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HomeMy WebLinkAbout0026 BISHOPS TERRACE - Health E Bishops Terrace nis 251 215 I` 5 i ,f �F I p f r ! V `I d I 'V A 1 i t TOWN OF BA.RNSTABLE � t O �1 LOC ,1. O�i- Rua t_� SEWAGE # VILLAG ASSESSOR'S MAP & LOT ZS Z INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY NY) S LEACHING FACILITY: (type) LIMAW-t (size) P7 ���� NO.OF BEDROOMS BUILDER OR OWNER 1 PERMITDATE: 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 L ��� 7P o vo 04 Cob Z 4 T J TOWN OF BARNSTABLE �. LOQATION:�! 6'sA'pl ter-eloce< SEWAGE # ozDaa-ya z VILLAC-E ASSESSOR'S MAP & LOT ,)SI— !CIS INSTAU R'S NAME&PHONE NO. C&Oc O SEPTIC 1 ANK CAPACITY LEACHING FACILITY: (type) 11A CZ (size) NO,OF BEDROOMS BUILDER OR OWNER t Pi';RMIT DATE: 9 u u COMPLIANCE DATE: e U 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 r II ! 130q. Date Received: Date ecei�ed Permit No. Or) Date Owner /�/ (�L1�%I1�✓h Address Engineer ` Installer A.B. CANCO - 775-2800 Inspected by Date t1 UPGRADES/ALTERATIONS 1 III 7`� ©, s 11 } 'd N v TOWN OF BARNSTABLE LC ::TION �, L�PS�c��� ''r"e.t��ct C- SEWAGE # VUJ.AGE 6S ,Ma ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. tk-S P<.r—1,i®n SEPTIC TANK CAPACITY 10.00 G ct%10 t1 s LEACHING FACILITY: (type) 10 Qc� (size) Q a o nA !40.OF BEDROOMS 1XILDER OR OWNER Q,-e:TCe(� zERMIT 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 , o t . TOWN OF BARNSTABLE � / LOCA=csJN �� �•'S4� /s e/I-- SEWAGE# VIL LAGS46i ASSESSOR'S MAP&LOTAE 'a/S INSTALLER'S NAME&PHONE NO. SEPTIC_TANK CAPACITY MOO LEACHING FACILM- (type) P (size) ,000 w NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 Ieaching facility) y' o� Feet Furnished by '✓"� �y���� � Gl„(®f'� ��� �9�'r va � 7 ' 005 O � f's� n t C7a ; ,'I' 1 1 �� R, � ^ � r W � G � b� � � � � 1 � I • � Q � f� W SZJ Pv .., �. Commonwealth of Massachusetts Y F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,M 26 Bishops Terrace - Property Address . Mike Santos Owner: Owner's Name information is required for every. Hyannis Ma 02601 4/1.2/13 page. Clty(Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information - filling out forms on the computer, use.:only the tab 1. Inspector ...... - key to move your cursor-do not... Matthew Gllfoy.. use the return: key. Name of Inspector B & B Excavation,Inc. reD:... .. Company Name 14 Teaberry Lane Company Address Forestdale :. MA::. 02644 City/Town State Zip Code 508-477-0653 $113640 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 a Title 5(310 CMR 15.000). The system: p U J ® Passes. ❑ Conditionally Passes ❑ Falls 22 w Needs Further Evaluation by the Local Approving:Authority 5 4/12/13 Inspector's Signature... .. Date v rn The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the.system owner shall submit the... report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to.the buyer, if applicable, and the.approving:authority- This report only:describes conditions at the time.of inspection and under the conditions of use at that time..This inspection does.not address how the system.will perform in the future under - the same or different:conditions:of use. : ::: - t5ins•11/10,: Title 5 OfficiVinpectiobsurface Sewage:Disposal System Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 26 Bishops Terrace Property Address Mike Santos Owner Owner's Name information is required for every Hyannis Ma 02601 4/12113 page. City/Town State Zip Code Date of Inspection ,B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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 FIND(Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 26 Bishops Terrace Property Address Mike Santos Owner Owner's Name information is required for every Hyannis Ma 02601 4/12/13 _ page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 26 Bishops Terrace Property Address Mike Santos Owner Owner's Name information is required for every Hyannis Ma 02601 4/12/13 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-11/10 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 26 Bishops Terrace Property Address Mike Santos Owner Owner's Name information is required for every Hyannis Ma 02601 4/12/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No El 1K Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts ti, W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 26 Bishops Terrace Property Address: ... Mike Santos Owner Owner's Name information is Hyannis Ma 02601 4/12/13 required for every. y page. City/Town --- -State ...:Zip Code Date of Inspection C. Checklist Check ifahe following.have been done. You must indicate":yes" or"no":as to each of the following: Yes . No I L ❑ ® Pumping information was provided by the owner, occupant, or Board of Health i i ❑ N Were:any of the:systern components pumped out in the previous two weeks? I. 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 El ® this inspection? Were.as built plans of thesystem obtained and.examined?(If they were not.::::. ❑ ® available note as N/A) Was the.facility or dwelling inspected for.signs of sewage back, up? Z El 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).::: 2 Number:of bedrooms (actual)-. 2 DESIGN flow based on 310 CMR 15.203,(for example: 110 gpd x#of bedrooms): .. 220 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 26 Bishops Terrace Property Address Mike Santos Owner Owner's Name information is required for every Hyannis Ma 02601 4/12/13 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage n/a 9 ( Y 9 (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: t5ins•11/10 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 ;M 26 Bishops Terrace Property Address Mike Santos Owner Owner's Name information is Hyannis Ma 02601 4/12/13 required for every - Y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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 stem P Y ❑ 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Bishops Terrace Property Address Mike Santos Owner Owner's Name information is required for every Hyannis Ma 02601 4/12/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10feet Comments(on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in working order no sign of leakage or blockage. Septic Tank(locate on site plan): 6" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ® No Dimensions: 1000 gal Sludge depth: 6" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 f Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 26 Bishops Terrace Property Address Mike Santos Owner Owner's Name information is required for every Hyannis Ma 02601 4/12/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? scour stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection tank appears to be stucturally sound no sign of backup. 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 26 Bishops Terrace Property Address Mike Santos Owner Owner's Name information is required for every Hyannis Ma 02601 4/12/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition.of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 26 Bishops Terrace Property Address Mike Santos Owner Owner's Name information is required for every Hyannis Ma 02601 4/12/13 page. CityrFown 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.): no d-box Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 26 Bishops Terrace Property Address Mike Santos Owner Owner's Name information is required for every Hyannis Ma 02601 4/12/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appears to be in working condition. No sign of hydraulic failure.Water level was 3'8" below invert. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 26 Bishops Terrace Property Address Mike Santos Owner Owner's Name information is required for every Hyannis Ma 02601 4/12/13 _ 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.): I t5ins•11/10 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 ;M 26 Bishops Terrace Property Address Mike Santos Owner Owner's Name information is required for every Hyannis Ma 02601 4/12/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately [A q� =�o. �;` 3� a2 = � 3: ;P G 33 =3�, t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 26 Bishops Terrace Property Address Mike Santos Owner Owner's Name information is required for every Hyannis Ma 02601 4/12/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells i Estimated depth to high ground water: 20 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: topo maps/town gw contour maps 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: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 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 e° 26 Bishops Terrace i GSM Property Address Mike Santos Owner Owner's Name information is required for every Hyannis Ma 02601 4/12/13 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 v � Certified Mail#7012 1010 0000 2850 7831 Town of Barnstable o� Regulatory Services BARNSTABM Thomas F. Geiler, Director 9 MAM Public Health Division Thomas McKean, Director, 200 MainrStreet, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 29, 2013 Mike Santos I 4830 Route 28 +� Cotuit, MA 02635 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 26 Bishops"Terrace, Hyannis, was inspected on March 19, 2013 by Timothy O'Connell, R.S., Health Inspector for the Town of Barnstable. The inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.500 —Owner's Responsibility to Maintain Structural Elements. Top row of basement steps within bulkhead area not secure. Basement door at bottom of stairs does not lock. 105 CMR 410.300—Sanitary Drainage System Required. You have not complied a with Town of Barnstable Board of Health conditions set forth in a letter dated September 8, 2010 which was mailed to you. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by correcting above violations; by compiling with Barnstable Board of Health. See enclosed letter. 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. Non-compliance will result in_a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. QAOrder IetterAHousing violations\Rental ordinance\26 Bishops Terrace 3-29-13 x r =McKean, OARD OF HEALTH CHO Director of Public Health Town of Barnstable i Q:\Order letters\Housing violations\Rental ordinance\26 Bishops Terrace 3-29-13 e ' °fsr " Town of Barnstable Barnstable BAWWABLE, 9� i�"j i 6 . ,�� Board of Health AjED""p�A 200 Main Street, Hyannis MA 02601 I I 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 JunichiSawayanagi Paul Canniff,D.M.D. September 8, 2010 Michael Santos 4830 Falmouth Road Cotuit, MA 02635 RE: 26 Bishops Terrace, Hyannis A = 251 - 215 Dear Mr. Santos: You are granted permission to continue to utilize the onsite sewage disposal system located at 26 Bishop's Terrace, Hyannis with the following conditions: (1) You shall hire a DEP certified septic system inspector to conduct annual inspections of this system during the next three years. (2) If this property is sold anytime within the next five (5) years (between June 8, 2010 and June 8, 2015), the buyer shall be informed of the inspection report and failed system status. This system shall be replaced with a new septic system in conformance with the State Environmental Code, Title V, and local health regulations. (3) Before this property is rented in the future, the owner shall register the rental dwelling unit with the Public Health Division. According to the septic inspection report dated 4/17/08, this system "failed" inspection. The inspection report noted a high water stain in the leaching pit. However, according to the homeowner, the system did not fail. When the plumbing pipes broke, the water drained into the basement shower drain and filled the leaching pit at that particular time. Sincer yours, Wayne iller, M.D. Chairm n Q:\WPFILES\26 Bishops Terrace MSantos Ju120IO.doc r I i EXCERPT FROM THE FEBRUARY 9, 2010 , BOARD OF HEALTH MEETING: I. Hearing — Septic Failed (Cont.): A. Michael Santos, owner— 26 Bishops Terrace, Hyannis, Map/Parcel 251-215, septic failure. Michael Santos was present and stated the unit is a rental. Mr. McKean pointed out the unit is not registered as a rental with the Town. Mr. Santos said he did not realize there was'a rental registration requirement in the Town and he will be happy to register his properties with the Town. The re-inspection of septic shows it now passes. The original inspection had noted that there was a high water stain in the SAS. Mr. Santos believes that when the heating pipes broke, it pumped a lot of excess water into the system and caused the high water mark. Dr. Miller asked Mr. McKean what would be the item monitored. It is due to be pumped. Mr. Santos recommended that yearly as he pumps it, a note be made of the high water mark to monitor it. Dr. Miller said that he would like it done more frequently that yearly. Mr. Santos said as soon as weather permits, he can have it dug up so the Board can view the water line themselves (the State requires the Board to personally view it when they accept a passed inspection after a failed system is on record. Upon a motion duly made by Mr. Sawayanagi, seconded by Dr. Can niff, the Board voted to Continue to April 13, 2010 BOH and there be a site visit by the Board members in April prior to meeting. (Unanimously, voted in favor.) Crocker; Sharon From: Crocker, Sharon Sent: Wednesday, May 05, 2010 12:30 PM To: u nniff(canniff.paul@gmail.com); McKean, Subject: 26 Bishop's CTerra=. I spoke with Dr. Miller. He is available the following dates: Wed - Fri May 26, 27 or 28 or Mon Jun 7 Please let me know if you are available for any of these d or a s' visit to locate. Would like to set time up so the visit can be finish by 3:45 pm. Thank you. ► 5 � 3 1,--3 Town of Barnstable. �pftHE 1p�� Board of Health ` ► BARNSrABLE, # 200 Main Street - Hyannis MA 02601 MASS. 039. pTfD MA't p Agreement to Extend Time Limit for Acting Upon a Variance Request In the Matter of a variance request form received on the Petitioner(s), C regarding the property at the petitioner(s) and the Board of Health agree that the Board of Health ha until (insert date)to act upon the Petitioners'completed application for a variance. In executing this Agreement, the Petitioner(s)hereto specifically waive any claim for a constructive grant of relief based upon time limits applicable prior to the execution of this Agreement. Petitioner(s): Board of Health: r Signature: Signature: Petioner(s)or P ti i r s Representative Chairman ti Lte: /�/(C /r Print: Wayne Miller, M.D. L�(o Date: Petitioner(s)or Petitioner's Representative Town of Barnstable Board of Health Public Health Division 200 Main Street Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508) 790-6304 file q:extend.doc 3 Town ®f Barnstable - Board of Health BA MASS.ass. ' 200 Main Street - Hyannis MA 02601 0 1639• ArfO MA't A Agreement to Extend Time Limit for Acting Upon a Variance Request In the Matter of a variance request form received on 1p ® % the Petitioner(s), ' Cn regarding the property at the petitioner(s) and the Board of Health agree that the Board of Health has until (insert date)to act upon the Petitioners'completed application for a variance. In executing this Agreement, the Petitioner(s) hereto specifically waive any claim for a constructive grant of relief based upon time limits applicable prior to the execution of this Agreement. Petitioner(s): Board of Health: Signature: �epresentaffve— Signature: Petitione6�rs) Chairman Print: /i4,1 �P. Print: Wayne Miller, M.D. Date: S / /(,� Date: Address of Petitioner(s)or Petitioner's Representative Town of Barnstable Board.of Health Public Health Division 200 Main Street Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508) 790-6304 file q:extend.doc er d • Excerpt from the Board of Health Minutes on November 10, 2009: A. Michael Santos, owner`26 Bishops Terrace, Hyannis,-Map/Parcel 251-215, septic failure. Michael Santos, owner, summarized. The owners had.not disclosed the septic inspection at the time of the closing. He received notice two months ago from the Health Division and this was the first he had heard of it. The house was abandoned in Jan 2008 and water was not shut off and the pipes burst and Mr. Santos believes this caused the failure. Mr. McKean reviewed the files and found there is an earlier report in 2004 showed the level was getting higher. Upon a motion duly made by Junichi Sawayanagi, seconded by Susan Rask, the Board voted to Continue until December 8, 2009 meeting and Mr. Santos will have an inspection report done prior to that for the Board to evaluate. (Unanimously, voted in favor.) Excerpt from the Board of Health Minutes on December 8, 2009: II. Hearing — Septic Failed (Cont.): Michael Santos, owner- 26 Bishops Terrace, Hyannis, Map/Parcel 251- 215, septic failure. Mr. Michael Santos was unable to make the meeting and hoped for a continuance. The Board had requested a septic inspection be done. The recent inspection was reviewed at the meeting. It stated the system passed. A prior inspection in 2004 had showed the level in the leaching pit was at 4 feet and the pit is 6 feet in total. Mr. McKean expressed concern that the system was showing signs of age at that time. Dr. Miller requested it continue to be pumped and would like the following information: 1) what is the zone the lot is in, 2) what is the anticipated use of the building, 3) is sewer anticipated in the area soon. If the unit is to be used for rental, the septic may likely endure heavy use. Upon a motion duly made by Mr. Sawayanagi, seconded by Dr. Canniff, the Board voted to Continue to the January 12, 2010, Board of Health meeting. (Unanimously, voted in favor.) DEC-8-2009 03.:31P FROM:RIDGE REALTY 5084283140 TO:615087906304 P.2/16 Dec 08 2009 4:24PM PHTRICK OCONNELL 5084281613 p. 1 Commonwealth of Masomhusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foam-Not for Voluntary Assessments 2e Bishops Terrace Properly Addntas Mike Santos owrrr Ownses Name require foron Hyannis MA 02W1- November23,2009 required for - *V"pspe. Ctyrrown at" Zip Cods Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be sltsrsd In any way. Map n fillirg out A. General Information horns on the Computer,use 1. lnspector: only the lab key to"we yor do not Patrick M.O'Connell tau use the return Nerve of Inspector key. Septio Inspection Services Co. Company Name VQ 189 Comrnelt Road Company Address Marstons Mille MA 02"8 Cih►lrwm state ap cod. 608-428-1779 St 12855 Telephone Number l:Icarm Number B. Certification certify that 1 have personally Inspected the sewer 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 pertbmled based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system Inspector pursuant to 8600n 18.340 Of T109 5(310 CMR 16.000).The system: ® posses ❑ Condl iwWy Posses ❑ Falls ❑ Needs Further Evalu Von by the Local Approving Authority 2 co November 23,2009 _ pector' ignmure nets 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 this 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 appropAate regional oftioe of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the appraAng authority. "'"This report only descrlbss 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. 01-M SAMUdee•ONO TO 6 Oh l IMP C11en FOW SUbP M awra•DIRM r8y AM•FSW 1 d tS DEC-8-2009 03:31P FROM:RIDGE REALTY 5084283140 T0:615087906304 P.3/16 uec U" tuu:J 4:Z4PM PRTRICK OCOMMELL S004281613 p,.2 Commonwoo th of Massachusetts Title 5 Official Inspection Form Subsurface Sou"o Dlspasat Systom Form-Not for Voluntary Assessments 26 Bishops Terrace ProMrq Address Mike Santos Owner Owner's Name — Inf neflon li n*lredfor Hyannis MA 02601 November23.2009 every Page. cayrrown of ft Zip C de D9W or Inspedion S. Certification (cunt.) Inspection Summary:Check A,B,C,D or E 1 always complete all of Secdon D A) System Passes: IN I have not found any information which Indicates that any of the failure criterial described in 310 CMR 15.303 or In 310 CMR 15.304 exist.Any failure criteria not evaluated we Indicated below. Comments: Tank is not In need of pumping at this time,leaching pit had 2'of stendinit water at time of Inspection. 8) System Cendidenalty Pansies: ❑ One or more system components as described In the'Conditfonal Peas section need to be. replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will peas. Answer yes,no or not determined(Y, N.ND)In the❑for the foiloWing 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,exhibit*substantial infiltration or extiltration or tank failure Is Imminent, System will pass fnspection if the existing tank is repleced with a complying septia 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 or break out or high static water level in the distrlburm box due to broken or obstructed plpe(s)or due to a broken, settled or uneven dkgribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(*)are replaced ❑ obstruction Is removed 09aa6 91a�,E00.0� TIUi6 OIRMI Irnp�Glon Face BuYRafw i��d�pont 8y71M�•Ypa 2d f6 DEC-8-2009 03:32P FROM:RIDGE REALTY 5084283140 TO:615087906304 P.4/16 lien UB 2008 4:24PM PRTRICK OCOMMELL 5084281613 p. s Comrnonwonith of Massachusettts Title 5 Official Inspection Form Subeur►ece Sewage Disposal 8ysbm Porn-Not/or Voluntary Assessments 26 81ahops Terrace PMP"Address MI ke Santos Owner owners None information to required ror Hyannis MA 02601 November 23,2000 evens+Pap, citylrown stab Yip Code Date orinspedim — B. Cordfleation (cant.) 8) System Conditionally Prices(conL): ❑ C11180 twtlon box Is leveled or replaced NO 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 appmvel of the Board of Health): ❑ broken pipe($)are replaced ❑ obstruction is removed NO Explain: C) Further Evaluation Is Required by the Board of Health: ❑ Conditions exist which require further evaluatlan by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. I. System vrlll past unless Board of Health detsnnlnes In accordance with 310 CMR 15.303(1 xb)that the system Is not functioning In a mannerwhlch will protect public health, safety and the environment: ❑ Cesspool or privy Is vAthfn 50 feet of a surface water ❑ Cesspool or privy)a within 110 Meet of a bordering vegetated wetland or a ask marsh 2. System will fall unless the Board of Me"land Public Water Supplier,If any) detsrnhines that the system is functioning In a manner that protects the public health, safety and environment: ❑ The system has a septic tank and roll absorption system(SAS)and the SAS is within 100 That of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank end.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 Nast of a private water supply wail. ��� �•06� Ift 6 of at kepwkn Pomr.Ouhsuffmo 6MMO 01*000 SpWn.Pop 3 d 16 DEC-8-2009 03:32P FROM:RIDGE REALTY 5084283140 TO:615087906304 P.5/16 lies UH 2,009 4: 24PM PATRICK OCONNELL 5084281613 p.4 Comrrtonviroalt h of MassachustirsMtl< Title 5 Official Inspection Form Subsurface Sewage Dispoeel 6ysbm Form-Not for Voluntary Assessments 28 Bishops Terrace Property Addr+ew Mike Santos Owner Ownsea.Name — Infamilon Is requlred for Hyannis MA 02601 November 23,2009 ev"pNA. Cilyfrwn State Ztp Code Drte of Inspection B. CertMcation (cont.) - C) Further Evaluation Is Required by the Board of Health(cant): ❑ The system has aseptic tank and'SAS and the SAS islets than 100 het but 50 feet or more from a private water supply well". Method used to determine distance; "This system passes H the well water analysis,performed at a DEP certified laboratory,for collform bacteria Indicates absent and the presence of ammonla nitrogen and nitrate nitrogen Is squat 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 1!LVA lndkmte "Yee"or"No"to each of the following.for ia Inspections: Yes No ❑ ® Backup of smogs Into facility or system component due to overloaded or dogged 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 60 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 plpe(s).Number of umea pumpetl: ❑ ® 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. 0 irr0oi•tloC'a� Tills Offs"ImpMcdonf ra&ftjf A UmMe CUpwim SyMem-Fm d15 DEC-8-2009 03:33P FROM:RIDGE REALTY 5084283140 TO:615087906304 P.6/16 uec oe 2,009 4s24PM PATRICK OCONNELL . 5084281613 p.5 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage 01spossl system Form-Not for Voluntary Assessments 26 Bishops Terrace Praperry Adrness Mike Santos Owner Owners Nsms tnkmolbn a Hyannis raqulmd for AAA 02801 November 23,2009 awry Page. Q4'Ram to Zip Code Date of Inspection B. Certification (cost.) 0) Syatsm Failure CriEer s Applicable to All Systems(coat.): Yes No ❑ ® Any portion of a cesspool or privy Is within a Zone i of a public well. ❑ ® Arty 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 then 50 feet from a private water supply well with no acceptable water quality analysis (Thie system passes If the well water analysis,performed at a DEP cartifled laboratory,for fecal caliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 15 ppm, provided that no other failure criterte are triggered.A copy of the anatyale and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 20000pol- 10,000gpd. ❑ ® The system WI&I have determined that one or more of the above failure criteria exist as described In 310 CMR 16.303, therefore the system falls.The system owner should contact the Board of Health to determine what wilt'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 al 10,000 9Pd 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 surfsoe 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 Mllhead Protection Area—itJIfPA)or a mapped Zone II of*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 lsrye system considered a significant threat under Section E or failed under Section 0 shell upgrade,the system In accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. crease eame..doe•osoe Talre**W r y bn Poem:SubstdwA Some onpmA ewftn-Pepe A a i6 DEC-e-2009 03:33P FROM:RIDGE REALTY 5oe4283140 TO:6150e7906304 P.7/16 Uea utr cuua 4.CirPt PHTRICK OCOMMELL 5084201613 P.6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 26 Blsho_ps Terrace Property Address Mike Santos Owner owner's Nam* equiInforr requiree dd fat Is MIS MA 02601 November 23,2009 r - — every papa. CItyfro" Stab Zip Code Dale of InsWAwn 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 vows in the previous two week period? ❑ ® Have large volumes of water been Introduced to the system recently or as part of this inspection? M ❑ Wens as built plans of the system obtained and examined?(if they:were not available note as NIA) M ❑ Was the facility or dwelling Inspected for signs of sewage back up? M ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS, located on We? fig ❑ 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(end occupants if different from owner).provided with information on the proper maintenance of subsurface sewage disposal systems? The elm and location of the Sell Absorption Symbo t(SAS)an 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)1310 CMR 15.302(5)l o"ao awwaaao-am nara OWA Ittwec .n ram:ausrwas ewy.orpwr 9WGW-pns 6 or 16 DEC-8-2009 03:34P FROM:RIDGE REALTY 5084283140 TO:615087906304 P.8/16 Deo 08 2,009 4:25PM PRTRICK OCOMMELL 50/34281613 p.7 Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sege Disposal t3yatem Form•Not for Voluntary Assessments 28 Bishops Terrace Properly Address Mice Santos Owner Owner's Name lnfonestlon Is required for —Hyannis MA 02601 November 23,2009 every page. Cilyrrown Slate Zip Code fte of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(deadgn)- 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x N of bedrooms): Number of arrant residents: Unknown Does residence have a garbage grinder? 0 Yes 9 No Is laundry on a separate sewage system?(if yes separate inspection required) ❑ Yes M No Laundry system inspected? Q Yes Q No Sessonaluse? Q Yes H No Weber meter readings, If available last 2 ears use 2000 78;000 gal. 9 ( Y usage(gPd)) 2008 243,000 gl. Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied. CommarciaUindustrial Flow Conditions: Type of Estoblishment: Design flow(based on 310 CMR 15.203): Gslbns Wday Its Basis of design flow(sestslpersonslsq.ft,eta,): — Orissa trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ yes ❑ No Non-sanitary waste discharged to the Title S.system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupsncyluse: oaa — t3 er(describe): 06-255 eonadoc-CM up a Ofto"PWIGn farm:aww ftm smog 011Md begm•hP 7 of to DEC-e-2009 03:34P FROM:RIDGE REALTY 50042e3140 TO:6150e7906304 P.9/16 .€ec U" c)uua 4: 25PM PFlTRICK OCOMMELL 5084281613 0. 8 Commonwealth of Magan.chUSSUB Title 5 Official Inspection Form Subsurface sewage Disposal System Form-Not for Voluntary Assessments 26 Bishops Terrace Propnty Address ..._. Mike Santos Owner Owners Name Information is mqulred for Hyannis MA 02801 November 23,2009 rrc+�, Ivory page. c Ry Smite Zip Coda Gads a!Inapectlan D. System Information (corn.) General Information Pumping Records: Source of Information: Unknown Was system pumped,as part of the Inspection? ❑ Yea_ ® No If yes,volume pumped: sagons How was quantity pumped determined? — Reason for pumping: Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overffow cesspool ❑ wry ❑ Shared system(yea 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 ftm system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date Installed(If known)and source of information, 1870'a Were sewage odors detected when arriving at the site? ❑ Yea Nlo cease e.,ao..doc•oe ae Tu,s orcW tp*xctW Opp DO a6 DEC-8-2009 03:34P FROM:RIDGE REALTY 5084283140 TO:615087906304 P.10/16 L G'U uo cuu= t: corrr rHIKlCK OCOMMELL 5084281613r p.a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface 86WApe Disposal System Form-Not for Voluntary Assessments 28 81BhoDs Terrace Property Address Mike Santos owns owners NWM Informstlon is r"W ed for Hyannis MA 02001: November 23,200g every post. citYRom Stag Ap cods Date of InspWtw D. System Information (cont.) -� Building Sworar(locate on site plan). Depth below grade: � fear Material of construction: ®cast iron ❑40 PVC ❑other(explain): Disfanoe from private water supply wait or suction line: Comments(on condition of joints,venting,evldenee of leakage.etc.): Septic Tank(locate on site plan): Depth below grade: fee! Material-of caonatruction: ®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) ❑ Yea ❑ No Dimensions: 8.5'long x 5,7 wide- 1000 get. — Sludge depth: 3" _ Distance from top of sludge to bottom of outlet tee or baffle 27 Scum thickness 216 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 12 Now were dimensions determined? Measured OWM swo doe•am Ift 5 Oftto uspaeltan form.Sumame ot-me C omov,ovesm.Pop 0 of is DEC-8-2009 03:35P FROM:RIDGE REALTY 5oe4283140 TO:615oe7906304 P. 11/16 Dec 09 2009 4:26PM PATRICK OCOMMELL 5GS4281613 P. 10 Commonwealth of Maumchusette lugTitle 5 Official inspection Form Subsurface Sewage Disposal System Fenn-Not for Voluntary Assessments 25 Bishops Terrace Properly ANn as Mike Santa ovn,er owners Name Infor"flonis r6quiryfo snnis MA 02601 November23,2009�ypae cRy/rewn Seale Zip Code Date of InspeWon D. System Information (cont,) Comments(an pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,alm): Liquld level was found at bottom of outlet invert,tees are intent and clear. Grease Trap(locate on she plan): Depth below grade: fee Material of construction: ❑concrete ❑metal ❑Aberpless ❑polyethylene ❑other(explain} Dimensions: Scum thickness Distance from top of soum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Oats of last pumping: c„e Comments(on pumping recommerMstions,inlet and outlet tee or baffle condition, struclural indegrity, 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 grads: Material of construction: ❑concrete ❑motel ❑ fiberglass ❑polyethylene [I other(explain): M205 9.mo.,400•case ra.s omaw arv�c++on Fam a urtma s.Ww•orpwdsy*mm•POP+o a+s' DEC-8-2009 03:35P FROM:RIDCE REALTY 5084283140 T0:615087906304 P.12/16 Uec UU ZUU9 4:25PM PHTRICK OCOMNELL 5084281613 P. 11 Commonweal of Massachusetts Title 5 Official Inspection Form Subsurface Samoa Disposal System Form-Not for Voluntary Assessments 26 Bishops Terrace Properly Address Mike Santos Owner Owners Name Information i' Hyannis MA 02501 November 23,.2009 ragnlrad for every papa. CNyfraurn state Zip Code 11sle of tnapeollOn D. System Information (cost.) Tight of Holding Tank(cant.) Dimensions: Capacity: t7aillons Design Flow: caeom per dw Alarm present ❑ Yes ❑ No Alarm level: Alarm In worlds order. ❑ Yes ❑ No Date of lest pumping: Dote Comments(condition of alarm and(lost switches,etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes Q No Distribution Box(If present must be opened)(locate on elte plan): Depth of liquid level above outlet Invert Comments(note It box is Wei and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage Into or out of box,etc.): Pump Chamber(locate on site plan). Pumps in working order: ❑ Yes ❑ No Alarms In working order: ❑ Yes ❑ No oasesaan aoe•arse Tm•sonw.1V%p6 ►onFWWevn.urra6awo•otivowstern•rso.11on3 DEC-8-2009 03:35P FROM:RIDGE REALTY 5084283140 TO:615087906304 P.13/16 ueo un euuu 4s26PM PRTRICK OCONMELL 5084281613 p. 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal Sysbro Form-Not fi,r Voluntary Assessments 26 Bishops Terrace PropeAy Addrus Mike Santee Owner Owner's Nsms re aired for Is Hyannis MA 02601 November 23, 2009 required for every papa. Cilyfrown slaw Zip Code Data of Inspectlon D. System Information (cost.) Gwnmems (note condition of pump chamber, condition of pumps and appurtenances,.etc.): Sall Absorption System(SAS)(looste on site plea,excavation not required): If SAS not located,explain why: Type: ® teaching pits number: One M pit ❑ leeching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number; dimensions: ❑ overflow cesspool number: ❑ Innovative/eltemative system Typelnsme of technology: Comments (note condition of soft,signs of hydraulic failure,level of ponding,dr r np soil,condition of vegetation,etc.): Leaching pit had 2'of standing water at time of inspection with a high stain Ifne 8-10'below inlet pipe. Pit shows no evidence of hydraulic failure or surcharge. Sidewalk above high stain lines'had,rig solids or exposed aggregate In concrete indicating liquid level had not been higher tFtan stain fines. 09-M 8arlu.d=-ON TMr3 opkw kmplghm Form'su6.urtoora saufto almewt tyoam-pap tJ d 1a DEC-8-2009 03:36P FROM:RIDGE REALTY 5084283140 TO:615087906304 P.14/16 LC.r WU Q%JUO n;c ir11 r111 K1l:K UC:UMMtL.L 5084281613 p. 13 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Smngs Disposal System Form•Not for Voluntary Assessments 2e Bishops Terrace Property Aft en Mike Santos Owner Owner's Name in is p*W bnr Hyannla MA 02601 November 23,2009 every Pape. cilyrr"n 3bab zip code Qoteof lnfpedton D. System Information(cons) 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 ❑ Yea ❑ No Comments(note condition of soil,signs of hydraulic failure, level of ponding,oondition of vegetatlon; Privy(locate on site pion): Materials of construc tlon: — Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure,level of ponding,conditionof vegetation, etc.); aazss a.�ee.sae•aem tdr b o11kh1 b.o.wen>;omr,auhwfiw anrs�Darpowl Br+�•i�o.�a of to DEC-a-2009 03:3GP -FROM:RIDGE REALTY 5084293140 T0:615087906304 P.15/16 uvo uo euua mt:c-irn rrt I KILK UL;UMMhLL bUU4zU1U1 j P. 14 fhS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 26 Bishops Terrace _ Properly Address Mike Santos Cwner Owner's Name Informationis Hyannis MA 02601 November 23.2009 every page,e. required for for C /rown slate Zip Code Date of Impaction 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 altwells within 100 feet. Locate where public water supply enters the building. Bisho s Terrace Wager Service �/`r`I iii r•i iiiii ir`i r`r r`i r`I i`r`ti` i`r�I`1`/`I•/`I•r`/•r•i r•I•i i i r`i I`r•!`r•r`I•I•%/`r�i i r�i r♦r�i`i ri`r`r`r`i r`r•r•r•r`r`r`/♦ • ♦ t ti ♦ . • . ♦ • • ♦ • • • ♦ . • • ♦ • ♦ . • • • . r r / i i r r r r r r r r r i r r i r r ♦ r r r r r . ♦ • ♦ ♦ ♦ • • ♦ . ♦ ♦ ti ♦ ♦ • • r r r r J. s / i r / r r r r r i r r r r r r r r r r r I%r r r r i r r r r`r•r`r•iii/ • . ♦ ♦ • ♦ ♦ • • ri`ir�r`r`r`i J. r r •01 i 4F opr`r•i r`i r•I i r•i i`i i`r�r` •r'i r�r♦i r•r r` `r•i i r•r`�i i`i r`r`i i i i�r`i r•i/`r♦r`r%r %I`r,i r•i r`%r`r•/•r`r`i r`i •r•r•i r`i r%r`I r`r•i r'r•r`i i r•i i i r`r`��i •r�r�i r♦i r�r�i i�%�ir♦iii r�����r`i•i`r`I`i •I•i i r`i r•r•i i r`/`I`r`r•r•r`i i r`r`r�i 20 21 30 33 DEC-8-2009 03:36P FROM:RIDCE REALTY 50e42e3140 T0:6150e7906304 P.16/16 Dec 08 2009 4-.27PM PATR.ICK OCOMMELL 5084201613 P. 15 Commonwealth of Massachusefte Title 5 Official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assesernents 26 Bishops Terrece ProparlyAddim Mike Swtca Owner Ownees Name irffonnalton is Hyannis MA 02601 November 23.2009 required for "wry page, Gllyrrown idle 721p Code Ooteo/lntrredlon D. System Information (cont.) SU Exam: ® Check Slope ® Surface water ® Check caller ® Shallow wells Estimated depth to ground water. ZO tau Please Indlcate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans an retard If checked, date of design plan reviewed: Date ❑ Observed site(abutting propertylabservalion hole within ISO feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, Installers-(attach documentatlon) ® Accessed USGS database-explaln; USGS topo map and town GIS You must describe how you established the high ground waterelevation: Town Groundwater contour map shows water below el.35 and two male shows property above el: 60. (W2515 SwasAw•09= TM 5 dlksm-Imedlan Feel:8uh1L9ics 8WwpW Ck"M0j SPOM-fta 18or 16 DEC-V:31P FROM:RIDGE REALTY 5084283140 TO:615087906304 P.1/16 • e R FACSIMILE TRANSMITTAL SHEET 7Tn- ,11 FROM: A,e�7-J4�� UUi �cd� i Mtge COMPANY/AGENT DATE: / `ce A FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER: z /o PHONE NUMBER: SENDER'S FAX NUMBER: 508-428-3140 RE: SENDER'S PHONE NUMBER: 2�� 508-428-2770 5547n ❑ URGENT R RFVIEW ❑ PLEASE(:OMMFNT ❑ PLEAS}REPLY ❑ PLEASN. RF?(:Y(:I.l? NATES/C.OMMETFTS: ol- R 508'428-2770 7.Ridgerealtyl.com 70 COUNTRY CLUB RD, SANDWICH, MA 02563 //p Town of Barnstable oFtME Board of Health STABLE, # 200 Main Street - Hyannis MA 02601 MASS. Y� %639. `0g plEG MA'S a Agreement to Extend Time Limit for Acting Upon a Variance Request In the Matter of a variance request forM received on , the Petitioner(s), regarding the property at the petitioner(s)and the Board of Health agree that the Board of Health has until (insert date)to act upon the Petitioners'completed application for a variance. In executing this Agreement, the Petitioner(s)hereto specifically waive any claim for a constructive grant of relief based upon time limits applicable prior to the execution of this Agreement. Petitioner(s): Board of Health: Signature: Signature: Petitioners)or P titioner's Representative Chairman Print: Print:Print: Wayne Miller, M.D. Date: �l 0 U Date: Address of Petitioners or Petitioner's Representative O P Town of Barnstable Board of Health Public Health Division 200 Main Street Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508) 790-6304 file q:extend.doc 1 A P C101�TINC. , �,1J. �t NC h _ kt 'A_1!Yhase Construction of New .n an 4830 Rt.28 Cotuit Ma.02635 (508)420-9200 Oct.20,2009 Health Dept. Thomas McKean 200 Main St. Hyannis,Ma. 02601 Mr.McKean, Per our discussion,relative to--W Bishops.Terrace ih Hyannis,I wish to request a hearing in front of the Board/As you know there was a septic inspection performed prior to my purchasing the property and the tesul s�were withheld.I had no knowledge of any problems with the•system but was aware of only a flood. • It is mybeliefthatahe sewage ejection system servicing the apartment and the flood may have been the culpritrof the.failed leaching at the time of the inspection The house was vacant over the winter,heat was (turned of f and a pipe froze.This in turn was left for several months with the ejection pump pumping the leaching full of water and completely saturating it.I am quite confident this is the case and have had no problems with the sys m since it has been occupied by my tenants in July of'08.Since your letter requesting repairs,was-received I had another inspection performed.I can provide you a copy of the results which will confirm the performance of the leaching field. It is my request:to provide proof of the flood,a copy of a new report reflecting no failure to the system and ask the Board to review the information to determine if the current order should remain in effect. Since" rely; Michael A. Santos Apcon.Inc. N ca co (114 e� ICS C-: it r+ . . . . . . . . . . . . . . . . . . . THE Town of Barnstable Barnstable AD- Regulatory Services Department "' 'raC` ARNSTABLE 9a "' ` r63q. Public Health Division-Cy 1$ s 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geder,Director FAX: 508-790-6304 Thomas A.McKean,CHO �LJ Q � coo p7 08/07/09 Michael Santos 26 Bishops Terrace Hyannis, MA 02601 FINAL ORDER ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at, 26 Bishops Terrace, Hyannis, MA was last inspected on 4/17/2008,by Shawn McElroy S.M. Enterprizes, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: "Backup of sewage into facility or system component due to an overloaded or clogged SAS." The deadline for repair has past. We, The Department of the Board of Health, have not been-informed that you have taken any steps to bring your failed system into compliance. Therefore, you are ordered to repair or replace the septic system within 60 days from the date you receive this notification. You may request a hearing before the Board of Health, a written petition requesting a hearing on the matter, within seven (7) days after the day this order was received. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH OARD OF HEALTH omas McKean, R.S., CHO Agent of the Board of Health l Town of Barnstable Barnstable ° Regulatory Services Department AlA"'alCeC j * BARNSTABLL -MASS Public Health Division m 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO April 24, 2008 Countrywide REO Marketing C "i 2270 Lakeside Blvd. Mailstop RLS-3-32 j Lo 2 b Richardson, TX 75082 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 26 Bishop's Terrace, Hyannis MA was last inspected on April 17, 2008,by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. ` � 1 You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. , Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF T BOARD OF HEALTH s McKean,R.S., CHO. Agent of the Board'of Health CERTIFIED MAIL# 7006 2150 0002 1038 7220 Q:\SEPTIC\Letters Septic Inspection Failures\26 Bishop's Terrace.doc COMMONWEALTH OF MASSACHUSETTS EXECUTIVE. OFFICE OF ENVIRONMENTAL AFFAIRS rt DEPARTMENT OF ENVIRONMENTAL PROTECTION 1 A d r — LO'r a ..� DEC 2 1 -TOWN or r TITLE S HE OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: ,. �a L`�h� �� e 1'� C-e_ HT�n1 � m Q Owner's Name: , Owner's Address: ;Zt1J �1C�p`�i-eA'PQC -1 Is TD-T Date of Inspection:j ® Name of Inspector: (please print) c Company Name• . L1_C, Mailing Address: p (��•� ']�`3 �..e al�'e.(`l�a�•ems i'Y1 t., �� Telephone Number; 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 Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Z� ( � �---7 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. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1 { f Page 2 of 11 OFFICIAL INSPECTION FORM'—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSA CSYSTEM INSPECTION FORM PART A " CERTIFICATION(continued) Property Address: ., Owner: Date of Inspection: 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: B. System Conditionally Passes: n A- 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. -p-JP�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: 1 ► l l Observation of sewage backup or break out or tiigh statiu 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)anxcplaced obstruction is removed distribution box is leveled or,replaced. ND explain: 4kThe 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: t 1 , ' Page 3 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: �� )i�!jcA0n 1"�u Owner: l�n�e- 61( eirYT Date of Inspection: 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 12f)Cesspool or privy is within 50.feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: �) The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**.Method used to determine distance **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: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT-FOR VOLUNTARY'ASSESSMENTS SUBSURFACE SEWAGE D.ISPO:SAIY'S.YSTEM•INSPECTION FORM . PART.A, . CERTIFICATION(continued) Property Address: 2:1 Owner: j Gt1 P� i�J Ct 1 Date of Inspection: ],.i,)1 a dO 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. 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.IThis system passes if the well water..analysis, performed at a DEP certified laboratory;for coHform bacteria and volatile organic.componnds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is.equal to<or less than 5.ppm, provided that no other:.failure criteria are triggered.A copy of the analysis must be Attached to this form.] . (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure: E. Large Systems: To be considered a large system the system must serve facility with a design now of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each'ofthe following: (The following criteria apply to large'systems.in.addition to the criteria above) 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 15304.The system owner should contact the appropriate regional office of the Department. . Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: (3 LCO 045 1avcc1)nIS j M Owner: A, Date of Inspection: _ f l,;jcpq 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? A 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? V\ _ 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: Yes no Existing information. For example, a-planat the Board of Health. _ Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ( SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: —; n'n ly m ct Owner: e�7��0 Date of Inspection:la ) 1: )c)LA FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 'a Number of current residents: Does residence have a garbage grinder(yes or no):_p Is laundry on a separate sewage system(yes or no): _0[if yes separate inspection required] Laundry system inspected(yes or no):4�S, Seasonal use: (yes or no): n o Water meter readings,if available(last 2 years usage(gpd)): Sump.pump(yes or no):�� Last date of occupancy: ,e.(1'T' COMMERCIAL/INDUSTRIAL Type of establishment: . Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):— Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:_H©m e_ Q L'_��\-,4 Was system pumped as part of the inspection(yes or no):DjZ) If yes,volume pumped: Qallons--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) —Tight,tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):l !E Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS f� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �fp bt S�c�OS i Owner:Ae.yo np- ©111)� V'*. .Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: _ Materials of construction:_cast iron _;�_40 PVC_other(explain): Distance from private water supply well or suction line: n G Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: '/�(locate on site plan) Depth below grade: U+� Material of construction: concrete_metal_fiberglass___polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: i bC Sludge depth: �1 Distance from top of sludge to bottom of outlet tee or baffle: ( t\ Scum thickness: Q Distance from top of scum to top of outlet tee or baffle: L4 `.) Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: M �- t 2. Comments(on pumping recommendations, inlet and out et tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): S '-e— GREASE TRAPA) D(locate on site plan) Depth below grade:— 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE-DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: - c,Ted' Owner: mg 01 r 1,e_i t'er Date of Inspection: ►Q' 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: Qallons Design Flow: gallons/day Alarm•present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX:1A(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): PUMP CHAMBER: 1.1�1 (locate on site plan) Pumps in working order(yes or no)-- Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):. Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: /� 'c;�n of-, ��, Owner: r�i�.�q� Q- Date of Inspection: lAhAjoij SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type 4A&leaching pits,number: leaching chambers,num er: 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.): R it Vinci � ��' �} 1,7�'fi � � cxl� CESSPOOLS: no (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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.): PRIVY:D (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.): 0 Page 10 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address Owner --� j- -4 — n► �� '4. Z 1"C'C1 Date of Inspection: 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 ehters the building. \ a � 30 �31 i Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ', .ta ��f�t G9 Owner: Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water—%-&eet Please indicate(check) all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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: 3 4,l�5 t1�ra 4—��°� d cjf 11 �s No. ` 002-- 112-2- Fee-� � / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �l/ ✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipprication for �N!6paal bpgtem Construction Permit Application for a Permit to Construct( j Repair( )Upgrade( )Abandon( ) ❑Complete System XJndividual Components Location dres or Lot No. Owner's Name,Address and Tel.No. s (7 �,r1LL C Assessor's Map/Parcel _ � t2Gl7�N' 2�J 1 Z�s zZ —zoo Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 7J zSaaD ¢,C3 exX3 -C) c,_/Mwsy cS.T- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations'(Answer when applicable) /YC. L/h b 1--o O U-K-,%10 Pyr Date last inspected: Agreement: The undersigned agrees to ensure the cons ' n and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of TRIC115 f e En ironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been i e by h s Uard o ealth. Signe Date �(' ( 'y z Application Approved by _ Date —a2- Application Disapproved for following reasons Permit No. Z—q 22- Date Issued 3 k Zyo 2; y22 r 1�,��• No. � Fee � "i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 'E 0[pprication for �Bigpoga[ *pgtem Congtruction Permit Application for a Permit to Construct Repair Upgrade Abandon pp ('� p (• )Upg ( ) ( ) El Complete System X.Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. _ZCp /Sh6P 47"nif Assessor's Map/parcel ���' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. .� �f J Coco W yA4WDG Type of Building: ' Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) t i Other Fixtures,t Design Flow gallons per day. Calculated daily flow gallons. Plan Date °� `, Number of sheets Revision Date Title } Size of Septic Tank Type of S.A.S. Description of Soil " P I Nature of Repairs or Alterations tAnswer when applicable) A-<) p U_Q{c.. /p < •fi 1 i Date last nspected- Agreement: The undersigned agrees to ensure thekonstruction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of it 5 f e Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has beenjie by h s ard•o ealth Signe Date (:� ' (� 'y2 APPlication Approved by = Date 1 u oz Application Disapproved for QTfollowing reasons Permit No. 2 ' 2 Date Issued O 2. Ff t ——————— —————— —————---————————————————— THE COMMONWEALTH OF MASSACHUSETTS -6 brl t y BARNSTABLE, MASSACHUSETTS o� Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( Upgraded( ) Abandoned( )by P Con c C) at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2A�Z� 22 dated Installer A�Cc-4-r�, C c-, Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. l�.�JZ% '722---------------------------Fee w� . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mioogar *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair( pgrade( )Abandon( ) System located at A.n.ram. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this pe t Date: 9 " j 9 --O 2 Approved by P i v TOWN OF BARNSTABLE F7c. LOCATION ab & 40Rs kc-na ec SEWAGE # �Da -ya z VILLAG ASSESSOR'S MAP & LOT 2,5t- )/,5 INST R'S NAME&PHONE NO. & SEPTIC ANK CAPACITY r LEACHING FACILITY: (type) b4 CO- i. (size) NO.OF BEDROOM'S BUELDER OR OWNER PERMIIDATE: 9. o c COMPLIANCE DATE: �� 0 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 wi n 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 i f 4 7� n PR ,:fir " � eP-a� <<y, •�+ °`";•,� i i Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary g p y ry Assessments 26 Bishops Terrace Property Address Countrywide REO Marketing 2270 Lakeside Blvd Mailstop RLS-3-32 Richardson. TX 75082 Owner Owner's Name - -- -- —------ information's Y H annis MA 02601 _4-17-08 required for _ every page. City,7own State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the computer,use Inspector: only the tab key to move your Shawn Mcelroy cursor-do not -- _.._... - -— -.._........... use the return Name of Inspector key. Upper Cape Septic Services ------ _ __ _...._.._. _...--.--------------.-----___--- Company Name —-- r� 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town state Zip Code 1-800-495-0905 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 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 Local Approving Authority 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. t5insp•0310B Title 5 Official Insoec9on Form:Subsurface Sewage Disposal System-Page 1 of 15 l-d 9£6096b809 Aoileon ume4S d91:90 06 LO unr Commonwealth of Massachusetts Title 5 Official Inspection orm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Bishops Terrace Property Address Countrywide REO Marketing 2270 Lakeside Blvd Mailstop RLS-3_32 Richardson, TX 75082 Ovmer Owner's Name information is Hyannis MA 02601 4-17-08 required for _._y _.._.... . . _..___. .. ....___— every page. City/Town State Zip Code Date of Inspection B. Certification (cant_) Inspection Summary: Check A,B,C,D or E I 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: 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 or break out or high static water level in i he 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 -9insp•03109 Title 5 Official Inspection Forth:Sutsurtace Sewage Disposal System-Page 2 of 15 6-d 966096V809 Aoileon unne4S dZZ:90 OL LO unr t t t Commonwealth of Massachusetts - Title 5 Official Inspection Form F Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y� 26 Bishops Terrace Property Address Countrywide REO Marketing 2270 Lakeside Blvd Mailstop RLS-3-32 Richardson, TX 75082 Owner Owner's Name -- ----......__._... ..... information is required for Hyannis — —_ MA — 02601 4-17-08 every page. CilyiTown State Zip Code Date of Inspection B. Certification (cunt.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced NO 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 HeaRb)-. ❑ broken pipe(s) are replaced ❑ obstruction is removed NO 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 pubtic 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(arid 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. t5in5p•03128 Title 5 QHioal fnspec6on Fo-n:Subsurface Sewage Disposal System-Page 3 of 15 Z-d 9E6096t,809 AoaleoW umeys d86:90 Ol LO unf Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Bisho -ps Terrace ..........----. .- .. Properly Address .Countrywide REO,Marketing 2270 Lakeside Blvd Mailstop RLS-3-32 Richardson, TX 75082 Owner Owner's Name information is required for Hyaqnis MA 02601 4-17-08 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): El 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 chterfa 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 0 El Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool D Static liquid level in the distribution box above outlet invert due to an,overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/z 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. t'insp-0?V06 Tie 5 Official inspection Form:Subsurface Sewage Oisposal System-Oage 4 d 15 C-d 9C6096t,909 Aoileon umeqs d96:90 ol, Lo unr Commonwealth of Massachusetts . Title 5 Official Inspection Form y� Subsurface Sewage Disposal System Form -Not for VoluntaryAssessments per- 26 Bishops Terrace Property Address Countrywide REO Marketing 2270 Lakeside Blvd Mailstop RLS-3-32 Richardson. TX 75082 _ O,vner Owner's---...._ Name -- ....._..... information is required for Hyannis _ MA 02601 4-17-08 eq _ every page. City,7own State Zip Code Date of Inspection B. Certification (coat.) D) System Failure Criteria Applicable to All Systems (cunt.): 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,o0ogpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure- E) Large Systems. To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either`yes" or"non to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone 11 of a public water supply well if you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or 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_ t5insp-0348 Title 5Official Inspection Form:Sut-surface Sewage Disposal System-Page 5 o115 L'd 9£6096t,909 Aoileon unme4S dZ7,:90 06 LO unr Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 26 Bishops Terrace Property Address .............. Couq!ywide REO Marketing 2270 Lakeside Blvd Mailstop RLS-3-32 Richardson, TX 75082 Owner owner's Name information is required for Hyannis MA 02601 4-17-08 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? ❑ 1Z 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) El Was the facility or dwelling inspected for signs of sewage back up? El Was the site inspected for signs of break out? El Were all system components, excluding the SAS, located on site? El 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: El 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)] t5ins3-G3J08 Tille 5 01ficial inspection Form:Subsurface seviage ompowi sysb,-Page 6 of is t,-d 9C609617909 �Aoileon umeqs d9l,:90 ol, Zo unr Commonwealth of Massachusetts Title 5 Official Inspection Form - _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Bishops Terrace Property Address Countrywide REO Marketing 2270 Lakeside Blvd Mailstop RLS-3-32 Richardson, TX 75082 Owner Owner's Name information is Hyannis MA 02601 4-17-08 required for y __.... . -- ---.. . ..— ----.... . - .. every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 - - Number of bedrooms (actual): 2 220 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): -- 0 Number of current residents: - - Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection requiredl ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes JZ No Water meter readings, if available (last 2 years usage (gpd))= _ - Sump pump? ❑ Yes ® No 3-08 _ Last date of occupancy: Date CommerciallIndustrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons perday(gpd) Basis of design flow(seatslpersons/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 occupancyluse: - -- - D ate Other(describe): t5i nsp.03M Title S Official Inspectior.Form:Subsurface Sewage Disposal Sysren•Page 7:)f 15 9-d 9£6096V809 Aoajeon unne4S d LZ:90 0l LO unf Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Countr�kqe REO Marketing 2270 Lakeside Blvd Mailstop R S-3-32 Richardson, TX 75082 Owner Owner's Name every page. CityiTcwn State Zip Code Date of Inspection � D. �� ����/�����U��K� ����t } � � - ° � (cont-) � General Information | | Pumping Records: Source ofinformation: NSA------------ ------'' ------ ---- -'--- Was system pumped mspart of the inspection? 0 Yes [R No If yes, volume ------ -------------- ---- ------ ---'--- ^ nmxonm How was quantity pumped determined? - -' - ' ---------- Remsontorpumnping: ------------- ------ -------------- '---- — Type of System: 1z Septic tank,disthbutimm box, soil absorption system El Single cesspool [� Overflow cesspool �] Privy Fl Shared system (yes or no) (if yes, attach previous inspection records, |yany) El Innovative/Altemative technology. Attach a copy of the current operation and maintenance contract (to bm obtained from system owner) and m copy nflatest inspection mf the )A\system by system operator under contract [l Tight tank. Attach m copy of the DEPapproval. � �l Other(describe): - Approximate age of all components, date installed (if known) and source of information: ' 1980's _ _______ Were sewage odors detected when arriving ad the site? F] Yes E No 15i"sp'03Jm rw°,Official/"spectiDn Form:s.°=*=°Sewage oupm=S�ste"'Page o*`^ � � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Bishops Terrace Property Address Countrywide REO Marketing 2270 Lakeside Blvd Mailstop RLS-3-32 Richardson, TX 75082 Owner -6wn'e r-'s N—a—m—e information is required for Hyannis MA 02601 4-17-08 every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 12" Depth below grade: feet- Material of construction. El cast iron 40 PVC El 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): 4" Depth below grade: feet ------ Material of construction: concrete El metal El fiberglass El polyethylene E] other(explain) If tank is metal, list age: Ye.ars--- Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) E) Yes 0 No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000 Gal Sludge depth.- Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet lee or baffle How were dimensions determined? t5inw;-C348 'Ukle 5 Official Inspeclion Form:Suk3surlace Sewage Disposal system-Page 9 of 15 9-d 966096V909 A0,1190" UMEHS dl,Z:90 Ol, L0 unp Commonwealth of Massachusetts Title 5 Official Inspection Form P Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Bishops Terrace --._..... -- --....... ...-- Property Address Count�fwide REO Marketing 2270 Lakeside Blvd Mails op RLS-3-32 Richardson, TX 75082 Owner Owner's Name information is Hyannis required for Y ..-_ MA _ 02601 _ 4-17-08 every page. CitylTown State Zip Code Date of Inspection D. System Information (cunt.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank in good condition: 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 lene y y ❑ other(explain): tSinsp•03M8 Title 5 Official rnspection Form:Subsurface Sewage Disposal System•Page 10 of 15 9-d 9£6096t,809 Aoileon uMeyS d66:90 01• L0 unp i Commonwealth of Massachusetts .„� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Bishops Terrace Property Address Countrywide REO Marketing 2270 Lakeside Blvd Mailstop RLS-3-32 Richardson, TX 75082 Owner Owner's Name information is Hyannis MA 02601 4-17-08 requiredfor Y _..-- ._.. ._.. _.. -----.... ---•-._._—,... every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont-) Dimensions: —_ ... - ... _. . ....._... :Ca acii --.. ..-- - P Y gallons Design Flow: 9 per — 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 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No tSinsp-0310E Title 5 Otliciai Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 t,'d 9£6096t,809 Aoileon uMe4S d17,:90 06 LO unr Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Bishops Terrace Property Address Countrywide REO Marketing 2270 Lakeside Blvd Mailstop RLS-3-32 Richardson,TX 75032 Owner Owner's Name information is required for Hyqnnis MA 02601 4-17-08 every page. 6itylfown......... State Zip Code dii.e-iInspection lnsp-e.ction D. System Information (cont.) Comments(note condition of pump chamber, condition of purnps 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: ❑ 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.): Leach pit had clear sign of hydrolic failure with stain line above inlet invert. 15insp 0308 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Z-d 9C6096t,909 A0.1190" UMBqS d66:90 Ol, Lo unr t , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 26 Bishops Terrace Property Address Countrywide REO Marketing 2270 Lakeside Blvd Mailstop RLS-3-32 Richardson,TX 75082 Owner's Name Owner ... .. ..... - information is required for yY annis MA 02601 4-17-08 every page. City.rTown 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.): t5insp-03106 TNe 5 OHicial'nspecton Form:SiAsurface Sewage Dsposa System-Page 13 al 15 S-d 986096V809 Aoaieo" unne4S d17,:90 Ol LO unp Commonwealth of Massachusetts � � --- -. - Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1Z.1 .2.6-Bishops Terrace ............ ------ Property Address Count wide REO Marketing 2270 Lakeside Blvd Mailstop RLS-3-32 Richardson, TX 75082 Owner Owner's Name information Is Hyannis V1 A 02601 4-17-08 required to _66if own _�iate Z---ip Ccde Cate of I nspecdon ev in page. 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_ Locatewhere public water supply enters the building. 5- 3 1 '3 0--posal S,'v=-Page!4cf 15 9-d SC6096V909 Aoileon UM84S d61:90 U Zo unr Commonwealth of Massachusetts AR 0 Title 5 Official Inspection Form Subsurface Sewage Disposat System Form -Not for Voluntary Assessments y a,. 26 Bishops Terrace Property Address Countrywide REO Marketing 2270 Lakeside Blvd Mailstop RLS-3-32 Richardson, TX 75082 Owner Owner's Name equ edformatlon forIS Hyannis MA 02601 4-17-08 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: 0 Obtained from system design plans on record If checked, date of design plan reviewed: ---- ---- ---------- -- D ate ® 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: Town maps show groundwater at greater than 12'. - -- - -- . .......... . ...__.. _...-- wlso-UJ08 Title S Official Inspection Form:Subsurface Sewage Disposal System-Pale 15 of 15 6-d S£6056b909 Aoileon unne4S d66:90 06 LO unr THE COMMONWEALTH OF MASSACHUSETTS SOAR® OF HEAL.T OF.......... .:..... .. ..-� . ... ApplirFatiun for ElifiVoo 1 Worko ( om4rnrtinn Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst® at: e l� '� s •- - ------ ------••------ ..._.. /oration-Address o"` t No. y� •--•--FAFi=- ::- "---`'-. OYwe'n=e-r--- ={`�r✓�-sa- Address ^ = --------------- -----•---------- ------•--•------------—•----•---•---•---------•--------------------------------------•-------- '^ _.............• ............................................................ —Y---------------•---- ° --- Insta[ler Address / Q Type of Buildi � Size Lot_-_�(�,��-_ �.Sq. feet Dwelling—No. of Bedrooms--_•_______________ --_.-__--Expansion Attic ( ) Gaffiage Grinder ( ) P4 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Pa Other fixtures -------------------------------- - W Design Flow______________________��.:_.._�_.__._gallons per person per day. Total daily flow___.._______�!�_ �____gallons. Ar WSeptic Tank—Liquid capacity,.. gallons Length................ Width-___-_.__...-_-- Diameter---------------- Depth_---_--.--:-._-. x Disposal Trench— o. ...:................ Width.......... Length---- Total leaching area____c_ _______._e_.sq. ft. Seepage Pit No..__..Y_...__..... Diameter.) ..... Depth below inlet...... Total leaching area,-�?.......0-sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date---------------------------------------- Test Pit No. 1..... minutes per inch Depth of Test Pit.................... Depth to ground water-_-_-__-___-_______-__-- rX4 Test Pit No. 2................minutes per inch Depth of Test- Pit......__j_�__ Depth to ground water-----.____----_-____-..- - ---------- -------------- E -------- •------------------------------ -----------------•--•------ Description of Soil �� -�,� l l��-f - ---- ------------------------------------------------------------------- V ----------------------------------------------------------------------------------------------------------------- ------ ----------------------------------------------- VNature of Repairs or Alterations.—Answer when applicable-----------------------------------------------------------------------.-_--:---_---.-.-_------. ----------------------------------------••--'---------'-------••--------•-----------••----•----••--•--•-•------.....-••-•.....---•----•••---------------------......---'-------•----------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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...................................................................................... -- ---------------------------- p Dat Application Approved BY " - ,•' }�,-- `�/--- -------�- �� Date Application Disapproved for the following re¢sons:..._.- ! �-� � __ _��-.�:�t,�i.�A-. ----.................................................... .............................. Date PermitNo......................................................... Issued........................................................ Date No:.we-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . l� 4 .Yid Appliratian for 4%upuual urko -Tonotrnrtiun merit Application is hereby made for a Permit to Construct ( ) or 'Repair ( ) an Individual Sewage Disposal Syst at ' . . 0 � o-cation-Address ar t No. ------------------------- Owner p a.' Address _.._... x az +a'.In60afler: Address '� - . U Type of Buildi €d� Size Lot__; R �_ "_.Sq. feet Dwelling No. of Bedrooms............................................Expansion Attic ( ) Gar'hage Grinder ( ) Other—Type of Building a g -----------------........... No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ............................................................... Design Flow......................_..''__"' allons er erson er da Total daily flow..._.__._._ »" gallons. Wg< P P P Y Y WSeptic Tank—Liquid capacity/-API'f0 allons Length................ Width---------------- Diameter---------------- Depth.:------_-__---- x Disposal Trench—No. -------------------- Width.� v-,Total Length......._.. Total leaching area--_-— -yY..sq. ft. Seepage Pit No.---- ---------.... Diameter ._ _._._ 15epth below inlet..... ,2_........ Total leaching arelg '_:S _sq. ft. z Other Distribution box ( ) Dosing tank ( ) I . aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1...._ minutes per inch Depth of Test Pit_........•_____..__. Depth to ground water________________________ f34 Test Pit No. 2................minutes per inch Depth of Test Pit----___.._--------- Depth to ground water------------------------ o Description of Soil -� ' � -- -------------------------------------- U --••-••......-•-•---••----------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable-----------------------------------------------------------------------------._.---_----__--.... ----------------------------------------------•-----------------------------------------------------------------------------.--.------------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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..................-------------------------------------------------------------•---- Application Approved BY = •--- ---•--•• -• 1-` G Dale,-------------------- Date Application Disapproved for the following reasons: C_,..._ a ✓�...__ _ "tt ,.r ma ' s -•----•------------------------ ---•----•---------••---------•--•-•-•-------••--•-•----- . Date PermitNo......................................................... Issued......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �. . .- OF....... . . CUrrftf irte ofmptittnre THI 3IS TO CERTIFY, ThatAhe Individual Sewage Disposal. System constructed ( ) or Repaired ( ) by ,���f��-�.,•r`� .. � *�� '�. �', �� ,y - --------------------------•------•-- ------•-- � � InstBlle � � .. t. � has been installed in accordance with the provisions of Article XI of,The-State Sanitary Code a,§ described in the application for Disposal Works Construction Permit No............ fi `_.___ dated :. _-. TIME ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. --------•----------------- Inspector ^C t +eta :-. DATE p � d THE COMMONWEALTH OF MASSACHUSETTS BOARD OF- HEALTH ,, �. �.�....., . ........4&o "•'--- "� r.. ,--•- f-- - FEE --- ' �iun rrYni# Permission 's ereb ranted_____ cam, --Mi r ^� *"w _.---__-•--•__ to Construuc,t (`Y) or Repair ( )F an Indiv teal Sewage lsposal System t f y x at NO.-rrx --------------------------- as shown on the application for Disposal Works Construction Permit Nth _.__ Dated__ _ E, k� - a :',;Board of Health DATE................................................................................ = < FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS