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Home My WebLink About0081 STERLING ROAD - Health 81 Sterling Road Hyannis A=268-161 J i 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i�W/. 81 Sterling Road Property Address Kam Ling Kuet Owner Owner's Name information is Hyannis MA 02601 01/10/13 required for every y page. Cityrrown State Zip Code, Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms o on the computes, use only the tab 1. Inspector: key to move your cursor-do not Michael Kellett use the return Name of Inspector key. Aardvark Environmental Inspections VQ Company Name PO Box 886 Company Address MW East Dennis MA 02641 City/Town State Zip Code 508-385-7608 S13742 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 tion 15.340 of cD4 Title 5(310 CMR 15.000).The system: ® Passes ElConditionally Passes ❑ Fails:-R ❑ Needs Further Evaluation by the Local Approving Authority yy 0 01/15/13 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the.system owner and copies sent to the buyer,if applicable,and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-11/10 Tiue-5 ofrcud :Subsurface Sewage Disposalzm•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form Not for Voluntary Assessments 81 Sterling Road Property Address Kam Ling Kuet Owner Owner's Name information is required for every Hyannis MA 02601 01/10/13 page. CityrFown 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 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 extidtration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-11/10 Tile 5Officiat tnspedion Form:subsurface sewage Disposal System-Page 2 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 81 Sterling Road Property Address Kam Ling Kuet Owner Owner's Name information is required for every Hyannis MA 02601 01/10/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,setifed 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 mannerwhich will protect public health, safety and the environment: j ❑ Cesspool or privy is within 50 feet of a surface wafter ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh CJIi IS•11iiv --ne F viiciai InspeCto n Fow.Su15swface Se'"ye U'sposal Syptain•Rage 3 Gi 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 81 Sterling Road Property Address Kam Ling Kuet Owner Owner's Name information is required for every Hyannis MA 02601 01/10/13 page. Cityfrown 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 mannerthat protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**,. Method used to determine distance: **This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form_ 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of eflluentto 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 El ® Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow t5ins•11/10 Title 5Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 81 Sterling Road Property Address Kam Ling Kuet Owner Owner's Name information is required for every Hyannis MA 02601 01/10/13 page. Cityfrown 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 otherfailure 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 eidst 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 15A00 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 11 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 faded under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5Official Inspection Farm: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 .�' 81 Sterling Road Property Address Kam Ling Kuet Owner Owner's Name information is required for every Hyannis MA 02601 01/10/13 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 We 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 15203(for example: 110 gpd x#of bedrooms): 330 t5ins•11/10 Trite 5 Of iciat Mspectim Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5. Official Inspection Form "s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 81 Sterling Road Property Address Kam Ling Kuet Owner Owner's Name information is required for every Hyannis MA 02601 01/10/13 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings,if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 10/13Date Commercial/lndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: t5ins-11/10 Trite 5 Officiat 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 81 Sterling Road Property Address Kam Ling Kuet Owner Owner's Name information is required for every Hyannis MA 02601 01/10/13 page. City1rown 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: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes,attach previous inspection records,if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-'I Ill 0 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 81 Sterling Road Property Address Kam Ling Kuet Owner Owner's Name information is required for every Hyannis MA 02601 01/10/13 page. Citylrown State Zip Code Date of Inspection D. System Information (coot.) Approximate age of all components,date installed(if known)and source of information: 12/30/97 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.3 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.): Septic Tank(locate on site plan): Depth below grade: 0.5 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: 1,000 gal 3" Sludge depth: t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments �< 81 Sterling Road Property Address Kam Ling Kuet Owner Owner's Name information is required for every Hyannis MA 02601 01/10/13 page. City/rown 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 28" Scum thickness 3" 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 16" 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 tank was sound and tight with tees in place and liquid at outlet invert. 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: Dane t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form Not for Voluntary Assessments 81 Sterling Road Property Address Kam Ling Kuet Owner Owner's Name information is required for every Hyannis MA 02601 01/10/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑. No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 We 5 Offaiat Inspection Forth:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspect ion Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 P Y rY 81 Sterling Road Property Address Kam Ling Kuet Owner Owner's Name information required for e is very Y H annis MA 02601 01/10/13 page, Cityfrown 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 even 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 box was level and tight with no sign of carryover. Pump'Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Soil Absorption System(SAS)(locate on site plan,excavation not required): r If SAS not located,explain why: t5ins•11/10 Idle 5 Offlciat fnspectlon Form Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 81 Sterling Road Property Address Kam Ling Kuet Owner Owner's Flame information is Hyannis MA 02601 01/10/13 required for every y page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ® 2 leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number,length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil, condition of vegetation,etc.): This system has a 6'x4'precast pit surrounded by a foot of stone.There was also two 500 gallon chambers surrounded by 3'of stone.There was no sign of ponding or failure in the stones. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Tine 5 Official hspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 's Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 81 Sterling Road Property Address Kam Ling Kuet Owner Owner's Name information is Hyannis MA 02601 01/10/13 required for every y page. Cityrrown 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.): - r Privy(locate on site plan): Materials of construction: Dimensions Depot of solids Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): t5ins•11/10 Title 5 offiaan Inspection Form:subsurrace Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 81 Sterling Road Property Address Kam Ling Kuet Owner Owner's Name information is required for every Hyannis MA 02601 01/10/13 page. Cityfrown 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 rear 24 28 35 30 49 7 34 5 52 t5ins-11/10 Title 5Ofrxial 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 81 Sterling Road Property Address Kam Ling Kuet Owner Owner's Name information is required for every Hyannis MA 02601 01/10/13 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: 6.2 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators installers- attach documentation ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered to 12.0 feet andfound no water. I adjusted to 6.2 feet. Bottom of leaching is at 5.8 feet. Before filing this Inspection Report;please see Report Completeness Checklist on next page. t5ins•11110 Trite 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 81 Sterling Road Property Address Kam Ling Kuet Owner Owner's Name information is required for every Hyannis MA 02601 01/10/13 page. Cityfrown state Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C,D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Me 5 Official inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 to usage&Sao pholm PhonO SOWS WaspitblovigurtsMs ulsft� �%a Vsa Sara game Zoo . ant bdow tend sommavlawr sup _ ► t motor gap 4 cs lewd adjudOw . � • ... _ ^ $ .� ' , - , ' , � ' 4 " ! -.i "fit �. ♦ ,.. i e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 81 Sterling Road Hyannis Property Address Kam Ling Kuet Owner Owner's Name information is required for y H annis MA 02601 February3 2010 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. R Important: A. General Information' When filling out forms on the computer,use 1. Inspector: i only the tab key to move your Jason C. Ellis cursor-do not Name of Inspector use the-return key. Absolutlely The Best Septic Service Company Name 1 P.O. Box 762 Company Address Orleans MA 02653 CitylTown State Zip Code 508-737-3977 IRS 1126 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that,;he i information reported below is true, accurate and complete as of the time of the inspection. TKO ins i tion was performed based on my training and experience in the proper function and;maintenance-of onsA e sewage disposal systems. I am a DEP approved system inspector pursuantto,Section 15 340g Title 5(310 CMR 15.000).The system: a y" ® Passes ❑ Conditionally Passes ❑ Fails -_- L 52, ANeedEvo luation by the Local Approving Authority w M February 3, 2010 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. V 0 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposa System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "r 81 Sterling Road Hyannis Property Address Kam Ling Kuet Owner Owner's Name information is Hyannis MA 02601 February 3, 2010 required for _y ry every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in satisfactory condition at time of inspection. 13) 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-W08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 81 Sterling Road Hyannis Property Address Kam Ling Kuet Owner Owner's Name information is Hyannis MA 02601 February 3 2010 required for y ry , every page. City Fown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh, J t5ins•09/08 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 vyy< 81 Sterling Road Hyannis Property Address Kam Ling Kuet Owner Owner's Name information is Y required for Hyannis MA 02601 February 3, 2010 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank.and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 81 Sterling Road Hyannis Property Address Kam Ling Kuet Owner Owner's Name information is Hyannis MA 02601 February 3 2010 required for y ry every page. Cityrrown 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: 0. ❑ ® 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 El ® 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-09/08 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 81 Sterling Road Hyannis Property Address Kam Ling Kuet Owner Owner's Name information is required for Hyannis MA 02601 February 3, 2010 _ every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ 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): N/A Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-09/08 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 81 Sterling Road Hyannis Property Address Kam Ling Kuet Owner Owner's Name information is Hyannis MA 02601 February 3, 2010 required for Y ry every page. CityrFown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage 08-426gpd 09- 9 ( Y 9 (gpd)): 411 gpd Detail: Sump pump? ❑ Yes ® No Last date of occupancy: several weeks Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 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 81 Sterling Road Hyannis Property Address Kam Ling Kuet Owner Owner's Name information is rY Hyannis MA 02601 February 3 required for , 2010 every 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: Owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons gallons How was quantity pumped determined? Truck Reason for pumping: Maintenence 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-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s•'•� 81 Sterling Road Hyannis Property Address Kam Ling Kuet Owner Owner's Name information is required for Hyannis MA 02601 February 3, 2010 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1997 -Board of Health Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10'+feet Comments (on condition of joints, venting, evidence of leakage, etc.): good condition Septic Tank(locate on site plan): Depth below grade: 0.5' 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 gallons Sludge depth: 18" t5ins-09/08 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 81 Sterling Road Hyannis Property Address Kam Ling Kuet Owner Owner's Name information is February Hyannis MA 02601 required for y 3, 2010 every 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 16" Scum thickness 0" 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 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.): Good condition-Needed pumping 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 81 Sterling Road Hyannis Property Address Kam Ling Kuet Owner Owners Name information is Hyannis MA 02601 February 3, 2010 required for y ry every page. Cityrrown 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 s Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 81 Sterling Road Hyannis Property Address Kam Ling Kuet Owner Owner's Name information is Hyannis MA 02601 February required for y 3, 2010 every page. Citylrown 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 oil 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.): Satisfactory condition - 18" below grade Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 81 Sterling Road Hyannis Property Address Kam Ling Kuet Owner Owner's Name information is u Hyannis MA 02601 February 3 2010 required for y ry every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ® leaching chambers number: 2 ❑ 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 - Leach pit and chambers dry at time of inspection. 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•09/08 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 N Svey`'e 81 Sterling Road Hyannis Property Address Kam Ling Kuet Owner Owner's Name information is February 3 2010 Hyannis MA 02601 required for y ry , every page. Cityrrown 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 81 Sterling Road Hyannis Property Address Kam Ling Kuet Owner Owner's Name information is Hyannis MA 02601 February 3, 2010 required for � ry every 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 W I I Rc4,z- 1A B o t D-bow ❑/ ` \L.�gc.tt GLIA�t$a�1,3 i \ off A-t : Ztf ' 0 A-3% 2k.5i Q-L� y,r 51 A_s t5ins•09/08 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 81 Sterling Road Hyannis Property Address Kam Ling Kuet Owner Owner's Name information is ry Hyannis MA 02601 February 3 2010 required for y , every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 5'+ below sas 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: Permit- 12-1-97 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: USGS topo and groundwater contour maps You must describe how you established the high ground water elevation: Known groundwater conditions, USGS Topo and Groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 81 Sterling Road Hyannis Property Address Kam Ling Kuet Owner Owners Name information is Februa 3 2010 Hyannis MA 02601 required for Y ry , every page. Cityffown 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 opTHe to,,,_ Town of Barnstable Department of Health, Safety, and Environmental Services • Public Health Division RABNBrABM `"AM 9. � 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A. McKean, RS, CHO FAX: 508-790-6304 Director of Public Health Jerry Canducci December 2, 1997 81 Sterling Road Hyannis, MA 02601 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 81 Sterling Road, Hyannis was inspected on November 22, 1997, by Joseph Macomber, Jr., a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Liquid depth in both leaching pits was less than 6" below invert. • Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged.S.A.S. You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (7) seven days of receipt of this notice. You are also directed to bring the septic system into compliance within ten(10) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF BOARD OF HEALTH I�Zis McKean, R.S., C.H.O. Agent of the Board of Health q/health\dbfiles\tit1e5i.doc I � Town of Barnstable .� Department of Health, Safety, and Environmental Services MAMAeLE' Public Health Division 367 Main Street, Hyannis MA 02601 Office: 308.790�4263 Thomas A.McKean,RS,CHO Director of Public Health FAX: 508-790.4304 TO: c` nOluC�1 a� DATE: 2-1 l�i917 c�2Go i ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. � `S !yy7 The septic system owned by you located at -S i Sl wasInspected Nagy. Z 2� k ► bY a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 _15.00) due to the following: • , �,� �/1 Ids n co a cam' cLaa 53 S,A-S. Yo are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 withi en days of receipt of this notice. A C' )CAJ - J You are also directed to bring the septic system into compliance with' ays of receipt of this order letter. You are further directed to maintain the system by hiring a license r to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health s z 161 DATE: 11 /22/97 PROPERTY ADDRESS: 81 Ster'linct' Road Hyannis,Mass. 02601 On the above date, I Inspected the "ptic system at the above address. This system consists of the following: 1 . 2-1000 gallon precast leaching pits . 6 'x8 ' 2. 1 -1000 gallon septic tank. Base-d on my Ine-c�&ctlon, I certify the following conditions: 2 . This is not a title five septic system. 3 . This is a sewage system that is in hydraulic failure. 4 . 'The present system must be omitted and .a new Title five septic system installed. Under the 1995 code. SIGNATUR7: � Name : J . P . Macomber Jr•. i -------,--------------- Company: J . P_ — Macomber & Son-'Inc , Address :_ 66------ 1--- .-- __CencervilLe �Mass�_02632 , Phone :---5CS--7-7S-3-338------- I THIS CERTIFICATION DOES NOT CONSMUTE A GUARANTY OR WARRANTY RRA�� - JOSEPti P, MAGOhRBER & SON, INC. 7�nkrC�upoolrLsschflelds Pump d In$"lird Town Sewer Connections P.O. Box 66 ' Centerville, MA 02632.0066 775-3338 77! -6 12 COMMONWEALTH OF MASSACHUSETTS I r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS 1' DEPARTMENT OF ENVIRONMENTAL PRO 1 ONE WINTER STREET. BOSTON. MA 02108 611.'9O. 1 f,i� / u ILLI.�0t F 1 ELD 'I ` C4 Go�cmor l 5-0'r' V W J :- ARGEO PAUL CELLUCCI � �99 Li Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT FORM OV.-V PART A CERTIFICATION Je' C Property Address:81 Sterling Road Hyannis,Mass . Address of owner:12343`a o-- &7 Wood Date of Inspection:1 1 /22/97 (If different) Trail Name of Inspector:)_P_Marc)mhPr .Tr, Houston Texas I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) 770-77 Company Name: J.P.Macomber & Son Inc. Mailing Address: Box 66 Centerville,Mass . 02632 Telephone Number: 508-775-3338 CERTIFICATION STATEMENT I ceri-fy that I have personally inspected the sewage disposal system at this address and that the informat,on reponec celo is u.,e a:�_ and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper r,n.^.on a- maintenance of on-site sewage disposal systems. The system: _ Passes Conditionally Passes Zeeds Funher Evaluation By the Local Approving Authority ads Inspector's Signature: i Date: �)uywClr g ..�� Tne System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of compie;,nti nspect.on If the system is a shared system or has a design flow of 10,000 gpd or greater. the Inspector and the system o-n2r sr31 S-:), the report to the appropriate regional office of the Department of Environmental Protection The original snouie oe sen: to r.e save^ o, and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, 8, C, or D: Al SYSTEM PASSES: b I have not found any information which indicates that the system violates any of the failure criteria as dei,ned r 310 Any failure criteria not evaluated are indicated below. 'I COMMENTS: BI SYSTEM CONDITIONALLY PASSES: /G)C) One or more system components as described in the "Conditional Pass" section need to be replaced or repaired Tne completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances If "not determined', epa � �-.• The septic tank is metal, unless the owner or operator has provided the system inspecior with a copy of a Cen' ,�jj: Compliance (attached) indicating that the tank was installed within twenry (20) years prior to the date of ire or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or ext:i:raf,o." :. failure Is imminent. The. system will pass inspection if the existing septic tank is replaced with a conform.ng ` as approved by the Board of Health. I (revised 04/25/97) Page 1 of 10 DEP on the worlo wine weo nnp rnww.magnet state ma us/oeo Printed on RecyUeo Paper r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Properly address: 81 Sterling Road Hyannis,Mass. O ner: Jerry Canducci Datc of InsPec"on: 11 /22/97 Bj SYSTEM CONDITIONALLY PASSES tcon(mued) NLl L( Sewage backup or breakout or high static water level observed to the dis(fibution box 15 Cue to oro�e- e s pipets) or due to a broken, settled or uneven distribution box. The system will pass inspection t� :� a _ .•a Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed p,pe(sI Tne sys:ern ass inspect,on if(with approval of the Board of Health) broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _A)P_ Conditions exist which require further evaluation by the Board of Health in order to determine if (he system is fa:i-z ;o -o;ec :-'e publ,c health. safety and the environment 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIO.IIC in A WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a Sall marsh P P Y 8 8 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) D TERn,.I,�_S T.,A' THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: /J The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface a s_D. tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public v,ate; The system has a septic tank and soil absorption system and the SAS is within 50 feet of a pry.-a.e . a:er The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 :E-e: o- .more - a private water supply well, unless a well water analysis for colrform bacteria and volatile organ,c comco-.,')CS the well is free from pollution from that facility and the presence of ammonia nitrogen and nwate noroze—. less than S ppm. Method used to determine distance .0 (approximation not valid) 3) OTHER /yzi ldlke vl tr—l..d 04/I5/f7) P.Q. 2 of 10 SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FOR" PART A • CERTIFICATION (continued) Property Address: 81 Sterling Road Hyannis,Mass . O..ner Jerry Canducci Date of Inspection: 11 /22/97 D) SYSTEM FAILS: You must indicate e,. er "Yes" or "No' as to each of the following f have delermrned that the system violates one or more of the following failure criteria as defines ,n 310 C'•'- for this celerminatfon is identified below. The Board of Health should be contacted to determine wnat well ce neces the failure Yes No _ Backup of sewage into facility or system component due to an overloaded or clogged SAS Or cessDOC _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an o-eioaeec car cesspool Static liquid level in the distribution box above outlet inven due to an overloaded or cloggec SAS A*l,qu,d depth in GktZ2:p,pl is less than 6" below invert of available volume is less than 1i2 Ca, ! J Required pumping more than a times in the last year NOT due to clogged or obstruclec "lumber of limes pumped Any ponion of the Soil Absorption System, cesspool or privy is below the high groundwater eie.a,"e^ Any ponion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a s pace —a-er / Any portion of a cesspool or privy is within a Zone I of a public well Any ponion 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 pr,�a!e -a:e: s r_ �e . acceptable water quality analysis If the well has been analyzed to be acceptable. anach ^f Lei! ar_a ., col,form ba(ierla. volatile organic compounds, ammonia nitrogen and nitrate nitrogen E) LARGE SYSTEM FAILS: you must ndic.ate ether "Yes" or "No" as to each of the following: The following cmeria apply to large systems in addition to the criteria above. The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the systern public health and safety and the environment because one or more of the following conditions exist Yes No ,(I the system is within 400 feet of a surface drinking water supply �19 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 • IW?A) or a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundha:er :rea:Te— _ _ s requirements of )1 a CMR 5 00 and 6 00 Please consult the local regional oH,ce of the Depanment for funner (r•vi..d 04/25/)71 Y.q• 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Properly Address: 81 Sterling Road Hyannis,Mass . O`.ner: Jerry Canducci Date of Inspection: 1 1 /22/97 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following. Yes No _., Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been rece,,,ng norma now rates during that period. Large volumes of water have not been introduced into the sys�em recef'!-, o as pan of this inspection. _ As built plans have been obtained and examined Note if they are not available with N/A The faciliry or dwelling was inspected for signs of sewage back-up. The system does not receive non sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components.)J64CIuding the Soil Absorption System, have been located on the site 1 The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for cond,:,on o baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum The size and location of the Soil Absorption System on the site has been determined based on. _ The faciliry owner (and occupants, if different from owner) were provided with information on the proper ma,n,enan,e Sub•Suriace Disposal System Existing information Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Pan C is at issue, approximation of distance is unacceptable) f 1 5.301(3)(b)J P•p• 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Properly Address: 81 Sterling Road Hyannis,Mass . Owner: Jerry Canducci Date of Inspection: 1 1 /22/97 FLOW CONDITIONS RESIDENTIAL: Design flow. •3 R.P.d./bedroom for S.A.S. Number of bedrooms: :5 Number of current residen(s: Garbage grinder (yes or no):-'&-1fn Laundry connected to system (yes or no): S Seasonal use (yes or no):WIP ,� water meter readings, if available (last two (2) year usage lgpd): Z ,-7�n Sump Pump (yes or no): �JJ � 7 WJ Last date of occupanc> COMMERCIAUINDUSTRIAL• Type of establishment. Des,gn Clow allons/day Grease trap present (yes or no)'Z Industrial Waste Holding Tank present: (yes or no)it,//St Non-sanaary waste discharged to the Title 5 system: (yes or no)Aol water meter readings, if available Last date of occupancy OTHER: (Descr,be) ) Last date of occupancy GENERAL INFORMATION PUMPING RECORDS and,source of informat,on: System pumped as pan of inspection: (yes or no) S If yes, volume pumped � 6L0D gallons l Reason for pumping 1 / �AJj T-We �&a'4c'e TYPE OF SYSTEM X. D 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) L� I/A TTychnology etc. Copy of up to date contracil 'X2 APPROXly9kTEA of all components, date in Ned (if kno n) 4nd sourcq of information:/kj� ✓ y' l i5 O Sewage odors detected when arriving a( the site: (yes or no) �.5 (r.vl..d 01/2S/97) 5 of 10 f SU85URFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR-,A PART C SYSTEM INFORMATION (continued) Property Address: 81 Sterling Road Hyannis,Mass. owner. Jerry Canducci Date of inspection: 11 /22/97 BUILDING SEWER: .,ocate on site plan) 1 Depth pelow grade nnalerial of construction as iron _ 40 PVC _ other (explain) r � D,stance from onvale water supply well or suction line i;vAer PLC A&fst' Diameter y!f Comments tcond,t,on of joints, venting. evidence of leakage, etc.) rITO SEPTIC TANK: i(jO�9 � ]oca:e on s'te plan: Depth below grade /b ma(enal of con struci,on,.�ncrete• :metal _; fiberglass, Polyethylene tither(explain) tank is metal. list age ��As age confirmed by Cen Lcaie of CompGance�J� (Yes/No) D'm e n s'o n$ Sludge depin � D,stance from top of sludge to bonom of outlet tee or baffle Scvm thickness IL�C. � Distance from top of scum to top of outlet tee or baffle. 7r,;,v y-� D,stance from oonom of scum to bonom of outlet tee or baffle no— d,mens,ons were dete(mined. _G S Comments recommendation for pumping, condino of inlet and outlet tees or baffles, depth of liquid level n relation to outlet rove s ._:3 -.te ntl. evldence.of leakage, etc ) t '. fib_ . ;-1 �ls � �., Ile- CREASE TRAP: 'rL�� :locate on site plan) Deo(h below grade QUA,�a Material of con sit uclionA1!/COncrete/V_,o9metd(AFiberglass A)/?Polyethylene,G other(explain) D,mens,ons: x , ' Scum thickness. N Distance from top of scum to top of outlet tee or baffle:/ -W Distance from oonom of scum to bonom of outlet tee or baffle: 40 Dale of Iasi pumping `omments irecommendal,on for pumping. condition of inlet and outlet tees or baffles, depth of (quid level in relation to outlet -aver.. s!r_ ntegr'ry. evidence of leakage. etc 1 I P.9. 6 of 10 SUBSURFACE SEWACE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properly Address: 81 Sterling Road Hyannis,Mass . Owner: Jerry Canducci Daie of Inspection: 1 1 /22/97 TIGHT OR HOLDING TANK: w/ .(Tank must be pumped pfiur to, or at time, of inspection) (loc.ate on site plan) Depth below grade:/r,//? material of construct on:,I,.Aconcrete,tZAmetal4A) FiberglassA�A Polyethylene tJAother(explain) /1 ' Dimensions t/, . Capac'ry: AJt? gallons Design flow IV;# gallons/day Alarm level" 41,4 Alarm in working orderlA Yes,,64 No Date of previous pumping r� Comments (condition of inlet tee. condition of alarm and float switches, etc ) DISTRIBUTION BOX:Apve- (locate on site plan) Depth o: Iicu.d level above outlet invert: /0 Comments (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc I PUMP CHAMBER: /004,1e (locate on site plan) Pumps - „orking order: (Yes or No) y/ Alarms in working order (Yes or No) -VA Comments (note condition of pump chamber, condition of pumps and appunenances, etcJ i Iz•�:..e 04/25/97) P.g• 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 81 Sterling Road Hyannis,Mass . Owner: Jerry Canducci Date of Inspection: 11 /22/97 SOIL ABSORPTION SYSTEM (SAS):6-1"KI"��' '`TS ;locate on site plan, if possible. excavation not required• but may be approximated by non intrusive methods) if not determined to be present, explain: Type leaching pits, number:- leaching chambers, number. leaching galleries, number:= leaching .trenches, numl:x0ength:—�►�— leaching fields, number, dimensions: C/ overflow cesspool, number: O Alternative system; N- Name of Technology: Comments (note condition of soil, signs of hydraulic W,ure, level of p ndin co dition of vegetation, etc.) CESSPOOLS: e (locate on site plan) Number and configuration: AI! Depth-cop of liquid to inlet invert Depth of solids layer: /1 Depth of scum layer: Dimensions of cesspool, Materials of construction i( Indication of groundwater: inflow (cesspool must be pumped as pan of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PR IVY: ive_ (locate on site plan) Materials of constructs Dimensions: 2%/J Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 42 y /•S' it/��t /'Z S (r.v1..d 04/79/97) P&g. 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properly Address:81 Sterling Road Hyannis Ma Owner: Jerry Canducci Date of Inspection: 1 1 /2 2/9 7 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) R / z"� rL, 9 b � �• v y�Y,g r� ,, ,• � -3 r()tG 40 rAa —1cx�C��nitL r 1rovi—d P.g• 9 of 10 SUBSURFACE SEWACE DISP. SYSTEM INSPECTION FORM SYSTEM INFOI. iON (continued) PropenyAddress: 81 Sterling Road Hyannis,Mass . 0^ner Jerry Cpnducci Date of Inspection: 1 1 /2 2/9 7 Depth to Groundwater Feet Please indicate all the melhods used to determine High CroundwatV ElL,:a!ion: Obtained from Des,gn Plans on record Y Observai�on of Site (Abuning property, observation hole, basenxril-sjmp etc.) --Determine it from local conditions CneCk with local Board of health Cneck FENA Maps _ Ceck pumping records ./`neck local a>cavators. installers use uSCS Data Descr.oe .n your own words how you established the High Cround.•+ulcr'E legation (Must be completed) Used Cape Cod Water Table Contours And Public Water Supply Wellhead Protection Areas September 1995 Water Resources Office Cape Cod Commission (r•v1••C 0�/73/97) P•5• o1 10 7....r. n+rr-rr-.rn-m.ns+rrn�.rrr.rrn:•.�.-r•:.a+r.mi-s*�rr..ra:-+is*+asm.mn .. .n.-�-.r —r TOWN OF Barnstable WARD OF HEALTH � I SUIISURFACF SEWACF DISPOSAL SYSTF,M INSPECTION FORM - PART D .- CERTIFICATION �_ �'...�.^._r•.-.:.--. r.-.-T.r..:.n•r,:r:n.:.rsrrTrrr.r-•.�+•-.v*+s-rar+rmr-Tmnw.+.•ar r+r'rrarssa•rers mnntmrr.r.r.rr-r...r.r.:-rrrr---. -. -TYPE OR PRINT CH ARLY- PROPERTY INSPECTED 9 Road Hyannis ,Mass. Sterling H , STREET ADDRESS Mass. ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME Jerry Canducci PART D - CERTIFICATION r NAME OF INSPECTOR Joseph p.Macomber Jr. COMPANY NAME J.P.Macomber & SSn Inc. COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or City Stat• LIP COMPANY TELEPHONE ( 508 ) 775-3.338 FAX ( 508 ) 790=1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 , 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have conaticted has found that the system fails to Protect the p' tiblic health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . "r Inspector Signature Date 1 1 /22/97 One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the I30ARD OF HEAL711. * If the inspection FAILED, the owner or "operator shall upgrade ' the system within one year of the date of the inspection , unless allowed or required otherwise as provided in 310 CmR 16 . 305 , partd . doc ------------- P7 _ ss THE COMMONWEALTH OF MA,SSA.CHUSETTS DEPA TNI[ENT OF ENVIRONMENTAL PROT ECTION_ CTZON BE IT KNOWN THAT Joseph P p . Macomber, Jr. � Has satisf-ied the Departzment's qualifications as required and is hereby authorized to use the title CER { i D "TITLE S SYSTEM INSPECTOR as provided in 310 CMR 15 .340 and Section 13 of Chapter 21 A of the General Laws _ Issued by The Department of Environmental Protection. tun< Zz-- C� f� Acting Ohector of the f) 11 ()ti u( W2Ie1 Pollution Control .r- �� , /3 - � ' a � , _ �. + �' t 1 � .' �r�a f' 7 � . i f. .. � •+ e i December 1, 1997 Ms. Leila Bruce Barnstable Housing Authority 146 South Street Hyannis, MA 02601 Dear Leila: Sorry this letter is late but I got that "thing" last week that ugly upper respiratory/throat infection and I was out on Tuesday and Wednesday before Thanksgiving. I reinspected the dwelling on November 21, 1997 at 81 Sterling Road, Hyannis. The septic has been pumped and Macomber shall be taking out a repair permit to upgrade the system. Fowler & Sons has corrected the mouse entry problem and the problem with them in the attic of the house. The dishwasher has been removed. Mr. Canducci has cleaned all the mold in the house and the stove has also been cleaned thereby rendering the burners of the stove operable. New steps have been replaced in the rear breezeway entry. The smoke detectors are currently working with new batteries. It appears Ms. Miranda needs help with housekeeping/sanitation due to her disabilities. Sorry for any inconvenience of this letter. If you have any questions regarding this please feel free to call me. Sincerely, e Donna Z. Mioran i Health Inspector TOWN OF BARNSTABLE W, /,,t/ ►� i,v G R LOCP�TION � Q_ SEWAGE # -a. (o q VILLAGE 9 YAM,N� S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 110'M A C 0A 13ef`t Baal SEPTIC TANK CAPACITY /D o O LEACHING FACILITY: (type) (size) NO.OF BEDROOMS` c BUILDER OR OWNER .. PERMTTDATE: _1�/ -c?' 7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells,exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility`(If any wetlands exist within 300 feet of.leaching facility) Feet Furnished by C ) _ ;0 0 G 4 f r _ I r y NO.1 7-6 8 6 c Fee 50 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: YY PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for Mi!gpoml *pztem Construction Perron Application for a Permit to Construct( )RepairXX )Upgrade( )Abandon( ) 11 Complete System El Individual Components Location Address or Lot No. 81 Sterling Road Owner's Name,Address and Tel.No. Jerry Canducci Hyannis,Mass. 02601 12343 Honey Wood Trail Assessor'sMap/Parcel Houston Texas 770-77 Installer's Name,Address,and Tel.No.5 0 8-7 7 5-3 3 3 8 Designer's Name,Address and Tel.No.5 0 8-7 7 5-3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632 Type of Building: Dwelling XX No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder(NO) Other Type of Building RES No.of Persons 4 Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3 x 1 1 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1000 gallons Type of S.A.S. 2-1 000 pits. Description of Soil Loamy sand to boney sand Nature of Repairs or Alterations(Answer when applicable) Adding two 500 gallon chambers to the existing septic system. Ltdl Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu by this o d of ealth. Signed Date 1 2/1 /9 7 Application Approved by Date Application Disapproved for the following reasons Permit No. 2 7-6 7r Date Issued No. °/ °� ."ay Fee$ 5� r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,, MASSACHUSETTS f ' Application for i� ova[ p terry `Con.5truction Permit Application for a Permit to Construct( )Repair�X)Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot No. 81 S er nq Road Owner's Name,Address and Tel.No. Jerry Canducc i Hyannis,Mass. 02601 12343 Honey Wood Trail Assessor'sMap/Parcel Houston Texas 770-77 Installer's Name,Address,and Tel.No. 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66zCenterville,Mass. 02632 Box 66 Centerville,Mass. 02632 a ,Type of Building: Dwelling XXNo.of Bedrooms 3 I Lot Size sq. ft. Garbage Grinder(NO) Other Type of Building RES No. of Persons 4 Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 t gallons per day. Calculated daily flow 3 x 1 1 0 gallons. .,Plan Date 'i Number of sheets Revision Date Title i 11 Size of Septic Tank ---Type of S.A.S. 2-1000 pits. Description of Soil Loamy sand to boney sand. Nature of Repairs or Alterations(Answer when applicable) Adding two 5000galloncchambers to the,texisting s*ptic system. ah "1 � ' D/1;7 t Date last ins ected�, ' A reement: ', g The undersigned agrees to ensure the consf'ucfion and maintenance of the afore described on-site sewage disposal system in accordance with'the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has Been issued by this o d of ealth. Signed'„ t Date 12/1 /9 7 Application Approved by y Date Application Disapproved for the following reasons r i l Permit No. 2 7`Co Zt- Date Issued b, r -- —————— — w, — -------------'------ THE COMMONWEALTH OF MASSACHUSETTS ! BARNSTABLE, MASSACHUSETTS (Eertifirate of QCompliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired(XX)Upgraded( ) Abandoned( )by J.P.Macomber &, Son Inc. at 81 Sterling Road 13ynnis,Mass. has been constructed in accordance with the provisions of Title 5 and the f f I sposal System Construction Permit No.9 7 4 P 9_ dated 12 —�— J.P.Macomber & Sor nc. •--� J.P.Macomber & Son Inc. Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date �"1 -�,:� -r Inspector — /7— ---------------------------Fee$ 50 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS MiOpOar *p5tem Con0truction Permit Permission is hereby granted to Construct( )Repair(X�Upgrade( )Abandon( ) System located at 81 Sterling Road Hyannis,Mass. -al 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 ermit. /� p Date: Z 2 7 Approved by C. Y` �` 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) 1, Joseph P.Macomber Jr_ , hereby certify that the application for disposal works construction permit signed by me dated 12/1 /9 7 , concerning the property located at 81 sterling Road Hyannis,Mass _ meets all of the following criteria: There are no wetlands located within 100 feet of the proposed leaching facility A/ There are no private wells within 150 feet of the proposed septic system b/",There is no increase in flow and/or change in use proposed There are no variances requested or needed. if the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will I14.t be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) I B)Observed Groundwater Table Elevation(according to Health Division well map) l6 SIGNED : 4 < DATE: 1 2/1 /9 7 LICEN D SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert e n S c TOWN OF BARNSTABLE �C/ I 00A1.10N V. S�e/� L '/yl/:Cs:. �Q 2_ SEWAGE # Q.: 'ASSESSORS MAP & LOT' — VIIxLAGE .. . . INSTALLER'S NAME&PHONE N0. /lA A C O/�t So.�/ SEPTIC TANK,CAPACITY, L IrAGHING FACII:TTY; (type) •� fLo w c H,t 186*s (size) NO;:OF BEDROOMS 9J BUILDER OR OWNER - C1: _ PER PTDATE: 9'; ;COMPLIANCE DATE: �2 — O Se ari tion Distance Between the: j Maximum Adjusted Groundwater Table and Bottom of Leaching Facility. Feet . Pc:vate.Water Supply Well and Leaching Facility (If any wells exist ;oi:$ite or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist :.: `:fihin 300 feet of leaching facility) Feet Funlshed by '.'J.':::::. •:A •.1. .. .. . . .. a s t O `!ram a A j T P 339 578 747 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse N ber P st ce,Sta P Code n= Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee LO rn Return Receipt Showing to *' Whom&Date Delivered Q Retum Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ 717 € Postmark or Date 0 U. C0 I s i I Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the R return address of the article,date,detach,and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the _ gummed ends it space permits. Otherwise,affix to back of article. Endorse front of article _ RETURN RECEIPT REQUESTED adjacent to the number. ~ 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. 0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. li 6. Save this receipt and present it if you make an inquiry. a l�� f (5�)-T 5-703�J FORM30 HOBBS&WARREN,INC. THE COMMONWEALTH OF MASSACHUSETTS 80 RD. O HEAL-TH t:y 1 crt-wrdwi y 1 f W �- o n DEPARTMENT,_ �—� J 77 ADDRESS -a TELEPHDNE" T N/ � ' Address Occupan floor Apartment No. No. P Occu a44- n s No.of Habitable Ro ms No.Sleeping Rooms S No.dwelling or rooming units% NoStorie' �QVX_d �~ Name and address of owner[TA ) _ lyl _ it ,0'AV 9 "f Remarks Reg. Vim YARD Out Bld s.: Fences: t I Garbage and Rubbish Containers: Drainage Infestation Rats or other:, .� �, (� - ''/1 �,I A- 1 l)C jC_ STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ,, ❑ B ❑ F ❑ M Doors,Windows: Alm,6e ,1'2fr I �`� _ l Roof o - `. 1 A I"- Gutters-,-Drain : ) ,,. Walls: Foundation: /, / Chimney: BASEMENT Gen.Sanitation: Dampness: V`C 11 -A A J Stairs " Irv ° Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: 11101/J� N ( Y---)I'l Hall Lighting: A ,v , /j� Hall Windows: ` HEATING Chimneys: l Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: o a ❑ MS ❑ ST ❑ P Waste Line: Z: Q l` ' � W>-rc--_-YTI—,/A IV Ahr�_ fl�l�;�1 tc H.W.Tanks S-fet arid'Vent s " ` ELECTRICAL Panels, Meters,Cir.: /} /'zA K-V Id"7 ❑ 110 ❑ 220 Fusing,Grnd.: V At tr War y �-. ✓v AMP: Gen.Cond. Distrib. Box: } Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom M/`){ � /n l ri I 1 A Pant f . �� v ,,..-� Den Living Room Bedroom 1 •�" i 11 ) /)IV r /1 A Bedroom 2) l '��/ wow Bedroom 3 / / Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink LA /k- ,_I Stove rJ,1' Q r_` 4 A to#G . Bathing,Toilet Facil. Vent., P'rimb.,Sanit'n.: " •'_F •1 1-y-, twwa_' Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: ,-�-, /1 ,,�, ..- ,.ram,". -�r A General ulliding Posted I t ,, v--- A,/ Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT,IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIE'S'OFF PERJURY.' � r INSPECTOR, f/�t//[/�LA1� f/ %"+TITLE TIME DATE � AP.M. THE NEXT SCHEDULED REINSPECTION py � P.M. a 410.750: Condition's Deemed to Endanger or Impair Health or Safety The following conditions, .when found to exist in residential premises, shall be deemed conditions which.may endanger or impair the health, or safety and well-being of a person or persons, occupying the premises. This listing ' is composed of these items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential to fall within this category in any given situation but may not do so in every case and therefore cannot be included in this listing. Failure to include shall in no way be construed as.a determination that other o f o shall failure violations may not be found t all within this category. Nor silur to include affect the duty of the local health official to order repair or correction of the violation(s) pursuant to 410 CMR 410.830 through 410.833 nor shall it affect the legal obligation of the person to whom the order is issued•to .comply with such order. (A) Failure to provide a supply of water sufficient in, quantity, pressure ` and temperature, both hot and •cold, to meet the ordinary needs of the occupant in accordance-with 105 CMR 410.180•and 410.190 for a period of 24 hours or longer. -- (B) Failure-to provide heat as required by 105 CMR 410.201 or-improper venting�or.use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. _ (6 Shut-off:and/or failure to restore electricity or gas'. T (D). . Failure to supply the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253(A), 410.253(B) and the lighting in common area required by 105 CMR 410.254. - .'(E) Failure to provide a safe-supply of water. (F) Failure to provide a toilet and maintain a sewage_system, in operable �• condition as required by 105 CMR 410.150(A)(1) and 410.300. "(G) Failure to provide adequate exits, or the obstruction of-any exit, passageway or common area caused by an object, including. garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450 and ,410.451. (H) - Failure-to comply with the security requirements of 105 +CMR 41D.480(D). (I) Failure-to comply with any provisions of 105 CMR 410.600 through 410.6.02 ;..Mch:results in any accumulation of garbage, rubbish, fil'th:or other causes ' -'Aif. sickness which may provide a food source-or harborage for rodents, insects Mr other pests or otherwise contribute to accidents ..or to the creation or ::spread of disease. - (J) The presence of lead-based-paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Heilth'Regualtions for Lead Poisoning Prevention and Control 105 CMR 460.000. _ t - F - _ _ ;(K) ' toof, foundation, or_other structural_defects that may expose the occupant or anyone, else to fire, burns,,.shock, accident or other dangers or f pattSent to health -or dafety. (L)- Failure to install electrical, plumbing, heating and gas-burning facilitiee in accordance with accepted plumbing, heating, gas-fitting and " - " electrical wiring standards or failure to maintain such facilities as arw required by 105 CMR 410.351 and 410.352 so as to expose the-occupant- or. anyone elsw to fire, burns, -shock, accident or other danger or impairment • -�' to.-health or safety.- - ( Any of the following-conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said-'condition or conditions: < -(;)' lack of a kitchen oink of sufficient size and capacity for washing dishes and kitchen utensils or lack 'of a.stove and oven or any defect that renders either operable. (2) -'failure to provide a washbasin and a-shower or bathtub as required - in-105 CMR 410.150(A)(2) and 410.150(A)(3) and any defect which- renders them inoperable. - - __ {3) any defect in the electrical, plumbing, or- heating ,system which makes _ such system or any part thereof in violation ,of generally accepted ! plumbing heating,, gae-fitting, or electrical wiring standards that do not create an immediate hazard. „(r) failure to maintain a safe. handrail or -protective railing for 'every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A) and 410:503(B). (5) failure to eliminate rodents, cockroaches, insect infestations and other pests as'required by 105 CMR 410.550. (N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A) through (M) shall be deemed to be a condition which may endanger or,materially imps*r the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within.the time so ordered by the board of health.. ti PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel Id: 268 161- - Account No: 171691 Parent : Location: 81 STERLING RD Neighborhood: 55CC Fire Dist : HY Devel Lot : 25 Lot Size: . 30 Acres Current Own: CANDUCCI, CAROL ANN & State Class : 101 CANDUCCI, GERALD A No. Bldgs : 1 Area: 1156 PO BOX 2765 Year Added: HOUSTON TX 77252 Deed Date : 030193 Reference : 8486/160 January 1st : CANDUCCI, CAROL ANN & Deed MMDD: 0393 Deed Ref : 8486/160 Comments : Values : Land: 32600 Buildings : - 60700 Extra Features : Road System: 81 Index: 1532 (STERLING ROAD ) Frntg: 99 Index: ( ) Frntg: Control Info: Last Auto Upd: 012096 Status : C Last TACS Update : 011796 Land Reviewed By: Date: 0000 Bldgs Reviewed By: Date : 0000 Tax Title : Account : Taken: Account Status : Hold Status : Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [268] [162] [ ] [ ] [ ] '7-75'-7(9,z� ® 114.Enterprise Rd. (508)775-8300 . Hyannis,MA 02601 1-800-541-0282 Fred L.Ralston DHHILS Director CAPE ORGANIZATION FOR RIGHTS.OF THE DISABLED .`�, �` (o- , . �� `- .. ' � . 1 + �` ( -. .. � � � _ a S a HP OfficeJet Fax Log Report for Personal Printer/Fax/Copier BARNSTABLE HEALTH DEPT 5087606304 Sep-26-97 02:57 PM Last Fax Identification Result Pages Tvoe Date Time Duration DiagLiostic 97757022 OK 02 Sent Sep-26 02:54P 00:01:38 002580030022 1.2.0 2.8 II Town of Barnstable IKE rq� Department of Health,Safety,and Environmental Services Public Health Division STB P.O.Box 534, Hyannis MA 02601 s MASS' 9� 039. Ark p�.l A Phone: - 1-508-790-6265 FAX: 1-508-790-6304 FGq �Cmd�dZ��m fi)�000.,/ c To: MFrom:4"ICAM S Fax: � V Pages(including ver): Phone: f p Date: 11'7 Re: CC: ❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle •Comments: fOAM30 H0888pWARREN,INC. THE COMMONWEALTH OF MASSACHUSETTS r, 0 h a., 4} � f R a s� EAy H ' 4IS 7 b �v11VV//in is Y��%'its f Fz.tC 4S1bS03 ��iet t.:.+i il�e r •t 9 ;,y +f{."+f a;,s�i der.� Y rah":tS.r "4.:t33v: t ;4!,'eT '� : 'S a, �?w�yt..ty �t•cl ASti:�Q�- .vX '*�� YA.�6�".! v �:,` , iSgY '•R• A � ..va. '.,.s. Ftt Cd•f° , �,; da,, � I ` 7a.F T ti$.k+.S:� ,I V i• r 1,�^i .,� .S f 4• I 5� E m, $• r;Fr k •t; .. t, .;U'. ..� � s ' •� �' }�>�TELEPH NE S iau. Y aas.a i Address g try* €° z:<r {c 9I)v. .vnX I s, . No Occu a ' . i Floor Apartment No , r AR Dt• ___fevl ,'16 um— �� nr"f�31101rjt� No."of Habitable Rooms No Sleeping. I 44c ,,,,�� No.dwelling or rooming units -'` No S Name and address of owner, i .:__.. _ s,• v..';r <;a Rlfnarb;_stI Reg. vb. � r� YARD Out Bld s.: Fences: Garba a and Rubbis h " ?r,3 : ' t •r. -,Y f3�+7 t 'I # ~f Containers: 1)0 Drainage nfestation Rats or other: bi A • Ste s,Stairs,Porches:,.. STRUCTURE EXT ,., •.• ; Dual Egress:and 0 t`.n. O B OF ❑M Doors Windows: Roof ° 91, Walls: Foundation: i Chimney' BASEMENT Gen.Sanitatio Dam Less: ° '� i Stairs: Lighting: r t , : f,.2 y1 If r r A l k I STRUCTURE INT. Hall,StairWa ' a=,':-'s `•.` "''- + 'Y' r Obst'n. ' Hall Floor Wall Ceilin __ Hall Lighting Hall Windows: HEATING Chimneys:, I Central ❑Y O N Equip.Repair I TYPE: Stacks Flues Vents: r. r a r A •°s a" �'" PLUMBING: SuPPIy Line: o,,, , OMS O ST op Waste Line: ": a _ Ifilb,t H.W.Tank s S re t v an ens q,c; 5I^,a a W.v Yea ho ELECTRICAL Panels,Meters, t 0110 0220 Fusing,Grnd.: �. AMP: Distrib.Box: ' I Gen:Cond. .., . .. ... . � ,. .: �..• . � • Gen.Basement WiriL A DWELLING UNIT y' Ventil. L to Outlets Walls;, ,.Ceils.. Wind: Doors.. Floors, ,Locks i Kitchen Bathroom ' Pant S'Y;3^!. � r ,.r Den s t -. , �R'!��C,'a i �#: v ,•s„, c, :.-.t s .rac l�:.= a fLt,�s .:., tT. z'�45E._e •i� Q Livina Room Bedroom 1 Bedroom 2 Bedroom 3 ' Bedroom 4 - Hot Water Facil. Sup.Ten. Gas,Oil Elect.:, ... ,. r _.+" ¢ ' +A •,z Ir Y t, �' Stacks Flues, ents Sa a ies: i Kitchen Facilities Sink ' Stove a t+ * f Bathing,Toilet Facll. Vent.,P m San t n.: WAS Basin Shower orTub:` Infestation Rats,Mice Roaches or Other: MP .E ress Dual and Obst"n:.. , BuildinGeneral , Posted,,r+ i Locks on Doors: ONE.OR MORE OF.THE VIOLATIONS CHENO A .)VE4S'A CONDITION WHICH MAY MATERIALLY'IMPAIR THE;HEALTH OR"SAFETY"AND VNELL BEING"OF THE OCCUPANT AS DETERMINED 'BY 105CMR 4i0 750,'OF�THE CODE,"OR THE 4,AUTHORIZED,INSPECTOR.(See Over) �.,kq ," �, �,,,.,,• , , -,r�� z•� f.�� "THIS INSPECTION REPORT.S.SIGNED,.AND•-CERTIFIED�UNDER THEkPA1NS D PENAL F PERJURY." Oil. INSPECTOR LE DATE A.M. P.M. THE NEXT SCHEDULED REINSPECTION SENDER: ■Complete items t and/or 2 for additional services. I also wish to receive the ■Complete items 3,4a,and 4b. following services(for an a Print your name and address on the reverse of this form so that we can return this extra fee): d ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address v permit. $ ■Wdte'Retum Receipt Requested'on the mailpieoe below the article number. 2. ❑ Restricted Delivery N ■The Return Receipt will show to whom the article was delivered and the date ., delivered. Consult postmaster for fee. a 3.Article Addresse to: 4a.Article Number c a G!6 � 4b.Service Type ° ° ❑ Registered ® Certified � W ❑ Express Mail ❑ Insured 9 cc ❑ Return Receipt for Merchandise ❑ COD a 7.Date of Delivery pf W 5.Received By:(Print Name) 8.Addressee's Address Only i requested W and fee is paid) r g 6.Signatu ddr g t) 9' XEitk tr`�i k lJAM : i rn PS Form 3811, December 1994 102595-97-8-0179 Domestic Return Receipt r UNITED STATES POSTAL SERVICE First-Class MailPostage&Fees Paid USPS Permit No.G-10 • Print your name, address, and ZIP Code in this box• F Public Health DIVISIOR M Town of Barnstable N P.o.Box 534 i Hyannis,Massachusetts 02601 NOV 24 '67 141:17 y,.•,.. _ P , :I I ,j 4� •i. 1� 11 I I• I� ;e I 1,. y. •I i• 1♦ I 1 JII 1• i k i. , •d f•,{ :1 i :i j.: Ii i i PI • z. �L ,.I •I .4 : r; , .. ..., .. . . F DIY �i SoNsi.PAX 1174 B t� :t. i,. •l4 - •I. I, I 4 : 1 1 2 ii I �J. I - i •.I n 1 i r- . r , I ; 4n , 0 _ s= I' I' R I , �I. I� .I :.. . . . ... : r F Q. , 1 I ` : { I;N .QF.PAk� : . r i i V1 U. •i M. Ma. COOP:I I l.: ,I i �IJI��►(� , I k t r • i r I' I 4 I S , •5 I. I , I' I r' •r 1 I' s.. ., r' l' 1• i' 4 .br I _ 'I '1 i. NOV 24 '97 14:18 I ( I —P.2 loll tr so I r S s cr i 11-24-97 07:05PM FROM SONAT OFFSHORE TO 915087753344 P001/001 TITransocean TRANSOCEAN OFFSHORE INC. JERRY CANDUCCI 4 GREENWAY PLAZA I?104b) MANAGER OPERATIONS SERVICES POST OFFICE BOX 2765 HOUSTON,TEXAS 77252.2765 Date : 24 Nov.'97 To : Barnstable Dept. of 11S&E Services Fax#: (508) 775-3344 Attn : Donna Miorandi Subi : Inspection of 81 Sterling Rd. Miss Miota,ndi, I wish to thank you for the inspection visit you paid to my house on Friday. 1t was easy to recognize how busy your whole department is when I stopped by last week. I appno.cime. your finding time to come while I was still in town. 1 know you're aware of the awkward situation that exists with this rental unit so you can imagine how relieved I was when you said my efforts had been satisfactory to get your approval. If you would be so kind as to inform Leila Botsford, Leased Housing Coordinator at the Barnstable Housing Authority, I will be able to get things back on track with the authority at least, if not the tenant. Leila Botsford Tel. 771-7292 Fxx 778-9312 Thanks once again. Best Regards, Jerry Canducei (713)850.3711 FAX (713)850-6496 OFFIM: ieniQdoopwpter.com I Date To Whom It May Concern: I, , voluntarily grant permission to the Town (Occupants name) of Barnstable Board of Health (Agent or Health Inspector)to inspect my, dwelling unit located at J W R YAW6 in accordance (House#, [Apt\Unit#if applicable],stre t,villa e) with the Town of Barnstable Code (Chapters 59 and 170) and the State Sanitary Code (105 CMR 410.000) on I hereby authorize and name (Date of inspection) to be my tenant representative for the (Occup representative) purpose of this inspection, is an adult person ( ccupant r es tative) designated and duly authorized to act on my behalf and will be accompanying the Town of Barnstable Board of Health for the inspection, granting access to any and all locations (including bedrooms, bathrooms, closets, etc.,) allowing the use of photographs and answering questions. This authorization is only valid for the inspection date specified above, and must be renewed for any future inspection(s.) Occupants Signature \ Date Occupants epr sentat e ignature Date Q.\Rcntal Ordinance\inspection permission 2.doc r Date bt, To Whom It May Concern: I, , voluntarily grant permission to the Town (Occupants name) of Barnstable Board of Health (Agent or Health Inspector)to inspect r&y,dwelling unit J �IANAI , located at a in accordance (House#, [Apt\Unit#if applicable],Itreet,v' lage) with the Town of Barnstable Code (Chapters 59 and 170) and the State Sanitary Code t (105 CMR 410.000) on t I hereby authorize and name j (Date of inspection) V._ -- to be my tenant representative for the -Toccupant re res nta ive) purpose of this inspection. 1 s an adult person (Occupant represen e) designated and duly authorized to act on.my behalf and will be accompanying the Town of Barnstable Board of Health for the inspection, granting access to any and all locations (including bedrooms, bathrooms, closets, etc.,) allowing the use of photographs and answering questions. This authorization is only valid for the inspection date specified above, and must be renewed for any future inspection(s.) Occupants Signature \ 'Date Occupan s Representati Signature \ Date Q.\Rcntal Ordinance\inspection permission 2.doc ASSESSOR'S MAP NO. PARCEL 16 t � ��' -3c,� LOCATION SEWAGE PERMIT NO. mod, i Ste r/; VIi: LAGS - INSTA LLER'S NAME & ADDRESS �`. -P . h.,q CorY-\(o 4e_.r- 4 SO rS 1 ) S 1 SA00 -" -(FI y % r, ci S U I L D E R OR OWNER -T- r �s ► � DATE PERMIT ISSUED DATE COMPLIANCE ISSUED I Al / e � JA A 1\• C" ! / THE COMMONWEALTH orMAssAcHuesrrs U�� K� �� HEALTH ��" ~" "�� " ................................OF......................................................................................... �� ^� Appliratiou� 4�� p��^� Worms Tomitrur4mon Daum | Anol�u�ooi� �cr�nr made u �cr��t �o Cons ( \ or Repair ( \ an Individual Sewage Disposal | ^^ ' ' ^ ` ' � System at: ...-' ....'-------'--...----...--'--'---------'-'----- -------------'---'-------------'---'--'------- c��'�a�s or Lot No. Carolyn Irwin ................. ...-.......................................................................... ..........-...................................................................................... o°"o Address ' _.J ..P_. ...._______________________ _________________________________________________ Ins tauer Addre. Type of Building Size Lot.--'--'-----'--'Sq. feet Dwelling-XNo. of 8edcnooza-'-----'.l-------.........Expansion Attic ( ) Garbage Grinder ( ) Other--Type of Building ---------------------------- No. of persons__--------- Showers ( ) -- Cafeteria ( ) Otherfixtures —.--.---_---------.----.---------.------.--------------__--.---------' Design Flow............................................ per person per day. Total daily flow............................................ . Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench--YJo..................... Width.................... Total Length.................... Total leaching area....................sq. f t. Seepage Pit Nu------- Diaoetec------- Depth below inlet.................... Total leaching area..................sq. ft. . (}t6�rD�t�bodoo bo� / ) Dosing ) �� ` ' ~ ` ' ~� Percolation Test Results Performed by.-----.---------.—.----.-----__-- Date...-----......................... Test Pit No. l................minutes per inch Depth of Test Pit.---'-__-' Depth to ground water--------------------- . [� Test Pit No. 3................minutes per inch Depth of Test Pit.---.----- Dcptboogrouud water........................ ............................................................................................................................................................. 0 Description cfSoil-'--------.Eazzd.-8,.'<�r-au.al...............................................................................-............................ ........................................................................................................................................................................................................ -----------------------'-------------'------'-----'----------'------'---- ! ! � U Nature of Repairs or Alterations--Answer when applicable----------------'--'------------------- / . _---------.—..__--_----'-_-----_.—.____''--'-_----- P.it............................................... Agreement: ' The undersigned agrees to install the zforedescribed Individual Sewage Disposal System in accordance with ' the provisions of UE, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue b e b rd of heiph. Date Date Date ______ Ez.... No....O.Q.... F 9tv...00- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................. ........................OF................................................11......................... Appliration for Uhipmal Works Towitrurtion "nutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: 81 Sterling...P�9A!q...Ry4AIq i s ............................... ----------------- . .....**------------------------------------------------------------------------------------------- Location-Address or Lot No. Carolyn Irwin ................................................................................................. .................................................................................................. J-P-macomber Owner Address . ..... .. ......... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling X No. of Bedrooms...........................................Expansion Attic Garbage Grinder ( ) 4 44 Other—Type of Building ............................ No. of persons..-.-____.__-___--_..__-___- Showers Cafeteria ( ) P4 Other fixtures ........................................... ---------------------*-----------------------------------------------------------------------------------Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Llquid capacity............gallons Length________________ Width..._._.__.....__ Diameter_----._-_____-__ Depth.....__..__..... Disposal Trench—No..................... Width_....___.__.___..... Total Length......._.._..._..._. Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter--__-___-__-.____-__ Depth below inlet....._.............. Total leaching area..................sq. f t. Z Other Distribution box Dosing tank Percolation Test Results Performed by............................................................. ............ Date.................................... 4 Test Pit No. I................minutes per inch Depth of Test Pit.__.___....._..___.. Depth to ground water_--__--..----___-.._._.. Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth,to ground water_.-___-__--_____-..._--_ a -•••----------------------------•------•----•-••--•-•--•-•-•-••-•••••------------------•----•-•-•---......................................................... 0 Description of Soil-------------------a-md...S'.-.0-rave.1............................................................................................................... U ..........................................................................................................................................................___...................................... .......................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- ........................................................................................................................!---I e ach. it................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T'IE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in L operation until a Certificate of Compliance has been issued by the board of health. Signedl, ..................... ....6/1-4/18.8......... Date ............ ..... ....... ....... .... ................ ........................................ Application Approved By................. ...... Date Application Disapproved for the following reasons:................................................................................................................ ........................................................................................................I................................................................. ............................. Date PermitNo.-----CA..................... Issued....................................................... Daze THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ..........................................OF................................................................................... Tntifirate of Tom pliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaire(K];X) by........J.!.?.!.Ma.combe.r..................................I.........................................................................................................................Macomber.. '31 Sterling Road Hyannis Installer at................................................................................................................................................................................................... has been installed in accordance with the provisions of TIT-LE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...__.._._S._..-_3-1 Z_7...... dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 20 .....................DATE....................... L�L Inspector........ 7............................................. V THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable 01F,Y151 .................. ......................OF..................................................................................... 20.00 N .................... FE_...................... Disposal Work.5 TuInstrurtion "amit V Permission is hereby granted.J.*.P.*Aaco_n,.t.o.r........................................................................................................... ...................... to Con&Iuq qr Repairy(X ) an Individual Sewage Disposal System atNo..........S.t_e_A-i-n.g...Road----Hlanni.s................................................................................................................................ .......... ........... ---------------- Street cIrl as shown on the application for Disposal Works Construction Permit NoM.'30e.- Dated.......................................... ........... ............................... . ......ED.................................................... DATE................................................................................ L/ Board of Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS