HomeMy WebLinkAbout42-44 HIRAMAR ROAD - Health 42 -44 HIRAMA_R RCS., HYANNIS
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• Sender: Please print your name, address, and ZIP+4 in this box •
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�a^�\ Town of Barnstable
Health Division
�& 200 Main Street
Hyannis,MA 02601 (J'
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SENDER: COMPLETE TvHIS SECTION COMPLETE THIS SECTION,ON DELIVERY
■ 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. g, Racal by(Printed Name) C. Date of Delivery
■ Attach this card to the back of the mailpiece, lTJ
or on the;front if space permits.
D. Is delivery address different from item 1? ❑Yes
1. Article Addrressed to:
If YES,enter delivery address below: ❑No
W",-t - W� \\\o.w. tk• e3��pn
fAv�- C Z 4A b 3. Service Type
®Certified Mail ❑Express Mail
❑Registered ®Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number �t Ii7O07fiO71� � OO�S '5818� 8'481i
(Transfer from seroloe label) w
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540
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HAItRYlean CLIFF SERVICES n(�
Drain Cleaning, Heating & Plumbing �J lL-�J
23 County Road
Mashpee, MA 02649 1332
PHONE TE O ORD
Home: 508-477-9732 Cell: 774-836-7069
ORDER TAKEN BY CU OME 'S ORDER NUMBER
TO ❑ DAY WORK ❑ CONTRACT ❑ EXTRA
JOB NAME/NUMBER
JOB LOCATION
JOB PHONE STARTING DATE
TERMS:
MATERIAL PRICE -AMOUNT rc - DESCRIPTION OF WORK
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• W 1 'lam ��.. � � I
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OTHER CHARGES s
TOTALOTHER
LABOR HRS. IRATE AMOUNT
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TOTALLABOR
DATE COMPLETED
TOTAL MATERIALS TOTAL MATERIALS
TOTAL OTHER
Work ordered by /
`�1 J TAX
Signature '
I hereby acknowledge the satisfactory completion of the above described work. TOTAL
Town of Barnstable
OF SHE A Regulatory Services , Barnstable
• P` o Thomas F. Geiler, Director ;mericaCity
Public Health-DivisionBAMNSrABL I I
MASS. E'g Thomas McKean, Director 1e39. zoc» `
$Ar A`e 200 Main Street
Eo Na+
Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
C
Mr. William H. Baron III a � October 22 2007
P.O. Box 590
Marstons Mills; MA 02648
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, 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 42 Hiramar Road, Hyannis, MA was inspected by Health
Inspector Meredith Morgan on October 19, 2007. The inspection was conducted on the basis
of a complaint
The following violations of the State Sanitary Code were observed:
105 CMR 410.550 (B)- Extermination of Insects, Rodents and Skunks:
Significant cockroach infestation observed within the property.
105 CMR 410.500- Owner's Responsibility to Maintain Structural Elements_:
Damaged flooring and walls observed throughout property.
105 CMR 410.501-Weathertight Elements:
All windows in home considered to not be weathertight.
105 CMR 410.351- Owner's Installation and Maintenance Responsibilities:
Toilet not properly affixed to floor. Electrical switch damaged in storage area. Bathroom
cabinets have significant water damage and rot.
1� 70-10—Smoke Detectors and Carbon Monoxide Alarms:
Smoke detector and CO detector not operable.
4 170-4 of the Town of Barnstable Code: Owner's Responsibility to Register Rental
Unit(s). This property is not currently registered with the Town of Barnstable Health Division.
*Enclosed please find a copy of the Town of Barnstable Rental Registration application
You are directed to correct the violations listed.above within each specific.time~frame
given for a particular violation. Smoke and CO detectors must be functioning properly
within twenty-four (24) hours of receipt of this notice. The property must be registered
with the Town of Barnstable within five (5) days .of receipt of this notice. The Town of
Barnstable must receive an invoice from a PPO (professional pest control operator)
C —1 toc)"1 0-1 to vc�,o S 5 2)1£S -61A b t
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within ten (10) days of receipt of this notice. This includes the cleaning of all surfaces
contaminated by cockroaches, dead cockroaches, cockroach eggs and cockroach fecal.
matter. All remaining violations must be corrected within thirty (A) days of receipt of
this notice. If applicable, all relevant building permits must be pulled prior to the start
of work.
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.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S., CHO
Director of Public Health
Town of Barnstable
CC: Meredith Morgan, Health Inspector
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`X TOWN OF BARNSTABLE
LOCATION V) —uU /"i ece ere✓ Z-4 SEWAGE 4#
VILLAGE lea i;r v-✓I 5 ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. i"',22 C N r e s' c� • r
SEPTIC. TANK CAPACITY
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LEACHING FACILITY: (type) (size) S
NO.OF BEDROOMS !
BUILDER OR OWNER
I PERMITDATE: COMPLIANCE DATE:
I
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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TOWN OF BfAFU11STABLE
t 'iIGN ' _ SEWAGE #
yLAr, _ �� � ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY _.,C S—o 0
LEACHING FACILITY: (type) /,N,!,�>-p� P` (size)'__
No.OF BEDROOMS _
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any.wells'exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished h;v
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NO. �! / Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
0[pprication for Mgooar *pztem Construction 30ermit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components
Location Address or Lot No. k,a kA 10 Y _ e— Owner's Name,Address and Tel.No.
Assessor's Map/Parcel q/I ` `~'t"' q\,Q e 10�1.,
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
15 k U�iS Si r
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures r` r , -
Design Flow tA`-ko gallons per day. Calculated daily flow (I gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank --seCP'O Type of S.A.S. SCEN-" L
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) yj(a- r
N ti
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the tal�nd not to place the system in operation until a Certifi-
cate of Compliance has b d of He t C�
Signed I Date r - ` Z
Application Approved by Date 1i
Application Disapproved for the ollowin reasons
Permit No. '7 7.5 �!i Date Issued
71
No. / `• -7J Fee _
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THE COMMONWEALTH OF MASSACHUSETTS Entered co}nputer:
i Yes
PUBLIC"HEALTH DIVISION -TOWN OF BARNSTABLE" MASSACHUSETTS"
Zippficatiou for Mi5pool *pgtem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ,Complete System ❑Individual Components
Location Address or Lot No. 1.�a...l�� .��� Owner's Name,Address and Tel.No.
Assessor's Map/Parcel Q� T �`�` `�—w'S �1 0
Installer's Name,Address,and Tel.No., Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms_— Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
" ,Other Fixtures
w � t,
;Design Flow. glAc gallons per day. Calculated daily flow s gallons.
r' Plan Date- Number of sheets Revision Date
Title '
Size of Septic Tank 1�/M Cse R)LIcl&, Type of S.A.S. tN t\\A C&
Description of Soil 1 .e� (ooko C P 5
Nature of Repairs or Alterations(Answer when applicable) Slanp"sm CX W e— ` r S( 1
G L IS - Srs
rfir H
Date last inspected:
Agreement:
The undersigned'agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Ems ental Code and not to place the system in operation until a Certifi-
cate of Compliance has be - �dof ealth ^'..
Signed Date
Application Approved by Date r ¢�
Application Disapproved for the llowin easons
Permit No. 7 Date Issued
----------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
\_ THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded
Abandoned( )by - -
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated i
Installer Designer A
The issuance of this pe sh � onstrued as a guarantee that the s s will fun ttio as dosgned6 �
e _• Date Inspector U ;;TI i it l
---�y------------------------------------
No. 7 5_1 I ' Fee��_
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Mizpo!6al 6potem Construction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade( Aba don( )
System located at y Ct L 1r . ku4v✓
IJ t C rA_u e C
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 permit.
Date: it Approved by
1/6/99
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only. -
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I, hereby certify that the application for disposal works
construction permit signed by me dated 4 95 concerning the
property located at �AA )�C y c-,..VU-c--(— iy A C— meets all of the
following criteria:
6/�/ / The failed system is connected to a residential dwelling only. There are no commercial or business
�/ uses associated with the dwelling.
4/ The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
(. There are no wetlands within 100 feet of the proposed septic system
There are no private wells within 150 feet of the proposed septic system
• here is no increase in flow and/or change in use proposed
'_ here are no variances requested or needed.
_11/The bottom of the proposed leaching facility will not be located less than five feet above the
maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor
method when applicable]
r_
If the S.A.S."will be located with 250 feet of any vegetated wetlands, the bottom of the proposed
leaching facility will not be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information)
J B) G.W. Elevation pL +the MAY. High G.W. Adjustment
DIFFERENCE BETWEEN A and B /
SIGNED: DATE: �l L
(Sketch proposed plan of system on back].
q:health folder.cert.
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Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of Environmental Protection
One Winter Street, Boston MA 02108 (617)292-5500
TRUDY CORE
Secretary
ARGEO PAUL CELLUCCI DAVID B.STRURS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 42-44 Hiramar Road, Hyannis, MA Name of Owner: Ted Hyora
Address of Owner: 25 Weks Pond Dr.
Date of Inspection: October 21, 1999 Forestdale, MA 02644
Name of Inspector: (Please Print) James M. Ford
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name: James M. Ford
Mailing Address: P.O. Box 49, Osterville, MA 02655-0049 Map:
Telephone Number: (508)862-9400 Parcel.
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
_ Passes
Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
✓ F 'Is
4
Inspector's Signature: � Date: October 27, 1999
The System Inspector shall submit qaopy 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 Department of Environmental Protection. The original should be sent to the
system owner and copies sent to the buyer, if applicable,and the approving authority.
NOTES AND COMMENTS
Fo
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7410
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revised 9/2/98 Page 1of11
Printed on Recycled Paper
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 42-44 Hiramar Road, Hyannis, MA
Owner: Ted Hyora
Date of Inspection: October 21, 1999
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
_ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 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,or ND). Describe basis of determination in all instances. If"not determined",explain why not.
_ The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or
the septic tank,whether or not metal, is cracked, structurally unsound,shows substantial infiltration or exfiltration,or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
Sewage backup or breakout 4 highstatic water level observed in the distribution box is 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 levelled or replaced
The system required pumping more than four 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 reeved
revised 9/2/98 Page 2of11
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 42-44 Hiramar Road, Hyannis, AM
Owner: Ted Mora
Date of Inspection: October 21, 1999
+r.
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 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 THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a 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 AND SAFETY AND
THE ENVIRONMENT:
_ The system has.a septic tank and soil absorption system(SAS)and.the SAS is within 100 feet to a surface water supply or
tributary.to a surface water,supply. `
_ The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis 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. Method used to determine distance (appro3dmation not valid).
3) OTHER
revised 9/2/98 Page 3ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 42-44 Hiramar Road, Hyannis, MA
Owner: Ted Hyora
Date of Inspection: October 21, 1999
D. SYSTEM FAILS:
You must indicate either"Yes" or"No" as to each of the following:
✓ I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
✓ — Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
✓ p°
or Discharge nding 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 1/2 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 Soil Absorption System,cesspool or privy is below the high groundwater elevation.
✓ Any portion of a 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria, volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must indicate either"Yes"or"No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
_ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
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
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further information.
revised 9/2/98 Page4of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 42-44 Hiramar Road, Hyannis, MA
Owner: Ted Hyora
Date of Inspection: October 21, 1999
Check if the following have been done: You must indicate either".Yes". or"No" as.to each of the.following:,
Yes No
✓ _ Pumping information was provided by the owner,occupant,or Board of Health.
✓ _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
✓ _ As built plans have been obtained and'examined: Note if they are not available with N/A.
✓ The facility or dwelling was inspected for signs of sewage back-up.
✓ _ The system does not receive non-sanitary or industrial waste flow.
✓ _ The site was inspected for signs of breakout.
✓ _ All system components,excluding the Soil Absorption System,have been located on the site.
✓ _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for conditions of baffles
or tees, material of construction,-dimensions, depth of liquid,depth of sludge,depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
✓ Existing information. For example,Plan at B.O.H.
✓ _ 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)].
✓ _ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of
SubSurface Disposal Systems.
revised 9'/2/98 Page 5of11
a
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 42-44 Hiramar Road, Hyannis, MA a
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Owner: Ted Hyora
Date of Inspection: October 21, 1999
FLOW CONDITIONS
RESIDENTIAL:
Design flow: n/a g.p.d./bedroom.
Number of bedrooms(design): n/a Number of bedrooms(actual): 2-2 bedroom(duplex)
Total DESIGN flow n/a
Number of current residents: Varies
Garbage grinder(yes or no): No
Laundry(separate system)(yes or no): No laundry ; If yes, separate inspection required
Laundry system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings, if available(last two year's usage(gpd): 1998-109,500 total gals.• 1997-159,750 total pals.
Sump Pump(yes or no): rIo
Last date of occupancy: Currently occupied.
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow: gpd(Based on 15.203)
Basis of design flow
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:
OTHER: (Describe) _ r
Last date of occupancy:
P Y:
GENERAL INFORMATION.
PUMPING RECORDS and source of information:
None on file-per Treatment Plant
System pumped as part of inspection(yes or no): No
If yes,volume pumped: gallons
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)
I/A Technology etc. Attach copy of up to date operation and maintenance contract.
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components,date-installed(if known)and source of-information: Unknown.
Sewage odors detected when arriving at the site: (yes or no) No
revised 9/2/98 Page 6of11
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 42-44 Hiramar Road, Hyannis, MA
Owner: Ted Mora
Date of Inspection: October 21, 1999
BUILDING SEWER:
(Locate on site plan)
Depth below grade:
Material of construction: _cast iron _40 PVC _other(explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints,venting,evidence of leakage,etc.)
SEPTIC TANK: None
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: __ ._ . .....
Scum thickness:
Distance from top of scum to top of outlet tee or baffle: =.
Distance from bottom of scum to bottom of outlet tee or baffle:
How dimensions were determined: - . .. .._. . .
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage,etc.)
GREASE TRAP: None
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) y
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:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
-. evidence.of leakage,etc.).
revised 9/2/98 Page 7of11
L
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 42-44 Hiramar Road, Hyannis, MA
Owner: Ted Hyora
Date of Inspection: October 21, 1999
TIGHT OR HOLDING TANK: None (Tank must be.pumped prior to,or 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:
Alarm level: Alarm in working order: Yes_ No_
Date of previous pumping:
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX: None
(locate on site plan)
Depth of liquid level above outlet invert: �. . .
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
PUMP CHAMBER: None
(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.)
revised 9/2/98 Page 8of11
IV
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 42-44 Hiramar Road, Hyannis, MA
Owner: Ted Mora _. .
Date of Inspection: October 21, 1999
SOIL ABSORPTION SYSTEM(SAS): ✓
(locate on site plan, if possible;excavation not required, location may be approximated by-non-intrusive methods) ;
If not located,explain:
Type:
leaching pits,number:
leaching chambers,number:
leaching galleries, number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number: 2
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.)
The first overflow cesspool was S'Wx 3'6"T The bottom to grade was 7' The second overflow cesspool was 5'Wx 4'T. The bottom to
grade was 76" The liquid level in both cesspools was 12"above the inlet pipe and backing-up into the main cesspool.
CESSPOOLS: ✓
(locate on site plan)
Number and configuration: I with 2 overflows
Depth-top of liquid to inlet invert: 2"
Depth of solids layer: 12"
Depth of scum layer: 10"
Dimensions of cesspool: S'W x 3'T
Materials of construction: Cesspool block
Indication of groundwater: None
inflow(cesspool must be pumped as part of inspection).
Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
The bottom of the cesspool to grade was 6'
PRIVY: None
(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.)
revised 9/2/98 Page 9ofII
.q
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 42-44 Htramar Road, Hyannis, MA - -
Owner: Ted Hyora
Date of Inspection: October 21, 1999
Map:
Parcel:
SKETCH OF SEWAGE DISPOSAL SYSTEM:_
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
y� 41
A
Scl j
3
�- 3
A3- S 3 ,
f33- 3(0
revised 9/2/98 Page 10of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 42-44 Hiramar Road, Hyannis, MA
Owner: Ted Mora
Date of Inspection: October 21, 1999 { '
MRCS Report name
Soil Type
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater 20 +/- Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
✓ Observed Site(Abutting property,observation hole,basement sump etc.)
Determined from local conditions
Checked with local Board of Health
Checked FEMA Maps
Checked pumping records
Check local excavators, installers
✓ Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
A septic system was installed on the next lot on the same day as this inspection. A test hole was dug to 10'below grade and
M the s were showing approximately
no water was observed. Using the Barnstable Topographic Map and Water Contours Map, map g app y
20' +/-to groundwater at this site.
This report has been prepared and the system inspected and failed as of the date of inspection. This report is not a warranty
or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,
written or implied, relating to the system, the inspection and/or this report.
s.
revised 9/2/98 Page ttof11
j � •
L0• CATiON SEW CE PERMIT N0.
VILLA E
�4-zA N N,,S,
I N S T A LLER'S NAME & ADDRESS
B U I L D E R OR OWN ER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
�I - 7 - 3S
CAT'ION 9v SEWAGE PE MIT NO.
•1'
.VILLAGE-
INSTA LLER'S -NAME & ADDRESS
r, O'A4JIw/2--
S UAL D E R OR OWN ER
DATE PERMIT ISSUED
D A T E COMPLIANCE ISSUED
-P �
�P
i\� 4
�Ju
i
b .
rjy '' 11 TOWN OF BARNSTABLE
-`'LOCATION MIy-,qM✓ar (Zcj SEWAGE #
VILLAGE 1L►j J8,1 1l_S ASSESSOR'S MAP & LOT
&STALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) C�s�spao�S (size)
NO.OF BEDROOMS
BUILDER OR OWNER G.. u�►o%4
PERMITDATE: 'L .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
M
an
c�
C-d
T
1
1
I
M cv� cn oo c�
�5cM co � ,: f
No. ��.. (� Fx$.....J......
THE COMMONNWEALTH.OF MASSACHUSETTS
BOAR® OF HE L
............. � .�i�.... OF...... ...9.
Appliration for Ui"oiial Works Tutuarttr#inn rerutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ran Individual Sewage Disposal
System at:=74%_
. .. tt
- - -• - ----- - --•--------•------•------•--•------ ---------- ---------- --........-•---••--•----..L ion-Addres / ram' or Lot No.
Ow Address
.-•----.�-�' �.t�Yl . ... ....----•...............•-•-•-------..........-----.......-------•----•-••---•-------••---
Installer Address
d Dwelling gNo. of Bedrooms............................................Ex Expansion Attic Size Lot............................ r feet
Type of Building Si
Other—Type Ter of Building No. of persons............................ 5h Garbage Grinder ( )
g— P ( )
ayp g ............................ p Showers ( ) — Cafeteria ( }
Q' Other fixtures --------------------•-••--•-•-•-- .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter------------_--- Depth................
x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft.
3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date-----------........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2......:.........minutes per inch Dept f Test Pit.................... Depth to ground: water........................
a' -•-•• ..... . . ..• ...... ................................
-----------------•--------••------•--••---•---------------.............---•--•---..----
O Description of Soil....... ---- ...
..................
......................................................................................x
--........--••..................•---•-----•----•...........................-----•------•----•-•-•-•----••---•--•-•----
U
UW ----••-•••.........................••••----...................................................••-----•-•-•---•-- -------------/ -
Nature of Repairs or Alterations—Answer when applicable_.__......f�.. ._ _. ---_-----_r....... .. etlJ
-----------------••------•--.----------------------------------------•------•------------------......--------------------------------------------------- ------......----- ,c ..
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be issued b he and f health. JJ
_Si ne � �.
G _. ...---
ate
Application Approved By............-------- -• .................-------_.+......__ ..........................
-----•. ..i...........................
. -- -----
Date
Application Disapproved for the following reasons------------------------•------••----.....---...•........------•-----------------------------•-----•-------...._.
................................................................................•-•-------•-----.........-----.............-----•---------------------------------------------------------•--......-----
Date
PermitNo.......... ................................. Issued.......................................................
Date
k
THE COMMONWEALTH OF MASSACHUSETTS
-.,--,-., BOARD OF HEALTH
• k.l�Jdt'r jFj fX,y � �
! .
..........._/ ........................ ...... ................... ._.. ......._......_....__...__....--_..
ApV iraftou for UiipnsFal Works Tnntrurtion "permit
Application is hereby made for a Permit to Construct ( ) or Repair (,--an Individual Sewage Disposal
System at•
..................................................
Location-Address or Lot No.
=
r.✓ f f J
_ ! r /
�`. Owner ^" Address
Installer Address
dType of Building Size Lot............................Sq. feet
Dwelling"No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
`k Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria
Q' Other fixtures ............................................................ ---------------
---------------------------
-......_-------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—J iquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width..................... Total Length..........-_..___._. Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter_................... Depth below inlet..................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by....................................................................-•--- Date.------••••------•-•-••...........................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.._......__.....___. Depth to ground water........................
" ................ -----
-•
f..
Descriptionof Soil......... .........................................................................................................................................................
V ....-•••-••-••--•------•-••--•--••••-••......•--•-••--•-•-••••••---•-•----•--•-•---•••------•-•-•-•-•--•-•--•-••••••-•-••----•-•---•--••---•-••----••---`-•----•--•-----•........-•-------•-•-•••--------
W ---•-•-•••-•. ....•------------•----------••----•----••...............••••-•--.....--•--•-•••••-••----•••••-••-- ! ' •••......• ,
UNature of Repairs or Alterations—Answer when applicable..___.._ .i......... .. ....:_. ... ___._ ___.._ _
Agreement:
The undersigned. agrees to- install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITI,;a, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of,health.
Signed yt ! .. �; { / !} ................................- .�' 5
_______ :_. ____ ______..........................................
1 ate
Application Approved. By---•= _:.. ..... ` �'-' ''�--........................... ,% -----•-••'�.•.........
Date`.•
Application Disapproved for the following reasons: ............:
-••...............................•-------------------------------•------..._........._..------------•-•- ---------
-••--•-•--•---•--•---- -•--------••-•--••-----•••--------•---•-••-•--••----------•---
Date
Permit No.......... 1.tom+? ` ...... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
.. BOARD OF HEALTH
..........................................OF......... ....................................... ......................
%Trrfifiratr of Tnntphanrr
THIS IS%'TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( =•)
I
Installer
has been installed in accordance with the provisions of TI T LE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No---------- _._.!_ -.: dated_...14-_rij. ..............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................�_�__-_.. .................................. Inspector........._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
G 5'" V-2 . ......... .......OF..... ?'
............................ ,
No......................... FEE........................
ipnt1AIL17 OI�an uanti#Perm>sslon is hereby granted----- ._----- 9: ............ -- .. _..---- •-------- --•------.....---........_.......
to Construct ( )�r epair ( an Individua ev�ge Dispo System
` reet
as shown on the application for Disposal Works Construction Permit No, �.�_7_.J __ Dated _,y_ .. .....................
�7�;�Oh
\.Ie Board of Health
DATE ��� r /�.i _-•--•-•-•-••---•------
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS