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HomeMy WebLinkAbout0055 STRAIGHTWAY - Health 55 Straightway Hyannis F/R A = 267 148 I; � 1 'TOWN OF BARNS"TABLE ,OtATION �J� �i�+ rtvyr SEWAGE # ,.. °,'ILLAGE r4 n " 5. - ASSESSOR.'S MAP& LOT__ _r___, NSTALI-ER'S NAME&PHONE NO. ;EP- IC TANK CAPAcl'TY `IFS -�,�� ,f3ACH1NG T�Ac1LTT'Y: (type)�..=.... (size) �. 40.OF'BEI)1ZOO�itS WILDER OR OWNED 1 'E ITDA7"E: CON41'UANCE DATE: separation Distance Between the: vhaximum Adjusted Groundwaterl�ble to the;By ilttom of Leaching Facility Beet 'rivatc`!slater:Supply Well turd Leaching paci ity (If any wells exist on site or-witkdn 200 feet of leaching facilltyj ;dge of Wcdand road Leaching Facility(If any4etlands exist within 300 feet f leaden�facility) 1 �urnishcd byC�P.Pi' O UJ � w o 1 �` Ty W o Commonwealth of Massachusetts F W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 55 Straightway Property Address Christine Menard Owner Owner's Name information is required for every Hyannis ✓ Ma 02601 7/11/2017 page. City/Town State Zip Code Date of Inspection le Cri -� 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 �'/� /a�(R on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection VQ Company Name 74 Beldan Ln. Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmail.com S14522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the L al Approving Authority 7/11/2017 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. ,� �Qj{ VS t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Diftl System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Straightway Property Address Christine Menard Owner Owner's Name information is required for every Hyannis Ma 02601 7/11/2017 page. Cityrrown 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 dwelling located at 55 Straightway Hyannis is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 4 Infiltrators. The system was found to be in proper working condition at the time of inspection. 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-3/13 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 M 55 Straightway Property Address Christine Menard Owner Owner's Name information is required for every Hyannis Ma 02601 7/11/2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pump's/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3f13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 55 Straightway Property Address Christine Menard Owner Owner's Name information is required for every Hyannis Ma 02601 7/11/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the 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 %day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 55 Straightway Property Address Christine Menard Owner Owner's Name information is required for every Hyannis Ma 02601 7/11/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® 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 forma ❑ ® 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 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Straightway Property Address Christine Menard Owner Owner's Name information is required for every Hyannis Ma 02601 7/11/2017 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M , 55 Straightway Property Address Christine Menard Owner Owner's Name information is required for every Hyannis Ma 02601 7/11/2017 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current 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: '*irrigation system t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Straightway Property Address Christine Menard Owner Owner's Name information is required for every Hyannis Ma 02601 7/11/2017 page. Cityfrown 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 I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 55 Straightway Property Address Christine Menard Owner Owner's Name information is required for every Hyannis Ma 02601 7/11/2017 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: system repaired 6/27/03 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 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.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 1 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: 611 t5ins-3113 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 55 Straightway Property Address Christine Menard Owner Owner's Name information is required for every Hyannis Ma 02601 7/11/2017 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 3" 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 10" How were dimensions determined? opened covers, took measurements 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 does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Outlet baffle intact, middle cover is on riser. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 55 Straightway Property Address Christine Menard Owner Owner's Name information is required for every Hyannis Ma 02601 7/11/2017 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts u . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M 55 Straightway Property Address Christine Menard Owner Owner's Name information is required for every y H annis Ma 02601 7/11/2017 page.e. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was in good condition, no rot, water level was even with outlet invert. Cover is on a riser Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Straightway Property Address Christine Menard Owner Owner's Name information is Hyannis Ma 02601 7/11/2017 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 Infiltrators ❑ 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.): s.a.s. was video inspected and found dry with no signs of past hydraulic overloading. 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•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Straightway Property Address Christine Menard Owner Owner's Name information is required for every Hyannis Ma 02601 7/11/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M 55 Straightway Property Address Christine Menard Owner Owner's Name information is required for every Hyannis Ma 02601 7/11/2017 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately E l � _ tf3( .3O AZ 3S �3Z Z3 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments' M 55 Straightway Property Address Christine Menard Owner Owner's Name information is required for every Hyannis Ma 02601 7/11/2017 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: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Straightway Property Address Christine Menard Owner Owner's Name information is required for every Hyannis Ma 02601 7/11/2017 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Straightway Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 1-8-10 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. A. General Information 1. Inspector: � M41 Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance aof on site sewage disposal systems. I am a DEP approved system inspector pursuantF0 ection .1_S.34CFW Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails .Q ❑ Needs Further Evaluation by the Local Approving Authority •ZJ �., U3 1-13-10 i 'ter 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. LY 65 straightway hyannis•03/08 Title 5 Official Inspection Form:Subsu ce 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 55 Straightway Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 1-8-10 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D cr E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. 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: ❑ Observation of sewage backup ackup 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 55 straightway hyannis•03/08 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Straightway Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 1-8-10 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 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. i. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 55 straightway hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 L+ r Commonwealth of Massachusetts f Title 5 Official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Straightway Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 1-8-10 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 ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ❑ Liquid depth in cesspool is less than 6°below invert or available volume is less than day flow ❑ ® 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. 55 straightway hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 55 Straightway Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 1-8-10 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. ❑ ® 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 CM 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ` ❑ ❑ the.system is within 200 feet,of a tributary to a surface drinking water supply ❑ Elthe'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. 56 straightway hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 15 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Straightway 55 M a 9 Y Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 1-8-10 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 CM 15.302(5)] 55 straightway hyannis-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-F:age 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 55 Straightway Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 1-8-10 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 10-09 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 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: Last date of occupancy/use: Date Other(describe): 55 straightway hyannis•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15_. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 55 Straightway Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 1-8-10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.)Y t General Information Pumping Records: Source of information: Inspector Was system pumped as part of the inspection? ® Yes ❑ No 1000gal If yes,volume pumped: gallons How was quantity pumped determined? Reciept Reason for pumping: Maintenance to remove heavy solids. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy es r El Shared system (y or (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): Approximate age of all components, date installed (if known) and source of information: 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No 55 straightway hyannis-03/08 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 55 Straightway Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 1-8-10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 24" 4 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 18„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: 1000gal Sludge depth: 20" Distance from top of sludge to,bottom of outlet tee or baffle 12 Scum thickness 10 Distance from top,of scum to top of outlet tee or baffle 4 Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Tape 55 straightway hyannis•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Straightway Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 1-8-10 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.): Tank is in good condition with baffles installed and no sign of leakage. Tank was pumped at inspection to remove excess solids. 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 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): 65 straightway hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Straightway Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Hyannis MA 02601 1-8-10 required for y - 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: 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 Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes , ❑ No Alarms in working order: ❑ Yes ❑ No 55 straightway hyannis-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Straightway Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 1-8-10 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: ❑ leaching pits number: ® leaching chambers number: 4-Infiltrators ❑ 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.): Infiltrators in good condition with no sign of back-up into d-box or surrounding stone. 55 straightway hyannis-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. p 55 Straightway Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis 2 MA 02601 1-8-10 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 55 straightway hyannis-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �7M 55 Straightway Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 1-8-10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. i DUO C 12 A- 30' 55 straightway hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth -Not for Voluntary Assessments wM 55 Straightway Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 1-8-10 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: 12' feet Please indicate all,methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers-(attach documentation) ® Accessed USGS database - explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. 55 straightway hyannis•03/08 Tie 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 15 - 1Z 1 ® REC'EIVEF) COMMONWEALTH OF MASSACHUSETTS 1 0 2003 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFA R WN qF p STggLE DEPARTMENT OF ENVIRONMENTAL PROTECTION Ab 4 r FA LIED INSPECTION t J� TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM , PART A CERTIFICATION Property Address: 55 STRIAGHT WAY HYANNIS,MA 02601 au--I 1y d Owner's Name: DILMA GOMES ^PV Owner's Address: 132 BUICKWOOD DRIVE HYANNIS,MA 02601 `! Date of Inspection: 5/12/03 Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-1270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _ Passes _ Conditionally,, sses _ Needs Furth t valuation by the Local Approving Authority X Fails Inspector's Signature: Date: 5/12/03 The system inspector shall submit a cop f this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If he 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. Notes and Comments SYSTEM FAILED TITLE V INSPECTION.THE LEACH FIELD WAS PONDING AT THE TIME OF THE INSPECTION- THE LIQUID FROM LEACH FIELD WAS FLOWING DOWN DRIVEWAY. ****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(lie same or different conditions of use. Title 5 Incnartinn Fnrm 6/1 S/1000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 55 STRIAGHT WAY HYANNIS,MA 02601 Owner: DILMA GOMES Date of Inspection: 5/12/03 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: SYSTEM FAILED TITLE V INSPECTION.THE LEACH FIELD WAS PONDING AT THE TIME OF THE INSPECTION-THE LIQUID FROM LEACH FIELD WAS FLOWING DOWN DRIVEWAY. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 55 STRIAGHT WAY HYANNIS,MA 02601 Owner: DILMA GOMES Date of Inspection: 5/12/03 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a z Page'4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 55 STRIAGHT WAY HYANNIS,MA 02601 Owner: DILMA GOMES Date of Inspection: 5/12/03 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] YES (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—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. a Page's of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 55 STRIAGHT WAY HYANNIS,MA 02601 Owner: DILMA GOMES Date of Inspection: 5/12/03 Check if the following have been done.You must indicate"yes"or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health _ X Were any of the system components pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period? _ X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information.For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] S Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 55 STRIAGHT WAY HYANNIS,MA 02601 Owner: DILMA GOMES Date of Inspection: 5/12/03 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents: 3 Does residence have a garbage grinder(yes or no):NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a 02-- COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no):NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1973 BY OWNER Were sewage odors detected when arriving at the site(yes or no):NO r, Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 55 STRIAGHT WAY HYANNIS,MA 02601 Owner: DILMA GOMES Date of Inspection: 5/12/03 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 12" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: L 8' 6" H 5' 7" W 4' 10"" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 0" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): THE LIQUID LEVEL IN THE SEPTIC TANK IS OVER THE TEE-THE LEACH FIELD IS IN HYDRAULIC FAILURE.WHEN NEW LEACH FIELD IS INSTALLED CHECK SEPTIC TANK FOR TEES. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): n/a Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 55 STRIAGHT WAY HYANNIS,MA 02601 Owner: DILMA GOMES Date of Inspection: 5/12/03 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a 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 BOX AS PER ASBUILT FROM TOWN PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 55 STRIAGHT WAY HYANNIS,MA 02601 Owner: DILMA GOMES Date of Inspection: 5/12/03 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: n/a n/a leaching chambers, number: 0 GALLIES leaching galleries, number: 4 n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): THE LEACH FIELD IS PONDING TO THE SURFACE WITH SEWAGE FLOWING DOWN DRIVEWAY AT THE TIME OF THE INSPECTION.FIELD IS PAST THE EFFECTIVE DEPTH OF LEACHING AND NEEDS TO BE REPAIRED-COMPONENTS TO SYSTEM WERE DETERMINED BASED ON ASBUILT CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.): n/a 4 Page 10 of 11 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 55 STRIAGHT WAY HYANNIS,MA 02601 Owner: DILMA GOMES Date of Inspection: 5/12/03 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanera reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. 57 FlZoN'i � � B v DLI . E = Page"11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 55 STRIAGHT WAY HYANNIS,MA 02601 Owner: DILMA GOMES Date of Inspection: 5/12/03 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: GROUNDWATER WAS DETERMINED BY VISUAL AND USGS MAPS AND CHARTS- 12+FT TOWN OF BA.RNSTABLE LOCATION : �Z r K-t?e !!!�,4Y SEWAGE # VILLAGE /fW/f,0 " ASSESSOR'S MAP & LOT�,76->' "'�P INSTALLER'S NAME&PHONE NO. V'i.►a �-��r�/�- �joJ�•� SEPTIC TANK CAPACITY /�O �xirTiw4 LEACHING FACILITY: (type) (size) NO. OF BEDROOMS -� BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: 63 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) f Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Cfii•� C r.�oCl//� o Y-f as � 0 o � v No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppricatton for Mfgpozar *potent Construction Permit Application for a Permit to Construct( . )Repair( Upgrade )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No.j/'� J_,;MA&W/ wx�/��y�,�,�� Owner's Name,Address and Tel.No. Assessor's Map/Parcel O /�� / 61e (5::-4,&45rT Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 5�t 1 gallons per day. Calculated daily flow ��° gallons. Plan Date �" -,Z fA Number of sheets / Revision Date Title _ Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 issued by Board of Health. Signed Date "�� Application Approved by —S Date CAP 2cS�3 Application Disapproved for the following reasons Permit No. 2007'- Z 9 Z Date Issued Fee �. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Zippricatiou for Migozar *pgtem Construction Permit Application for a Permit to Construct( )Repair(Upgrade 15)Abandon( ) El Complete System El Individual Components Location Address or Lot No.�`f` �/�jar���/� Owner's Name,Address and Tel.No. Assessor's Map/Parcel ;Z(5"7 i Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ,1627 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building /PL`S' No.of Persons Showers( ) Cafeteria( ) Other Fixtures- r Design Flow �.�G / gallons per day. Calculated daily flow yo• fb gallons. t. Plan Date �''�� Number of sheets / Revision Date _ Title _ t f Size of Septic Tank "' Type of S.A.S. ­0/ Description of Soil ` Nature of Repairs or Alterations(Answer when applicable) r t 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 issued by Board of Health. Signed Date l T Application Approved by —r Date & 2S U3 Application Disapproved for the following reasons Permit No. 2 bO 3 ' Z R Z— Date Issued (P 7-5 63 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(` ')Upgraded ') Abandoned( )by '�3 at 3`J" JCWP_6!�fil A*6e6 Y has been constructeMbcl ance with the provisions of Title 5 and the for Disposal System Construction Permit No. Z�3' Zg 2 dated �0 Installer ��/'i G' ir' Designer The issuance of his ermit s 11 not be construed as a guarantee that the system i s. e - e Date 7 d3 Inspector - -------------------------- No. `"'�/o�— 2?2 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mtq;poar *p!tem Construction Permit Permission is hereby granted to Construct( ) e air Up e6 )Ab ndon System located at �� tt .7 W 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:Constru ion in t be completed within three years of the date of this pe Date:_ CP 2 S O Approved by a TOWN OF BARNSTABLE LOCATION -J74'-4',9�'�" �i11� SEWAGE #-74No-'S 't VILLAGE ASSESSOR'S MAP & LOTo7d-v' -'�dp INSTALLER'S NAME&PHONE NO. 0T--,, N j SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS —� BUILDER OR OWNER63 PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching.facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by t` 1 ,4 i J a G t eL fN2 1-G t I ' w .M1� S YOU WISH TO OPEN A BUSINESS? �a =Yourformation: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which o by M:G.L-it does not give you permission'tdope.rate.] Business Certificates are available at the Town Clerk's Office, 1" FL., 367 t, Hyannis, MA 02601 (Tdwn Hall) " a�. = Fill in please: G� Sv3irwx APP UGANT'S YOUR NAME: ' � BUSINESS YOUR HOME ADDR SS: S y II ems. S 0,2�0-0 /• _._ ----- - TELEPHONE # Home Telephone Number NAME OF NEW.BUS•INES'S TYpE•t�.F Bl7SINE55. ---- IS THIS A 140ME 00C,PATION? ' Np.. - ADDRESS DE BUSI1VE55 S .riq��,y�r�� A- 'ji/S ':MAP/PARCEL-NUMBER_ a7;7 / qg When starting a new business there are several things you must do in order-to be in compliance with the rules and regulations bf the Town.of Barnstable. This form is intended to assist you-in obtaining the information you (nay need: You MUST GO TO 200 Main St, - (corner of Yarmouth Rd, & Main Street), to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM ISSI ER'S OFFI E This individ I h s qen inf . e f ny permit requirements that pertain to,this type,of busine�JST COMPLY WITH HOME OCCUP 4� RULES AND REGULATIONS. '� Authpr' tl i ture** COMPLY MAY RESULTIHF ESILURE TO COMMENTS: , 2. BOARD OF HEALTH This individual has b infTr ed of t ermit req ments that pertain to this type of business. Au rized Signatur COMMENTS: . AJa f-00 SN001110321AM=S'1b�12131HW Sf�O�o�b ; =Lt ltiy,�r .: n nn 3: CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature.** i ;rq ,I.i tCIAJ I COMMENTS: Dater / Z7 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: y 0 BUSINESS LOCATION: 5S s� '9 Gy ww �/`�� S INVENTORY MAILING ADDRESS: 'sue�''t TOTAL AMOUNT: TELEPHONE NUMBER: 22 y X3 ,gr 83>o 0 CONTACT PERSON: 24 190 P>1&f EMERGENCY CONTACT TELEPHONE NUMBER: �' SOB ��o ��� S MSDS ON SITE? TYPE OF BUSINESS: P/�z/ti i/ %g INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) . NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS . �,........,..A .f:.v .,,sV'�tY" .;: .,,lie..,f4li..Sz'. v. =Nl:. $....-- ,.. ,E. . •. Date: / 7 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: `` � `'''l ' INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: r� �`� u"3 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE.NUMBER: 7 G" 9 > MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: r.� Waste Transportation: /� Last shipment of hazardous waste: Name of Hauler- Destination: ' Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31 , of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public, Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants III Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW- - L- USED - - Any other.pro,ducts.with°poison".Iabetls, Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor & furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers. (including bleach) Spot removers & cleaning fluids (dry cleaners) ,l Other cleaning solvents ! ff �- • , �;,t L �� �� Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT Y CANARY COPY-BUSINESS Health Complaints 10-Jun-03 Time: 2:00:00 PM Date: 6/9/2003 Complaint Number: 4088 Referred To: DAVID STANTON Taken By: SAM WHITE Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name: Number: 55 Street: straightway Village: HYANNIS Assessors Map-Parcel: Complaint Description: She is moving, and is concerned that the organization is living in the house. there is some trash in the yard. She once saw them pour paint into the cesspool. Actions Taken/Results: DS WENT TO SAID LOCATION. NO ONE WAS HOME. NO TRASH WAS OBSERVED IN THE FRONT YARD. DS HAD RECENTLY CITED THE LOCATION FOR AN OVERFLOWING SEPTIC, AND AT THIS TIME, IT WAS NOT OVERFLOWING. SHE HAS ALREADY CONTACTED AN ENGINEER AND INSTALLER TO DO THE WORK, BUT IT HAS NOT BEEN DONE YET. NO ACTION REQUIRED, AS NO VIOLATION WAS OBSERVED. Investigation Date: 6/9/2003 Investigation Time: 3:55:00 PM 1 oFtHE 1p , Town of Barnstable X lJ Regulatory Services v MnSS. g Thomas F. Geiler,Director 9 o� i639• S[a� ire �0 /!8 639. " Public Health Division � "d U11-P�� F Thomas McKean,Director �d � p ro CC 200 Main Street, Hyannis, MA 02601 tll�`�^eef' �n I S9�(e�n� kvs� Office: 508-862-4644 Fax: 508-790-6304 May 22, 2003 Dilma Gomes PO Box 297 W. Yarmouth, MA 02673 NOTICE OF VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE The property owned by you located at 55 Straightway. Hyannis, was inspected on May 12, 2003 by David Stanton RS, Health Inspector for the Town of Barnstable, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code II - Minimum Standards of Fitness for Human Habitation: :w 105 CMR 410.300 AND 310 CMR 15.02 (207): Septic system is in hydraulic failure. Raw sewage has been observed going down the driveway and into the street towards the storm drain. 1) You are directed to hire a licensed septage hauler to pump the overflowing septic system within twenty-four (24) hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary (daily if need be)to keep it from overflowing onto the ground. 3) You are further directed to contact and hire a professional engineer to design a septic system, which meets local and state regulation requirements within fourteen (14) days of receipt of this letter in order to repair this system or connect to town sewer. 4) The newly installed septic system shall be completed on or before June 13, 2003. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. a: Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health $arnstable Assessing Search Results Page 1 of 2 Va ,r, — ". 31 ,}a S��I' h�'a�lix a o o-��•a; '` U. t Home. epartments Assessors Division. Property Assessment Search Results SS STRAIGHT WA Y Owner: GOMES, DILMA Property Sketch Legend Map/Parcel/Parcel Extension 267 /148/ Mailing Address . GOMES, DILMA PO BOX 297 ' W YARMOUTH, MA. 02673 y i Assessed Values: Appraised Value Assessed Value Building Value: $79,600 $79,600 Extra Features: $7,100 $7,100 Outbuildings: $0 $0 Land Value: $41,900 $41,900 Interactive Property Map: Map requires Plug in: Totals:$ 128,600 $ 128,600 I have visited the ma s before � - Show Me The Map ' April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: VIRK, SOM P 3/15/1990 7082/114 $ 1 P-DELTA, INC 9/15/1986 5287/310 $ 135,000 WHITE,JAMES E 1933/82 $0 GOMES, DILMA 6/24/1999 12359/325 $ 127,000 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $ 1,208.84 Town Fire District Rates Other Rates 9.40 Barnstable 2.88 Land Bank 3%of Town Tax Hyannis FD Tax $371.65 C.O.M.M. 1,54 Cotuit 1.88 Land Bank Tax $36.27 Hyannis 2.89 http://www.town.barnstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/Asse 5/22/03 Barnstable Assessing Search Results Page 2 of 2 West Barnstable 1.96 Total: $ 1,616.76 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 0.23 Year Built 1971 Appraised Value $41,900 Living Area 1276 Assessed Value $41,900 Replacement Cost$94,800 Depreciation 16 Building Value 79,600 Construction Details Style Raised Ranch Interior Floors CarpetVinyl/Asphalt Model Residential Interior Walls Drywall Grade Average Grade Heat Fuel Gas Stories 1 Story Heat Type Hot Air Exterior Walls Wood ShingleClapboard AC Type None Roof Structure Gable/Hip Bedrooms 3 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 2 Bathrooms Total Rooms 6 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value BRR Bsmt Rec Room 293 $ 1,200 $ 1,200 BGAR Bsmt Garage 1 $3,400 $3,400 FPL1 Fireplace 1 $2,500 $2,500 Property Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/Asse 5/22/03 r• ASSESSORS MAP NO: `p_C. `? / 6 PARCEL NO: C !X S? Fps... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTHHEALTH GCy�I...................O F.�<t�rls�lGbIP.-......... ApplirFatiou for Uiiivaa al Works Towarurtinn Prratit , Application is hereby made for a Permit to Construct ( ) or Repair (off) an Individual Sewage Disposal System at: /l // /1F�2?1.Pls............................ ............. -- L ation-A dress 4,ddress Lot No. 1....................... .................Gl� �7�Ui/.'�+r.... .......... rr11 Owner / �/ .--•-----------•..............................................•. •�•j6-..... .�►�� E}¢�P.!f.# ..........---•---• t.._ c/ Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures -----------------•----•------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0-4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ --•------------------------------ -••-----------------------•---.....----•------..........•-••.•••••.......................................................... ODescription of Soil........................................------------•-••-•--•-•-••-•--------------------------------------------------------...---------••----------------•-----------•- x U ---•-------------------------------------••----•---••--------------•-•-•-----•------.._.....-•-----------------------------•------------•-------------•---------------------------..._------------...._. ----•-----------•-•------------------------------------------------------------------------------------------------__-.,.I...-------------------------------•-•----- ------ ----------------------- U Nature of Repair or Alterations—An wer when applicableTMsi____ A4r.(`��.. q�!�Cf1Ad11L5.................... •l (.W1s129r q3 r �l Agreement: sl The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i1TL is 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been pis—sued by the board of health. Signed----, I IW/o'---------------------------------- 8.Rl...------. (/ Date Application Approved By---------•---4.0...v......... ----•--•-•------- i.7 Date Application Disapproved for the following reasons---- ------------------------•----------------------------------------------------------------------------------- --------------------•------••---••-------•------•••---------._...--------•-----------.........._.......•-------•------•------------------------------------------------------------------------••------ Date PermitNo.--•••-....3--7_-.4o.6..........--•-----.. Issued....................................................... Date NO._ Z-�2L ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF /HEALTH Crcu'� ....... .......OFGrn-ucbfc..-...-...................................................... Appliration for Disposal Works Tonotrnrtiun "rrmi# Application is hereby made for a Permit to Construct ( ) or Repair (V4 ) an Individual Sewage Disposal System at: t2L-of .....Z46LVI ............................. ---......._....----...----•--......-----------.._..__.._..._..........._...._...---•--•----------- Location-Address or, Lot No. 1. 7.. � lS J J .. v...../�P� Gdl! /S✓�i tJ)9/1l ------------------------^•---...---... Owner V I /Address U a I' jSo ��4/n � o Gins, l�Grn;✓ � ............... ---------------------....---..........._.._.........._f... Installer Address QType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms________________________________ _Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ______________ No. of persons._.______.____.____.____.___ Showers — Cafeteria Q' Other fixtures ...................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity............gallons Length................ Width----------------- Diameter__-__________.__ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----------------_-- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) PercolationTest Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Fz, Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water........................ ------------------------------------------------------------------•------------------------------------------------------------------------------------------ ODescription of Soil........................................................---•-•--•---------------------------•---------•--•---------•----.............................................. x V W --••---•••••----•-----------•---------------------- ..............................................-----•--------- ------- -----••---------------------•-------._...-•----••••---•---•-•--------------- U Nature of Repairs or Alterations—Answer when applicable-G 1 & _.ag a r-• �( - ry i e•l'ji is( 2.5:•_---_-_--•--_•--_-. Agreement: J The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITiZj 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed 1%,_._ cf? t -1a '2 / ---•----------------------------- -•�--�---"�--.�..------- H / -------------------Date--•- Application Approved By---•---•--•-••�`'•-.. -------- -- - -�- --------------------- .......... Date Application Disapproved for the following reasons-----------------------•--------------------------------------•------------------------------- ------------•-•-- -•..............•---•----..._•--------.._.....---------•------------•-------------•----------------•---•----•-•-------•--•---••- -----------•-•-------•---------•----•••-•-••-•-•------•--•----••_.._.._ Date PermitNo.--------. ��� ?�?-----------•----•--- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS qi` BOARD OF HEALTH / �(�(tJJ'1 QF .f"3�a�1{!n ifc:................................................... ........... .............................. Trr#ifirFa#r of Tnmpliaanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ✓) by ---•------ -------------------- •-----------•--•-----•----•----------•----........._....-----------------------•-----......------ Installer has been installed in accordance with the provisiol�of TITLZ 5 oiL'rhe State Sanitary Code as described in the application for Disposal Works Construction Permit No------ ... dated_............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................�._.' ----....__...._ Inspector............................. ...................................... - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Irat»e1.... OF.. :CMs �'_'P w-_...... NO.. � (y (O FEE... ................ Disposal Works TDnnstra ion rrmi# Permission is hereby granted............ ! � ........... -----••-•-•--•-------------------------------------------------------- to Construct ( ) or Repair ( 4 an Individu 1 Sewage Disposal System atNo.................-:------- ........ ' .-----`..:e..._- ------------------------------------------------------------------------------•- t�Street as shown on the application for Disposal Works Construction Per .t N 0 Dated.......................................... �-, --------•-._..._.. —__Boar_d of Health DATE................ ` a _w_�.,r FORM 1255 HOBBS & WARREN, INC., PUBLISHERS TOWN OF BARNSTABLE BAR-W 708 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager 01 1M4n t rY1/'S Address .of Offender t6l_ J&x _2q 7 MV/MB Reg.# Village/State/Zip / 74 ,2A'7? Business Name L1'w am/6m; on -c;- / 2O>) Business Address ifFix-y IV. AP Signature ofN^Enforcing Officer Village/State/Zip Location of Offense :5. fj� '! 11{ Enfotcieng DE�pat/Dyivlision Offense ,,an it R&f.^$114,ke Hr f1A ow, (4-r// (rrA�f'm Qrtk A/vs. �.r w .. fnt fkI Facts SpW.1h14 'AlkC-rtw^ �rrnn.e}r 011) 4 1AIA,-ell r A!d <4,,n.,A. L&- /1, �: 4Aor t sr"'f &)Ae I)r rj 'Its , u..AA0, 'tt IA! .ra o. m S f r/,IA✓`fill -t's� 11"IMA7 Cr j, le'bo This will sp' rvel only as Ja w'arnring. At this time ,no-legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. .' '�;. �f>`. r• .y �-�. IriF°�- Y,t,7�.,+g :3^^ '7,.ii. � > x°-•c.- n,y., .gin 3 ..,*sw , .. - x�,�.. . »- ++�j"'°'qt':!..� ,.. �«_t %' M "z a•� x sfi•-•-•;a- a,.....z � .R'�--� � -6. �,-9 TOWNf OF BARNSTABLE BAR-W £ ' Ordinance or Regulation + WARNING NOTICE Names of Offender/Manager Address of Offender 8ftV h 7 MV/MB Reg.# Village/State/Zip wU• �� ,, �,., ;' ,%b+'A ,/�,4 7? ,Business Name r�,t am/gym; on ; o20a 114 Business Address ' v_ Signature of- Enforcing Officer Village/State/Zip ( +fir #,�i.•'?r At Location of Offense . ;.J ,;,. � , t.akA. �*ry '� 4f4U/ 1�j �� �p�t` rry E�jnfotciing Detp�t/Division Offense 1. red + t Pa{P4 r ! f ( i� i+ d��r �f aAd t 4A?, � 1 m x"�l,t. iaT i � t�rf LA ,�tv 1. ...y,.. f Facts SarojA#t � sr$,.rti r�, n r, c�,, ;,fin:rl� I r) n� n- r!�� ..<• ,, 44Vol ;�. �f f f) .f 0 A,— t_ . kiT 2.�! This Twill servel only as ?a warning. At this time no' legal action has .been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. Health Complaints 13-May-03 Time: 1:45:00 PM Date: 5/12/2003 Complaint Number: 4029 Referred To: DAVID STANTON Taken By: DAVID STANTON Complaint Type: TITLE V SEWAGE Article X Detail: Business Name: Number: 55 Street: straight way Village: hYANNIS Assessors Map-Parcel: Complaint Description: sewage going into street/storm drain Actions Taken/Results: DS WENT TO SAID LOCATION. THERE WAS LIQUID PRESENT COMING FROM THE FRONT YARD, AND HEADING TOWARDS THE STORM DRAIN. A WARNING NOTICE HAS BEEN MAILED, STATING TO PUMP THE SYSTEM AS OFTEN AS REQ'D TO PREVENT BREAKOUT. Investigation Date: 5/12/2003 Investigation Time: 4:00:00 PM Barnstable Assessing Search Results Page 1 of 2 4 ref ,; . 1 � i s ? Wol . ten.. Home: Department3 ssessors Division: Property Assessment Search Results ' SS STRAIGHT WA Y Owner: GOMES, DILMA Property Sketch Legend Map/Parcel/Parcel Extension 267 /148/ Mailing Address GOMES, DILMA sE PO BOX 297 , W YARMOUTH, MA. 02673 Assessed Values: Appraised Value Assessed Value Building Value: $79,600 $79,600 Extra Features: $7,100 $7,100 Outbuildings: $0 $0 Land Value: $41,900 $41,900 Interactive Property Map: Map requires Plug in: Totals:$ 128,600 $ 128,600 I have visited the maps before Show Me The Map , ! ] April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: VIRK, SOM P 3/15/1990 7082/114 $ 1 P-DELTA, INC 9/15/1986 5287/310 $ 135,000 WHITE,JAMES E 1933/82 $0 GOMES, DILMA 6/24/1999 12359/325 $ 127,000 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $ 1,208.84 Town Fire District Rates Other Rates 9.40 Barnstable 2.88 Land Bank 3%of Town Tax Hyannis FD Tax $371.65 C.O.M.M. 1.54 Cotuit 1.88 Land Bank Tax $36.27 Hyannis 2.89 http://www.town.barnstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/Asse 5/12/03 Barnstable Assessing Search Results Page 2 of 2 West Barnstable 1.96 Total: $ 1,616.76 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 0.23 Year Built 1971 Appraised Value $41,900 Living Area 1276 Assessed Value $41,900 Replacement Cost$94,800 Depreciation 16 Building Value 79,600 Construction Details Style Raised Ranch Interior Floors CarpetVinyl/Asphalt Model Residential Interior Walls Drywall Grade Average Grade Heat Fuel Gas Stories 1 Story Heat Type Hot Air Exterior Walls Wood ShingleClapboard AC Type None Roof Structure Gable/Hip Bedrooms 3 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 2 Bathrooms Total Rooms 6 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value BRR Bsmt Rec Room 293 $ 1,200 $ 1,200 BGAR Bsmt Garage 1 $3,400 $3,400 FPL1 Fireplace 1 $2,500 $2,500 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area (Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.barnstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/Asse 5/12/03 • • .d -Ir• 30. 1 M 3� .,• • i� 1 l�,• 4 {� Rf "� �" Ik�F r4EF�rr� ��, � 11 tA� t `�,[a i. sv 1 1 �[ �� •a,i� i ��. ,�Jli i ���F,~t! ,�ifi § 4Pt r� t r i�x�f� � i ., e r .� ��i� ��'�r �►:�� �� k�. #� `�4' [�°Mbf �'' � ';,� 1;�: l � �� �it rk 111 a�l. 4nna111"""��„ tf o- i {., + } 1.. �!� e MI at i - 1 [r ICI 1 G, ""$44 �a t i4yk� E OltIl € . ��4i#'i 4 YI 'TV ��fT I NIL, A ## U. � r ! € i AID ' 'r"i," itl,+ r��• ,t I '�' t� � oafI ' � d i l 4t 1 jfAI 'i' yy ;I, l '�� .� �i �,� �1 Ly � �6� L� • hhgg i f 1'i t f 1 , i � ���I�' � .:s urt �'. �� i� t �i 1 AP ? ��1 �� 9`• >� f4 ��}{�at ,�� ��•� �[5.i 3(i [d�A ► SOIL TEST TOP OF FOUNDA,7ION 20 FT. MINIMUM FRAM CELLAR 10 FT. 'MINIMUM FROM SLAB OR CRAWL SPACE DATE OF SOIL TEST ELEV. 1,00�00_ 10, FT MINIMUM -� CLEAN SAND SOIL TEST DONE Eli � Et� {Ef31ttG WITNESSED BY -------------_ (AS$VMED) CONCRETE COVERS INSPECTION. PORT OBSERVATION HOLE 1 ELEV.=__92.00 4 SCHEDULE 40 PVC PIPE LOAM AND SEER MEN. PITCH '1/8"' PER FT, PERCOLATION RATE _ <`�__ MIN,/INCH AT _,_ 30 __ INCHES 1 LA'�ER OF DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 9.04 1 f8:. TO 1/2" 4 CAST IRON PIPE 83.40 WASHED STONE VENT (OR EQUAL) MINIMUM . , ,� SLAB ELEV: = �_ $1 15N NOT REQUlRD t) 8 A LOAMY SAND 10YR4/1 NO "' PITCH 1/4"" PER FT. LEGEND: SLEEVE' iiE. EXISTING SPOT ELEVATION X0.0 FLOW LINE s ELEV. - *54 -144 C MEDIUM SAND `lOYRZ/4 �.� � `� ----- EXISTING CONTOUR ----QO---- Y 9�r FINAL SPOT ELEVA�0 , ELEV, - 10 0 ° o FINAL CONTOUR MIN. _ 510.30 ?E 0 - 1tI, 0 SOIL TEST LOCATION ELEV. - �--- L 'jEL a p�►Rr, I ELEV. - 89'07 UN UTILITY POLE 6., SUMP ° �, �a u. �_, a - -.-----_ ELEV. = _ZYxYY_ ELEV. = - 5_ ELEV = _ m 0 0 0 ° 0 0 0 0 0 o c _ TOWN WATER �W W BAFFLE DISTRIBUTION ° ° ° GAS. 0 0 0 0 0 0 0 014» > 0 0 $7, CATCH BASIN ELEV. ° v ° a .0 0 a o° o 0 0 0 0. 0 o ELEV. ___-_ GAS LINE G _ LIQUID OUTLET rt _flQ.1?4_ 0 BOX CESSPOOL PP QER,ld TEE 4 FEET 14 INCHES (TO BE PLACED ON FIRM BASE) TO BE WATER TESTED CLEANOUT -- �" C.O. 5 FEET 19 INCHES IF MORE THAN ONE OUTLET 4 HIGH CAPACITY INFILTRATORS WITH 6 _FEET 24 INCHES 1500 GALLON STONE: IN AN WELL N �_ ELEV. = _85.50_ NO WATER ENCOUNTERED AT __.1_44"_ ELEV. 7 FEET 29 INCHES (TO BE PLACED ON FIRM BASE} 8 FEET 34 INCHES SEPTIC TANK11' X 30' X 2' TRENCH FORMATION' 'ZONE 3/4" TO 1 1/2'" CLEAN C� t� -� � INDEX DOUBLE WASHED STONE SOIL +ABSORP I ION { ADJUST-- FREE �+ OF FINES & SILT SYSTEM JTEM SAS d DESIGN CALCULATIONS NUMBER OF BEDROOMS 3 SEWAGE DISPOSAL. SYSTEM PROFILE � GARBAGE *DISPOSAL UNIT NOT TO SCALE TOTAL ESTIMATED FLOW USGS 'PROBABLE WATER TABLE ELEV. = --__.-- ( 110 GAL../BR./DAY X 3 BR.) _. GAL./DAY OBSERVED WATER' TABLE ( / f } ELEV.. ----- REQUIRED SEPTIC TANK CAPACITY -4 GAL. BOTTOM OF TEST HGLE--ELE V. = �� _ ACTUAL SIZE OF SEPTIC TANK GAL. SOIL CLASSIFICATION DESIGN PERCOLATION. RATE _ MIN,/IN. EFFLUENT LOADING RATE Q _ GAL./DAYfS.F. LEACHING AREA .MPQ SQ, FT. (lOX30)t(44X2X4) LEACHING CAPACITY F(AREA X RATE) 44Q4Q GAL./DAY 460.00 X 0.74 RESERVE LEACHING CAPACITY NONE GAL./DAY NOTES:, 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN'S RULES AND REGULATIONS FOR THE i Q �41.9 I SUBSURFACE DISPOSAL OF SEWAGE. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO _ 85:0 WITHIN 6° OF FINJSHED GRADE, �1 3. ALL COMPONENTS OF THE SANITARY SY,3TEM SHALL BE CAPABLE OF y �1 WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 89.8 88 6 �i 10 FT, OF DRIVES OR PARKING AREAS. H-20 LOADING,SHALL BE .©0' �\ 40 MIL VINYL' , USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS, 1 11NER 4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE: SHALL BE I r' MORTARED IN PLACE. O0' 1 5, NO DETERMINATION ,HAS BEEN MADE AS TO COMPLIANCE- WE IFi f ,,-'• DEEDED OR ZONING REGULATIONS, OWNER / APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY, lf1 QOOT f'S,F. 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION 7 �85.7 CONTRACTOR IS TO CALL DIG-SAFE" AT 1 �888-344-72 3 D. BOX 85.7 �' AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE. x 99.7 \ I �o' 7. CONTRACTOR IS TO VERIFY GRADES ANi7 ELEVATIONS AS WELL a � � 95 41 rr AS SITE CONDITIONS PRIOR TO COMMENCING.WOOk ON SITE. % ANY VARIATION IS TO BE BROUGHT 'TO THE ATTENTION OF 92.0 --{ THE DESIGN ENGINEER IMMEDIATELY. \ fj SOST 8. PARCEL IS IN FLOOD ZONE _ _�__ 9. LOT IS SHOWN ON ASSESSORS MAP _Z$Z.;�, AS ;PARCEL . �. 10, ALL EXISTING -SEPTIC FACILITIES ARE TO BE PUMPED AND REMOVED. 11. A 40 ML VINYL LINER IS TO BE INSTALLED !WERE SHOWN. IT IS # fi ~"� ca STEPS 94 0 /, REQUIRED DUE TO THE, CRACKS IN THE EXISTING RETAINING WALE;. . 4 4 SN OF U4 12. PROPERTY LINE INFORMATION FROM A PLAN BY ROBERT G. MCGLONE 1�v00 GALLON �C DATED 'APRIL 12, 1971, 1 0 , 9"6 SEPTIC TAN 1. 85.9 z� � 13. SEPTIC WASTE LINE FROM HOUSE TO SEPTIC TANK IS TO BE SLEEVED I (. p. INSIDE A 150 PSE PRESSURE PIPE. N rLk w 1 o Dl1MA S �4 ' 92.71000 G�LLON1l '` " No APPROVED: R BOARD p c /� ` SEPTIC' TANK ` 1+ AP'P.RO D: 6:OARD 0�1 -HEAL. 1 M /DRIVE q 88,7 G F� 95.5 0. ITAR ,- ;4 86:3 95. , CHAT AGENT moo¢, � 90 1.9 x 91.1 i f 95G4 ,9Z �.� `\ � �'RtJPC1S�D SEPTIC =T}E I �t hf \ B KFILL FOR ��`'�1t ,jam!� , 86.9 LOCUS � �� �.T0 �7 tQ©.OPT 7 LOC. 5 s y IiYANI�CIS, BATAB , � SS r9'1tii TMGHAT �STERN ROAD SMrry sr 508= 713 9873922 SOUTH `DENNiS, MASS, Q�6�0 DATE ' SCALE :: P iA Y 2a 200 3 1 2,0' A _ REV JuNE 4, 2003, NO, 17Q-goo LOCATION MAP ( REV SHEET i O� 1 C S8 77 5E�+0-5 dW 5690 ,QO:DWG Ci20C13 ;SWEET.$,k E-,GINEI IN