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Home My WebLink About0067 SAINT CATHERINE AVE - Health 67 Saint Catherine Ave. Hyannis A = 291 — 064 TOWN OF BARNSTABLE LOCATION 6, �T <,47i0��//f'e/4Ag'SEWAGE# Z 30 VILLAGE /i�yi4/O' e� IP ASSESSOR'S MAP&PARCEL - ,�� INSTALLER'S NAME&PHONE NO. J:m SEPTIC TANK CAPACITY/J'e1Ae- -"S-oy G.4-e LEACHING FACILITY.(type) e--9/1f44 oeo=a LJ (size) X� NO.OF BEDROOMS .1� OWNER 16 -' /4 Z- -<54? PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: �`� �.t t2J Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /-Z Feet Private Water Supply Well and Leaching Facility(If any wells exist ori` 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 Q � 1 1 \ SIz �� y o Town of Barnstable ' Barnstable Regulatory Services Department Q p NOWdoffly �STABM 0 D Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scalli,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL 4 7015 1520 00012273 3418 May 24 2016 ' Secure Solutions 316 Delaware Road Suite #21 Delmar,NY 12054 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 67 Saint Catherine Avenue, Hyannis, MA was inspected on April 25,2016 by Joseph M. Martins, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system sho,�wed:th t the,system"failed" uI�der the guidelines of 1995 TITLE V (310 CMR 15.00)AND/OR-SECTION 360-9.1 due TO the following: , • A breach in cesspool wall. , • As well as outlet pipe being higher than inlet pipe from house. You are ordered to repair or replace the septic system within sixty (60) days from:jthe r_ date of this notification., rr Failure to repair/replace the septic system within the deadline period will result>n future enforcement action. PER ORDER OF THE BOARD OF HEALTH vi ��s�cRean, R.S., CHO k3l'o Agent of the Board of Health Q 6 _ _ Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\67 Saint Catherine Ave,Hy May 2016.doc J"� Town of Barnstable aaxivsrnscE, Regulatory Services Department Ufa►,�" Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO. Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) ❑ Leaching,facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: DA 1, S, QASEPTIMDEADLINES TO REPAIR'FAILED SYSTEMS.doc Parcel Detail Page I of 3 RAAAS'rAi3LE,: Ip ->.•'. ;, �-��'!�" - §awl �J , Logged In As: Pa rce I Detail Monday,June 20 2016 Parcel Lookup Parcel Info Parcel ID 291-064 I Developer LOT 11 B Lo Location 167 SAINT CATHERINE AVE I Pri Frontage 120 ' Sec Road , Sec Frontage I Village Hyannis I Fire District fHYANNIS I Town sewer exists at this address[No ( Road Index 11405 I i Interactive Map Owner Info owner FOURLEY, JOHN&LISA Co-owner Streetl ,67 SAINT CATHERINE AVE Street2 City HYANNIS I State EA j zip 02601 Country Land Info Acres 10.33 � use Single Fam MDL-01 I Zoning tRB Nghbd 10104�71 Topography Level I Road Paved Utilities I Septic,Gas,Public Water Location Construction Info Building 1 of 1 Year 1965 I Root Gable/Hip I Ext Wood Shingle Built Struct Wall Living 1430 � Roof AsphfF GIs/Cmp AC None Area Are Cover T ype 4 Style Ranch Walt Rooms 4 Bedrooms tAa 25 sriz- 1. 12. AR 16 — Model Residential Floo lCarpet ( RoBoms 1,2 Fu11-0 Half Grade Average Min Heat Hot Water Total ,6 Rooms � a 2 us Type Rooms Stories 1l Fuel Story I Heat Foll ation Found [poured Conc. I Gross 3540 Area Permit Histo Issue Date Purpose Permit# Amount Insp Date Comments 11/1/1995 Addition 11486 $3,800 1/15/1996 12:00:00 AM HYSHINGL i. http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=22618 6/20/2016 Parcel Detail Page 2 of 3 Visit History Date Who Purpose 11/15/2006 12:00:00 AM Jeannette Kirwan Change of Address 3/9/2001 12:00:00 AM SM Meas/Listed-Interior Access 1 0/15/1 987 12:00:00 AM ME Meas/Est Sales History Line Sale Date Owner Book/Page Sale Price 1 6/23/2006 HURLEY,JOHN&LISA C180413 $325,000 2 12/15/1989 FLINT,JANICE M C119279 $1 3 7/1/1966 FLINT,FRANK E&JANICE M C38179 $0 - Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2016 $96,500 $38,600 $2.500 $70,400 $208,000 11 2 2015 $96,300 $38,600 $2,900 $68,100 $205,900 3 2014 $96,300 $38,600 $3,000 $68,100 $206,000 4 2013 $96,300 $38,600 $3,100 $68,100 $206,100 5 2012 $96,300 $38,500 $2,400 $68,100 $205,300 6 2011 $130,100 $3,100 $0 $68,100 $201,300 7 2010 $130,000 $3,100 $0 $104,700 $237,800 8 2009 $122,300 $2,500 $0 $141,400 $266,200 9 2008 $145,800 $2,500 $0 $147,300 $295,600 11 2007 $145,000 $2,500 $0 $147,300 $294,800 12 2006 $132,500 $2,500 $0 $148,400 $283,400 13 2005 $122,300 $2,500 $0 $134,500 $259,300 14 2004 $99,100 $2,500 $0 $100,800 $202,400 15 2003 $90,300 $2,500 $0 $30,700 $123,500 16 2002 $90,300 $2,500 $0 $30,700 $123,500 17 2001 $90,000 $2,500 $0 $30,700 $123,200 18 2000 $74,400 $2,300 $0 $20,100 $96,800 19 1999 $74.400 $2,300 $0 $20,100 $96,800 20 1998 $74,400 $2,300 $0 $20,100 $96,800 21 1997 $70,200 $0 $0 $16,700 $86,900 22 1996 $70,200 $0 $0 $16,700 $86,900 23 1995 $70,200 $0 $0 $16,700 $86,900 24 1994 $65,200 $0 $0 $24,100 $89,300 25 1993 $65,200 $0 $0 $24,100 $89,300 26 1992 $74,200 $0 $0 $26,800 $101,000 27 1991 $88,300 $0 $0 $43,500 $131,800 28 1990 $88,300 $0 $0 $43,500 $131,800 29 1989 $88,300 $0 $0 $43,500 $131,800 30 1988 $63,400 $0 $0 $20,300 $83,700 31 1987 $63,400 $0 $0 $20,300 $83,700 32 1986 $63,400 $0 $0 $20,300 $83,700 33 1985 1 $0 $0 $0 $0 $0 L- Photos http://issgl2/intranet/propdata/ParcelDetaii.aspx?ID=22618 6/20/2016 Commonwealth of Massachusetts Title -5 Official Inspection Foy Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 67 St.Cathennes Ave Hyannis! W121167988 Property Address N c/o Secure Soutions ethorr>as@secure=so.lutionsllc.com, srofh@secure-solutions){c.com Owner Owner's Name s information is 316 Delaware Rd Suite 21 ;Delmar NY 12054 4/25/201 tV required for every t _ 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 wtay.Please see completeness checklist at the end of the form. Important:when filling out forms A. General Information �j on the computer: _"I Az 0-3 use only the tab 1. Inspector key to move your cursor-do not Joseph M Martins use the return key. Name of Inspector mp Sepcheek Co �y Company Name ` 17 Northside Dr hoe Company Address - k South Dennis MA 02660 CityfTown State Zip Code 508-385-5891 SI 147 Tetephone.Nuinber 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 S(310 CMR 16 000).The system: Passes ❑ Conditionally Passes ® Fails Needs Further Evaluation by the Local Approving Authority 4/25/2010 pector'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 shalt submit the report to the appropriate regional office of the DEP_The original should be sent to the system owner and copies-sent to the buyer, if applicable, and the approving authority, ***This report only describes conditions at the time of inspection and under the conditions of use: st:.that time.This inspection does not address how;the system will perform in°the future under` the.same or different conditions of use. t5416*3i15 Title 5 O,Yicial Inspection Form:Subsurface Sawa a O's sal 9_ -Po Sysieriil P40e17r'oiV' Commonwealth of Massachusetts - a .Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary:Assessments 67 St..Catherines Ave Hyannis W121167988' Property Address. c%o Secure 'Soutions ethomas secure-solutionsllc.com; sroth@secure-solutionsllc com Owner +-* Owner's Name information is" 316 Delaware Rd Suite 21 'Delmar: NY 12054 4/23/2016 required for every - page. Z, CityFrown State Zip Code Date of Inspection B. Certification(cone) Inspection Summary: Check A,B,C,D or E I always compiete all of Section D A) System Passes: ❑ 'I have not found any information which indicates that any of the failure criteria.described in 310 CMR 15,303.or in 310 CMR 15-304.exist.Any failure criteria not evaluated are indicated'below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for°yes "no"or"not determined(Y N;'ND)for the following statements. If"not determined,"please.explain_ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is Structurally Unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the.existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, hot 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 Title 5.Official Inspeclion Form;Subsurface Sewage Disposal System-Page of 17 Commonwealth of Massachusetts y Title 5 Official. Inspection Form { Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 St. Catherines Ave Hyannis WI211.67988 Property Address cio Secure Soutions ethomas secure-solutionslic.com, srothar7secure-solutionsllccom Owner Owner's Name information is required for every 316 Delaware Rd Suite 21 Delmar NY 12054 4/2512016 page_ City/Town State Zip Code . Date of inspection B. Certification (cunt) El Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpstalarTns are repaired. B) System Conditionally Passes(cone.) ❑ 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;: ID 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 wil) pass unless Beard of Health determines in accordance with;310 CMR 15.303(1)(b)that the system is not functioning,in a mannerwhich will protect public healthi 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•3113 TWe 5 Official Inspecdon Form:Subsurface Sewage:Disposal Sysmm-?age 3:of 1 \ i v Commonwealth of Massachusetts n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 67 St. Catherines Ave Hyannis W121167988 Property Address clo Secure Soutions ethomasilsecure-solutionsile.com; sronsecure-solutionsHc:com Owner Owner's Name - information is reouired for every 316 Delaware Rd Suite 21 Delmar NY 12054 4/25/2016 : 4. page_ CityfTown State Zip Code Date of Inspection B. Certification (coat.) 2. System will.fail unless the Board of Health(and Public Water Supplier, if any) determines Ghat 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 rWater supply. El The system has a.septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank,and.SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"". Method used to determine distance: **This system passes if the well water analysis,performed at.a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this,form. 3. Other; D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No to each of the following`for all inspections. Yes: No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge,or ponding of effluent to the surface of the ground or surface waters due to an.overloaded.or clogged SAS or,cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less t..han 6" below invert or available volume is,less than Yi.day flow t5ihs+3/13 Title 5 Official Inspector)Form_Subsudacesewage�Dispesal System•Page ot.17 Commonwealth of Massachusetts y- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 St.Catherines Ave Hyannis W121167988 Property Address c/o Secure Soutions ethomas@secure-solutionsllc.corn, sroth@secure-solutionsllc.com Owner Owner's Name information is required for every 316 Delaware Rd Suite 21 Delmar NY 12054 4/25/2016 page. Cityrrown state Zip Code Date of inspection B. Certification .(Cont.) Yes No Required pumping more than 4 times in the last year.NDTdueto clogged of obstructed pipe(s): Number of times pumped:. El N Any portion of the SAS,cesspool or privy is below high ground water elevation:-. 0 R Any portion of cesspool or privy is within:10.0 feet of a surface water supply or tributary to a surface water supply. H` Any portion of a.cesspool or privy is within a Zone 1 of a public well. E M 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 qualify analysts. 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.1 F, The system is a cesspool serving a facility with a design flow of 2000gpd- 10;0009pd. 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 faits.The system owner should contact the;Board of Health to determine'what will be necessary to correct the failure. Et 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 Q the system,is'within 400 feet of`a surface drinking water supply thesystern is within 200 feet of a'tributary to a surface drinking water supply o the,system:is located in.a nitrogen sensitive area (Interim Wellhead Protection, Area— IWPA)or a mapped Zone If 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 I.,in Section D above the large;system:has failed. The owner or operator of any large system considered:a significant threat under Section€or failed under Section D shall upgrade the system in accordance with 310 CNIR 15.304. The system owner should contact the appropriate regional office of the Department t5ins,`•3173 Title S.Official Inspection Form Salsuda64.Seteage disposal Sys tem,•Page S of 7 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 67 St.Cathennes Ave;<Hyannis WI21167988 Property Address c%Secure Soutions ethomas@secure-solutionslic.com srothosecure-solutionsllc corn Owner Owner's Name information is required for every 316 Delaware Rd Suite 21 Delmar NY 12054 4/25/2016 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? ET ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank. inspected for the condition of the baffles ortees,.material of construction, dimensions,depth'of liquids 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 zany of thefailure criteria related to Part C is at issue approximation of distance'is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flows Conditions: Number of bedrooms(design): N/A Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example:110 gpd x#of bedrooms): 330 t5iris 3l13 Title 5 Official Inspw ton Form:Subsurface Senage;Dismsal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Ins pecfio Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 St. Catherines Ave Hyannis WI21167988 Property Address T c/o Secure Soutions ethomas@secure-solutionsllc.com; sroth@secure-solutionsile.com Owner Owner's Name informationrairedfor is 316 Delaware Rd Suite 21 Delmar NY 12054 4/25/2016 ,required for every gage. CItyrrown State Zip Code Date of Inspection D. System Information Description: MAIN CESSPOOL CONNECTED TO A OVERFLOW CESSPOOL. THERE MAY ALSO BE. ANOTHER CESSPOOL CONNECTED TO A LAUNDRY/KITCHEN LINE Number of current residents 0 Does residence have a garbage grinder? ❑ Yes 0 No. Is laundry on a separate sewage system?(include laundry system-inspection Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes No Water meter readings, if available (last 2 years.usage (gpd)): ZERO Detail: 201'5: 0 2014'.0 Sump pump? ❑ Yes No Last date of occupancy: UNKNOWN Date Commercial/industrial Flow Conditions: Type of Establishment: NIA Design flow(based on 310 CMR 15.203): canons per day(gpd) Basis of design flow(seats/persons/sq.ft.;etc.)': Grease trap present? ❑ 'Yes ❑ .No Industrial waste holding tank present? ❑ Yes ❑. No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 Ti fe 5 Official Inspection Form:Subsurface Sewage Disposal Sys ern Page 7of 17 Commonwealth of Massachusetts ,y Title 5 Official Inspection Form Subsurface-Sewage Disposal System Form -Not for Voluntary.Assessments 67 St. Catherines Ave Hyannis ,W121167988 Property Address clo Secure SoutionS ethomas secure-msolutionsllc.com, sroth@secure-solutionslle:Corh Owner Owner's Name required for as 316 Delaware Rd Suite 21 Delmar NY 12054 4/25/2416 required far.every Page. City/Town State Z104 Code Date oflnspection D. System Information (cunt.) Last date of occupancyluse: Date Other(describe below): General Information Pumping,Records: Source of information` PUMPED IN 2002 PER BARN!VM PLANT Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped' aaiions How was quantity pumped determined? --- --- Reason,for pumping': Type of System: E Septic tank,distribution box, soil,absorption system ❑. Single cesspool [overflow cesspool q 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); MAYBE ANOTHER CESSPOOL FOR LAUNDRY LINE .t5 ns•3113 We 5 Official.Inspection Form;Subsurface SeWage Disposal System:Page 8 of 17 Commonwealth of Massachusetts � Title a Official Inspection Form to Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ., 67 St.Cathednes Ave Hyannis WI21167988 Property Address clo Secure Soutions ethomas@secure-solutionstic.com roth@secure-solutionsllc:com Owner Owner's Name information is 346 Delaware Rd Suite 21 Delmar' NY 12054 4/2512016 required for every 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: 51'YEARS.APPEAR ORIGINAL. HOUSE BUILT IN 1965 Were sewage odors detected when arriving at the site? ❑ Yes N No Building Sewer(locate on site plan): Depth below grade-.. 2€ee# Material of construction: cast iron ❑40 PVC` 2 SEWER PIPES ❑ other(explain}` G Distance from private water,supply well or suction line:; >ai1 et Comments(on condition of joints,venting, evidence of leakage, etc.): NO EVIDENCE OF LEAKS i Septic Tank(locate on site plan):. Depth belouv grade_; NO SEPTIC TANK PRESENT feet Material of construction: ❑ concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list_age: A - years. Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes '❑ No Dimensions`: Sludge depth: t5ins•M,3 Me 5 OfWat inspection Form:Subsurface Swage DIjspasal Sy*rn.•Page 9 of-13 Commonwealth of Massachusetts -- Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not'for Voluntary Assessments ti 67 St_ Catherines Ave Hyannis W121167988 Property Address c/o Secure Soutions ethomas@secure-solutionsilc.com roth(psecure-solutionsllc.com Owner Owner's Name information is requi:;ed for every Delaware Rd Suite 21 Delmar NY 12054 412512016 ,page. City/Town state Zip Code Hate of Inspection D. System Information (cost.) Septic Tank(cont.) Distance from top of sludge.to bottom of:outlet tee or baffle -- Scum hickness 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 relatecfto.outlet invert,evidence of lelakage, etc;); Grease Trap(locate on site plan): Depth below gratle N/A feet Material of construction: ❑ concrete ❑ metal ❑fiberglass n polyethylene ❑ other(explain): Dimensions; Scum thickness r 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 lastpumping 'Date i ;5ins•'3/13 Title 5 Official Inspection Form:Suti§urfaca Sewage Disposal Systi=m,-Page 10 of 17 Commonwealth of Massachusetts Y - . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 67 St, Catherines Ave Hyannis W121167988 Property.Address cto Secure Soutions ethomas@m'secure-solutionsilc.com; Broth@secure-solutionsllc com Owner Owner's Name information is 316 Delaware Rd Suite 21 Delmar NY 12054 4/25/2016 required for every page. CRY/Town state Zip Code Date of Inspection D. System Information (cunt:) 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: N/A Material of construction: ❑ concrete. ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: wµ_ gallons per day Alarm present: ❑' Yes ❑ No Alarm IeveL Alarm in working order: ❑ 'Yes ❑ No Date. of last pumping; pie Comments (condition of alarm and float switches, etc.):. Attach copy of current pumping'contract(required). Is copy attached? ❑ Yes ❑ No 66 3)73 Me 5 Official inspecton Form Subsurface;semo Disposal Sysia Page 1 f of 9'_- . Commonwealth of Massachusetts z Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not"for Voluntary Assessments 67 St. Catharines Ave Hyannis WI21167988, Property Address c/o Secure Soutions ethomas@secure-solutlonslic.com„ sroth@secure-solutionsllc.com Owner Owner's Name information is required for every 316 Delaware Rd Suite 21 Delmar NY 12654 4/25/2016. . page.. Cityrrown stafe Zip Code. Date of Inspection D. System Information (cont.,). Distribution Sox(if present must be,opened) (locate on site plan): Depth of liquid level'above-outlet invert NO DBtJX PRESENT Comments(note if box is level and distribution to outlets equal;,any evidence of solids carryover, any evidence of Ieakage into or out of box, etc-)* Pump Chamber(locate on site plan).- Pumps in working order. El' Yes ❑ No* Alarms in working order ❑: Yes ❑ No* Comments(note.condition of pump chamber,condition of pumps and appurtenances, etc.): N/A *If pumps or alarms are not in working order, system is a conditional.pass. Soil Absorption Systern (SAS)(locate on site plan, excavation not required): If SAS not located,explain why: t5ins 3l13 Trtle 5 Official Impedon Foam:Subsurface Sewage Disposal Systam•Page 12;of 1`r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 67 St.Catherines Ave Hyannis W121167988 Property Address c/o Secure Soutions ethomas@secure-solutionslic.com, sroth@secure-solutionslle.com Owner Owner's Name required is 316 Delaware Rd Suite 21 Delmar NY 12054. 4/25/2016 required for every page. City(rown State Zip Code Date of Inspection D. System Information (co.n.t.) i Type: leaching pits number- El leaching chambers number- 17 leaching galleries number: [] leaching trenches number,length: leaching fields number,dimensions: overRow cesspool number: 1 innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of pending;damp soil, condition of vegetation,etc.): CESSPOOL IS DRY. NO STONE SURROUNDING. HAS AN OPENING 2/3 UP&NE SIDE OF CESSPOOL SIDE APP 8"X8"W ROOTS COWLING IN AND OBSERVED SOIL_ SYSTEM;IS FAILED DUE TO THIS BREACH AS WELL AS OTHER PROBLEM W MAIN CESSPOOL.GRADE TO CESSPOOL BOTTOM IS 8 5: _ II Cesspools;(cesspool must be pumped as part of inspection) (locate on site plan): 1 OR 2 (LAUNDRY LINE Number and configuration NOT FOUND) Depth—tap of liquid to inlet invert --- Depth of solids layer Depth of scum layer Dimensions of cesspool APP'5X6 Materials of construction. BLOCK Indication of groundwater inflow ❑ Yes No .t5ins•3/13: Title 5 MOW,Inspection Form:Subsurface Sewage DrsposaI System•Page 13 of l Commonwealth of Massachusetts Title 5 Official Inspection Form µ. Subsurface Sewage Disposal System-Form-Not for Voluntary Assessments 67 St. Catherines Ave Hyannis W121167988 Property Address c/o Secure So.utions._ .ethomas@secure-solutionsllc.com sroth@secure-solutionsiic:com Owner Owner's Name information is 316'Delaware :Rd Suite 21 Delmar` NY 120`54 4/25/2016 required for every !Town - C' pane. �y State Zip Code Date of tnspectior, D. System Information (cont.) Comments (note condition:of soil-,:signs.of hydraulic failure,;level of ponding, condition of vegetation, etc:)_ ORANGEBURG PIPE, HAS 3" :PVC LI'NE GOING TO OVERFLOW CESSPOOL THAT IS 6" HIGHER THAN PIPE COMING FROM HOUSE. THERE iS ALSO A 1" PVC PIPE INSIDE THE 37' LINE MAYBE CONNECTED TO A LAUNDRY LINE?SYSTEM IS FAILED DUE TO OUTLET BEING HIGHER THAN INLET PIPE FROM HOUSE. GRADE TO CESSPOOL BOTTOM IS 70' Privy(locate on site plan): Materials of construction: N/ " Dimensions Depth of solids Comments(note condition of soil, signs.of hydraulic failure,level of pond ing, condition of vegetation, etc:): t5im•3113 T N.le 5 Official inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm-Not for Voluntary Assessments a 67 St.Catherines Ave Hyannis W121167988 ~ Property Address c/o Secure Soutions ethomas a@secure-solutionsllc.corn, sroth@secure-solutionsllc.com Owner Owner's Name information is required for every 316 Delaware. Rd Suite 21, Delmar, NY 12054- 4/25/2016. page. City/TownState Zip Code Date of Inspection D. System Information (cunt.) 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 e t c tl!S:c, :31'k v•` 1 t f7 I 3 r } i gins•3113 Title 5 Official Insp ection Form:Subsurface Sewage Disposal Sysfarn•Page 95 o>>Q Commonwealth of Massachusefts a Title 5 Official Inspection Form Subsurface Sewage D..isposal System Form -Not for Voluntary Assessments: 67 St. Catherines Ave Hyannis 1IV121167988 Property Address c/o Secure Soutions _ ethomas@secure-solutionslic.com, smth@secure-solutionsiic.com Owner Owner's Naive information is 316 Delaware Rd Suite 21 'Delmar NY 12054 4/25/2016 required for every pager City/Town state Zip Coder Date of Inspection D. System Information (cunt.) Site.Exam: Check Slope Surface water ;Check cellar Shallow wells Estimated depth to high ground water: - --- feet Please indicate all methods used to determine the high ground water elevation: El Obtained from system design plans on record If checked, date.of`design plan reviewed_ Date Observed site(abutting pro pertylobservation hole within 150 feet of SAS) Checked with focal Board of,Health:--explain: Checked with local excavators, installers (attach.documentation) El Accessed USGS database--explain:. You must describe how you established the high ground water elevation: NOT DETERMINED DUE TO FAILURE. Before filing this Inspection:Report,please see Report Completeness Checklist on next page. tams:•3f13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16:of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form-Not for Voluntary'Assessments 67 St.Catherines Ave Hyannis _ WI21167988 Property Address c/o Secure Soutions ethomas@secure-solutionsllG.COm, sroth@secure,-solutionsilc.som Owner Owner's Name information is required for every 316 Delaware Rd Suite 21 Delmar NY 12054 4/25/2016 page. C1ty1rown State,. Zip Code Date of Inspection E. Report Completeness.Checklist Z 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 I i t5ins-•:3113 'rill"Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17r DEEP•OBSERVATION HOLE LOG Uole# Depth from Soil Horizon Soil Texture Shcl Color Sol[• Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. F•: � � r sl to cy,46'(3rayell j f DEEP OBSERVATION-HOLE LOG Hole# Depth from Soil Horizon SollTexture Soil Color Soil Other. Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. consiltalpy.%arayel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soll 1401"12on Soil Texture Soil Color Soil Other Surface(in.) (USDA) (MUDYeII) Mottling (Structure,Stones,Boulders. Conslatenov.%Gravoll DEEP OBSERVATION HOLE LOG Hole# Depth from Sol[Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsoll) Mottling (Structure,Slopes:Boulders, ConsistancV. i Flood Insurance Rate_Map / Above 500 year flood boundary No Yes Within 500 year boundary No_1 /Yee Within 100 year flood boundary No,,— Yas Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring per l lal oxist in all areas observed thrpughout the area proposed for the soil absorption system? / If not,what is the depth of naturally occurring per sous material`s Certification I certify that on (date)I.have passed the soil evaluator examination approved by the Department of Env ir nmental Protection and that the above analysis was performed by me consistent with . the required training,exp s d eri cc described in�1 10 ClvM 15.01 . Signature � Date QASEPT[CkPERCPORM.DOC ilia Town of Barnstable Departinent of Regulatory Services Public Health Division Date MA84 �•a79. 200 Main Street,Hyannis MA 02601 ; ' �fpNlA'ta . Y �7 Date Scheduled Time . 3y.f1 fl?Fee Pd. _ • Gam] ' m Sail Suitability, Assessment for Sew ge leis os l Performed-By: ILI' U Witnessed By: .�, �,�. S 4� i AA LOCATION& GENERAL-INFORMATION Location Address 6l�� Address Assessor's Map/Parcel: jq/"— �� f Engineer's Name NEW CONSTRUCTION REPAIR Telepbono ff ' Land Use• 7— Slopes(96) Surface Stones . Distances ft ro: Open Water Body ft _Possible Wet Aren ft Drinking Wafer Well . ft Draihage Way ft Property Llne _R Other ft 001MTCH'(Street name,dimensions of lot,exact locations of test holes&pare tests,locate wetlands in proximity, to boles) Parent material(geologic) Depth to Bedrock Depth to Oroundwater, Standing Water In Hole: Weeping fl'om Pit Fnae Estimated Seasonal High Oroundwater DETERMINATION FOR SEASONAL•HIGH WATER TABz, Method Used: Depth Observed standing In obs.hole: Dellth to weeping from side of obs,hole: in, Depot 10 soil tttottlOOt lit, Index Well fr Rcading Date: Index Well level •• Ill' Orohadwater Adjustment B• _-..r ..,._ Act,Actor _ Adj_pl)"dwatet level Observation PERCOLATION TEST Hole# /_ Tinto at 9" Depth of Pero Time at 6" Start Pro-soak Time @ Time(9"-6") End Pro-soak Rate Min./tuch Site Suitability Assessment: Site Passed Site Failed: Additional Tasting Needed(YM) , Original: Public Health Division Observ'tIon Hole Data To Be Completed on Back— ***Yf percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conseirvation Division at least one(1)week prior to beginning. Q!%EPTICIPERCFORM.DOC i