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HomeMy WebLinkAbout0136 STEVENS STREET - Health ens�;Street } Hyannis ;. p f k,=_309 006 � 0 m t Py B 5 L _ _ C. TOWN OF BARNSTABLE � LOCATION 13 4 c /�cJ rs J Sal SEWAGE # 4I959, _ VILLAGE ASSESSOR'S MAP & LOT : bc)� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY .%'� LEACHING.FACILITY:(type)a '" (size) %02a S NO. OF BEDROOMS Ay^� BUILDER OR OWNER PERMIT DATE: C) .I COMPLIANCE DATE: �O 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 ofi leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by e�� �_ � �� a �� 4 n 1='`p �� ,.. .,. ) (?--/ No. a.®®X oil Fee /1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplicatfon for �Disspogar 6potem Co tructton Vermtt Application for a Permit to Construct( ) Repairs( ) Upgrade( ) Abandon( ❑.Complete System ❑Individual om onents 1 Location Address or Lot No.l-;-,g �42n Owner's Name,Address;and Tel.No. 6 J,Ul ��VC� 1((f Assessor's Map/Parcel 3,-" Installer's Name,Address,and Tel. Designer's Name,Address and Tel.No. Type of Building: V Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Ta / Type of S.A.S. Description of Soil l Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this B of Health. Signed Date Application Approved by Date '� C S -o Application Disapproved by: Date for the following reasons Permit No. &00 o I/l Date Issued { , ` No. .P 0 ox- M . i Fee i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes i Zipprtcatton for atopogal �&pgtem (C tructton Vermtt Application for a Permit to Construct O Repair O Upgrade O Abandon( ❑.Complete System ❑Individual Components C ) /36 Location Address or Lot No. .* 4„y,111� Owner's Name,Address;and Tel.No. Cq) 4 10 Assessor's Map/Parcel 3B aep c, / L j{ Installer's Name,Address,and Tel.N r Designer's Name,Address and Tel.No. ,,t� is vVW_ - Type of Building: Dwelling No:of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd �I Plan Date Number of sheets Revision Date Title � I Size of Septic Tan ( Type of S.A.S. s h Description of Soil l �' I �I Nature of Repairs or Alterations(Answer when applicable) Date last inspected: 1 ' Agreement: t M t The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in I accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by thisb?,p 031f Health. i Signed Date G I Application Approved by Date -. • ( S ' �C Application Disapproved by: ^: Date for the following reasons I I Permit No. 7-Od l i Date Issued a '� 1 �-0 � -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certtftcate of (Compliance THIS IS CERT that he n-site Sew a Dis osal System Constructed ) Repaired ( ) Upgraded ( ) Abandoned( )by at has been constructed in accordance r/ with the provisions of Title 5 and the for Disposal System Construction Permit No. 02yo 9 "b Ll I dated —1 S-0 L, Installer, Designer #bedrooms 1A Approved design w gpd 1 The issuance of this p i shall n be-construed as a guarantee that the system will` cti In as designed. Date Inspector G •� ------- ---------------------- --------�— No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 1=t_qpoga16potem Cow tructtort Vermtt Permission is hereby granted to Constru ) Repair ( ) Up rade ( ) Abandon Cy System located at TV I and as described in the above Application for Disposal System Construction Permit.The applica t-recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this p�.it. Date ( 5— 0 Approved by �--- Barnstable Assessing Search Results Page 1 of 2 ;j Home: Departments:Assessors Division: Property Assessment Search Results New Search New Interactive Maps >> Owner: 2008 Assessed Values: MORIN,JACQUES N 136 STEVENS STREET Appraised Value Assessed Value Map/Parcel/Parcel Extension Building Value: $44,200 $44,200 309 /006/ Extra Features: $0 $0 Outbuildings: $0 $0 Mailing Address Land Value: $ 112,300 $ 112,300 MORIN,JACQUES N Totals $ 156,500 $ 156,500 104 BERRY HOLLOW DR MARSTONS MILLS, MA.02648 2008 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Community Preservation Act Tax $30.89 Fire District Rates Town Barnstable FD-All Classes $2.04 $6.58 C.O.M.M. -All Classes $1.03 Commei Hyannis FD Tax(Residential) $239.45 Cotuit FD-All Classes $1.03 $5.80 Hyannis-Residential $1.53 Persona Town Tax(Residential) $ 1,029.77 Hyannis-Commercial $2.35 $5.80 Hyannis-Personal $2.35 Other R, W Barnstable-Residential $1.86 Commur W Barnstable-Commercial $1.86 W Barnstable-Personal $1.86 Total: $1,300.11 Construction Details Building Property Prso erty��Skdetch & ASBUILTk itch C Building value $44,200 Interior Floors Hardwood Style Cottage Interior Walls Plastered Model Residential Heat Fuel Oil Grade Average Minus Heat Type Hot Water Stories 1 Story AC Type None http://www.town.bamstable.ma.us/assessing/assess/displayparcel08map.asp?mappar=3 090... 2/27/2008 Barnstable Assessing Search Results Page 2 of 2 Exterior Walls Wood Shingle Bedrooms 1 Bedroom Roof Structure Gable/Hip Bathrooms 1 Full N3 Roof Cover Asph/F GIs/Gmp living area 480 Replacement Cost $58926 Year Built 1930 ,313 ,, �3 ff. Depreciation 25 Total Rooms 3 Rooms Land / h CODE 1010v= Lot Size(Acres) 0.29 Appraised Value $ 112,300 AsBuilt Card N/A Assessed Value $ 112,300 ~t View Interactive Maps >% Sales History: Owner: Sale Date Book/Page: Sale Price: MORIN,JACQUES N Aug 27 2007 12:OOAM C183958 $ 1 MORIN, KYLE J Jun 4 2007 12:OOAM C183275 $ 1 MORIN,JACQUES N Feb 23 2004 12:OOAM C172152 $ 153,000 PEREIRA, ELZIRA S Sep 26 2001 12:OOAM C162889 $ 117,000 BARRY, PATRICIA A May 15 1990 12:OOAM C120583 $60,000 BROWN, FRANKLIN C46345 $0 Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value Property Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area UST Utility Area (Unfinished) (Finished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story (Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story (Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/assessing/assess/displayparcel08map.asp?mappar=3090... 2/27/2008 No. o �r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for �Dtgoal 6p!tem Con5tructton Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(X) ®.Complete System ❑Individual Components Location Address or Lot No. 13LP 3TEVLK6 Owner's Name,Address,and Tel.No. bo N pF SARN31 A B �3ogob Ln). Assessor IsMap/Parcel HYAK[W11s M� v2t�o1 Installer's Name,Address,and Tel.No. M&L4 Y rpepl 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 Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 76TA L. 4_01NPIL DF SF.PT1 C IRNVl L-W- 'Ikf--;t 9-Y069:0 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo Health. Sign Date Z" 3 C7 Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. �' :%2� Date Issued 1491 ------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( 5()by H IOM W hj KEPT. , TbW N DF BAR Pl 5AQLE at 12b AEVCNS rk NJAUN S MR - 021.01 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. % �'! ` dated Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector —----•—----------------.--��-----—————====—————__——-- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Dtgool 6p!tem Congtructton Permit r Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon Q6 ) System located at 1-4t Si JLV E&J& `tea. R q A N i s , Nark 62(nC5 j 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: ConstructiNnust, com eted within three years of the dat f this p Date � Approve r:- M -77 Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes y Zpprtcation for �tgpogar 6pgtem� �or� tructton k_ Permit Application for a Permit to Construct( Repair( Upgrade( Abandon OO ®-Corriplete System ❑Individual Components Location Address or Lot No. I' EV r r� Owner's Name,Address;and Tel.No. 181A)N pF 9A RfK\1S j A B L Assessor's Map/Parcel hYA N W M Y I (--�'2to' Installer's Name,Address,and Tel.No. ��Hf,JA�/ ��� 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 Design Flow(min.required) gpd Design flow provided gpd i+w» Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1_67A L R r N I)L (fit- ,S[P n r. 1 A (1 Date last inspected: f 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 Environmgntal Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boa Health. Signed" t. Date 3 017 Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. """y� Date Issued Q ——————————————————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance ;AA i. THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( Y)by H ldr�W M f-FT T6w N �)F at 12)u yrNC, jj, HAM S MQ . DZID01 has been constructed ,(iinn/accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ,r Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. f. Date Inspector /� f�No. �W� �• / ----------------------- --. Fee r THE COMMONWEALTH OF MASSACHUSETTS , PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS ty'i�YKy lwtgpogal 6pgtem Congtructton Permit Permission is hereby granted 6 Construct ( ) Repair ( ) Upgrade ( ) Abandon ( x ) System located atSir\/E N1 N N I 6?_C0d I and as described in the above Applicafion for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. L Provided: Construction gust e comp eted within three years of the, date�of 0—this si p Date /a°' e U Approve(by TOWN OF BARNSTABLE LOCATION ACn �/ y%�+ 3 S! SEWAGE # (51 '15 _ YII.LAGE /ems/40 � A ASSESSOR'S MAP & LOT �bb INSTALLER'S NAME&PHONE NO. Z-16 /�.S " SEPTIC TANK CAPACITY LEACHING FACILITY: (type)cz — — (size) ', :=� NO. OF BEDROOMS r}, —0 BUILDER OR OWNER PERMIT DATE: — COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet w 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 i ae` i No. d,�0 l % Fee $5 0 �V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Migooaf *p5tem Couttruction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 136 S e cgs St. , Hyannis Pat Barry Assessor's ap .e Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P O Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. ,D 5Cb& 13X 2(o'X Z Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) Title-5 septic system con- sisting of a 1 , 500 gal, tank, D-box and 2 precast leach chambers with stone all around. ;Z_5- !E-- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu d by thi Boaz of Health. / Signed Date L- Application Approved by ® Date 6- M—d Application Disapproved for the following reasons Permit No. d O2S' -0 0' Date Issued ,fir 47? �> � � Fee $5 r�7L -, ,firTHE COMMONWEALTH OF MASSACHUSETTS Entered in compute " Yes PUB.LIC"HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS :y. �. Zipprication for �Digpo!5al *p5tem Congtructibn Permit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. .- 136 F. es St. , Hyannis Pat Barry Assessor's e ap ye (X� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. WM. E. Robinson Septic Service P 0 Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building NO f-ReApTssT-, Showers( ) Cafeteria( ) Other Fixtures'" Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 15OLDG Type of S.A.S.(Q � Description of Soil Sand µ i Natuie;of Repairs or Alterations(Answer when applicable) Tttle-5 septic system con- sisi ng of a 1 , 500 gal. tank, D-box and 2 precast leach cnam b ers with stone all around. i Date last ins pected: i Agreement: f The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi,-j,,BoarjVof Healt Signed I� Application Approved by d �/� I ) Date G ` 19—0 Application Disapproved for the following reasons r! Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS * BARNSTABLE, MASSACHUSETTS " Barry Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( X)Upgraded( ) Abandoned( )by Wm. E. Robinson Septic Service at 136 Stevens St. , Hyannis,_ has been constructed in accordance with the provisions of Title 5 and:the&Dispojalaystem Cons uctio Permid .r'" dated ��!�j ' .ter ZF-Vl Installer Wm. E. Robinson Sr. Designer The issuance of thi permit sha11 not be construed as a guarantee that the system will function as desig�}ed. Date ��U 101 Inspector ��Q -C \Qt� J No. .� Fee 5 0 THE COMMONWEALTH OF MASSACHUSETTS Barry PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ' lwfi6po5ar *pgtem Construction Permit Permission is hereby g ant d to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 1r3G Stevens St. , Hyannis 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:Construcot� t le completed within three years of the date of this , frmit. Date: 1 � Approved by 11h) noes - / l�t®T[CE_TES Form U To Be Used For the Repair Of Failed Septic Systems Only- OF SACITCH AND A�CAWffl ItOR A U SIrOSAL L W i l l iain E_ Robinson.Shy certify dm the appiicaoon far disposal works consuUction pestmn aid by one dam © � , meaning the property led at 136 Stevens St. , Hyannis meets A of the fouoWing criteria: • Thq faded systems is conumW m a ttaidett d dwdlmg a dy. 7huc am no wmm=ciat or business as 06VAed wuh the dweii n& rh t is classified xt Ct.ASS 1 and tDt P fate is ss t11G�tt.x agttal to minuucs pa inter arc no avdauft within 100 feet of the proposed septic kVMcW — am no pdvaw wells within lie fm of the pmposed Scpgic sySM, is m uKnam inflow mOK chasm in ux puWMd are no variames requested or neodod- bone=of the b=hmg fi=htY wa w&Ir k=wd Us&than five fimm above the vtmun MWe devotion IMPS OM POWK venter table usamg the Fnmptor Whoa applrca1*1 It the&-kS.will be lotaaed frith 250 feet of any vegctamcd vjcda»d:.the boonm of 1be proposed lrrcbiQ8 beaky wilt W b--totaled Mess flew foWV=1141 feet above the madmum add gloandwater table dmaduk Ph=r wmpftm the hftwmr ) Top of Gmand Oling GiS iafotmapunl 0 8► G.W.Eievatiam +1k MAX MO G_W--Adfinuaw DIFFERENCE BETWEEN A and S SIGNED: DATE: ``--(Skewh Pt'oPOScd Plan of SYSM an bade- . 7 u c 1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS Z W DEPARTMENT OF ENVIRONMENTAL PROTECTION M + d it MAP �� v9� PARCEL .. CD O,,M 5y0 LOX U TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 136 STEVENS ST HYANNIS 02601 M309 P006 Owner's Name: EVANDRO DECASTRO Owner's Address: BOX 3018 NANTUCKET MA. 02584 Date of Inspection: 2/16/04 RECEIVED Name of Inspector: (please print) JOHN GRACI,INC. MAR 0 5 2004 Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET, MA. 02536 TOWN OF BARNSTAgLE HEALTH DEPT. Telephone Number: 508-564-6813 FAX 508-564-7270 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 _ Conditional asses _ Needs Furt Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 2/16/04 The system inspector shall submiia 'copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspecon. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system ownersll 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 PASSED TITLE V INSPECTION. RECOMMEND PUMIPNG NOW AND EVERY ONE YEAR TO PROLONG THE SYSTEM'S USEFUL LIFE. ****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. Titla 5 Imna.ntinn Fnrm tiii si,?nnn 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 136 STEVENS ST HYANNIS 02601 M309 P006 Owner: EVANDRO DECASTRO Date of Inspection: 2/16/04 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: SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMIPNG NOW AND EVERY ONE YEAR TO PROLONG THE SYSTEM'S USEFUL LIFE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined" please explain. n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a Pagb 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 136 STEVENS ST HYANNIS 02601 M309 P006 Owner: EVANDRO DECASTRO Date of Inspection: 2/16/04 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 _ ys em 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 n/a "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 136 STEVENS ST HYANNIS 02601 M309 P006 Owner: EVANDRO DECASTRO Date of Inspection: 2/16/04 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 NOT IN THE LAST YR INFO FROM OWNER. 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 tributaryto surface a water supply. I . _ 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 r'p ivate water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply _ X the system is within 200 feet of a tributary to a surface drinking water supply Pp Y X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. a Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 136 STEVENS ST HYANNIS 02601 M309 P006 Owner: EVANDRO DECASTRO Date of Inspection: 2116104 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 t e 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 `? i X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up ? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site X _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions, depth of liquid, depth of sludge and depth of scum X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no X _ Existing information. For example, a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] • 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 136 STEVENS ST HYANNIS 02601 M309 P006 Owner: EVANDRO DECASTRO Date of Inspection: 2/16/04 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 4 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)):#k(a Sump pump(yes or no): NO 1 G JYj�c. Last date of occupancy: n/a V COMMERCIALANDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sqft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system (yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: NOT IN THE LAST YR INFO FROM OWNER Was system pumped as part of the inspection (yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes, attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components, date installed(if known)and source of information: 9-20-01 INFO FROM ASBUILT Were sewage odors detected when arriving at the site(yes or no): NO ti Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 136 STEVENS ST HYANNIS 02601 M309 P006 Owner: EVANDRO DECASTRO Date of Inspection: 2/16/04 BUILDING SEWER(locate on site plan) Depth below grade: 30" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints, venting, evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 24" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: H 10' 6" H 5' 7" W 5' 8" Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness:3" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle:15'R How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING NOW AND EVERY YEAR TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP: _(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): n/a 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 136 STEVENS ST HYANNIS 02601 M309 P006 Owner: EVANDRO DECASTRO Date of Inspection: 2/16/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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.): D-BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a R Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 136 STEVENS ST HYANNIS 02601 M309 P006 Owner: EVANDRO DECASTRO Date of Inspection: 2/16/04 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: n/a CHAMBERS leaching chambers, number: 2 n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH FIELD IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.RECOMMEND PUMPING THE FIELD NOW AND EVERY ONE YEAR-AT THE TIME OF INSPECTION THE FIELD HAS 3" OF LEACHING LEFT. BOTTOM IS AT 61-SHOWED NO SIGNS OF FAILURE AT THE TIME OF THE INSPECTION. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): n/a 4 Page 10 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 136 STEVENS ST HYANNIS 02601 M309 P006 Owner: EVANDRO DECASTRO Date of Inspection: 2/16/04 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 FDf)c C AA Ag g k 3C EAA DD �I in P-Age 11 of 11 J OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 136 STEVENS ST HYANNIS 02601 M309 P006 Owner: EVANDRO DECASTRO Date of Inspection: 2/16/04 SITE EXAM _Slope _Surface water _Check cellar _Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: i NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers- attach documentatio n) on) NO Accessed USGS database-exP lain: n/a You must describe how you established the high ground water elevation: GROUNDWATER WASD DETERMINED BY HAND AUGER- NO WATER AT 12' I I Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: 99 finQ/V)67 BUSINESS LOCATION: MAILINGADDRESS: _�� X /,23 J Mail To: TELEPHONE NUMBER: �g � � Board of Health Town of Barnstable CONTACTPERSON: ^/7/7 P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: Does your firm store any of the toxic or zardous materials listed below, either for sale or for you own use? YES NO t This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing address: ADDRESS: / S' TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes 4� Road Salt (Halite) Hydraulic fluid (including brake fluid) A/e Refrigerants Motor oils IA2 Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel 4ZZ2 Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal yV19 Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) _/^f�� Swimming pool chlorine Rustproofers — d�V Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes a Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyesQPCB's Lacquer thinnersOther chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers -� Paint brush cleaners A� Any other products with "poison" labels (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS