 Feet. --------------- ---- � I -Test Hole Test Hole 3 I THE PROPERTY LINES ARE APPROXIMATE AND I No. 1 No. 2 LL I COMPILED FROM THE SURVEY PLAN GENERATED BY 0 i Failed LOW & WELLER, INC. of YARMOUTH, MA DEPTH SOILS ELEV. DEPTH SOILS ELEV. 1-- I Failed Leach Pit LOT #52 CERTIFIED PLOT PLAN OF LOT #1 QUAKER ROAD, HYANNIS, MA" 0 99.50 0 99.50 = I Leach Pit DATED DEC. 18, 1984 Sandy Loan Sandy Loam i TEST HOLE #1 0 0 & THE DEED DESCRIPTION (CERT # 162604) IT SHOULD BE USED FOR NO PURPOSE OTHER THAN 10 rR 3/2 1 10 rR 3/2 ELEV.= 99.50 THE SEPTIC SYSTEM INSTALLATION. 0'-6" A. 99-00 0"-9' Aa 98.75 0 I Ley Sandy 0 i i-f2 D_Box O EXISTING LEACH PITS TO BE PUMPED OUT AND FILLED IN PLACE ,o rR 5/5 10 TR s/s 0 6"- 40` Bw 96.17 10"- 42" Be 96.00 0 PROJECT BENCH MARK NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE Med-Coarse Med-Coarse Ii" • .y TOP OF FOUNDATION FROM THE EXISTING LEACH PITS TO BE DISPOSED Sand Sand r_\ I 11T/�1 F_LEV. = 100.00 (Assumed) OF AS PER BOARD OF HEALTH SPECIFICATIONS. L3 Y 7/4 � 2.6 Y i j♦ 1•-L� I I �� ... `-•-.- - I • - NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY 42 132 C, 88.50 1 42"- 132 C, 88.5oI - 9. fti • c' GARAGE ASSESSORS MAP 292 PAECEL 017/002 I R T �'` Slab EXISTING LEGEND _ a0 54 :� • Foundation 6 BEDROOM r9� - HOUSE j =t � M7 104X1 DENOTES PROPOSED • SPOT GRADE •� v DENOTES EXISTING x 104.46 SPOT GRADE Perc #1 Depth to Perc: 50" to 68" i 4" PVC Perc Rate= 2 MPI I VENT I� ' II LOT #1 PL PROPERTY LINE I I ` ::'. ` Groundwater Not Observed t9B I I \\ ._ - i � 99 No Observed ESHWT I i 12'� 13,600 Square Feet PROPOSED CONTOUR ADJUSTED H2O Elev. = None -------- - -- --- --- ��\ ; --- --- --- ---- , .� -- -- - - -- ---97 EXISTING CONTOUR t1 \t I 21.75' EXISTING tl \ i DRIVEWAY _ I __- 1 DEEP TEST HOLE & 2-18" DIAM. ACCESS MANHOLES _ _ l 120.00 ,-' PERCOLATION TEST LOCATION Pr 12' T t - -+- ----� 6 FOOT STOCKADE FENCE Mft.ET PLOT PLAN OUTIET J V f` QUA ��FR ROAD THE ACCESS COVERS FOR THE SEPTIC TANK, J DISTRIBl1TION BOX AND LEACNMIG COMPONENT OF PROPOSED SEPTIC SYSTEM UPGRADE • > �,.. SET DEEPER THAN 5 WCHES BELOW FINSHED 40 FOOT RIGHT OF WAY) - -- =-- �- - - _ GRADE ED�D� RAISED TO MA,1i1N 6• OF PREPARED FOR STEEL REINFORCED PRECAST CONCRETE PLAN VI LW INSTALL Tl1F-TITS GAS BAFFLES DR EQUALS N A N C Y 8c S H E E H A N K R AJ E W S K 3-24" REMOVABU COVERS -\ AT # 7 QUAKER ROAD 3' min•clearance INLET m!.T__12'' min. Inkrt to outlet - ' auTLET ,3- a T H YA N N I S, M A ,o•� T� Ll°a`d �" ,.• f _ Design Calculations i Number of Bedrooms: 6 Equivalent to 660 Gal./Day (330 Gal./Day Min. per Title V) ZN AU PREPARED BY: E I glad depth � OF M `o /� 1 bs Garbage Grinder: No p�� 9 C RMEN E. ,SfA Y :Q Leaching Capacity Proposed: 660 Gal./Day Minimum (Min. Per Title V) _ Septic Tank : - 2 x 330 Gal./Doy = 1320 USE Exist. 2,000 GAL. Septic Tank. 0 20 40 50 E. 1VVIRONMENTAL SERVICES, INC. f -4 12 0' ' ts' -6• SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch CROSS SECTION END-SECTION Bottom Area: 0.74 gal/sq. ft. x 648 sq. ft. = 479.52 gallons P.O. BOX 627 sdewau Area: 0.74 gal./sq. ft. x 264 sq. ft. = 195.36 gallons '�� ° EAST FALMOUTH, MA 02536 Providing: = 674.88 gallons GIs S TYPICAL 2000 GALLON SEPTIC TANK SCALE: 1 "=20' S'INITAjk�l'a TEL/FAX : 508-539-7966 Use: (7) 3050 H-20 INFILTRATOR CHAMBERS, HAVING A 2' EFFECTIVE DEPTH, NOT TO SCALE (4' W x 7' L) TO BE USED WITH 4' OF WASHED STONE ON THE SIDES AND 1 "=20' DRAWN BY: CES ATE: OCTOBER 17, 2005 2.5' OF WASHED STONE ON THE ENDS. PROJECT#SD815 FILENAME: SD815PP.DWG SHEET 1 OF 1