HomeMy WebLinkAbout70-80 CAPTAIN COOK LANE - HYANNIS CONDOS 70-80 CAPT.COOK LANE,
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ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(781)383-1234 K(781)545-2800 (781)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address 70-80 Captain Cook Lane
Building 9 -�/ 532)�
Center Village,Hyannis,MA
Owner's Name Multiple Owners
Owner's Address Huntingest Property Management
40 Industry Road—P.O.Box 340
Marstons Mills.MA 02648
Date of Inspection 01/22/09 -
Name of Inspector Paul W.Davis
Company Name Rosano Davis Sanitary Pumping Inc
Mailing Address 9 Rocky Lane
Cohasset,MA 02025
Telephone Number 781-383-1234
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 fimction 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 EvaMocal
❑Fails Approving Authority
Inspector's Signature: Date:01/30/09
The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty
(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:
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""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.
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Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
Property: 70-80 Captain Cook Lane/Building 9 CERTIFICATION(Continued)
Center Village Hyannis MA
Owner: Multiple Owners
Date: 01/22/09
INSPECTION SUMMARY:CheckA,B,C,D or E/ALWAYS complete all of section D.-
A] SYSTEM PASSES:
X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 or in 310 CMR 15.3(
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.
Indicate 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 breakout or high static water level in the distribution box due to broken or obstructed pipes)or
due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): j
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced i
ND explain:
_ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with
approval of the Board of Health):
_ broken pipe(s)are replaced
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obstruction is removed
ND explain:
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Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION(Continued)
Property: 70-80 Captain Cook Lane/Building 9
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: 01/22/09
C Further Evaluation is Required by the Board of Health:
Conditions exist which require€urther evaluation by the Board or Health in order to determine if the system is failing to protect the
public health,safety and the environment.
1) System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not
functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering_vegetated wetland or a salt marsh
2) System will fail unless 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 of more from a private water supply
well**- Method use 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:
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Title 5 Inspection Form 6/15/2000
I
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
Property: 70-80 Captain Cook Lane/Building 9 CERTIFICATION(Continued)
Center Villaee,Hyannis,MA
Owner: Multiple Owners
Date: 01/22/09
D System Failure Criteria applicable to all systems:
You must indicate either"Yes"or"No" to each of the following for all inspections:
Yes No
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool.
_ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
_ X Liquid depth in cesspool is less than 6"below invert or available volume is than 1/2 day flow.
_ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
X Any portion of the SAS,cesspool or privy is below the high groundwater elevation.
X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. [The 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.]
NO(Yes/No)The system I have determined that one of more of the following failure criteria exist as described in 310 CMR 15.303,
fails. therefore the system fails. The system owner should contact the Board-of Health to determine what will be
necessary to correct the failure.
E.Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must indicate either"Yes"or"No"to each of the following:
(The following criteria apply to large systems in addition to the criteria above.)
1
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)
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Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION(Continued)
Property: 70-80 Captain Cook Lane/Building 9
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: 01/22/09
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 with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department.
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Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART B
CHECKLIST
Property: 70-80 Captain Cook Lane/Building 9
Center.Village,Hyannis,MA.
Owner: Multiple Owners
Date: 01/22/09
Check if the following have been done You must indicate"yes"or"no"as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X _ Has the system received normal flows in the prevous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection?
X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break.out?
X _ Were the septic tank manholes were uncovered,opened,and the interior of the septic tank inspected for condition of baffles
or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of
subsurface sewage disposal systems?
The size and location of the Soil Absorption System on the site has been determined based on:
Yes No
X _ Existing information.For example, Plan at B.O.H.
X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
[15.302(3)(b))
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LTitleection Form 6/15/2000
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ROSANO DAVIS
9 ROCKY LANE
z COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION
Property: 70-80 Captain Cook Lane/Building 9
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: 01/22/09
FLOW CONDITIONS
RESIDENTIAL:
Number of bedrooms(design): Number of bedrooms(actual): 12 units.
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):
Number of current residents: Number varies but typically 18 on average
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system(yes or no): No (If yes separate inspection required)
Laundry system inspected (yes or no): _
Seasonal use(yes or no): .No..
Water meter readings,if available(last two(2)year,usage(gpd)):Water usage records were not available at time of inspection
Sump Pump(yes or no):No
Last date of occupancy: 01/22/09—Units were still occupied at time of inspection
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:Property currently under regular maintenance schedule Tank pumped 12/4/08
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: gallons-how was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
}
Septic tank,distribution box,soil absorption system
Single cesspool
Overflow cesspool
_ Privy
No 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)
No Tight Tank. Attach a copy of the DEP Approval
X Other(describe) Septic tank,soil absorption system
` Approximate age of all components,date installed(if known)and source of information: 36 years per previous inspection
f Were sewage orders detected when arriving at the site(yes or no): No
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Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION(Continued)
Property: 70-SO Captain Cook Lane/Building 9
Center Village,Hyannis,MA
Owner: .Multiple Owners
Date: 01/22/09
This page intentionally left blank
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Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION(Continued)
Property: 70-80 Captain Cook Lane/Building 9
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: 01/22/09
BUILDING SEWER(locate on site plan)
Depth below grade: 48".
Material of construction: X cast iron 40 PVC other(explain) 4" cast iron inlet pipe.
Distance from private water supply well or suction line:No known wells in immediate area.
Comments: (on condition of joints,venting,evidence of leakage,etc.)
All piping appeared to be clean and flowing freely. No evidence of leakage
SEPTIC TANK: YES(locate on site plan)
Depth below grade: 41".
Material of construction: X concrete metal Fiberglass Polyethylene
other(explain)2 000-gallon precast concrete septic tank.
If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes or No):—(Attach a copy of certificate)
Dimensions:6'deep X 4'wide X 12' long.
Sludge Depth: 511.
Distance from top of sludge to bottom of outlet tee or baffle: Zabel filter in place.
Scum thickness: 011.
Distance from top of scum to top of outlet tee or baffle: Zabel filter in place.
Distance from bottom of scum to bottom of outlet tee or baffle: Zabel filter in place.
How dimensions were determined:Measured with a tape.
Comments:(on pumping recommendations,inlet and outlet tees or baffle condition,structural integrity,liquid levels as related to outlet
invert,evidence of leakage,etc.)
Septic tank was pumped at time of inspection Cast iron inlet tee and A 100 Zabel filter on outlet tee in place Tank is structurally
sound and water tight and all effluent levels were at an appropriate height.There are no repairs recommended at this time
GREASE TRAP:NO(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 tog of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle: I
Date of last pumping: I
Comments:(on pumping recommendations,inlet and outlet tees or baffle condition,structural integrity,liquid levels as related to outlet
invert,evidence-of leakage,etc.)
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Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION(Continued)
Property: 70-80 Captain Cook Lane/Building 9
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: 01/22/09
TIGHT or HOLDING TANK: NO.(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 I
Design flow: gallons/day
Alarm Present(Yes or No)
Alarm level: Alarm in working order _(Yes/No)
Date of last pumping:
Comments:(condition of alarm and float switches,etc.)
DISTRIBUTION BOX: NO.(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: NO.(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.)
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Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
Property: 70-80 Captain Cook Lane/Buildi�SYSTEM INFORMATION(Continued)
Center Village,Hyannis MA
Owner: Multiple Owners
Date: 01/22/09
SOIL ABSORPTION SYSTEM(SAS):YES-(locate on site plan,excavation not required)
If SAS not located,explain why:
Type:
X leaching pits,number: 1—8' deep X 6'wide leaching pit
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.):
There was no surface wetness breakout or si ns of h draulic failure observed.Pit had 4'of effluent in it.Leachin appears to be in
good working condition.There are no repairs recommended at this time
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: NO-(locate on site plan)
Materials of construction:.
Dimensions:
Depth of solids: I
Comments: (note condition of soil,signs,of hydraulic failure,level of ponding,condition of vegetation,etc.)
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'itle 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION(Continued)
Property: 70-80 Captain Cook Lane/Building 9
Center Village Hyannis MA
Owner: Multiple Owners
Date: 01/22/09
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells
within 100 feet. Locate where public water supply enters the building.
C
eo c
6'dee p x6 `w ide L D 49:
BU16ing
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'itle 5 Inspection Form 6/15/2000
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ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION(Continued)
Property: 70-80 Captain Cook Lane/Building 9
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: 01/22/09
SITE EXAM
Slope
Surface water
Check Cellar.
Shallow wells
Estimated Depth to groundwater: Greater than 18 feet
Please indicate(check)all methods used to determine the high groundwater elevation:
_ Obtained from system design plans on record. If checked,date of design plan reviewed:
X Observed site(abutting property/observation hole within 150 feet of SAS)
X Checked with local Board of Health-explain:Previous Title 5 Inspections.
_ Check local excavators,installers-(attach documentation).
Accessed USGS database-explain:
You MUST describe haw you established the High Groundwater Elevation:
During previous inspections the high groundwater was indicated to be 18' 11" below grade Clearly there is separation from the
bottom of the SAS to the high groundwater elevation.It was by this non-intrusive method that it was estimated that separation exists
from the bottom of the SAS and the high groundwater.
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Title 5 Inspection Form 6/15/2000
EEC1 • • • • Igig
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la Complete items 1,2,and 3.Also complete A Signature
item 4 If Restricted Delivery is desired. X ❑Agent
■ Print your name and address on the reverse ' ❑Addressee
so that we can return the card to you. 9. eceived by(Printed Nam C. D of Q very
■ Attach this card to the back of the mailpiece, .
or on the front if space permits.
D. Is delive rely nt from item 1? ❑Yes
1. Article Addressed to: If YE�e c2 as below: ❑No` ` 3. Servic �ie�
{ 1ja rDuS�. Vn A bl5`6 \ kCertifi I-Express Mail
❑Registdred ELRetum Receipt for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number ++
(Transfer from service label) I! i!!(t 7 0 0,611 08101 0 0 01 3 5,2 41 8'' ..9 1 t------`
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540
UNITED STATES POSTAL £ ,uoj��
_age 8,Fee
uSPS
"_Sender. Please print your name, address, and ZIP+4 in this box
� Town of Barnstable
O Health Division
I 200 Main Street
,Hyannis MA 02601 M
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Certified Mail#7006 0810 0000 3524 8592
Town of Barnstable
Regulatory Services
► Y
� SAftNSTA6LE..`
v� 63& 1�$ Thomas F. Geiler,Director
19.
pTF°'"A�°' Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
February 26, 2007
Joseph MacDougall v
21 Ward Lane LI 3
Westborough, MA 0.1581
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 80 Captain Cook Lane, Centerville, was inspected
on February 26, 2007 by Timothy O'Connell, Health Inspector for the Town of
Barnstable. This 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 Town of Barnstable Code were observed:
1� 70-10—Smoke Detectors and Carbon Monoxide Alarms.No CO detector on second
floor.
You are directed to correct the violations listed above within twenty-four (24) hours
of your receipt of this notice by installing operable CO detector on 2nd floor.
*Note: COMM Fire Department has been notified that there was no CO detector
present on second floor at the time of the inspection.
J 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.
QAOrder letterMousing violations\Rental ordinance\80 Captain Cook Lane.doc
i
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.
PER ORDER_ OFF THE BOARD OF HEALTH
Thomas A. McKean, R.S., HO
Director of Public Health
Town of Barnstable
Cc: Anne Vallee, Tenant
Cc: Timothy O'Connell, Health Inspector
QAOrder letters\Housing violations\Rental ordinance\80 Captain Cook Lane.doc
I
Certified Mail#0000 0000 0000 0000 0000
4 t T Town of Barnstable
Regulatory
x Services
Thomas F. Geiler, Director
fFa Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
araL-
( ���Q.Q date
0i �
� ddress
(dJ{ city,stat , ip
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY
CODE II — i11`II'111,11I111111UM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE CODE CHAPTER 170.
The property owned b //11��
P P Y y you located at glL ap o�� ' was inspected
on 5: - y � (Address)
G , Health Inspector for the Town
(date) (Inspector's name) P
of Barnstable,
(Reason for inspection)
The following violation(s) of the State Sanitary Code were observed:
(State code violation number-violation description)
105 CMR 410.
105 CMR 410.
105 CMR 410.
105 CMR 410.
Q:\Order letters\Housing violations\Rental ordinance\template.doc
105 CMR 410.
The following violation(s) of the Town of Barnstable Code were observed:
Town code violation number-vic ation description)
§170-Q - 02
§170-_-
You are directed to correct the violations listed above within C/h1/-S )
op
of your receipt of this notice byaV (Written#) (#�
���-- UN
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.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S., CHO
Director of Public Health
Town of Barnstable
Cc: 00�c
(Name,tenant,owner,Fire Dept.,Building Dept....)
Cc: -ro
(Health inspector's name)
(Generic codes located at QAOrder letters\Housing violations\Rental Ordinance\GENERIC CODES.DOC)
QAOrder letters\Housing violations\Rental ordinance\template.doc
( r
{
Town of Barnstable
�'IKE T\
p� Regulatory Services
s BARNSTAHLE,i Thomas F. Geiler,Director
MASS.
°oar i539. a,� Public Health Division
FD MAC
Thomas McKean,Director
200 Main Street,Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
February 26, 2007
Attn: COMM Fire
Health Inspector Timothy B. O'Connell conducted a rental inspection in accordance with
Chapter 170 of the Town of Barnstable Code. In accordance with the State Sanitary
Code, 105 CMR 410.482, the Health Department is required to notify the Fire
Department if there is a smoke detector violation, or possible smoke detector violation.
The following property had possible smoke detector(and\or CO detector) violation(s):
80 Captain Cook Lane Center Village Condominiums,Assessors Map-Parcel: (274-
0
+ - Residence lacking carbon monoxide detector on second level.
Timothy B. 'Connell-Health Inspector
1
QAOrder letters\Housing violations\Rental ordinance\\Fire ViolationsTIRE TEMPLATE.doc
y�P�oFt"E'O�+tio� Town of Barnstable
Regulatory Services
BARNSTABLE,
9� 1"�; � Thomas F. Geiler,Director
Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
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Logged in As: Pa rce I Detail Monday, Februa
Parcel Lookup
Parcellnfo
Parcel ID 1274 014-OBH T _ Condo Unit UNIT 80
Condo
Complex ICENTER VILLAGE I Building i BLD 9
Location 80 CAPTAIN COOK LANE I Pri Frontage
I
Sec Road Sec .._ _...-
Frontage i
Village HYANNIS -� Fire District jHYANNIS
Sewer Acct�^ I Road Index 0236
Interactive
Map III;
Owner Info
Owner 1MACDOUGALL, JOSEPH W JR I Co-Owner MCAULIFFE,DAMES R
Streetl 21 WARD LN I Street2 I
City IWESTBOROUGH I state MA zip 101581 Country US
Land Info
Acres iuW. Use jCondominiu MDL-05 Zoning :B Nghbd 0001
Topography I Road!
- ....._.............
....._.__..
Utilities I Location
Construction Info
Building 1 of 1
Year _____-._��.._.___ Roof r _..___ _ . ___ Ext
Built 1972 I struct(Gable/Hip I wall[Wood Shingle
Effect 11`231-- cover h/F GIs/Cm AC
As Central
Area i I p p I Type I
Style Condominium IntDmwall Bed 2 Bedrooms
- I Wall I rY � I Rooms ._-.._,�..____.-..._�._�
Model I Res Condo
Bath
Floor
Int,_-____.______._..��__�-.__I Rooms L__.-_.-.___._.____.____.__._._
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http://issql/Intranet/propdata/ParcelDetail.aspx?ID=21182 2/26/2007
Parcel Detail Page 2 of 3
Average �� Heat Elec Baseb oard Total
Grade 1 - as[�io2�
Type� Rooms 14 Rooms
PTO[288]
Stories es Heat i-� - Found-s
2 Ston �I Fuel : ation I
Permit History _
Issue Date Purpose Permit# Amount Insp Date I Comments
Visit History u q
Date Who Purpose
Sales History
Line Sale Date Owner Book/Page Sale P
1 1/15/1986 MACDOUGALL, JOSEPH W JR 4884/317
2 GREELISH, ANNE V P60760
3 GREELISH, JOSEPH P JR ET AL P1173-El
4 GREELISH, JOSEPH P JR 4884/323
5 GREELISH, ANNE V 4791/287
Assessment History
Save# Year Building Value XF Value OB Value Land Value Total Parc(
1 2007 $241,000 $2,600 $0 $0
2 2006 $392,900 $2,600 $0 $0
3 2005 $224,400 $2,600 $0 $0
4 2004 $160,400 $2,600 $0 $0
5 2003 $95,400 $2,600 $0 $0
6 2002 $95,400 $2,600 $0 $0
7 2001 $95,400 $2,700 $0 $0
8 2000 $69,700 $2,500 $0 $0
9 1999 $69,700 $2,500 $0 $0
10 1998 $69,700 $2,500 $0 $0
11 1997 $53,200 $0 $0 $0
12 1996 $53,200 $0 $0 $0
13 1995 $53,200 $0 $0 $0
14 1994 $69,300 $0 $0 $0
15 1993 $69,300 $0 $0 $0
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Parcel Detail Page 3 of 3
16 1992 $78,800 $0 $0 $0
17 1991 $115,700 $0 $0 $0
18 1990 $115,700 $0 $0 $0
19 1989 $115,700 $0 $0 $0
20 1988 $69,500 $0 $0 $0
21 1987 $69,500 $0 $0 $0
22 1986 $69,500 $0 $0 $0
Photos _
1
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http://issgl/Intranet/propdata/ParcelDetail.asP x?ID=21182 2/26/2007
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FORM30 C-� HOBBSBWARREN'M THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF H H
CITYTY/TO�
W
a DEPARTMET O/�O 0
'c r, ADDRESS
GSM fy"I`
TELEPHONE
e l
Address Occupant___ Z'b�
Floor /i1 -Apartment No,_.g 0 _ No. of Occupants t
No.of Habitable Rooms3 No.Sleeping Rooms_-- -_7-
No.dwelling or rooming units f✓6 No.Stories JAI
q'_
Name and address of owner n°►C _____ _j/�
-- - - -- /T Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress: and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen. Sanitation:
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen. Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
—Pantry
Den
Living Room . y
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.:
Slacks,Flues s,Safeties:
Kitchen Facilities in
Stove _ --- - —
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: 0 1 O
Wash Basin,Shower or Tub:
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Building Posted
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OF PERJURY."
INSPECTOR �' TITLE
_tiR�_
AJL
1 ' -
DATE a-�' � `0 37 TIME 3�
A.M.
THE NEXT SCHEDULED REINSPECTION CJ 7D P.M.
r
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in.quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
7
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3) or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025 (' ?} 1a+
(781)383-1.234 (781)545-2800 (781)749-6178
-OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSM& S
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address 70-80 Captain Cook Lane
Building 9
Center Village,Hyannis,MA �/
Owner's Name Multiple Owners
Owner's Address Huntingest Property Management
40 Industry Road—P.O.Box 340
Marstons Mills,MA 02648
Date of Inspection Completed 1/1.9/06
Name.of Inspector Jeffrey F.O'Connell
Company Name Rosano Davis Sanitary Pumping,Inc.
Mailing Address 9 Rocky Lane
Cohasset,MA 02025
Telephone Number 781-383-1234
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
0 Needs Further Evaluation by the Loc Approving Authority
❑Fails
Inspector's Signature: Date: 02/02/06
The System Inspector shall su mit.a-copy.of.this inspection report to the Approving Authority. (Board of Health or DEP)within thirty
(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.
1 ^-
f ,
Title 5 Inspection Form 6/15/2000 -
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
-OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION(Continued)
Property: 70-80 Captain Cook Lane./Building 9
Center Village,Hyannis,MA
Owner.: Multiple Owners
Date: Completed 1/19/06
INSPECTION SUMMARY: Check A,B,C,D or E/AL WAYS complete all of section D:
A] SYSTEM PASSES:
X I have not found.any information which indicates that.any of the failure conditions described in 310 CMR 1.5..3.03 or in 310 CMR 1.5..3(
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 lobe replaced.or repaired. The system,upon
completion of the replacement or repair,as approved by the Board of Health,will pass.
Indicate 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 2.0 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
s.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.breakout or high.static water level in the distribution box due to broken or obstructed pipe(s)or
due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health):
broken.pipe(s)are replaced
_ obstruction is removed
_ distribution box is leveled.or replaced
ND explain:
The.system required pumping more.than 4-times-a year.due.to broken or obstructed pipe.(s). The system will pass inspection if.(with
approval of the Board of Health):
broken pipe(s)are replaced
_ obstruction is removed
ND explain:
2
Title 5 Inspection Form 6/15/2000
JS
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
-OFFICIAL INSPECTION FIRM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION(Continued)
Property.: 70-80 Captain Cook Lane./Building 9
Center Village,Hyannis,MA
Owner.: Multiple Owners
Date: Completed 1/19/06
C Further Evaluation is Required by.the Board.of Health:
_ Conditions exist which require further evaluation by the Board or Health in order to determine if the system is failing to protect the
public health,safety and the environment.
1) System will pass.unless Board.of Health.determines in accordance with 31.0 CMR 15.3.03(1)(b)that.the system is not
functioning in a manner which will protect public health,safety and the environment:
-Cesspool or privy is within.50 feet of a.surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2) System will fail unless 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 aseptic tank.and.soilabsorption.system.(SAS).and.the.SAS is within 1.00 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 withina Zone 1 of 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 5.0 feet_of more from.a.private water.supply
well". Method use 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:
3
Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
-OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION(Continued)
Property.: 70-80 Captain Cook Lane./Building 9
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: Completed 1/19/06
.D .System Failure-Criteria applicable to all systems:
You must indicate either"Yes"or"No" to each of the following for all inspections:
Yes No
_ X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool.
_ X Discharge.or.ponding.of effluent.to.the surface.of the ground.or.surface waters due.to.an.overloaded or clogged.SAS or
cesspool.
_ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
_ X Liquid depth in cesspool is less than 6"below invert or available volume is than 1/2 day flow.
_ X Required.pumping more than 4.times in.the last year NOT.due to clogged.or obstructed.pipe(s).
Number of times pumped
_ X Any portion of the SAS,cesspool or privy is below the high groundwater elevation.
X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X .Any.portion.of.a cesspool or privy is less.than 10.0 feet.but.greater than.5.0 feet from.a.private water.s.upply well with no
acceptable water quality analysis. [The 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.]
NO.(Yes/No)The.systtem I have-determined.that.one of more of the following failure criteria exist as described in.310 CMR 1.5.303.,
fails. therefore the system fails. The system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E.Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must indicate.either"Yes".or"No".to.each.of the following:
(The following criteria apply to large systems in addition to the criteria above.)
Yes No
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-ofa
public water supply well)
4
Title 5 Inspection Form 6/15/2000
I
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
-OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION(Continued)
Property: 70-80 Captain Cook Lane./Building 9
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: Completed 1/19/06
If you have.answered"yes".to.any.question in.Section E the system is.consider-ed.a significant.threat,.or.answered"yes"in.Section D.abov.e
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 with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department.
UDDR5 IDMO(B nffi'6effi1 CDM(% y IBM HEM& ow
5
Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
-OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART B
CHECKLIST
Property: 70-80 Captain Cook Lane./Building 9
Center Village,Hyannis,MA.
Owner.: Multiple Owners
Date: Completed 1/19/06
Check if the following have been done You must indicate"yes"or"no"as to each of the following.
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
_ X Were any of the system components pumped out in the previous two weeks?
X _ Has the system received normal flows in the prevous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection?
X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out?
X _ Were.the.septic tank manholes were uncovered,.opened,.and.the interior of the.septic tank inspected for condition of.baffles
or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum?
_ X Was.the facility.owner.(and.occupants if different from.owner).provided with information.on the proper maintenance.of
subsurface sewage disposal systems?
The size and location of the Soil Absorption System on the site has been determined based on:
Yes No
X _ Existing information.For example, Plan at B.O.H.
X _ Determined in the field.(if-any.of the failure criteria related.to Part C is.at issue,.approximation.of_distance is.unacceptable)
[15.302(3)(b)]
6
Title 5 Inspection Form 6/15/2000
f
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(61.7)383-1234 (61.7)545-2800 (617)749-61.78
-OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION
.Property: 70-80 Captain Cook Lane./Building 9
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: Completed 1/19/06
FLOW CONDITIONS
RESIDENTIAL:
Number.of.bedrooms(design).: - Number.of.bedrooms.(actual): 12 units.
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):
Number of.currentresidents: Number varies but typically 18 on average.
Does residence have a garbage grinder(yes or no): No
Is laundry on.a.separate.sewage.system.(yes or no): No -(Ifyes.separate inspection required)
Laundry system inspected (yes or no):
.S.easonal.use.(yes.orno): No
Water meter readings,if available(last two(2)year usage(gpd)): Water usage records were not available at time of inspection.
.Sump Pump.(yes or no): No
Last date of occupancy: 0 /19/06—Units were still occupied at time of inspection.
COMMERCIAL./INDUSTRIAL:
Type of establishment:
Design flow.(based.on 310 CMR 1.5.203): gpd.
Basis of design flow(seats/persons/sgft,etc.):
Grease.trap.preseent.(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: Property currently under regular maintenance schedule.
Was system pumped as part of the inspection(yes or no): Yes
If yes,volume pumped: 2,000 gallons-how was quantity.pumped determined?Sight glass on vacuum truck.
Reason for pumping: To determine structural integrity and water tightness of septic tank.
TYPE OF.SYSTEM
Septic tank,distribution box,soil absorption system
Single cesspool
Overflow cesspool
Privy
No 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)
No Tight Tank. Attach a copy.of the DEP Approval
X Other(describe) Septic tank,soil absorption system.
Approximate.age.of.all-components,-date installed-(ifknown).and source of information: 36 years per previous inspection.
IWere sewage orders detected when arriving at the site(yes or no): No
7
Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
-OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION(Continued)
.Property: 70-80 Captain Cook Lane./Building 9
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: Completed 1/19/06
MUM flMge MM9eMff8M&DIly Ileft DDIl&M
8
Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
-OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION(Continued)
Property.: 70-80 Captain Cook Lane./Building 9
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: Completed 1/19/06
BUILDING SEWER(locate on site plan)
Depth.below.grade: 48".
Material of construction: X cast iron 40 PVC other(explain) Cast iron inlet pipe.
Distance from private water.supply well.or.suctionline: No known wells in immediate area.
Comments:(on condition of joints,venting,evidence of leakage,etc.)
All piping appeared to be clean and flowing freely.No evidence of leakage.
SEPTIC TANK: YES(locate on site plan)
Depth below.grade: 41".
Material of construction: X concrete metal Fiberglass Polyethylene
other-(explain)2,000-gallon precast concrete septic tank.
If tank is metal, list age Is age confirmed by Certificate of Compliance(Yes or No):_(Attach a copy of certificate)
Dimensions: 6' deep X 4'wide X 12' long.
Sludge Depth: 5".
Distance from top.of sludge.to bottom.of.outlet tee.or.baffie: 30".
Scum thickness: 0".
Distance from.top.of scum.to top of outlet.tee.or baffle: 6".
Distance from bottom of scum to bottom of outlet tee or baffle: 14".
How dimensions were determined: Measured with a tape.
Comments:.(on.pumping recommendations,inlet-and.outlet.tees.or.baffle-condition,structural integrity,liquid levels.as related.to-outlet
invert,evidence of leakage,etc.)
Septic tank was pumped at time of inspection.Inlet tee and outlet tees in place as required.Tank is structurally sound and water
tight and all effluent levels were at an appropriate height.There are no repairs recommended at this time.
GREASE TRAP:NO(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.tees or.baffle.condition,structural integrity,liquid levels.as related.to.outlet
invert,evidence of leakage,etc.)
9
Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
'9 ROCKY LANE
COH.ASSET MA 02025
(617)383-1234 (617)545-2800 (61.7)749-61.78
-OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION(Continued)
Property: 70-80 Captain Cook Lane./Building 9
Center Village,Hyannis,MA
Owner.: Multiple Owners
Date: Completed 1/19/06
TIGHT or HOLDING TANK: NO.(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/day
Alarm Present(Yes or No)_
Alarm level: Alarm in working order _(Yes/No)
Date of-last pumping:
Comments:(condition of alarm and float switches,etc.)
DISTRIBUTION BOX: NO.(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: NO.(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.)
10
Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (61.7)749-6178
I -OF'IN'ICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION(Continued)
Property: 70-80 Captain Cook Lane./Building 9
Center Village,Hyannis,MA
Owner.: Multiple Owners
Date: Completed 1/19/06
.SOIL ABSORPTION SYSTEM.(SAS): YES.(locate on.site.plan,excavation not required)
If SAS not located,explain why:
Type:
X Teaching pits,-number: 1—6'X 6' leaching pit.
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.):
There was no surface wetness,breakout or signs of hydraulic failure observed.Leaching appears to be in good working condition.
There are no repairs recommended at this time.
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: NO.(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.)
11
Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178 .
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C ,
SYSTEM INFORMATION(Continued)
Property: 70-80 Captain Cook Lane/Building 9
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: Completed 1/19/06
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells
within 100 feet. Locate where public water supply enters the building.
W
I
C
-- G 35a `
eacC ?i+ j
� - D = 49, L
Not to scod e,
�u� Odin 9
12
Title 5 Inspection Form 6/15/2000
j•
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
-OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART.0
SYSTEM INFORMATION(Continued)
Property: 70-80 Captain Cook Lane./Building 9
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: Completed 1/.19/06
SITE EXAM
Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to groundwater: Greater than 18 feet
Please indicate(check)all methods used to determine the high groundwater elevation:
Obtained from system design plans on record. If checked,date of design plan reviewed:
X Observed site(abutting property/observation hole within 150 feet of SAS)
X Checked with local Board of Health-explain: Previous Title 5 Inspection dated 10/28/03.
_ Check local excavators,installers-(attach documentation).
Accessed USGS database-explain:
You MUST describe how you established the High Groundwater Elevation:
During a previous inspection on 03/29/03 the high groundwater was indicated to be 18' 11" below grade.Clearly there is separation
from the bottom of the SAS to the high groundwater elevation.It was by this non-intrusive method that it was estimated that
separation exists from the bottom of the SAS and the high groundwater.
13
Title 5 Inspection Form 6/15/2000
r
COMMONWEALTH OF MASSACHUSETTS
E EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
p Y
d DEPARTMENT OF ENVIRONMENTAL PROTECTION
F
RECE 6
AM She
MAY 19 2003
TOWN OF BARNSTABLE
TITLE 5 HEALTH DEPT.
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 70-80(evens),Capt.Cook Lane' Bldg 9,;Center Village
Owner's Name:c/o Huntingest Management
Owner's Address:Unit C,40 Industry Rd.Marstons Mills,MA 02648
Date of Inspection: 03/29/03
Name of Inspector:Brian T.Axon
Company Name: A&K Septic Systems Plus
Mailing Address:565 Carriage Shop Road East Falmouth,MA 02536
Telephone Number:508-540-6706
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:
X Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority .
Fails
Inspector's Signature: Date: 04/18/03
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: System functioning fine.There is no evidence of failure criteria. System consists of 2000
gallon tank with d-box and 2-leaching pits with 4'of stone surround
""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.
i
Page 2 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:70-80(evens)Capt. Cook Lane,Bldg 9,Center Village
Owner: c/o Huntingest Management
Date of Inspection: 03-29-03
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303
or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
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 the distribution box due to broken or
obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain.-
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
Page 3 of 11
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:70-80(evens)Capt.Cook Lane,Center Village,Bldg 9
Owner: c/o Huntingest Management
Date of Inspection: 03/29/03
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a .
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 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:
i
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:70-80(evens)Capt. Cook Lane,Bldg 9,Center Village
Owner: c/o Huntingest Management
Date of Inspection: 03/29/03
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
x Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
x Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
x Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
x Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow.
x Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
x Any portion of the SAS, cesspool or privy is below high ground water elevation.
x Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
x Any portion of a cesspool or privy is within a Zone 1 of a public well.
x Any portion of a cesspool or privy is within 50 feet of a private water supply well.
x Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates thatAhe well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
_ 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.
I
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 70-80(evens)Capt.Cook Lane,Bldg 9,Center Village
Owner: c/o Huntingest Management
Date of Inspection: 03/29/03
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
_ . X Were any of the system components pumped out in the previous two weeks?
X _ Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection?
x _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out?
X _ Were all system components, excluding the SAS, located on site?
X - Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition
of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on; .
Yes no
Existing information.For example, a plan at the Board of Health.
x _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b)]
Page 6 of l 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 70-80(evens)Capt. Cook Lane,Bldg 9,Center Village
Owner: c/o Huntingest Management
Date of Inspection: 03/29/03
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 12 Number of bedrooms(actual) : 12
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 1320
Number of current residents: 18
Does residence have a garbage grinder(yes or no): no
Is laundry on a separate sewage system(yes or no): no [if yes separate inspection required]
Laundry system inspected(yes or no):NO
Seasonal use: (yes or no):no
Water meter readings, if available(last 2 years usage(gpd)):NA
Sump pump(yes or no): no
Last date of occupancy: current
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seat s/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: system on regular maintenance schedule
Was system pumped as part of the inspection(yes or no):NO
If yes,volume pumped: _gallons- How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
X Septic tank, distribution box, soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
Shared;system(yes or no)(if yes, attach previous inspection records,if any) -
_Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
_Tight tank Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components, date installed(if known)and source of information: 33 years, management co.
Were sewage odors detected when arriving at the site(yes or no): NO
Page 7 of 11 ,
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:70-80(evens)Capt.Cook Lane,Bldg 9,Center Village
Owner: c/o Huntingest Management
Date of Inspection: 03/29/03
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:
Comments(on condition of joints,venting, evidence of leakage, etc.):
SEPTIC TANK: x (locate on site plan)
Depth below grade: 0"
Material of construction: x 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: standard 2000 gallon tank
Sludge depth: 1" -
Distance from top of sludge to bottom of outlet tee or baffle: 35"
Scum thickness: 0"
Distance from top of scum to top of outlet tee or baffle:8"
Distance from bottom of scum to bottom of outlet tee or baffle: 20"
How were dimensions determined:Field instruments
Comments.(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage, etc.):
Recommend pumping every two years. Condition of tees and liquid levels are fine. There is no evidence of leakage.
Structural integrity is fine.
GREASE TRAP:_(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 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 70-80(evens) Capt.Cook Lane,Bldg 9,Center Village
Owner: c/o Huntingest Management
Date of Inspection: 03/29/03
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/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: x (if present must be opened)(locate on site plan) °
Depth of liquid level above outlet invert: 0"
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of
leakage into or out of box, etc.): Distribution is equal. There is no evidence of solids carryover or any evidence of
leakage.
PUMP CHAMBER: (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.):
i
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 70-80(evens)Capt.Cook Lane,Bldg 9,Center Village
Owner: c/o Huntingest Management
Date of Inspection: 03/29/03
SOIL ABSORPTION SYSTEM(SAS): x (locate on site plan,excavation not required)
If SAS not located explain why.-
Type
X leaching pits, number: 2
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.):
No signs of hydraulic failure. Condition of vegetation and soil is fine.
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 or 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.):
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 70-80(evens)Capt. Cook Lane,Bldg 9,Center Village
Owner:c/o Huntingest Management
Date of Inspection: 03/29/03
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,%vithin 100 feet.Locate where public water supply enters the building.
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r Page l l of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE_ SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:70-80(evens)Captain Cook Lane,Bldg 9,Center Village
Owner: c/o Huntingest Management
Date of Inspection: 03/29/03
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 14+feet
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:
x Observed site(abutting property/observation hole within 150 feet of SAS)
x 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:
Local conditions-site at high elevations
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VILLAGE'C` ��_— ___# 401VIS ASSESSO 'S MAP&L T�d S�• �Y
_ NAME&PHONE NO. 6 ,rl�
SEPTIC TANK CAPACITY cs2�0`
LEACHING FACILITY: (type) /•7� �� (size)
NO.OF BEDROOMS C�
BUILDER OR OWNER lfkfi�
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 1: / Feet
Private Water Supply Well-and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) /Al Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 3 eet of leaching fac' )_J - Feet
Furnished b7� Pl72� � — C'. ��
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