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Home My WebLink About0052 SECURITY STREET - Health -52`-SECURITY'ST.•-(HYAr1NIS) ` A=268-146 ° a o a 1 e ri e d t i T V+1N�11F:$AkNSTABLE.' LOCAVON VXLLA'�e dt/11 s prSSE5a®R'S MP& A'f__� _._.. �.. IN,TMW RW S NAIL&I='I'IQII N6 88P1IIC TANK'CAPACITY C ;� r _�. .. (size) ;------ r I" RN{gTI3A' k; cowo Cl"ICE X)l�'fi.E: :..._ .._ .:. �S��rtrptios11�15Pxtrarc:l3etv��et�.tka� ;; Niaxuxium l��ljustcd Gi'auracfwtjtei'I'��le Ro tiac,I3attorn of X,r,,tahinS I7ilei I gee+ Pil vow,"/t►t41vuplyly'VfcIIl ema ocailly �f auy�vf;19s exist . kzm � OW BMW.wlt�indq fact of lQtleiiiit� arlll' ') �?cl .<7fV►lAt4in s911CI''I.OAC�il61(� aCIIiXytYfg19�WGllarid4 R15Q II'I;C � a9il;.izu�'1l}(f:;fc.et ct`,Ius►cII�In�S'aritsry,a � -� II+iird3 rcl la cif f N16 n (� (1 v �r r No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete Syste ❑Individual Components Location Address or Lot No.j2 ,f�6 e'41A r ty Sr, Owner's Name,Address,and Tel.No. Assessor's Map/Parcel, / Ul Y Installer's Name Address,and Tel.No.sl� 88' 7O,177-f Designer's Name,Address,and Tel.No. c/ds�idh i�. O P'DS Type of Building: Dwelling No.of Bedrooms g 4— Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) IV W gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) :1"1157-011 �Dr,�Tia Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. r Signed .t Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 1 — O Date Issued 5' y :.';.^i°..y..,* ti....�^�,,.,._� R.y •.:'i ...�;...�;,: ... ,,.. ...-...,.ram' ..-». .^�.>.,s.a-•. .�. � 'S,-.... ... i . .4 .I• -�. •� „eF T �h ♦ f F1 4 No. l ! ` Fee f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 4f PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Ripfication for Misposal 6pstern Construction Permit /� I' Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete Syste ❑Individual Components Location Address or Lot No. r 5T Owner's Name,Address,and Tel.No. Assessor's Map/Parcel °��' r''f��i >(,t y� Q N, M C h y f' rL l Y), 01 V ) Installeifs Name,Address,and Tel.No. 0 "L/�v 97j� Designer's Name Address,and Tel.No. V � Type of Building: Dwelling No.of Bedrooms Lot Size sq.n. Garbage Grinder( ) Other. Type of Building No.of Persons Showers( ) Cafeteria( ) `Other Fixtures Design Flow(min.required) IV P_ gpd Design flow provided /t/ gpd r- Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soils i Nature of Repairs or Alterations(Answer when applicable) f/ X-y"-,T/Z>4 inspected: Date last ins i P 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 Certificate of Compliance has been issued by this Board of Health. / 1 ,I Signed �/•�'O / !^ r�G � �'"� Date �I Application Approved by �.Application Disapproved by / '• 'f Date for the following reasons Permit No. O I — c Oct Date Issued THE COMMONWEALTH OF MASSACHUSETTS �w J/'I/� BARNSTABLE, MASSACHUSETTS Z"dI5 f`, u x f Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by lyye t/ •�s! cJ / r at- --.r, ,f-a41,r/.- ,S17-. '� G9d71�// { has been constructed in accordance with the provisions of Title5 and the for Disposal System Construction Permit No.��-9 0� dated Installer ;��Jj�'%�/�/ U /�`�l�f'/( j Designer #bedrooms Approved design flow gpd The issuance of this permit shallinjot be construed as a guarantee that the system functiondesigned. Date , / Inspector No -- -r - -- r�-- --- ---- - - - ------------- ------------------- --------- 01 Fee THE COMMONWEALTH OF MASSACHUSETTS T PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) l System located at rj� .SrC G1/'/ = Ti�/ /_�7 and as described in the above Application for Disposal;System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. f' Provided:Construction mus be comp eted within three years of the date of this permit Date ( l"'= Approved by 1•� - --r—d Commonwealth of Massachusetts � - Title 5 Official Inspection Form = Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Security St Property Address Bank Owned (Contact Christina Junquira @ 1-508-737-5280) �+ Owner Owner's Name Qj information is required for every Hyannis MA 02601 4-2-16 N page. City/Town State Zip Code Date of Inspection ;i�* Inspection results must be submitted on this form. Inspection forms may not be altere in any way. Please see completeness checklist at the end of the form. A. General Information 1. inspector: Shawn Mcelroy ' Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation he Local Approving Authority 4-2-16 Tnspector'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•W3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 �p US Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0y`.ti 52 Security St Property Address Bank Owned (Contact Christina Junquira @ 1-508-737-5280) Owner ,^re: Owner's Name information is required for every Hy annis MA 02601 4-2-16 page. ... City/Town State Zip Code Date of inspection a:< 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 more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of.Health,will pass. Check the box for"yes", "no"or"not determined",(Y, N, ND)for the following statements. If"not determined," please explain. ` The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y. ❑ N ❑,ND (Explain below): t5ins•3113 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 7M 52 Security St Property Address Bank Owned (Contact Christina Junquira @ 1-508-737-5280) Owner Owner's Name information is required for every Hyannis MA 02601 4-2-16 . page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if pumps/alarms are repaired. 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•3113 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 , �M 52 Security St f Property Address Bank Owned (Contact Christina Junquira c@ 1-508-737-5280) Owner Owner's Name information is required for every Hyannis MA 02601 4-2-16 , page. City/Town State Zip Code Date of Inspection , B. Certification (cunt.) 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*". t Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliforrn 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 El `® 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 1/2 day flow t5irs•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I I Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'GSM 52 Security St Property Address Bank Owned (Contact Christina Junquira @ 1-508-737-5280) Owner Owner's Name information is required for every Hyannis MA 02601 4-2-16 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 2000gpd- 10,000gpd. „ ❑ , ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 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 . �M 52 Security St Property Address Bank Owned (Contact Christina Junquira @ 1-508-737-5280) Owner Owner's Name information is required For every Hyannis MA 02601 4-2-16 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. ForIexam le "a Ian at the Board of Health. ® ❑ 9 P p ® ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5irs-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 52 Security St Property Address Bank Owned (Contact Christina Junquira'@ 1-508-737-5280) Owner Owner's Name information is required for every Hyannis MA 02601 4-2-16 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? (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)): Detail: t • 4 Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 - Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , �M 52 Security St Property Address Bank Owned (Contact Christina Junquira di 1-508-737-5280). . Owner Owner's Name information is required for every Hyannis MA 02601 4-2-16 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: y gallons How was quantity Pum ed determined? P Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system - ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) 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•3113 Tide 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 52 Security St Property Address Bank Owned (Contact Christina Junquira @ 1-508-737-5280) Owner Owner's Name information is required for every Hyannis MA 02601 4-2-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 0 Approximate age of all components, date installed (if known) and source of information: 2007 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24"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: 8"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: 1000 gal Sludge depth: 12" t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Security St Property Address Bank Owned (Contact Christina Junquira @ 1-508-737-5280) Owner Owner's Name information is. required for every Hyannis MA 02601 4-2-16. 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 • - . 1" Distance from top of scum to top of outlet tee or baffle_ 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" 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-3/13 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 52 Security St Property Address Bank Owned (Contact Christina Junquira @ 1-508-737-5280) Owner Owner's Name information is Hyannis MA 02601 4-2-16 required for every H y ' 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts r , Title 5 Official Inspection Form, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Security St Property Address Bank Owned (Contact Christina Junquira cLD 1-508-737-5280) Owner Owner's Name information is required for every Hyannis MA 02601 4-2-16 ., 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. o Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working_order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5in3•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments 52 Security St Property Address Bank Owned (Contact Christina Junquira @ 1-508-737-5280) Owner Owner's Name information is required for every Hyannis MA 02601 4-2-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number. 2-500's ❑ 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.): Good condition and empty at inspection with stain line at 6"off bottom of chamber. 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•W 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 52 Security St Property Address Bank Owned (Contact Christina Junquira @ 1-508-737-5280) Owner Owner's Name information is required for every Hyannis MA 02601 4-2-16 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.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not forVoluntary Assessments qM 52 Security St Property Address Bank Owned (Contact Christina Junquira @ 1-508-737-5280) - Owner Owner's Name information is required for every Hyannis MA 02601 4-2-16 " 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 35° ' 7 1 ` t5ins-3/13 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 M 52 Security St Property Address Bank Owned (Contact Christina-Junquira @ 1-508-737-5280) Owner Owner's Name information is required for every Hyannis MA 02601 4-2-16 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: 12'+ 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 gr oundwater at 12. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Tide 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 52 Security St Property Address Bank Owned (Contact Christina Junquira @ 1-508-737-5280) Owner Owner's Name information is required for every Hyannis MA 02601 4-2-16 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 G TOWN OF BARNSTABLE fir. f c LOCATION k- 1 SEWAGE #q[�-t VILLAGE A SESSOR'S MAP & LOT Z��' INSTALLER'S NAME & PHONE N . tt 1:�`F kQd77(� SEPTIC TANK CAPACITY 160 0 ?t4z�-S LEACHING FACILITY:(typeO//7 r"//OZeV ' (size) NO. OF BEDROOMS PRIVATE WELLL PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: ''f� DATE COMPLIANCE ISSUED: �'��'� VARIANCE GRANTED: Yes No \�. �t " '?-9--z � /9�a APPROVED THE'COMMONWEALTH OF MASSACHUSETTS Sams b�l :COn$Mation Dopartmen OARD OF HEALTH tom, ate N OF BARNSTABLE Signed Appliratiun fur Diupuittl lVark.6 Tomitrnrtiun rantit Application is hereby made for a Permit to Construct ( ) or Repair (,e5"`an Individual Sewage Disposal System at, j��ry d's--------------•----•-----------•----------•-- ----.----•-----•---------•---------------- L tio}��1dd i or Lot No. 1... _.....- ( .......... mcp ddress a _ :/ --------------------------------------- �� ............................ . Ul � Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons.-..-..-----..-.------------ Showers ( ) — Cafeteria ( ) dOther fixtures .........................................•-•---------•-----...------------......------. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width.......--------- Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length...----......--...-- Total leaching area....................sq. ft. Seepage.Pit No...................... Diameter.................... Depth below inlet..--................ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1---------- -----minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ (Z Test Pit No. 2................minutes per inch Depth of Test Pit....---- ........... Depth to ground water............------------ 9 •------------••--------------------•-----•-•----•-••---•-•••-------••......-•------••---------••••••......................................................... 0 Description of Soil....................................................................................................................................................................... W V ....-.................................................................................................................................................................................................. ---- ------ --------------------------------------------------------- ----------------- U Ng ur�A airs r •••lteraat on, stye when applicable. �� J ----- SL, lltttl ¢...................... S-'_......--•--.....-•-----------------------------------------------------•------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Envir ental Code —The ndersigned further agrees not to place the system in operation until a Certificate of Compli c has board of health. r � . Signed .....mt��.................................... ...... .ceApplication Approved By ......i.....�........ .... ........ ... Daze Application Disapproved for the following re4sons: ................................................................................................................................ ..... .......... . ..................................................................... ............................................................................ �� Date Permit No. ..... ..`............�.°....�'C............... Issued ....."✓ lam..." .?? .................. Date ati I � f P iN. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 'TOWN OF BARNSTABLE P Appfiration for Ui_rpoottd Work,i Tonotrnrtion Permit Application is hereby made for a Permit to Construct ( ) or Repair (,r<an Individual Sewage Disposal System at `I 1 �iS, ..........................................�y.......... ...........4 ....... -------------------------------------------------------------------------------------------------- -Addr-ess- ...................... .�l✓•�/)j-17 or Lot No. // / ------•-•-------•--------------•-- ]` �/f f W !✓ 7 � .I .'f J�OI.�eC Ago. A/fl�N�f.'v'i.7 l� ;dress 1 jf�,/............................ a -- ............---------- --------------------------------------•-------------------...--- - III Y / ` ' Installer ` Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ___________________----•-• No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures .----•-----------•-------------•---------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width---------------- Diameter................ Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter-_--.-_.--.-.--_-_- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------- ----------------•--•-•••••--........-••-----•••-•----••-----..... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------:----------- Depth to ground water........................ GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 .........•................•-••-••••••...........--••-----•-........_....._-•••••---•----•-•---•••••......................................................... 0 Description of Soil........................................................................................................................................................................ x U w ------------------------------------------------- ------------------------••--•--------••-••-------------•-•--•---------••-----....•_:_..-• . r� f U N ture of . e airs r Alteration —A�swe when applicable.1.�SYGC-�.�_..�000 yCt-I)X;-_I��J,� •-GU?� r ,l ?_L_ f�x ---3 `--------------•------------------------------...------------.....------......-----------•--..........--------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Envipo.nmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iipe(�bfyythe'Soard of health. Signed .......-I-�I--UV] .. ''..... V..`�--------------------------------------------------- :J...f l.V. V _ Dace ApplicationApproved By ._:.;....... ---------------------------------------------------------------------------------------------. ... .... ~ Application Disapproved for the following reasons: l/ .................... . . . .................. .............. ...... ......------ ------- �A^^ ..............� --------------------Date PermitNo. ---- ........... �..... Issued .............................................. ....... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (fErtifirate of Complianre THIS IS TO, CERTIFY, That the Individual Sp age DisposalSystem constructed ( ) or Repaired,(_- - ) �, � . .................... .-- - _......... - ....... - at 4a '-- --- ---------------_--------------------...... .... has ........ t, been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application fo'r'-Disposal Works Construction Permit No. ._............. dated ............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ':�6 _/r/. r ^� DATE...... ------------- ..----------------------- Inspector- ...:..................__.. -------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH F TOWN OF BARNSTABLE No. ` .:._ FEE..... 0 f Rio nottl ork lutn�ff otrnrtion "amit Permission is hereby granted. ,' � Lt�/��L to Construct ( ) or Rep ',r )-an Individual Sewage Disposal System at No.................................. .................. /f'l�! f............... •........... ---- fStree „y as shown on the application for Disposal Works Construction Permtt�+N�p�__�.__...___Y✓.�J..____ Dated.__. _/..................... Board of Health DATE..........--............................ ---...-................................. FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS LISPS TRACKING# First-Class Mail I Postage&Fees Paid I USPS Permit No.G-10 I 9590 9402 1933%123 1800 05 I . . United States •Sender:Please print your name,address,and ZIP+4®in this box* Postal Service I Town of Barnstable Health Division it 200 Main Street I Hyannis,MA 02601 ---------------- L: ^- }��fCt".�OtO ,:ll,l,l,�li�,�l,il,�l!!'l�,ll!„�.,l:I�i,.,�ljli„a„�llilati'!Ilfi;l! I k o , I ■ Complete items 1,2,and 3. A. Signature . e Print your name and address on the reverse X C gent i so that we can return a card to you. fj Addressee ■ Attach this card to the back of the mailpiece, BrYi, bJ�� Na e) C. Date pf Delivery or on the front if space permits. 16121 1. Article Addre — D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑No '--Tormicoli, Robson A 55 Oak Neck Road Hyannis, MA 02601 II I II�III Ili III I II II II I I I IIIII I III I I I I I II I III .�r ❑Adult Service Signature ❑Registered Mail alllTMss® ❑��deult Signature Restricted Delivery ❑Registered Mail Restricted 9590 9402 1933 6123 1800 05 ❑Cert lied Mail Restricted Delivery Deliv etu Receipt for ❑Collect on Delivery erchandise ❑Collect on Delivery Restricted Delivery Signature ConfinnationT ��Gdir.-le_Nii nber_LTransfer_from secvice_IabeO.—�—__ lal El Signature Confirmation 7 015 1730 0001 4990 4 0 2 5 lail Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt l Ln ru .. 0 C3 om'Q Certified Mail Fee $ ��)' > Extra Services&Fees(check box,add fee as appropriate) r—I ❑Return Receipt(hardcopy) $ A�4 O ❑Return Receipt(electronic) $ Q!ere Q ❑Certified Mail Restricted Delivery $ 0 []Adult Signature Required $ � Fn` ❑Adult Signature Restricted Delivery$Postage � r-I Total Postage and Fees $ Formicoli, Robson a seor To 155 Oak Neck Road �tieet andAp(-No., -"-------of P�$oz ltfo: r- Hyannis, MA 02601 -�-"---- I Certified Mail service provides the following benefits: •A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail •A unique identifier for your mailpiece. associate for assistance.To receive a duplicate •Electronic verification of delivery or attempted return receipt for no additional fee,present this L' delivery. USPS®-postmarked Certified Mail receipt to the- •A record of delivery(including the recipient's retail asiociate. J signature)that is retained by the Postal Service' Restricted delivery service,which provides C for a specified period. delivery to the addressee specified by name,or xq to the addressee's authorized agent M Important Reminders: Adult signature service,which requires the -0 •You may purchase Certified Mail service with signee to be at least 21 years of age(not "L First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which~ •Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mail. and provides delivery to the addressee specified 7 ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mali service.However,the purchase (not available at retail). �p of Certified Mail service does not change the •To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. I USPS postmark.If you would like a postmark on fr1 •For an additional fee,and with a proper__ R this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office-for the following services: postmarking.If you don't need a postmark an thiss� -Return receipt service,which provides a record —Certified Mail receipt,detach the barcoded portiodu of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an _appropriate postage,and deposit the mailpiece. -1 electronic version:For a hardcopy return receipt, complete PS Form 3811,Domestic Retom Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. PS Form 3800,April 2015(Reverse)PSN 7530-02-000.9047 Town of Barnstable Barnstable Regulatory Services Department H-AmericaC'j MASSi639 Public Health Division m 200 Main Street Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL: 7015 1730 0001 4990 4025 October 19, 2017— SECOND NOTICE FORMICOLI, ROBSON 155 OAK NECK ROAD HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 52 Security Street, Hyannis,MA was last inspected on April 14,2016,by John P. Graci, Sr, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Distribution-box is rotted out and needs to be replaced. You were originally ordered to repair or replace the septic system before May 30, 2017; however,this system was not repaired or replaced as ordered. r You are ordered to repair or replace the system within 6 months. Failure to repair/replace the septic system within 6 months will result in scheduling'this issue before the Board of Health at a public meeting. PER ORDER OF THE BOA OF HEALTH Th cKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\52 Security St Hyannis SECOND NOTICE.doc h y rq m m [.- $ertifiedMailFee / is 41 n.l Extra Services&Fees(dwk boa,add fee as appropriate) Qa ❑Retum Receipt NWoopy) $ 1� ❑Return Receipt(electronic) $ y O ark O 0 ❑Certified Mail Restricted Delivery $ ��I �te i6 —' r ❑Adutt Signature Required $ 9(! ❑Adult Signature Restricted Delivery$ C O Postage ru LSPS � Total Postage and Fees d7 $ rq Deutsche Bank Nat'l TR CO TR l d c/o Robson Formicoli 155 Oak Neck Road Hyannis, MA 02601 Cerl —--I service provides the following benefits: ■A re( Iof the Certified Na-i label):.-... for an electronic return receipt,see a retail ■A uni your mailpiece. associate for assistance.To receive a duplicate ■Elect of delivery or attempted return receipt for no additional fee,present this deliv USPS®-postmarked Certified Mail receipt to the ■A rec cluding the recipients retail associate. signs' Ined by the Postal Service- G Restricted delivery service,which provides for alV._.....�_.r...... delivery to the addressee specified by name,or Important Reminders: to the addressee's authorized agent P Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailabie for requires the signee to be at least 21 years of age International mail. and provides delivery to the addressee specified, ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Cerfdied Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is Insurance coverage automatically included with accepted as legal proof of mailing,It should bear a certain Priority Mail items. USPS postmark.If you would like a postmark on ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail Item at a Post Office-for the following services: postmarking.If you don't need a postmark on this f-Return receipt service,which provides a record - Certified Mail receipt,detach the barcoded portion I of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply I I You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, "n- complete PS Form 3811,Domestic Return_ Receipt attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. PS Forrn$800,April 2015(Reverse)PSN 7530-02-000.9047 - f UNITED STATESZP* g5WA First-Class Mail Postage.&Fees Paid USPS 218 k4'"AY "16 Permit No.G-10 I • Sender: Please print your name, address, and ZIP+4®in this box* I f Town of Barnstable f Public Health Division 200 Main Street Hyannis, MA 02601 USPS TRACKING# I j 9590 94031ft }11'3 j � �ji7s � • e 7A' ■ Complete items 1,2,and 3. Signature �■ Print your name and address on the reverse SAgent so that,we can return the card to you. ❑Addressee ® Attach this card to the back of the mail iece, P cei by(P btedNN�ro�e) C. f D ery or on the front if space permits. p r V`Az �r I 1. Article Addressed to: D. is delivery address different from item 1? ❑Yes Deutsche Bank Nat'l TR CO TR If YES,enter delivery address below: ❑No I c/o Robson Formicoli 155 Oak Neck Road .a I Hyannis, MA 02601 I I�IlIIIiI Ilil III I I I I I II I III I II I II I I II III II I III 3. Service Type ❑Priority Mail Express® ❑Adult Signature ❑Registered MaiIT"' l ❑Adult Signature Restricted Delivery ❑Registered Mail Restrictedl 9590 9403 0521 5173 2829 44 ❑Certified Mail® Delivery ❑Certified Mail Restricted Delivery ❑Return Receipt for I ❑Collect on Delivery Merchandise 2. Article Number(transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature ConfirmationT"^ ---- -- Y -'Psured Mail ❑Signature Confirmation 7 015 15 2 01 o a o 1.�`2Z7 3 \3 3 7.1 �ry( Psured Mail Restricted Delivery Restricted Delivery �c wer$500) i PS Form 3811,April 2015 PSN 7530-02-000-9053 Domestic Return Receipt y u„yi' �rW Barnstable Town of Barnstable � Regulatory Services Department P • •ass.e, • � D 16 9. Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Certified Mail# 7015 1520 0001 2273 3371 May, 18, 2016 Deutsche Bank Nat'l TR Co TR c/o Robson Formicoli 155 Oak Neck Road Hyannis,MA 02601 • ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 52 Security Street, Hyannis,MA was last inspected on April 14,2011,by John Pz. Graci, Sr, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Distribution-box is rotted out and needs to be replaced. You are ordered to repair or replace the septic system within one (1) Year from the date you receive this notification. 'A. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. 6PER ORDER 0 THE BOARD OF HEALTH mas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Conditionally Passes Ltr\52 Security St Hy 2016.doc � 1 Town of Barnstable + lAHN3LlHLE, � , "�: ,b$ Regulatory Services D•epartinent pTFD MP'i� . Public Health,Division 200 Main Street;Hyannis MA 02601 Office: 508-8624644 Richard Scab,Director FAX 508-790-6304 Thomas A.McKean,CHO Feb 6,•2007 • Rev. 7/6/15 DEADLINE$ 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) b ❑.Leaching pit or cesspool with high liquid level,<12"below inlet(per Town Code §360-9.1) OTBER Repair deadline: l' QASEPTIMDEADLINES TO REPAIR FAILED SYSTEMS.doc Parcel Detail Page 1 of 4 77Ht — T 1 y0.7 n7 s+. !........./f ��y eG t.�'YiI�rGt/' 76ZS i! �J!4 Logged In As: Pa rce I Detail Wednesday, May 18 2016 Parcel Lookup Parcel Info 26$-146 , Developer Parcel ID Lot,'LOT 26 Location 52 SECURITY STREET I g 75 Pri Frontage j Sec Road P Sec Frontage Village HYANNIS Fire District HYANNIS �� r Town sewer exists at this address jNo Road Index 11465 �I Asbuilt Septic Scan: Interactive 268146_1 Map ) 268146 2 - ` Owner Info Owner FDEUTSCHE BANK NAIL TR CO TR ( Co-owner�%FORMICOLI, ROBSON M �' Streetl f155 OAK NECK ROAD Street2 City rHWANNIS State,MA zip 026 11 11 Country°�J Land Info ...�.. Acres 0.17 I use lSirtgle Fam MDL-01 I zoning 1RB I Nghbd]�0105 Topography,Level Road Paved Utilities Public Water,Gas,Septic � Location Construction Info Building 1 of 1 Year �1968____"j Roof[Gable/Hip ( Exl Wood Shingle Built Struct Wall g Living Roof '�."... AC (1080 Asph/F GIs/Cmp N one Area Cover Type Style Ranch Wall Drywall Rooms3 Bedrooms ( �»woKI, Int '�"""" ._......�. Bath Model Residential �I Floor,Carpet Rooms 5 Full-0 Half Ik Grade Average Minus Teatype HOt Air !� Rooms 5 ooms t, 2 sAs '�, �BMT} 4Heat sr a, 24 StoriedStory I Fuel_[Gas (Found- ation OUred COnC. 4 v� 4 Gross2016 Area Permit History_ Issue Date Purpose Permit# Amount Insp Date Comments http:Hissg12/intranet/propdata/ParcelDetail.aspx?ID=19476 5/18/2016 t Commonwealth of Massachusetts o7log'/��0 w Title 5 Official Inspection Form m' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . "zo °M 52 SECURITY STREET Property Address BANK OWNED r _ Owner Owner's Name / information is required for every HYANNIS ✓ MA 02601 04/14/2016 '►+` ' 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. I Important:When filling out forms A. General Information on the computer, 1 I use only the tab 1. Inspector: key to move your cursor-do not JOHN P GRACI SR _ use the return Name of Inspector key. GRACI SEPTIC INSPECTIONS LLC ,Q Company Name PO BOX 2119 _ Company Address TEATICKET MA 02536 City/Town State Zip Code 508-641-6694 S 1468 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluatio by the Local Approving Authority 04/14/2016 Inspector's Signature Date The system inspector shall bmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 ys of completing this inspection. If the system is a shared system or has a design flow of 10,000 d 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 L9 � �S 5} r �s'; �`3:_y7 yap 4 .. Commonwealth of Massachusetts j W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 SECURITY STREET Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 04/14/2016 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: NA 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, 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): NA t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form - ^I ^' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 SECURITY STREET Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 04/14/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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): DISTRIBUTION BOX IS CORODING AND NEEDS TO BE REPLACED. ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): NA 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•3/13 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 G„M 52 SECURITY STREET Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 04/14/2016 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: NA **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: NA D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less day flow than 1/2t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 SECURITY STREET Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 04/14/2016 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 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D.shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments q 52 SECURITY STREET Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 04/14/2016 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? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 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 52 SECURITY STREET Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 04/14/2016 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: 1000 GALLON SEPTIC TANK DISTRIBUTION BOX( NEEDS TO BE REPLACED)AND 2/500 GALLON LEACH CHAMBERS MEASURING 12'WX 261 X2'D. Number of current residents: VACANT _ Does residence have a garbage grinder? ❑ Yes ® 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 ears usage d TOWN 9 ( Y 9 (gP ))� Detail 2014-7500 2015- 14000 Sump pump? ❑ Yes ® No Last date of occupancy: VACANT Date Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): NA Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): NA 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: NA t5ins•3/13 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 52 SECURITY STREET Property Address BANK OWNED Owner Owner's Name information is HYANNIS MA 02601 04/14/2016 required for every _ _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: NA Date Other(describe below): NA General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ® Yes ❑ No _ If yes, volume pumped: NAgallons How was quantity pumped determined? NA Reason for pumping: NA 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments <c�M 52 SECURITY STREET Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 04/14/2016 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: 11/30/2007 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: (18) EIGHTEEN INCHES feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line. 10+ FEET feet Comments(on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK APPEARS TO BE STRUCTUARLLY SOUND AT TIME OF INSPECTION. UNABLE TO INSPECT UNDER NORMAL USEAGE. Septic Tank(locate on site plan): Depth below grade: (12)TWELVE INCHES feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) SEPTIC TANK APPEARS TO BE STRUCTURALLY SOUND AT TIME OF INSPECTION. RECOMMEND PUMPING NOW AND EVERY TWO YEARS. UNABLE TO INSPECT UNDER NORMAL USEAGE. If tank is metal, list age: NA years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 GALLON Sludge depth: (3) THREE INCHES t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 52 SECURITY STREET Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 04/14/2016 page. Cityrrown 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 (31)THIRTY ONE INCHES Scum thickness (1) ONE INCH Distance from top of scum to top of outlet tee or baffle (6) SIX INCHES Distance from bottom of scum to bottom of outlet tee or baffle 0 — How were dimensions determined? MEASURED/VIEWED Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): SEPTIC TANK APPEARS TO BE STRUCTUARLLY SOUND AT TIME OF INSPECTION . RECOMMEND PUMPING NOW EVERY TWO YEARS. UNABLE TO INSPECT UNDER NORMAL USEAGE. Grease Trap (locate on site plan): Depth below grade: NA feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): NA Dimensions: NA Scum thickness NA Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA Date of last pumping: NA Date t5ins-3/13 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 52 SECURITY STREET _ Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 04/14/2016 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.): NA Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: NA — Capacity: NA gallons Design Flow: NA gallons per day Alarm present: ❑ Yes ❑ No Alarm level: NA Alarm in working order: ❑ Yes ❑ No Date of last pumping: NA Date Comments (condition of alarm and float switches, etc.): NA Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 SECURITY STREET Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 04/14/2016 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 BOTTOM OF PIPE Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): DISTRIBUTION BOX IS CORODING AND NEEDS TO BE REPLACED. 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.): NA * 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: NA t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 52 SECURITY STREET _ Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 04/14/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: NA ® leaching chambers number: (2)TWO ❑ leaching galleries number: NA ❑ leaching trenches number, length: NA ❑ leaching fields number, dimensions: NA Eloverflow cesspool number: NA ❑ innovative/alternative system Type/name of technology. NA Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 2-500 GALLON LEACH CHAMBERS MEASURUING 12'W X 26'X 2' D NEVER MORE THAN (6) SIX INCHES OF LIQUID. APPEARS TO BE STRUCTUARLLY SOUND AT TIME OF INSPECTION. NOT ABLE TO INSPECT UNDER NORMAL USEAGE. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA. Depth—top of liquid to inlet invert NA Depth of solids layer NA Depth of scum layer NA Dimensions of cesspool NA Materials of construction NA Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 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 52 SECURITY STREET Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 04/14/2016 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.): NA Privy (locate on site plan): Materials of construction: NA Dimensions NA Depth of solids NA Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): NA t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ' a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 SECURITY STREET _ Property Address BANK OWNED Owner Owners Name information is required for every HYANNIS MA 02601 04/14/2016 page. Citylrown 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 MCL bw C-411,le n S-T 2 2-500G0l tan LL_ ODD- 3oQ bl- a0� 1-- 35 5 61- J" y .1 J -M 10 t5ins•3113 'ritle 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 nM 52 SECURITY STREET Property Address BANK OWNED _ Owner Owner's Name information is MA 02601 04/14/2016 required for every HYANNIS _ 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: feeetet FEET Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: AS BUILT ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: HAND AUGER Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 SECURITY STREET Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 04/14/2016 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 F ` TOWN OF BARNSTABLE LOCATION Ir->c? secvri:�Z SSf SEWAGE# -Pa)7"S'10 •VILLAGE W. t y-.+ jAr+ ASSESSOR'S MAP&PARCEL M 6107 - f%4 6 INSTALLERS NAME&PHONE NO.wom. C• 5br 7 7,5T77,b SEPTIC TANK CAPACITY !ODO LEACHING FACILITY:(type) d XSw (size) /J X"x.1 NO.OF BEDROOMS OWNER Cf—IAe_ PERMIT DATE: 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) r— Feet Edge of Wetland and Leaching Facility(If any wetlands exist . within 300 feet of leaching facility) Feet, FURNISHED BY beSt dak, lVi 7fo'� l m cb J r% CA Irb I; c M LL O t No. 540 e Fe / t, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplication for �Digoq;al 6potem Congtructiun Permit Application for a Permit to Construct( ) Repair(X) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components a ; Location Address or Lot N Owner's Name,Address,and Tel.No. —2 o' 4 Assessor's Map/Parcel a(pg - f [k4LD. 5a5��:.t,d�t sk-p_ , o_vi 1S , Installer's a A dress,and Tel.No. ' p j Designer's Name,Address and Tel.No.5��—��O U)rvl " `�;� , S F S�-r- "I scA.- D ons 6" jrvi � e_ a to, ni �-CArG1e r\,Ls Type of Building: rr�� Dwelling No.of Bedrooms J Lot Size sq. ft. Garbage Grinder (N4) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations( nswer whe applicable) Zt:r)5k L 0, 06,0 l '` A e- 5 kaods ,'-.1_Date last-inspCc�red-: 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 Certificate of Compliance has been issued by this Board of /Signed Date °� `®' ✓ Application Approved by Date Application Disapproved by: Date for the following reasons Permit No.e=9L Date Issued r"71- N o Fee �� x► THE COMMONWEALTH OF MASSACHUSETTS Entered-in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplicatton for �Bigogal *pgteut Conotructiou Permit m Application for a Permit to Construct O Repair(X) Upgrade O Abandon O ❑Complete System ❑Individual Components Location Address or Lot N Owner's Name,Address,and Tel.No. o 149 7::S"01 ; Q Crao e, Assessor's Map/Parcel a(,g / t y(D 5a Sic t S)-�-eor,f o e o—vQi n`CJo Installer's Na e Address,and Tel.No. �'"�?J~ �' 508__7 1 O= 7 a_)C) LADDesigner's Name,Address and Tel.No. " � ��SCr� St' S2Q`�i 4- (..1 SCL L.NO`Ob . O-0cnt Type of Building: k Dwelling No.of Bedrooms :-7 Lot Size sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures -^� Design Flow(min.required) gpd Design flow provided 3 V O gpd F Plan Date Number of sheets Revision Date Title of Septic Tank Type of S.A.S. Description of Soil ' Nature of Repairs-or Alterations(/Answer when applicable) 5u svj-,\ 40 Ajns 0�- U Sa_ CVO-C-N5 __ ate lasL_irtepec D 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 Certificate of Compliance has beem.issued by this Board of elalth. Signed,, ` Date '. Application Approvea'by'='" Date Application Disapproved by: Date for the following reasons Permit No.am Date Issued /� Q V :7- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS RIS�TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (,Y ) Upgraded'( ) Abandoned( )by W(V\ at 5Q eC.Uf" � S- 1 lrQ_e A j PQ(�A✓1 l S has sbnbe//enn��constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. o[Cit,/? dated Installer Rto i ,3 cs -1 Designer � #bedrooms 3 Approved design flow .,3 3 ® gpd The issuance of this permit shall notbe construed as a guarantee that the system will functio, as designed. Date l off-h '/ ,//6 Inspector No. J� CJ`1 Fee 1 , THE COMMONWEALTH OF MASSACHUSETTS C,(a:-P, PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Migoal *pgtem Cougtruction i3ermit Permission is hereby granted to Construct ( ) Repair O Upgrade ( ) Abandon ( ) System located at 5Q r, and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this Date Approved by ti pow-of Banstabh Thomas.F..Geiler,Director.' Public Health Division �pr�D j;q.�A Thomas:McKean,-Director. 20Q k4ain Street;.Ryaani%MA:02601 . O cc'.508-8b2-4G44 Fax::508=79M304 Installer&Designerfertification Form Sewage Permit# Assessor's Map\Parcel o`�� yQP Designer. 1- 5 . `-�c • Installer: oS(' C G Address _ toa kA),. Van S� -C Cdc Address: 1 0:. X \039: (1 �-�j 11 e o was.issued a Permit to install a Z�1©i n5(rv� (date) - .. (installer.) septic system at QW r+ S`V IQA_ .Sbased on a design drawn by a . (designer) I certify that the septicsystem ref&enced.above was:installed substantially according to the:design;.which may mclude minas:approved-_changes.such.as.laterat relocation of the distribution box:and/or septic tank:.:.:-- ' I_certify.that the septic:system referenced. above vas installed:with major changes:(i.e. greater than 10'.lateral relocation of the.SAS or any vertical relocation of'any component of tlie'septic-system)tint iii accordance with State &Racal Regulations:=PhA. evision_or -::.:certified as built:by-designer to follow. - - .04\lg MASS40 ler's.Signature). : =�:� o�S ••: N_�1S v _ �y . . . . esigner.'s S a -(Affix-De tamp..here) . PLEASE :RETURN. :TO BAItNSTABLE::: UBLaIC .HEALTH' .t3IViSIt�N,. CERTIlIICATE - ®�' COMPLIANCE_WILL..NOT._BE:.ISSUED_UNTIL BOTH JMS-.:FORM..AND-_AS-HVWT': CARD::ARE RECEIVED:BY-THEBARNSTABLE PUBLIC.HEALTH-DIVISION THANK-YOU q. Q Health/Septic/Demk6er Cei#ification Forrri 3=26-04:doc COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION � F r W d 1. Q y I y�' VO TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 52 SECURIITY ST WEST HYANNISPORT,MA 02672 M268 P146 Owner's Name: ARNOLD CUMMINGS Owner's Address: BOX 755 W. HYANNISPORT MA.02672 RECEIVED Date of Inspection: 5/14/01 Name of Inspector: (please print),:$ JOHN GRACI JUN 1 2001 Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 TOWN OF BARNSTABLE HEALTH DEPT. Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: t X Passes _ Conditionally Passes _ Needs Furt a valuation by the Local Approving Authority Fails Inspector's Signature: Date: 5/14/01 The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspec ion. If the system is a shared system or has a design now of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the'buyer, if applicable,and the approving authority. Notes and Comments THE SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. RECOMMEND PUTTING AN INSPECTION COVER IN THE LEACH FIELD. ****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. Page 2 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 52 SECURIITY ST WEST HYANNISPORT,MA 02672 M268 P146 Owner: ARNOLD CUMMINGS Date of Inspection: 5/14/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: THE SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. RECOMMEND PUTTING AN INSPECTION COVER IN THE LEACH FIELD. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or breakout 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: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 52 SECURUTY ST WEST HYANNISPORT,MA 02672 M268 P146 Owner: ARNOLD CUMMINGS Date of Inspection: 5/14/01 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further.evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank-and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: n/a Z Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 52 SECURIITY ST WEST HYANNISPORT,MA 02672 M268 P146 Owner: ARNOLD CUMMINGS Date of Inspection: 5/14/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for alLinspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than %2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Wa. _ X Any portion of the SAS,cesspool or privy is below high ground water elevation. _ X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or. less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] _ (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ X the system is within 400 feet of a surface drinking water supply _ X the system is within 200 feet of a tributary to a surface drinking water supply _ X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—I WPA)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 "y@§" in Section D above the large§y§tem ha§ failed:The owner or operator of ally large§y§t in comidered a significant!Meat 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. 4 A 7, A Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 52 SECURIITY ST WEST HYANNISPORT,MA 02672 M268 P146 Owner: ARNOLD CUMMINGS Date of Inspection: 5/14/01 Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health _ X Were any of the system components pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection '? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems'? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no X _ Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 52 SECURIITY ST WEST HYANNISPORT,MA 02672 M268 P146 Owner: ARNOLD CUMMINGS Date of Inspection: 5/14/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CM 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: 9/1/00 COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes, attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1994 Were sewage odors detected when arriving at the site(yes or no): NO A Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 52 SECURIITY ST WEST HYANNISPORT,MA 02672 M268 P146 Owner: ARNOLD CUMMINGS Date of Inspection: 5/14/01 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 12" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H 5.171 W 4' 10"" Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness:3" Distance from top of scum to top of outlet tee or baffle: 24" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE GREASE TRAP: _(locate on site plan) . Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a d ;r Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 52 SECURIITY ST WEST HYANNISPORT,MA 02672 M268 P146 Owner: ARNOLD CUMMINGS Date of Inspection: 5/14/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a Q Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 52 SECURIITY ST WEST HYANNISPORT,MA 02672 M268 P146 Owner: ARNOLD CUMMINGS Date of Inspection: 5/14/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: n/a INFULTRATORS leaching chambers, number: 3 n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH FIELD APPEARS TO BE FUNCTIONING PROPERLY.THE SYSTEM SHOWS NO SIGNS OF FAILURE. RECOMMEND INSPECTION COVER. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a n Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) . Property Address: 52 SECURIITY ST WEST HYANNISPORT,MA 02672 M268 P146 Owner: ARNOLD CUMMINGS Date of Inspection: 5/14/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. W pul 6 Occ� r A 0 o � 0 AA 31 44 35a Rc 33 AD a8 a S L C �9L 6 a� �a in Page I 1 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 52 SECURIITY ST WEST HYANNISPORT, MA 02672 M268 P146 Owner: ARNOLD CUMMINGS Date of Inspection: 5/14/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 10+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 10+FEET f EXISTING 1000 GALLON TANK DISTRIBUTION BOX 500 GALLON DRY WELLS CROSS SECTION Focus PLAN INSTALL GAS BAFFLE NOT TO SCALE NOT TO SCALE NOT TO SCALE NOT TO SCALE BM 100 MIN d 100.2 a \\ \\/\\ \\ \\ '\\ \\ \\ \\ \\ \\/\ \\ \\/\\ \\ \\�\\�\\�\\�\\�\\�\\�\\�\\�\\� \\�\\��\�\\�\\�\\�\\ �\ �\�/ WEST MAIN COVER TO BE WITHIN 6"OF GRADE MIN. 12"COVER 2" 1/$"-1/2" WA.SHED S OM '9yi " CqM 4"9 40 P.V.C.CH. 3«bSIIVIM[JM 4"SCH.40 P.V.0 ti �i - --- ._ OM n 3 s o. o 0 13 o � � o �' o o � 1 7 O � � O 0 a ! 9 G « 9 .0 T 4 E E o '::::::::.'..:::::::::::. o � � '�::iiisiiii'.•??:i:%iiiiiY::::vi1:i>:jji;i ..... :��:i::.i.:,':,:'i: / ..:%i'iii�iiii:':ii'i:::i:::�::::ri::ii::':::::• 9915 1 \ :::: 0 0 0 0 o c � 0 0 0 0 0 � � U 7 7 0 0 9 .6 � T 0 � 2 ;< 9 . o o a o o o o �� s>::;::._.::;.::>r;::. :•>::::»»:r='::;::;::.>:::::::.:::::xa:.. :; :'4:+7i;p :5;:;;;;><!«•t>:::.: 4.0 97.5 95.0 0 0 � � 0 � 0 � � 0 � ;c::. � � 0 � ;...• � LOCUS 1VIIN 3' 3' *--3.5 4.83 3.5' SON 6n 26 11.83 '�- 8.5' 1 3/4%1 1/2"DOUBLE WASHED STONE ZONE I I GAP\G BOTTOM OBS 88.7 sm SPECIFIC NOTES REMOVE EXISTING FLOOR PLAN DESIGN CALCULATIONS GENERAL NOTES ALL PIPING TO BE SCHEDULE 40 P.V.C. FINAL GRADE TO BE APPROX 98.5 OVER SAS. IF NOT TO SCALE EXISTING BEDROOMS 3 0 110 G.P.D. ALL LOCATIONS OF UTILITIES SHOWN ARE AS DEEPER,VENT WITH CHARCOAL FILTER WILL BE D-BOX AND SAS 330 G.P.D. MARKED BY DIG-SAFE AND ARE TO BE NECESSARY. REGRADE AS SHOWN. VERIFIED BY INSTALLER PRIOR TO 4ML VINYL BARRIER TO BE INSTALLED AT NO. OF UNITS 3 CONSTRUCTION BELOW INV. THERE ARE NO KNOWN WETLANDS WITHIN CORNER OF SAS AS SHOWN FIRST FLOOR DE 11 WIDTH 11.83' 150' OF THE PROPOSED LEACHING FACILITY i LENGTH 26' UNLESS SHOWN. INSTALLER TO NOTIFY DESIGNER 24 HOURS PRIOR TO SHED THERE ARE NO KNOWN POTABLE WELLS WITHIN BEGINNING OF JOB TO COORDINATE INSPECTIONS 1 SIDEWALL AREA 151.32 BATH BOTTOM AREA 307.58 100' OF THE PROPOSED LEACHING FACILITY. play I gAlg TOTAL SQUARE FEET 458.9 SF THERE AIjE NO KNOWN IRRIGATION WELLS p KIrmEN WITHIN 50 OF THE PROPOSED LEACHING BEDROOM FACILITY CAPACITY SIDEWBOTTOM LL 00.74 227. G.P.D. THIS PROPERTY DOES NOT FALL WITHIN A Set - CAPACITY BOTTOM 0 0.74 227.E G.P.D. FLOOD ZONE AS SHOWN ON FIRM MAP 1 � 1 CAPACITY TOTAL 339.8 G.P.D. THIS DESIGN(( DOES NOT REQUIRE VARIANCES TO TITLE y... .. .___'..::._ .. . . _.I THIS SYSTEM NOT DESIGNED TO SUPPLEMENTAL REGULATIONS, BARNSTABLE ,;? I BEDROOM ACCOMODATE A GARBAGE ALL CONSTRUCTION SHALL BE IN ACCORDANCE Q DISPOSAL WITH TIONS.AND BARNSTABLE SUPPLEMENTAL _ , __ _._ 4' T H 1_ 1 BEDROOM LIVING _..__ O O I ROOM IN-LINE ELEVATIONS PROPOSED AS-BUILT SURVEY INFORMATION 21 OL INV. 0 HOUSE EXISTING PROPERTY LINE DATA FROM INV INTO TANK, 99.15 David Greene, PLS 1965 INV OUT OF TANK 98.9 O UNFINISHED BASEMENT INV INTO D-BOX 97.67 PLAN TO BE USED FOR INSTALLATION 17. patio OF SEPTIC SYSTEM ONLY INV OUT OF D-BOX 97.5 INV INTO CHAMBER 97.0 BOTTOM OF CHAMBER 95.0 N07 FOR DETERMINING PROPERTY LINES P 0 C� 1 I I REN. ?ARK, - i C' �' i � A, '1"`� AIC' �� h deck C V r�\%,.,J' 4rd I L'#i I I \.��'% 1 1�l r� /'� WATER TABLE NONE ENCOUNTERED CORNER BULKHEAD 100.0 (ASSUMED) O vim+ I 2 500 GAL CHAMBERS WITH ITH 31 STONE � DATE: OBSERVED BY: WITNESSED BY: CD X X slab {.� X " BETWEEN AND O N ENDS AND 3.5' soIL LOGS April 9, 2007 LISA C. LYONS DON DESMARAIS o full foundation Slab SOIL EVALUATOR BOARD OF HEALTH \ STONE ON SIDES ELEV. oBs. HOLE #iDEPTH 100. 0" OVERALL DIMENSIONS: 11 .83 X 26' LOAMY SAND \ 99.4 B 10" M252 P148 #52 i LOAMY 4/6 m INSTALL VINYL BARRIER AS SHOWN 10YR4/6 79500+ SQ FT f 97.E C \ MEDRWCOARSE SAND 2.51'R 6/4 P# 119693 paved 88.7 38" 0 GROUNDWATER ENCOUNTERS PERC RATE<21vIINANCH \ BENCHMARK SET DUE TO LOT CONSTRAINTS, AGENT ALLOWED L corner lbu(l<heQ ONE PERC WITH REFERENCE TO ABBUTTING SCALE 1 : 1 O I _ PROPERTY DONE 3/27/06 (44 Security Street) \p E(, -100, 0 (Assumed) 0-9 SL 10YR3/2 �. 9-40 SL 10YR5/6 gas \ 40-120 M/CS 2.5y7/4 PERC RATE <2MIN/INCH g W �S~�i CI• i u'i � �. (� PLAN SHOWING: z- ! I� �� PROPOSED SEPTIC SYSTEM REPAIR IN BARNSTABLE FOR: DRAWN BY: LISA C. LYONS JULIE&EPIC CRANE DESIGNED & CHECKED BY:/ iJ • � �.�' LISA C. LYONS ��j '�.� REGIS\.$ �. LOCATION: 75 , 0 \ ,��Ij�/S TE RED S ��` ` REVISIONS: DESCRIPTION: DATE: 52 SECURITY ST W.HYANNISPORT LOT#: DATE:SEP 17,2007 M268 P146 LISA C. YONS, R.S. SECURITY STREET I CERTIFY THAT THIS PLAN CONFORMS TO LISA C. LYONS, R , S. (508) 790-9270 TITLE 5 AND BARNSTABLE B.O.H. REGULATIONS H'YAWS, MASSACHUSETTS (774) 487-1638 (EXCLUDING WAIVERS SPECIFIED)