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HomeMy WebLinkAbout0045 STRAIGHTWAY - Health 45 Straightway Hyannis P A = 267 147___ — — -- -- — -- � I i a' + f� A TOWKOFB STABLE ATION,= SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACII.TTY: (type) (size) NO. OF BEDROOMS IJ rr nn f BUILDER OR OWNER PEF+MITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist . on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any within 300 feet of leaching facility) Feet Furnished by Q W C� c� W � Yr�row� Town of Barnstable Barnstable Board of Health M-NnedcaCky + BARNS-TABLE. MAM. 200 Main Street, Hyannis MA 02601 1639. �� ArFD MA'S A 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 JunichiSawayanagi Paul Canniff,D.M.D. September 10, 2010 Joseph Katsman and Inessa Teter-Katsman 45 Straightway Hyannis, MA 02601 RE: 45 Straightway, Hyannis A = 267 - 147 Dear Mr. and Mrs. Katsman: You are granted an extension to repair your septic system located at 45 Straightway, Hyannis. This extension is granted until December 1, 2010. The septic system inspection report dated 1/14/2008 by Robert Paolini noted a stain,line observed at the riser. The leaching pit was in hydraulic failure. However, you stated 1hat you have been living there for two years as a second home and all indications have been that the septic is working fine and has been pumped once as maintenance with no indications of a problem. According to the Board members at the meeting, you may have another septic inspection report done by a certified septic inspector who will submit the results to the Health Division. According to the Health Agent, an admission of error from the original inspector or passing reports from two other DEP certified inspectors may qualify for a review and determination from the Board to reverse the original failure report to a passing evaluation. Please be aware that If the second inspection states the system to be in failure, youTsystem must be repaired by December 1, 2010. Sinc ly yours 4 < ayne iller, M.D., Chairman Board Health Q:\WPFILES\SepticDeadlineExt 45 Straightway Hy Aug20IO.doc Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis MA 02601 8-23-11 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. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your ,' --f cursor-do not Darrell Stone F t > Name of Inspector " a use the return , ; �y key. Cape Cod Septic Inspection. w Company Name Q PO Box 1466 - {; Company Address Harwich MA 102645 'elOA City/Town State Zip Code i-Y b 508-240-2500 S14995 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Pa es ❑ Conditionally Passes ❑ Fails ❑ ee s urther Evaluation by cal Approving Authority 8-28-11 In s Signature Date The system inspector II 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. 1 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 t i I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis MA 02601 8-23-11 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: The septic tank was pumped after the partial inspection. This report only provides information on the leach pit as requested by the board of health. Along with this report I've included pictures of the current ponding level in the pit, leach pit riser, and the septic tank outlet tee. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis MA 02601 8-23-11 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due . to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y, ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health):. ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if. the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Straightway Hyannis MA Property Address Joseph Katsman Owner Owner's Name information is Hyannis MA 02601 8-23-11 required for y every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the 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 El ® 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 1/2 day flow Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 4 of 17 t5ins•11/10 t Commonwealth of Massachusetts Alffit Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c M 45 Straightway Hyannis MA Property Address Joseph Katsman - - Owner Owners Name information is required for Hyannis MA 02601 8-23-11 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or ❑ ® tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water.quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpdEl - 10,000gpd. '® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ' ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection ❑ ❑ Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 t5ins•11/10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' 45 Straightway Hyannis MA Property Address Joseph Katsman Owner Owner's Name information is H annis MA 02601 8-23-11 required for y 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. ® El approximation in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CM 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Title 5 official Inspection Form:Subsurface Sewage Disposal system•Page 6 of 17 t5ins•11110 11 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °w 45 Straightway Hyannis MA Property Address Joseph Katsman Owner Owner's Name information is Hyannis MA 02601 8-23-11 required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents. Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: 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: Title 5 official Inspection Form:Subsurface Sewage Disposal system-Page 7 of 17 t5ins-11/10 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Straightway Hyannis MA Property Address Joseph Katsman - Owner Owner's Name information is Hyannis MA 02601 8-23-11 required for y State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Discount Septic Pumping Source of information: Was system pumped as part of the inspection? ® Yes ❑ No 1000 If yes, volume pumped: gallons How was quantity pumped determined? Weight i Maintenance 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) 0 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): Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 t5ins•11/10 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Straightway Hyannis MA Property Address Joseph Katsman Owner Owners Name information is required for Hyannis MA 02601 8-23-11 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (coat.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 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: 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: I Sludge depth: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis MA 02601 8-23-11 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 l { Date of last pumping: Date > ,{ t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i i i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 45 Straightway Hyannis MA Property Address Joseph Katsman Owner Owner's Name information is Hyannis MA 02601 8-23-11 required for y State Zip Code Date of Inspection every page. City/Town 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.): (tank must be pumped at time of inspection) locate on site plan): Tight or Holding Tank(ta p p p ) ( 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 t5ins•11/10 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °^ 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis MA 02601 8-23-11 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Straightway Hyannis MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis MA 02601 8-23-11 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 1 (6'X6') pit.with 2' stone Grade to cover 1" Pit 20" Bottom 95" Trace of liquid Staining @ 2' No sign of hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration ,l 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 El Yes ❑ No Title 5 Official Inspection Form:Subsurface Sewage Disposal system t5ins•11910 •Page 13 of 17 e F i r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis MA 02601 8-23-11 every page. Cityfrown 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.): F i l t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i } .� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wM 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis MA 02601 8-23-11 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 t5ins-1 Ill 0 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Straightway Hyannis MA Property Address Joseph Katsman Owner Owner's Name information is Hyannis MA 02601 8-23-11 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: 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: y Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 t5ins-11110 i r_ Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis MA 02601 8-23-11 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ❑ System Information—Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 3 9 1 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 j _ Commonwealth of Massachusetts _ W Title 5 Official Inspection Form o - Not for Voluntary Assessments Subsurface Sewage Disposal System Form ry 45 Straightway Hyannis MA Property Address Joseph Katsman Owner Owner's Name information is MA 02601 10-15-10 required for Hyannis, 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. Important: A. General Information When filling out f forms on the I w computer,use 1. Inspector: U only the tab key to move your Darrell Stone cursor-do not Name of Inspector use the return key. Cape Cod Septic Inspection Company Name PO Box 1466 Company Address Harwich MA 02645 n City/Town State Zip Code 508-240-2500 S14995 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® P sses ❑ Conditionally Passes ❑ Fails ee s F rther Evaly ati by h L al Approving Authority 10-17-10 nspec or's Signatur Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. l � osal s m•Pa e 1 of 17 Title 5 Official Inspection Form:SubsurI-SeDi sp i y 9 t5ins-09/08 rIC I it ��� � `'r� �� ��• �•+•�~ "1 � .�+� �,• ��:�� tit. j .ft k.� ��� '` yr 1 G+ .�'S,.t� � ! lf,�;'a.,�`�y-i.. •� ,.h[lt./fJ .0 ",J�1*.h S�"`Ptr,,.S.��- n'�j,. .r•�"r ,�" �� tl /r 1. cA -t N � CA o ell- i d 1 •..�+rya, 'g �'� � �� �. '�.,�y! ��.i� �`� ��;. �� ��f. �" � y ;i �. F era.? i r3.�¢`J s�J at+" �•r( ,�+4�. r�)ya['y�`F�* � _ r ��' YA r fay. i` 7 �•; � "^'G' �+ 1' , $�- tJy`•y„(' i �4i i!-3.= -r� a��',�y}+ r 4�t .{ .L=i 541�� :.. - "yry. !{4'�. l f -„R�M-•ir.{ •JAM MC _ram•_ s - _$! _ C� a L 3 i t a Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis, MA 02601 10-15-10 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: After reviewing 2 existing septic reports I determined there are a few discrepancies between them. Knowing this information I took extra steps to determine condition of the system. First, at the time of my inspection the leach pit was found dry. Second, around the leach pit I made two test holes to attempt to find contaminated soil. One 17" below the top of pit at the outer edge of the stone, and one under the inlet pipe at the edge of the pit, no blackened soil none was found in either hole, only clean dry stone. (please refer to page 15 for test hole locations)Third no staining line was observed in either tank, or pit risers as refered to in the 2008 report, only the stain line noted in the 2003 report at a @ 2'from the bottom could be observed, and I could not see any other staining at any higher point. B) System Conditionally Passes: El 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments cwM 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis, MA 02601 10-15-10 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): '❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): obstruction is removed. ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: El Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,. -safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water `❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis, MA 02601 10-15-10 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and.SAS and the SAS is within a Zone 1 of a public water supply. ❑ . The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a-private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 El ® 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 G W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Straightway Hyannis MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis, MA 02601 10-15-10 every page. City(rown 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 cesspooLor 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.] m ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ " ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ® the system is within 400 feet of a surface drinking water supply ® the system is within 200 feet of a tributary to a surface drinking water supply ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection El 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. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 t5ins•09/08 ` Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis, MA 02601 10-15-10 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] r D. System Information Residential Flow Conditions: Number of bedrooms (design): n/a Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis, MA 02601 10-15-10 every page. Citylrown State Zip Code Date of Inspection D. System Information Description: 4 Bedroom residential dwelling Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal,use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 4revio s 2 for g ( y g (9P ))� previous 2yrs Detail: 2010-97,000 12/11/09-09/14/10 per Barnstable Water Dept. 2009—243,000 2008-70,000 This property has a working irrigation system. 2007-97,000 Please note that the heaviest water useage in recient 2006-219,000 years was 2009. Sump pump? ❑ Yes ® No Last date of occupancy: Date 0 Date i 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i Commonwealth of Massachusetts v W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis, MA 02601 10-15-10 every page. Cityrrown 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: Pumped '98, '03, '04, '05, '06, Per BoH 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: ® 6Septic tank, distribution box, soil absorption system Single cesspool ❑. Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) EJ 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis, MA 02601 10-15-10 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1972 Per 2003 Report Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 23 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.)-. Apparent good condition Septic Tank(locate on site plan): 18' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 12 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis, MA 02601 10-15-10 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 20" Scum thickness 0 11 Distance from top of scum to top of outlet tee or baffle 5 Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Center cover to grade Normal liquid level No sign of leakage Concrete outlet tee Recommended next maintenance pumping within 1 year Recommended maintenance pumping every 2-3 years 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 o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis, MA 02601 10-15-10 every page. CitylTown 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis, MA 02601 10-15-10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): No D-box encountered 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.): I I i 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 u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis, MA 02601 10-15-10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 1 (6X6') pit with 2' stone Grade to pit 19" Cover to grade Bottom 94" Dry Staining @ 2' No sign of hydraulic failure i 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 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis, MA 02601 10-15-10 every page. CitylTown 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 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis, MA 02601 10-15-10 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 i 3� A g - 2 Z-Z 3 4 5 6 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 w Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 45 Straightway Hyannis, MA Property Address Joseph Katsman Owner Owner's Name information is MA 02601 10-15-10 required for Hyannis, every page. City/Town State Zip Code Date of Inspection D. System Infotmation (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth t >4 high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtair ed 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: See below You must describe how you established the high ground water elevation: Elevations from USGS maps Approx. property ELV. 30.0 -35.0 Approx. Bottom of SAS ELV. 22.17 -27.17 Approx. GW ELV. 13.0 Ajdustment 3.2' MIW-29 Zone B 8.9' September 2010 Separation >4' 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 i <L Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Straightway Han is, MA Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis, MA 02601 10-15-10 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection SL mmary: A, B, C, D, or E checked ® Inspection SL mmary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I" j t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 v Hv. k M = - _ cr m - { m I Customer# !6[# '3 3 5fius. �' .;:= #lomer;lc�ormatian -=-- ---- ----- '-- --- - ---- ------------------------ ----= --- -- - -- Pierriise liifarra n {JGcupar�t co Mama _ - = — _ __ MIM - - -- - _ - A�1dress - - - - - - - i..�t�+l .. - - ME {i31810 r. v ny - f - - - `•flId Customs E a� _ € ... m :... __.... _....._...-.,.._-:........._........ .__......._..................... :. General Gull tin : Cvr plaitrts Nr# s View Update S mice::pet�uls. 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O a' LL Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Straightway M 9 Y i Property Address Joseph Katsman Owner Owner's Name - requiratifor Hyannis Ma. 02601 1/14/2008 required for Y every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A General Information When filling out V n forms on the i computer,use only the tab key 1. Inspector: to move your Robert Paolini ���`t cursor-do not use the return Name of Inspector key. Capewide Enterprises,LLC Company Name tab P.O.Box 763 r 2 Company Address t` Centerville Ma. 2632 r-a erum City/Town - State Zip Code (508)428-4028 S14454 Telephone Number License Number - B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Eval ation the Local Approving Authority 1/14/2008 Inspec or's Signature Date f 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. 45 Straightway-12/07 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 , Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 45 Straightway Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis Ma. 02601 1/14/2008 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: J ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Leaching pit was dry at time of inspection.Stain lines in septic tank and leaching pit are up into risers. B) System Conditionally Passes: El .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 i the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health: *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: r k ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 45 Straightway-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments 45 Straightway Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis Ma. 02601 1/14/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain:, ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh i 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. 45'Straightway•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Straightway Property Address Joseph Katsman Owner Owner's Name information is required for H annis Ma. 02601 1/14/2008 y every page. City/Town _ State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No . ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El 0 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 lesss than '/2 day flow El ® 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. 45 Straightway•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 45 Straightway Property Address Joseph Katsman Owner Owner's Name information is required for y H annis Ma. 02601 1/14/2008 � every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes. No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. El 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.] El ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. - E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection El El { 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. 45 Straightway•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 45 Straightway Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis Ma. 02601 1/14/2008 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No El ® 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) Z. ❑ 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? Z ❑ 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? El information the facility owner(and occupants if different from owner) provided with ED 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)] i 45 Straightway-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Ii i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Straightway Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis Ma. 02601 1/14/2008 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR,15.203 (for example: 110 gpd x#of bedrooms): 440 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 d 2006:191,000 g ( y g (gpd)): 2007:73,000 Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): 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 j Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date 1 Other(describe): 45 Straightway-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Straightway Property Address Joseph Katsman Owner Owner's Name information is Hyannis Ma. 02601 1/14/2008 required for y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.), 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 0 maintenance contract(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1972 Were sewage odors detected when arriving at the site? ❑ Yes ® No 41 Straightway•11107 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Straightway Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis Ma. 02601 1/14/2008 every page.. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 2, Depth below grade: feet Material of construction: El cast iron 0 40 PVC D other(explain): Distance from private water supply well or.suction line: 10, feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): 2' Depth below grade: feet Material of construction: Z 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 gallon 6" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 22 I Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 14 How were dimensions determined? measured 45 Straightway•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 - Commonwealth of Massachusetts W Title .5 Official Inspection Form o Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 45 Straightway Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis Ma. 02601 1/14/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every 2 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness w Distance from top of scum to top of outlet tee or baffle. Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): f 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): 45 Straightway•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System form - Not for Voluntary Assessments 45 Straightway Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis Ma. 02601 1/14/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Aarm 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 o ; Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet inve-rt D-Box not present. 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.): t ; Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 45 Straightway-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G7M 45 Straightway Property Address Joseph Katsman Owner Owner's Name information is required for Hyannis Ma. 02601 1/14/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: r ® leaching pits number: 1-1000 gl. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields. number,.dimensions ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching Pit was dry at time of inspection.Stain lines observed up in risers.Pit is in hydraulic failure. 45 Straightway•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Straightway Property Address 'Joseph Katsman Owner Owner's Name information is required for Hyannis Ma. 02601 1/14/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil., signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids J Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, j etc.): I I 45 Straightway•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Ma Abutters Ma Size zoom Out I �i ryx ' � x In p Map Size A R. IL II ' y — i I. SS av 1 I 1 ` 2O Feet Set Scale 1" 20 I Aerial Photos ('nrn.rinht 9MF-9n07 T--of RA All rinhfe rocnn., http://www:town.bamstable.ma:us/arcims✓appgeoApp/map.aspx?propertyID=267147&map... 1/14/2008 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4M 45 Straightway Property Address Joseph Katsman Owner Owner's Name information is required'for Hyannis Ma. 02601 1/14/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of LP 10' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: USED:Gaherty& Miller model 12/16/94 ground water elevations.USED:USGS Observation Well Data.USED:Technical Bulletin 92-000-01 plate#2 annual.ranges of ground water elevations. i 45 Straightway-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 { Town of Barnstable OF THE 1p� Regulatory Services I ; BARNSTABLE ; Thomas F. Geiler, Director f v� 1 $ ArFp��p Public Health .Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts Department of Environmental Protection. ion. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. _ Town of Barnstable Barnstable pp THE rp wy lee; ps America City ri,tz';5rs,�LE ,� Regulatory Services Department � "ASS. Public Health Division ArFb MA't a`e W 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO January 30, 2008 Countrywide Home Loans 7105 Corporate Drive Plano, TX 75024-3632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 45 Straightway, Hyannis MA was inspected on January 14, 2008, by Robert Paolini, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system FAILED under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: Pit is in hydraulic failure. You are ordered.to repair or replace the septic system within Two (2) Years from the date of this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF T BOARD OF HEALTH mas McKean, R.S., CHO Agent of the Board of Health ' CERTIFIED MAIL# 7005 1160 0000 0191 0379 Q:\S,EPTIC\Letters Septic Inspection Failures\45 Straightway.doc ® Complete items 1,2,and 3.Also complete 7Agnat7w, Item 4 if Restricted Delivery is`desired. ❑Agent © Print your name and'address on the reverse ❑Addressee so that we can return the card to you. C, Date Qf Delivery o Attach this card to the back of the mailpiece, , a � �� r � V or on the front if space permits. +�/ D. Is deliverya -""0d'8!Werent from item 1? ❑Yes 1. Article Addressed to: ' If.YES,enter delive ,a.tlress below: ❑No '1 b CA CY n c a, 1� c v t � 66 ' I 1 r.no Ty. '15024 3u s V— 3. Se `' "...j / t„ B Certified ❑Express Mail ❑Registe�l?\ 0 Return Reoelo for Merchandise ❑Insured Mall'i ❑C.O.D' 4. Restricted Delivery?P tra Fee, C'❑Yes 2. Article Number . 7 0 0! 11':6 MJ ,0U 0 0 01.i9 % 3 7 (Transfer from service label) � PS Form 3811,February 2004 ' Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid I USPS Permit No.G-10 I I Sender: Please print our name, address, and ZIP+4 in this box • I P� Y I I I � I I Town of Barnstable Ii Health Division 200 Main Street Hyannis,MA 02601 I I I I 1I1 I I I I 1 11 11,1.31111 It ItIII It 1 11 11 I �pF SHE Tp� Town of Barnstable Barnstable P ~ Regulatory Services Department M�MedcaC j BARNS-TABLE, O D `"ASS Public Health Division i67q. �0 m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO 06/14/10 Joseph Katsman and Inessa Teter-Katsman 299 North Main St. Sharon, MA 02067 FINAL ORDER ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at, 45 Straightway,Hyannis, MA was last inspected on January 14, 2008,by Robert Paolini a certified Title V septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: "Pit is in hydraulic failure." The deadline for repair has passed. We, The Department of the Board of Health,have not been informed that you have taken any steps to bring your failed system into compliance. Therefore, you are ordered to repair or replace the septic system within 60 days from the date you receive this notification. You may request a hearing before the Board of Health, a written petition requesting a hearing on the matter, within seven (7) days after the day this order was received. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health June 20, 2010 Thomas McKean, R.S., CHO �o Agent of of the Board of Health From: Joseph Katsman and Inessa Teter-Katsman 45 Straightway, Hyannis MA Ref. The Failed Septic System Dear Mr. Thomas McKean, R.S., CHO, I am requesting a,hearing before the Board of Health on the matter(The Failed Septic System located at 45 Straightway, Hyannis, MA). Thank you very much. Joseph Katsman E Ay' J .. �.���9,$G Q'r /C cat�`S/�'�4 r•� d I , ear XS 4'r ;:� �� J��,,�, U.S. POSTAGE PRIG �Iy�►( CNAR7MA ; JUN 21.'10 UNITEDSTAPOSTlUsER Jc AMOUNT E 1000 $3.2 1 7009 1410 0002 0692 5183 �� 02611_ 00068885 03 . •,.ter �:� -itilF:}l;F�3.�8�iiFt-�iF}fli 7�#�l�f�i�if}9l4}FFl1lI�'i}ll��f.9lF�f�fl i I I113�; t 11► ! 1� : � �; � 11;f � . �I.l II t 1lII I , Y 1. _. 7009 1410 0002 0692 5183 LOCATION SEWAGE PERMIT 1110. VILLAGE L o?" 77ZI T Zl)A I . I N S T A LLER'S NAME i ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED OAT E COMPLIANCE ISSUED 7- 3a_ 7 �` 0� W h_ \ �` V n 1 ,ram„ �'1 , , � - . T . . � ._ v �. � l ` r5 mN► Town of Barnstable Barnstable Board of Health ' MASS, g 200 Main Street, Hyannis MA.02601 Q3 1.e34. 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi July 27, 2010 Hand-deliver to: Joseph & Inessa Katsman 45 Straightway Hyannis, MA 02601 Also, mail to: - >/ Joseph & Inessa Katsman 299 North` ain Street S h a ron.,_M--A'--0.2067, R : 45 Straightway, Hyannis Dear Joseph & Inessa. Katsman.- We received a request from you to be put on our Board of Health Agenda, You are on the August Board of Health Meeting for 8/24/10. This meeting is located at 367 Main Street, Hyannis, MA. It will be held in the Hearing Room on the second floor. The meeting begins at 300 pm and runs until approximately 6:00pm. ,An agenda will be available 4-5 days ahead of time. Please do not�confuse the meeting date. Originally, our meeting was scheduled for 8/10/10, but has now been re-scheduled for Tuesday, August 24, 2010. If you have any questions, please callus at 508-862-4644. Thank you. Sincerely, Sharon Crocker Administrative Assistant