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HomeMy WebLinkAbout0079 AUTUMN DRIVE - Health 79 AUTUMN DRIVE, CENTERVILLE A= 168 054 UPC 12543 Now HASTMOS, V4 Add i `. rr l-/���� n� �—�3`s��� Y� _ � � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 79 Autumn Drive Property Address i Leonard &Sheryl Berkowitz ;= Owner Owner's Name X information is -r! required for every Centerville MA 02632 11/22/17 :` page. Cityrrown State Zip Code Date of Inspection Q- �r Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Scott Campbell use the return Name of Inspector key. Cardinal Construction VIC] Company Name 32 Ridgetop Rd. Company Address Cotuit MA 02635 City/Town State Zip Code 508-420-1295 S1388 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑x Passes ❑ Conditionally Passes ❑ Fails ❑ Need Further Evaluation by the Local Approving Authority I 11/22/17 Inspe or Ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 tog td VS � t9 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Autumn Drive 'M Property Address Leonard &Sheryl Berkowitz Owner Owner's Name information is required for every Centerville MA 02632 11/22/17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑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: Installed riser on distribution box covers is 4" below grade. B) System Conditionally Passes: j ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Autumn Drive Property Address Leonard & Sheryl Berkowitz Owner Owner's Name information is required for every Centerville MA 02632 11/22/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Autumn Drive �M Property Address Leonard &Sheryl Berkowitz Owner Owner's Name information is required for every Centerville MA 02632 11/22/17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ❑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 ❑ na❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 L_ Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Autumn Drive Property Address Leonard &Sheryl Berkowitz Owner Owner's Name information is required for every Centerville MA 02632 11/22/17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 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. ❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0 Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ 0 The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either."yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or'failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 79 Autumn Drive Property Address Leonard &Sheryl Berkowitz Owner Owner's Name information is required for every Centerville MA 02632 11/22/17 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ 0 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? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? 0 ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) 0 ❑ 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, including 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? 0 ❑ 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: ❑X ❑ Existing information. For example, a plan at the Board of Health. 0 ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface:Sewage Disposal System Form - Not for Voluntary Assessments 79 Autumn Drive Property Address Leonard & Sheryl Berkowitz Owner Owner's Name information is required for every Centerville MA 02632 11/22/17 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: unknown Does residence have a garbage grinder? ❑ Yes ❑X No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑X No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑X Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: 2015=23,000 gallons 2016=6,000 gallons Sump pump? ❑ Yes 0 No Last date of occupancy: 2017Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? El Yes El No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Autumn Drive �M Property Address Leonard &Sheryl Berkowitz Owner Owner's Name information is required for every Centerville MA 02632 11/22/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: 2017 Date Other(describe below): General Information Pumping Records: Source of information: No pumping records at thr Board Of Health Was system pumped as part of the inspection? ❑ Yes x❑ 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 79 Autumn Drive Property Address Leonard & Sheryl Berkowitz Owner Owner's Name information is required for every Centerville MA 02632 11/22/17 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: New D-box and leaching installed 3/27/96 per board of health records Were sewage odors detected when arriving at the site? ❑ Yes ❑x No Building Sewer(locate on site plan): Depth below grade: 2.5feet Material of construction: ❑ cast iron 0 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting,evidence of leakage, etc.): no visible leaks. Septic Tank (locate on site plan): Depth below grade: 1.5feet Material of construction: ❑x concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Autumn Drive Property Address Leonard &Sheryl Berkowitz Owner Owner's Name information is required for every Centerville MA 02632 11/22/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 4.4 Scum thickness 2 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 14" How were dimensions determined? Tape measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank should be pumped every three years. Both tees in place at time of inspection. Structural integrity of tank is good. Liquid level at proper working height. No evidence of leakage into or out of tank. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 79 Autumn Drive Property Address Leonard &Sheryl Berkowitz Owner Owner's Name information is required for every Centerville MA 02632 11/22/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Autumn Drive M Property Address Leonard & Sheryl Berkowitz Owner Owner's Name information is required for every Centerville MA 02632 11/22/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is set level. Equal distribution to both lines. No evidence of solids carryover. No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumpsin working r ❑ ❑ * o g order: Yes No Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 79 Autumn Drive M Property Address Leonard &Sheryl Berkowitz Owner Owner's Name information is required for every Centerville MA 02632 11/22/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: 0 leaching trenches number, length: 2,30' ❑ 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.): Excavated down below bottom of leaching trench and stone was clean and dry. Photo enclosed with report. No hydraulic failure, no ponding or damp soil. Normal vegetation. (grass) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication,of groundwater inflow ❑ Yes ❑ No t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Autumn Drive Property Address Leonard & Sheryl Berkowitz Owner Owner's Name information is required for every Centerville MA 02632 11/22/17 page. City/Town State Zip Code Date of Inspection D. System Information cont. Y (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f 79 Autumn Drive Property Address Leonard &Sheryl Berkowitz Owner Owners Name information is required for every Centerville MA 02632 11/22/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: 0 hand-sketch in the area below ❑ drawing attached separately a� a� TM o p subwftto Stwme ptSpe=f Sydm.Page 15 of 17 t5ias•1 WD Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 79 Autumn Drive Property Address Leonard & Sheryl Berkowitz li Owner Owner's Name information is required for every Centerville MA 02632 11/22/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑x Check cellar ❑ Shallow wells Estimated depth to high ground water: 1 feeett Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Hand auger 5' below bottom of leaching during title 5: Inspection no water encountered. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 79 Autumn Drive Property Address Leonard & Sheryl Berkowitz Owner Owner's Name information is required for every Centerville MA 02632 11/22/17 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ❑x Inspection Summary: A, B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems) completed System Information —Estimated depth to high groundwater ❑x Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 79 Autumn Drive Property Address Federal Home Mortgage Corp Owner Owner's Name information is required for every Centerville MA 02632 06/18/12 page. Cityfrown State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms I st the computes, u vzoq use only the tab 1. Inspector: key to move your cursor-do not Michael Kellett use the return Name of Inspector key. Aardvark Environmental Inspections Company Name PO Box 896 Company Address East Dennis MA. 02641 CitylTowrr State Code s cl, 508-385-7608. SI 3742 Telephone Number License Number t C) B. Certification I certify that I,have personally inspected the sewage disposal system at this address Ad that the? information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of`on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 06/18/12 Inspector's Signature Date _ The system inspector shall submit a copy of this inspection report to the Approving Authority(Bbard of Health or DEP)within.30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall'submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same.or different conditions of use. ( f t5ins•1111 D Title 5 Official Inspectio Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 79 Autumn Drive Property Address Federal Home Mortgage Corp Owner Owner's Name information is required for every Centerville MA 02632 06/18/12 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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 ofthe replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes","no"or"not determined"(Y,N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*orthe septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfitration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved'by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): I stem Pa e 2 of 17 t5ins•11110 Title 50fficial Inspection Form:Subsurface Sewage Dlsposa Sy • g, Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 79 Autumn Drive Property Address Federal Home Mortgage Corp Owner Owner's Name information is Centerville MA 02632 06/18/12 required for every page. Cityrrown state Zip Code Date of Inspection B. Certification (cont.) E B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board.of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(i)(b)that the system is not functioning in a mannerwhich 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 wins 'i 1i i0 i iue 5OYeSaI Vnig*itoni Foim:Subsu ace Svw. v`6pOSai S'y,�em�Page 3 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 79 Autumn Drive Property Address Federal Home Mortgage Corp Owner Owner's Name information is Centerville MA 02632 06/18/12 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of.Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and.SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup-of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 79 Autumn Drive Property Address Federal Home Mortgage Corp Owner Owner's Name information is required for every Centerville MA 02632 06/18/12 page. Citylrown state Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5'ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria east 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 correctthe failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or`no"to each of the following,in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead:Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question.in Section E the system is considered a significant threat, or answered `fifes"in Section D above the large system has faded.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 Departrnent. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form & Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 79 Autumn Drive Property Address Federal Home Mortgage Corp Owner Owner's Name information is required for every Centerville MA 02632 06/18/12 page. City/Town state Zip Code- Date of Inspection C. Checklist Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal,flows in the previous two week period? ❑ ® Have large volumes_of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?.(if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding.the SAS,located on site? ® ❑ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum?. ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information.For example,a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)]' D. System information Residential flow Conditions: I Number of bedrooms(design):' 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15203(for example: 110 gpd x#of bedrooms): 330 t5ins•11/10 Title 5Official Inspection Form:Subsurface Sewage Disposal.System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 79 Autumn Drive Property Address Federal Home Mortgage Corp Owner Owner's Name information is required for every Centerville MA 02632 06/18/12 page. Citylrown state Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundrysystem inspected? Yes No Y P ❑ Seasonaluse? ❑ Yes ® No Water meter readings,if available(last 2 years usage(gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: 10/10 Date CommerciaWndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes. ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: t5ins-11/10 I Title 5 Official Inspection Form:Subsurface Sewage-Disposal System-Page 7 of 17 pt Commonweafth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 79 Autumn Drive Property Address Federal Home Mortgage Corp Owner Owner's Name information is required for every Centerville MA 02632 06/18/12' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: ' Source of information: Was system pumped as part of the inspection? ❑' Yes 0 No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared.system (yes or no)(if yes,attach previous inspection:records, if any) ❑ Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-111110 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 79 Autumn Drive Property Address Federal Home Mortgage Corp Owner Owner's Name information is required for every Centerville MA 02632 06/18/12 page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: 03/27/96 per BOH Were sewage odors detected when arriving at the site? ❑ Yes Z No Building Sewer(locate on site plan): Depth below grade: 2.4 feet Material of construction: ❑ cast iron ®',40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage,etc.): Septic Tank(locate on site plan): 1.7 Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain) If tank is metal,list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) El Yes ❑ No Dimensions: 1,000 gal Sludge depth: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 79 Autumn Drive Property Address Federal Home Mortgage Corp Owner Owner's Name information is required for every Centerville MA 02632 06118/12 page. Cityfrown state Zip Code Date of Inspection D. System Information (coot.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 181, How were dimensions determined? measured Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): The tank was sound and tight with tees in place and liquid at outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete E metal 0 fiberglass El polyethylene Q other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 79 Autumn Drive Property Address Federal Home Mortgage Corp Owner Owner's Name information is required for every Centerville MA 02632 06/18/12 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: :gallons per day r Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 TrUe 5 Official tnspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonweafth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 79 Autumn Drive Property Address Federal Home Mortgage Corp Owner Owner's Name information is required for every Centerville MA. 02632 06/18/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert even 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.): The box was level and tight with no sign of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Soil Absorption System.(SAS)(locate on site plan,excavation not required): If SAS not located,explain why: t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 79 Autumn Drive Property Address Federal Home Mortgage Corp Owner Owner's Name information is required for every Centerville MA 02632 06/18/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont) Type: ❑ leaching pits number: ❑ leaching chambers , number: ❑ leaching galleries number: ® leaching trenches number, length: 2@30' ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): This system has two trenches 2'wide by 30'long.There was no sign of ponding or failure in the stones. Cesspools (cesspool must be'pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Trtie5 Official Inspection Form:Subsurface Sewage.Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 79 Autumn Drive Property Address Federal Home Mortgage Corp Owner Owner's Name information is required for every Centerville MA 02632 06/18/12 , page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not.for Voluntary Assessments 79 Autumn Drive Property Address Federal Home Mortgage Corp - Owner Owner's Name information is Centerville MA 02632 06/18/12 required for every State Zip Code Date of inspection page. cityrrown D. System Information (cunt.) Sketch Of Sewage Disposal System:Provide a view of the sewage disposal system,including ties th at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet Locate where public water supply enters the building.Check one of the boxes below: hand-sketch of the area below ❑ drawing attached separately tar a8 Tft S DffkW WwMc800 Fame:Subw t ee'ewne DbpoWSistm.Pa9s 15 of V t5ins•11A D Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments w 79 Autumn Drive Property Address Federal Home Mortgage Corp Owner Owner's Flame information is required for every Centerville MA 02632 06/18/12 page. Cityfrown state Zip Code Date of Inspection. D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 20.0 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record. If checked,date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators,installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS maps show an elevation of over 20.0 feet: Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 79 Autumn Drive Property Address Federal Home Mortgage Corp Owner Owner's Name information is required for every Centerville MA 02632 06/18/12 page. Cityrrown state Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C,D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed Z System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Nauset Environmental Services, Inc. an Air Quality Company 3 October 2008 NES Job# 585 Report No. NES/IAQ-08/841 Katherine Rayle 79 Autumn Dr. Centerville, MA 02632 Re: Mold/moisture Inspection+Baseline Sampling at 79 Autumn Dr. with Scope of Work Dear Ms. Rayle: Nauset Environmental Services,Inc.(NES)is pleased to submit this letter report on the investigation of mold/moisture issues at 79 Autumn Drive. Following your authorization,NES sent William M. Vaughan, PhD, QEP & CIEC to the property on 11 September 2008 to inspect the basement and main floor and take air samples to document potential spore levels. BACKGROUND: There have reportedly been several leaks in recent years during your tenancy at P Y this address. In late 2007 the water heater and/or the furnace in the basement leaked spreading water over most of the basement. Reportedly there was visible mold growth that was painted over. There was also a leak around the tub on the main floor bathroom that adjoins your daughter, Jillian's, bedroom. She is allergic to mold and is reportedly taking ClaritinTM to alleviate the symptoms. NES was retained on a limited budget to conduct a mold/moisture inspection and take air samples to determine if there were residual settled spores, Condition 2 contamination,present in her room and wall cavity samples for hidden mold growth. EXECUTIVE SUMMARY The results from the visual inspection and moisture meter readings found many damp areas and visible mold growth in the basement that are consistent with the moldy/musty odor noted on entry. Activities to address the moisture conditions are presented. The limited air sampling in Jillian's room revealed Condition 2 contamination, settled spores, calling for mold remediation. Wall cavity sampling indicated hidden, active mold growth, Condition 3 contamination,in the one stud bay sampled in Jillian's room adjacent to the bathroom. A professional mold remediator should address those conditions. A limited mold Scope of Work is provided that addresses .both levels. It is limited because, as noted in this report, the available budget was not adequate for a thorough evaluation of hidden mold growth on both levels. ON SITE ACTIVITIES —Dr. Vaughan arrived at the house on 11 September to inspect the two levels of the building. Dr. Vaughan used a Tramex "Moisture Encounter Plus" non-penetrating, moisture meter(MM) to determine the moisture levels in various structural materials to a depth of about an inch. P.O. Box 1385 508/247-9167 [800/931-11511 East Orleans, MA 02643 FAX: 508/255-0738 MIM Inspection + Sampling &SOW for 79 Autumn Dr. Report No. NESIIAQ-081841 Page 2 Following on-site observations and a discussion of the main floor bathroom leak, Dr. Vaughan selected one location on the main floor,Jillian's bedroom,and two wall cavities to take air samples. Photographs of select areas were taken and are included in Attachment A. The air sampling plan was developed to characterize the spore levels in Jillian's room, due to her allergies and to check for hidden mold growth in the shared bathroom wall cavity and a nearby one, not impacted by the bathroom leak,the hall across from Jillian's door. No outdoor reference sample was taken since the focus was on indoor conditions. The bedroom air samples were taken at the breathing zone under "quiet" conditions and under "disturbed" conditions. The interior total spore samples were taken to determine the current total spore levels with the difference between quiet and disturbed spore levels indicating"settled" spore conditions or Condition 2 contamination (see below). All samples were collected on Cyclex-dTM cassettes for microscopic analysis. After the sampling pump flow rate was confirmed for each pump at 20 1pm using a rotometer transfer standard, the interior air samples were taken for timed intervals using digital timers. Sampling locations were documented with photographs seen in Attachment A. A log sheet documented the sampling activity during the sampling. Each"quiet"sample was taken following setup of the sampling tripod. Each"disturbed"sample was taken after disturbing the air in the general area using a 12" fan set on high speed for a couple of minutes. The drafts from the fan simulate human activity in the area that would disturb mold spores as building materials are dropped during remodeling or winds blow through open doors or window. The fan's drafts suspend spores from hard-to-reach areas where they have settled but would be dislodged by occupant activities. He then used the same flow rate of 20 liters per minute for the two wall cavity samples. After disinfecting the drill bit each time, he drilled an access hole for each sample. Each wall cavity sample was collected on a polycarbonate filter with a 0.4 micron pore size. A freshly cut section of TygonTM tubing with about a 45 degree cut on its tip was attached to a fresh,labeled cassette and the tube inserted into the hole drilled into the wall cavity. A photograph was taken(see Attachment A) to document each sampling location. During each 3-minute sampling period,he periodically tapped the adjacent wall with a rubber mallet in the general vicinity of the sample point. The exposed air sample cassettes were combined with a completed chain of custody form and shipped to EMLab/P&K Microbiology Services, Inc. (Cherry Hill, NJ). The air samples were designated for microscopic analysis. The exposed wall cavity cassettes were sealed with plugs on the inlet and exhaust ports before being documented on the same chain of custody form and also sent to P&K Microbiology Services, Inc. The analysis requested for this cavity sample was "culturable air fungi" which involves extraction and culturing on a growth media—malt extract agar (MEA) for general mold growth MIM Inspection + Sampling &SOW for 79 Autumn Dr. Report No. NESIIAQ-081841 Page 3 The following statements from EMLab P&K indicate why NES chose them for these analytical services: ■ "Because there is currently no governmental certification for environmental microbiology laboratories(except for drinking water and wastewater microbiology),P&K Microbiology Services,Inc.is an active participant in the EMPAT(Environmental Microbiology Proficiency Analytical Testing)program sponsored by the American Industrial Hygiene Association(AIHA). P&K has been formally accredited by the AIHA in Environmental Microbiology since July 2000 with a laboratory identification number of 103005." ■ "P&K is staffed by experienced and highly qualified mycologists and microbiologists and&K has more than twenty years experience in sampling,analysis of microbial aerosols." ■ "(P&K) has modeled its quality control system after the ISO guidelines, one of the most stringent sets of international standards in the industry, to ensure that its customers receive the high standard of accuracy, reliability and impartiality that they have come to expect from a leader in the environmental industry." OBSERVATIONS: Observations at 79 Autumn Drive are provided below: Basement ■ There was a heavy moldy/musty odor noted on entering the basement. [Moldy odors come from "microbial volatile organic compounds (MVOCs)" that are released from currently active colonies digesting the organic matter on which they are growing.] ■ There was still furniture and wall-to-wall carpet in the livingr_oom that had reportedly been wet by the leak(s) and had standing water for several leaks. The carpet still registered elevated moisture readings near the door to the hall at 40% of full scale on the dry setting (FS-DW) (see photo in Attachment A). ■ The paneling to the left of the basement fireplace was delaminating (see photo), a sign of excess dampness,and registered a damp 20%of moisture in wood(MW)(see photo)when the desired "dry" level is 15% MW or lower. ■ In the kitchen to the right of the sink the drywall registered 40% FS-DW near the bottom and 0%FS-DW 2-3' off the floor, a pattern consistent with impact from standing water on the floor that wicks up the dry wall. ■ In the utility area there were excessive cobwebs(see photo)indicating damp conditions for an extended period of time that has allowed biological growth of enough variety to support a spider population at the top of the food chain. ■ Near the door to the basement bathroom,the drywall moisture meter reading was off scale, indicating wet conditions (see photo). ■ The wall of the bathroom closet was also quite damp at 80% FS-DW. ■ The drywall right of the toilet was quite moist, registering off scale on the drywall setting (see photo) and 100% FS-DW under the sink(see photo). ■ The pipes near the furnace had many rusted areas indicating prior leaks (see photo). ■ The back side of the drywall near the water heater had visible mold growth (VMG) (see photos). MIM Inspection + Sampling &SOW for 79 Autumn Dr. Report No. NESIIAQ-081841 Page 4 Garage ♦ The right rear wall registered 70-80%FS-DW near the ceiling where there was a small area of dense VMG on the ceiling below the bathroom above (see photo). ♦ The MM went off scale on the DW setting near the patch of VMG mentioned above and located under Jillian's bedroom. ♦ There were patches of VMG under the work bench and along the left side wall of the garage (see photos). The VMG near the work bench also had elevated MM readings near 60%FS- DW (see photo). Main floor ♦ In Jillian's room there were water stains on the right rear of the ceiling. A MM reading on the wall below the stains indicate dry conditions at the time(see photo). (Due to texturizing on the ceiling the MM could not be used since it must lie flat on a surface to operate properly.) ♦ The MM indicated that the moisture was elevated under the rear window(40%FS-DW)and under the side window (20-30% FS-FW). ♦ The room air was damp with a relative humidity at 75% with the windows closed. ♦ The bathroom ceiling had extensive water staining along the rear(see photo). Brown stains result from water passing through the drywall and leaching tannins from the drywall paper, not from water condensing on the ceiling inside the room ♦ The MM registered off scale on the ceiling near the stains over the tub (see photo). ♦ There were blotchy water stains on the ceilings if the dining room and livingr oom (see photos). Attic ♦ There were areas of black staining along the rear(south) side of the attic sheathing,usually associated with damp sheathing due to a failing roof above that lets water ooze through keeping it damp and supporting mold growth in the grain of the plywood that leaves the stains. ♦ The roof sheathing on the north side was clearer than the south side (see photo) indicating that the discoloration noted above was not the typical north-side condensation mold growth resulting from winter condensation on the cooler north surface of the roof. Exterior ♦ The roof in general is in very poor condition,especially over the bathroom area(see photos) where the dark staining was noted above on the sheathing and stains on the bathroom ceiling. ♦ The gutters were so poorly maintained that they were supporting plant growth (see photos) leading to overflow of water that would impact the foundation,keeping the basement damper than desired. ♦ On the front, the roofing had failed badly enough that the sheathing had actually rotted and collapsed (see photo). Table 1 lists the sample locations and type for the total air Cyclex-dTM samples and polycarbonate wall cavity samples. Table 2 summarizes the results of the microscopic analysis from this round of MIM Inspection + Sampling &SOW for 79 Autumn Dr. Report No. NESIIAQ-081841 Page 5 sampling. Table 3 summarizes the results of culturing the wall cavity samples. The EMLab P&K mold reports and graphics are found in Attachment B. Attachment C describes the properties of the dominant spores and structures found. Table 1 — Sampling Locations (Bold sample numbers indicate disturbed air samples) Sample# Location Comments Room air 585-1 Jillian's room quiet(T=68F, RH=72%) 585-2 Jillian's room disturbed (T=67F, RH=75%) Wall cavity samples 585-3 Jillian's wall shared with bathroom 585-4 Hall wall opposite Jillian's door DISCUSSION: OBSERVATIONS There were several objective indications of on-going damp conditions in the basement with elevated moisture found in carpeting near the hall door to the living room,the paneling next to the fireplace, the drywall in the kitchen, closet, bathroom, and garage. There were also areas of visible mold growth (VMG) in the basement - the back side of the drywall near the water heater/furnace, the garage walls and the garage ceiling. There was also an obvious moldy odor noted on entering the basement. This set of lower level observations indicates that the damp conditions have and are supporting mold growth some hidden in wall cavities and some visible on the walls and ceiling. The damp conditions result from a combination of prior leaks that have not been dried promptly and penetrations through the foundation due to poor guttering and drainage that discharges water too close to the foundation so that it can readily penetrate into the basement. The observations on the main floor also indicated damp conditions. The objective measures of these conditions are the elevated humidity in Jillian's room along with the high MM readings under her windows and in the bathroom ceiling. The obvious water staining on ceilings indicates that poor roof conditions have led to prior(if not current) leaks impacting the main floor living space. The attic shows areas of mold growth in the grain of the sheathing,especially on the south(rear)side probably as a result of soaking associated with a failing roof that was readily observed and photographed. MOLD SAMPLING - ROOM AIR There are several terms and concepts that should be explained before looking in detail at the data from these samples: MIM Inspection + Sampling &SOW for 79 Autumn Dr. Report No. NESIIAQ-081841 Page 6 o CONTAMINATION-The terms Condition 2 and 3 used describe mold contamination are part of the December 2003 Institute for Inspection Cleaning and Restoration Certification (HCRC) S520 standard, "Standard and Reference Guide for Professional Mold Remediation." Condition 2 involves evidence of settled spores from a contaminated area,a condition documented to some extent by"disturbed"samples. Condition 3 refers to"actual mold growth and associated spores ... active or inactive, visible or hidden." o OUTDOOR SPORES -While ALL molds ultimately originate in nature,outdoors,there are some molds that are referred to as"outdoor fungi." This term means that that they are found only outdoors because they depend on plants, other fungi or animals to complete their life cycle. Others need a complex ecosystem to complete their life cycle. These outdoor spores may be found indoors because they were transported there but hardly ever develop colonies indoors. These include the ascospores,basidiospores(some coming from mushrooms that develop in the wild) and rusts. When found indoors these "outdoor" spores indicate the space has been experienced air exchange with the outdoors,not growth in response to moist conditions. o INDOOR SPORES -There are some molds that have adapted to a variety of food sources- organic debris, processed wood (i.e. cellulose, paper, etc) and more - that are commonly found indoors - loosely referred to as "indoor spores," even though they initially came in from outdoors. With the proper level of damp to wet conditions some of them amplify/grow indoors and serve as moisture/leak indicators In our area of southern New England, NES has found that the primary moisture/leak-indicators are the Aspergillus and Penicillium molds (referred to as "Asp-Pen like" when their spores are counted under a microscope, since their spores are indistinguishable). Less often NES has found that Cladosporium,the most abundant spore type found in outdoor air samples, can also amplify under moist conditions indoors and may serve as a secondary moisture/leak indicator. o STANDARDS - Many people look for standards to compare mold readings to with the desire to define a healthy or unhealthy space. Obviously very high spore readings found by counting spores/structure in a collected sample under a microscope(S/m3-spores/structures per cubic meter sampled) or colony readings found by counting the colonies that develop/grow on a nutrient media after sampled air has impacted that nutrient media (CFU/m3 - colony forming units per cubic meter) are unacceptable in occupied spaces. Because of the wide range of human sensitivities or allergic reactions to the irritants in/on mold spores AND the limited scientific research linking spore levels to various immune system reaction, no scientifically-based "standards" have been developed by medical or governmental agencies. [One medical commentary was issued in May 2004 by the Institute of Medicine(part of the National Academy of Sciences)in its report on"Damp Indoor Spaces and Health,"in which they state,"there are no generally accepted health-based standards for acceptable concentrations of fungal (mold) spores, hyphae or metabolites in the air." However, there is informal guidance from industrial hygienists and some allergists to try to keep indoor spore levels below 1,000 S/m3 in order to minimize the irritation for the general population. Some have suggested that a"healthy"level be considered at 500 CFU/m3 or 500 S/m3. Sensitized or allergic individuals may well be irritated and react at levels well below that guideline level. More information can be found on mold and health at the Centers for Disease Control and Prevention website M/M Inspection + Sampling &SOW for 79 Autumn Dr. Report No. NESIIAQ-081841 Page 7 o DEBRIS RATING-This column in the Attachment B data report for the Cyclex-D spore trap results is an evaluation of the "non-biological debris on the impact area examined by the microscopist." As more non-biological debris is plated on the impact area during the sampling, it coats and covers spores laid down earlier so that the microscopist cannot see/count the spores. Hence, higher debris ratings indicate difficulty in determining the number/type of spores collected on the sticky surface of the impact area. In addition, the more debris,the greater the chance that a spore would miss a sticky area and NOT even be collected. Hence,higher debris ratings lead to under counting of spores actually in the air. Table 2—Airborne Spore Levels (Disturbed sample numbers and results are indicated by bold type. Concentrations are expressed as spores/structures per cubic meter, S/m3.) Sample# Total Breakdown of dominant species (--80%) Jillian's bedroom 585-1 2,700 Ascospores (NONE)—0%,Asp-Pen like (2,210) - 83%, basidiospores (110) -4%, Cladosporium (110) -4% 585-2 23,000 Ascospores (50)—<1%,Asp-Pen like (21,700)—96 basidiospores (NONE)—0%, Cladosporium (370) -2% NOTE: "Asp-Pen like"refers to Aspergillus and Penicillium spores that are indistinguishable under the light microscope. The symbol"<1%"is read as "less than 1%." Looking at the data extracted into Table 2, one sees that: ♦ The gpiet spore levels in Jillian's room were elevated at 2,700 S/m3,nearly three times the informal guideline value(see above). The common outdoor spores-ascospores and basidiospores—made up only 4% of the mix. The primary moisture indicator spores, Asp-Pen like spores, dominated at 83% of this indoor sample, indicating impact from moisture-induced mold growth within the house. The secondary leak indicator, Cladosporium, spores were at 4% of the total. ♦ Under disturbed conditions the Jillian's room total spore level increased more than 8.5- fold,a significant change,to 27,000 S/m3 with 96%of this larger number being the Asp- Pen moisture/leak indicator spores (21,700 S/m3). This pattern clearly indicated the presence of Condition 2, settled spore contamination dominated by the primary leak- indicator type. NOTE: The"debris rating"was at"2+"for the quiet sample and"3+"for the disturbed sample(see Attachment B). As noted above,this rating is an indication of non-biological matter that has plated on the collection slide during the sampling, covering up some of the surface and preventing the microscopist to view/count some spores. The "2+" rating is designated when there is up to 25% occlusion of the exposed track, so the quiet reading was not seriously affected by non-biological debris. The "3+" rating indicates that 26-75% of the trace was obscured so there was some MIM Inspection + Sampling &SOW for 79 Autumn Dr. Report No. NESIIAQ-081841 Page 8 compromise in the counting of the sample leading to a likely undercount of this elevated disturbed sample. There were no Stachybotrys spores detected in Jillian's room at the time of this sampling. Stachybotrys is the "toxic black mold" mentioned heavily in the media. MOLD SAMPLING -WALL CAVITIES Table 3. Results from Culturing PC Air Filter Samples [Reporting units are colony forming units per cubic meter of air(CFU/m3)in the wall cavity air.] Sample# Total CFU/m3 Overview of species found 585-3 Jillian's bedroom wall shared with bathroom (see photo) MEA 1,800 Aspergillus sydowii (300)— 17%, Aspergillus versicolor(700)—37%, Cladosporium (317)— 17%, Penicillium(250)— 14% 585-4 Hall wall (see photo) MEA 970 Aspergillus versicolor(17)—2%, Cladosporium (200)—21%, Penicillium (733)—76% NOTE: Because of the method of collection of spores onto a polycarbonate filter,not all of the viable spores extracted onto the filter in the brief sample time and interval for shipping to the P&K may retain their viability when finally cultured. Hence these results are an understatement of the actual viable spores present at the time of sampling! The extent of the understatement is not known and cannot be known. The wall cavity results presented in Table 3 indicate that active mold colonies are present in these wall cavities with different mixes, implying different moisture conditions. The active colonies found in the wall between Jillian's bedroom and bathroom(1,800 CFU/m3)were dominated by the Asp-Pen leak indicator types at 70% -Aspergillus sydowii (17%), Aspergillus versicolor(39%)and Penicillium(14%)-and the secondary leak indicator, Cladosporium at 17%. This pattern indicates that moisture-induced mold growth has indeed occurred in this wall cavity, constituting Condition 3, hidden, active mold growth calling for professional mold mitigation. While the level of colony forming units (CFUs)in this stud bay is not as high as NES has found in many leak-impacted wall cavity samples, it still shows active mold growth in response to moist conditions. The levels might well be higher in other locations closer to the pipes, such as the closet/bathroom wall, where contents precluded easy sampling at this initial sampling. The second wall cavity sample in the hall across from Jillian's door had half the CFUs in the sample (970 CFU/m3) compared to the first sample into the shared bathroom wall cavity. The prevailing MIM Inspection + Sampling &SOW for 79 Autumn Dr. Report No. NESIIAQ-081841 Page 9 species mix was different with Penicillium dominating the mix at 76% and the secondary leak indicator, Cladosporium at 21%. While were fewer species cultured from this "control" sample away from leaking pipes,the value was not zero! NES has found no mold growth in the dry areas in many studies;so the finding of CFUs in this interior wall away from pipes indicates that damp house conditions mentioned above have led to mold growth away from the bathroom leak. SUMMARY: The pattern of visual and moisture meter observations indicate that moisture is penetrating the building shell that along with interior leaks combine for excessive damp interior conditions supporting mold growth. The air sampling in Jillian's room documented elevated mold levels on disturbance that clearly for professional mold remediation due to the very high level of Condition 2,settled spores. NOTE that due to budgetary constraints air sampling was focused on the room occupied by Jillian, the person with the mold sensitivity and was NOT aimed at characterizing the building more extensively. The wall cavity samples indicate active mold growth in the bathroom wall cavity selected in Jillian's wall. This finding constitutes Condition 3, hidden-active mold growth. NOTE that sampling additional wall cavities nearer the bathroom pipes/leak might well indicate different and,perhaps, higher active mold levels. The damp wall cavities under the two windows in her room are also potential mold growth sites that could not be sampled on a limited budget. With the limited budget,the damp,moldy conditions in the basement could only be documented by visual observations and MM readings. Any mold growth in the wall and cavities there as well as the VMG readily documented can easily contribute spores to the air that are transported to the main floor through normal air flow from the basement to the upper levels of the building. RECOMMENDATIONS: MOISTURE The overall pattern of damp conditions in this house is complex can only be corrected by giving attention to exterior and interior issues simultaneously: ♦ The roof needs to be replaced with compromised sheathing also replaced. ♦ New gutters need to be installed with adequate downspout drainage at least five feet from the foundation and away from the building-NOT into the back yard where water would drain toward the foundation. ♦ The residual damp building materials,such as the wall-to-wall carpeting,from the recent leaks should be removed safely. CAUTION: The still-damp building materials may well be supporting mold growth and need to be handled safely per the mold protocol below! Otherwise excessive mold spores M/M Inspection + Sampling &SOW for 79 Autumn Dr. Report No. NESIIAQ-081841 Page 10 will be released to the living space as a result of the physical disturbance of these colonies. ♦ Once the exterior drainage issues have been addressed,an Energy Star-rated dehumidifier should be operated in the basement year round in conjunction with a condensate pump for automatic discharge of collected water to an exterior drain, such as the washing machine discharge. MOLD IT IS NOT POSSIBLE TO DEVELOP A COMPREHENSIVE MOLD REMEDIATION PLAN FOR THIS HOUSE BASED ON THE LIMITED SAMPLING THAT WAS POSSIBLE AT THIS STAGE OF THE INVESTIGATION. More areas of potential mold growth should be investigated by similar sampling to that above or by opening the cavities for visual inspection in 6"x6" openings (realizing that mold growth may be present but below the ability of the eye to "see" it) such as: ♦ The mold levels in other rooms on the main floor and basement to see where Condition 2 settled spores exist as a result of hidden mold growth. At least three more locations on the main floor and two in the basement should be investigated. ♦ Additional wall/ceiling cavity samples should be taken to identify possible pockets of hidden mold growth: ■ Under the windows in Jillian's room (and other rooms where elevated MM readings indicate potential damp conditions that would support mold growth). ■ The closet wall in Jillian's room adjacent to the tub. ■ Basement walls/ceilings that had elevated moisture such as the rear kitchen wall, the bathroom wall next to the toilet and under the sink,the exterior garage walls, the garage ceiling and walls under the main floor bathroom,the walls adjacent to the prior water heater/furnace leak. To address the limited Condition2 and Condition 3 findings discussed above in Jillian's room only and NOT remove the possibility for future cross-contamination from adjacent hidden mold growth areas just mentioned, a professional mold mitigator should be engaged. An appropriate mold remediation professional would be one with remediation training and individual credentials recognized by the American Indoor Air Quality Council (�y �o.i �� and/or the IICRC v��,xyJicrc.or0 . (._............_........._......._:_...._..._.........�) In particular the mold remediation should include: • Any workers in Jillian's room (or the basement to remove carpeting and damp drywall) should wear respiratory and clothing protection. • All air scrubbers should be cleaned from the previous job AND, most importantly,checked (preferably using a particle counter to document its collection efficiency)to be sure that the HEPA filter in each unit is seated/sealed properly to ensure that particles are being captured and NOT recirculated! MIM Inspection + Sampling &SOW for 79 Autumn Dr. Report No. NESIIAQ-081841 Page ]] • The contents in Jillian's room (and/or the basement) should be evaluated for disposal or retention. Items to be saved should be removed and cleaned,following Chapter 9 of IICRC S520,before being placed in a clean, dry storage area before reuse. o Soft goods like upholstered furniture,mattresses,box springs,pillows,dolls,etc.are notoriously hard to clean adequately because of spore penetration through the fabric into the padding/cushions/filler behind the cloth outer lays. IF some items are to be saved, they should be HEPA vacuumed using a commercial unit, then wrapped in plastic before being stored OR HEPA vacuumed just prior to return to the space. o Books should be HEPA vacuumed and wiped before being reboxed and stored. o Clothing should be washed and then dried with an extra air fluff cycle before being stored. o Hard goods like tables, shelves and chairs should be HEPA vacuumed ON ALL SIDES, including drawers, and wiped down before being wrapped and/or stored, pending reuse. • Jillian's room (and/or the basement) should first be contained under negative pressure and isolated from the rest of the house before being cleaned under the general guidance of IICRC S520 Chapter 7 including: o Seal all vents to any forced air systems. BASEMENT removal of damp building materials o Slice, roll and bag the carpet in the contained living room. o Cut,bag and remove damp drywall. o Use HEPA vacuuming to clean remaining surfaces as indicated below. o Remove the lower 2-3 feet of drywall in Jillian's room out about 6 feet to the left of the closet door and in the closet backing on the tub. o IF there is visible mold growth on the back of any of the removed drywall,continue removal for at least two feet beyond the last VMG! o HEPA vacuum ALL surfaces in Jillian's room and the now-exposed wall cavities. • When done with the above remediation activities in Jillian's room, take a final step to remove settled spores knocked into the air by the action of the vacuum brushes by"polishing the air." The first floor should be air polished as well. This step is especially important for areas that are contaminated with settled spores, as this room is, and the goal is to significantly reduce these settled spores. [NOTE: air polishing would be a good idea for the basement if one wants to remove the disturbed spores at this time right after the removal of damp building materials. IF NOT, the containment barriers should be left in place until mold issues in the basement will receive further attention.] • Air polishing steps include: o Set up at least an air scrubber in Jillian's room(more in the basement)as opposed to operating in the negative air mode. o Set up 3-4 oscillating fans in Jillian's room (more in the basement) to minimize stagnant air zones. Direct them to sweep the floor and other horizontal surfaces to minimize settling. MIM Inspection + Sampling &SOW for 79 Autumn Dr. Report No. NESIIAQ-081841 Page 12 o Periodically, 2-3 times a day, use a leaf blower to stir up the settled spores left over after the remediation activities above so that they can eventually be moved to the air scrubbers on drafts from the fans and be filtered out of the air. At the same time,re- orient the oscillating fans to sweep new areas AND re-direct the exhaust from the sir scrubber to blow over different surfaces. o Operate the oscillating fans and air scrubbers for at least 24 hours after the cleanup is completed, periodically revisiting the areas for leaf blower mixing and ALSO repositioning the smaller fans and scrubber exhaust. o Operate the oscillating fans and air scrubbers an ADDITIONAL 24 HOURS AFTER the last aggressive leaf blowing to reduce the cloud of stirred-up spores. • Turn off all fans/scrubbers at least 12 hours before any post-remediation air sampling is scheduled. A successful limited remediation of Jillian's room will be indicated by a 95+%reduction of Asp-Pen like spores in the basement from any post-remediation verification air sampling. ------------------ ----------------The above discussion and recommendations are related to the information you provided and the conditions visually observable at the time of NES's site visit on 11 September 2008 and the results of sampling at that time and are thus limited to these activities and timeframe. Future events and changes in the condition and operation of the building may well alter the conditions for biological activity/growth, especially moisture. Such changes will alter the relative significance of these recommendations and the effectiveness of their implementation. Thus the impact of such changes and can not be considered part of the scope of this report/work. I trust the above information is sufficient for your current needs. Please call me with any questions or to clarify points. Very truly yours, William M. Vaughan, PhD, QEP, CIEC President, Senior Scientist QEP=Qualified Environmental Professional(since 1994) CIEC=Council-certified Indoor Environment Consultant(#0608032) CABV Files-De11\IAQ\585 Rayle MMI+Baseline.RPT.doc Attachment A Photographs Taken During Inspection & Sampling Selection of Inspection Photos FA P.. / �, F IH try �r{ if p. _ 1 i •.c & M /+�`a a�"" .rr�'°41�,a•'"'� � �yy>��»n S � 91�a �� 'Yr€��. rY>t y Visible mold growth (VMG)behind wall neat water heater as seen from hall / f a k. 3 y ff W-to-W carpet in basement living room with elevated moisture . sfi "' `. VOW � T a r � rFsi or r c e .� Elevated moisture in wood paneling to left of fireplace. h � ON ��yy d3 b F Y 'A3E e 9 t h y Delamination of wood paneling next to fireplace ' wA,,0 MEN - 4 ��. F,�f _z5�� n�✓ � x z � 4 Vol ipl�, Excess cobwebs in utility area , � r XS �zt t ,� s l r y efi1 G / r y {(� 4 f ra XXI Al s f k f � MM reading off scale near T A MR1bathroom door. ' � n j � 3 : YW 's. ✓` q 'C 'gy P .l u ` � S sAft, �a l x�n rr � Me Y/N= Rusted surfaces near the furnace and ' next to the water heater where VMG was seen behind the wall (see photo above) 40* i t y rr c a v WTo / A01 Ax V !. rp IKaa� Painted front surface of drywall near water heater where VMG was evident on back side (see photo above) 411 ! y \ � G _ � E / L +A G S, a �4> 3 Y � l i f l ! ds �•kF�E, T E x I u nq � t 3 / A Ivw MM reading off scale to right of bathroom toilet sop 0�, ; w ��-€ � as c a lt 700 a ' ry � \ aAS . milk ✓ s 1 y. SC IWIRI to Zan j N IN Mom` LIS AIN Vo ✓. MM reading 100% FS-DW under bathroom sink 4, � b k 8 5 f j AIN &'.e /x//Y�' f` f 4 l 4.j ➢ N 'y�, 6 �ate'' y C '' Wq - 3 y Ifi x / 1 V °�t✓ I� / # `b. � __ �� � � `ate ��6 L �� � �� ��+y' Elevated MM reading near VMG in garage r 9 � 3� If, 44* r . fS'•.. Fes' � R rz 1, Off scale MM reading near VMG at garage ceiling under Jillian's room&bathroom 'W I' r a P�3 - arc �� e �'/,✓ ,+n'r ..:.. '� _ r s �, a s/ eow"-oWR - y��� /w / ✓6 �s ���r ' s Or NO f A- e r 1h 5 f / �f NINEA v c K VMG under work bench 0 00 f J \ KZ �reAm w g W" 1 g € Y� VMG and water staining along side wall of garage. J"V ' ,`.{" `� All RII � n � r s� Ai r •,, e c a rV X✓ e Dry conditions in right rear corner of Jillian's room. (MM cannot monitor on textured ceilings, otherwise that moisture level would have been measured as we110 W as � � "El,7 r s t y a $ J, �,,w p b �k � 1Wi t r r W O ' gg ANO - m t � a '.R�� ➢i/ "<...c � � e � Extensive brown water staining on ceiling of bathroom. ri r Ar s ✓a � OW l / �- 4 x t Z ¢¢ a �„/' £ "� I1.'�4J4+.d ci Vy"O�/ U 'may'a"&' SM"� _ 2, , Elevated MM reading in bathroom ceiling over tub and near stains. iR y ; OWN a w 4 y / d Elevated MM readings above toilet. I ate ' " A°✓ �3` 3 � f n� ��" fix`� 'i g `.5��?�:� fit' •� NO } �a F 1 9 Y}y VNIA6 u 'WO d il� ' Dark staining of roof sheathing on the south (rear) side of the roof. s AWI / fi c+ r 02111 Lack of dense staining on north (front) side sheathing. ,ram FAM oi 04 New , mxop c#7 f SOM �{ E Y j s r Aj ,3 w 11 1 7 N .. Blotchy staining on south side of sheathing to left side of roof. ",, MT / low Wx s � / ) c / F f �, der hP .per' z R' § a AM 5 Y �l i r. e I A3, W Or'� �d O a M £ S Water staining on dining room ceiling. _. �..;.: - 3 r C s oi y R x d �U NO i,ra Ai �'Q.,r �nM 0�ra ✓ 4 ' E f It Water staining on living room ceiling E � ,y 6 { i Oft f r ;v< n Plants growing in un-cleaned rear gutter plus view of deteriorated roofing. 'g �t o n xMIN $a ro3', fi' mm 2 S V y p , Deteriorated rear roofing MR G W, 1 �/ _ .. _ m r r Deteriorated roofing over bathroom VAN ��1_ jwa"✓ x`a'g.1�'�� "� ,fir �. � � ,� <� �� r�`*:s�, �� 3 t �4� �� x )�s 3 Y l xIry Front gutters showing plant growth W, PAR sit s y- � }may Y Front roofing where sheathing has rotted and collapsed. Sampling photos MA Ism, w 2 r 0161, 01, 01, 1 r xt r r i,01pr 3,7 w N r : 4z .L - IN Egon ar' � t � \ z y q NO g a wim mw ORE l a%S 3 z < d j Y B atiFrF/ / k r ✓ WN ,�0a 'i� r,�✓ � Lk y-ms ��� fig, � 3 r1l, f ��` a E � F (� , 5 � §Y 4. 2* Ao vhn smut EMT, gip P . i e s. f a ATTACHMENT B Laboratory results from P&K Microbiology Services, Inc. The"Debris Rating"column in the data report is an evaluation of the"non-microbial debris on the impact area examined by the microscopist. Here is a summary of the meaning/significance of those codes. Non- Microbial Particulate Description Interpretation Debris Rating p No particles detected in No particulates on slide in impaction line impaction line area. area.The absence of particulates could indicate improper sampling or a blank sample, as most air samples typically contain some particulates 1 Minimal non-microbial debris Reported values are not affected by debris. resent. 2 Up to 25%of the trace Non-microbial particulates can mask the occluded with non-microbial presence of fungal spores. As a result, particulates. actual values could be higher than the 3 26%to 75%of the trace numbers reported. Higher debris ratings occluded with non-microbial increase the probability of this bias. articulateS. 4 76% to 90% of the trace occluded with non-microbial articulates 5 Greater than 90%of the trace Sample could not be read due to excessive occluded with non-microbial debris.Reported concentrations are particulates. estimations calculated from the number of spores observed on the perimeter of debris. The sample should be collected at shorter time interval, or other measures taken to reduce the collection of non-microbial debris. The Limit of Detection is the product of a raw count of 1 and 100 divided by the percent read.The analytical sensitivity (counts/m3)is the product of the Limit of Detection and 1000 divided by the sample volume. *All AIHA accredited laboratories are required to provide raw counts of fungal structures in spore trap reports.These counts are defined by AIHA as"Actual count without extrapolation or calculation".The number in parentheses next to the fungal type represents the exact number(or raw count)of fungal structures observed. $A"Version"greater than 1 indicates amended data. EMLab P&K 1936 Olney Avenue,Cherry Hill,NJ 08003 (866)871-1984 Fax(856)489-4085 www.en lab.com Client: NAUSET ENVIRONMENTAL Date of Sampling: 09-11-2008 SERVICES Date of Receipt: 09-12-2008 C/O: William M. Vaughan Date of Report: 09-15-2008 Re: 585 - Rayle SPORE TRAP REPORT:NON-VIABLE METHODOLOGY Lab ID-Version$ Air vol.(L) Background Counts of Fungal Presumptive Fungal ID Percentage Location Debris Fungal Structures/m3 (raw counts*) Structures 2054670-1 100 2+ 1 10 Alternaria(1) <1 585-1 11 110 Basidiospores(2) 4 Jillian's Rm-Quiet 11 110 Cladosporium(2) 4 2 20 Curvularia(2) 1 18 180 Myxomycetes(18) 7 221 2,210 Penicillium/Aspergillus types(42) 83 1 10 Pithomyces(1) < 1 §Total:2,700 4 40 Hyphal fragments(4) N/A Comments: 2054671-1 100 3+ 2 20 Alternaria(2) <1 585-2 5 50 Ascospores(1) < 1 Jillian's Rm- 37 370 Cladosporium(7) 2 Disturbed 2 20 Curvularia(2) <1 5 50 Ganoderma(5) <1 25 250 Myxomycetes(25) 1 1 10 Nigrospora(1) <1 2,170 21,700 Penicillium/Aspergillus types(217) 96 4 40 Pithomyces(4) <1 1 10 Rusts(1) <1 §Total:23,000 3 30 Hyphal fragments(3) N/A 2 20 Pollen(2) N/A Comments: Background debris indicates the amount of non-biological particulate matter present on the trace(dust in the air)and the resulting visibility for the analyst.It is rated from 1+(low)to 4+(high).Counts from areas with 4+background debris should be regarded as minimal counts and may be higher then reported.It is important to account for samples volumes when evaluating dust levels. The Limit of Detection is the product of a raw count of 1 and 100 divided by the percent read.The analytical sensitivity (counts/m3)is the product of the Limit of Detection and 1000 divided by the sample volume. *All AIHA accredited laboratories are required to provide raw counts of fungal structures in spore trap reports.These counts are defined by AIHA as"Actual count without extrapolation or calculation".The number in parentheses next to the fungal type represents the exact number(or raw count)of fungal structures observed. $A"Version"greater than 1 indicates amended data. §Total has been rounded to two significant figures to reflect analytical precision. (09-15- 008:585-Rovle ElYfLab.` &K 1936 Olney AVel)UE,Cherry 11il1.,N'0500.3 (866)871-1984 Fax(,856)489-4085 www.en lab-corn SPORETRAP REPORT: NON VIABLE METHODOLOGY ll,�Alternaria -Ascospores � 8asidiospores Ciadosporitim :.s Curvularia �`�Ganodprma Myxamycetes .:.`Nigraspara VII,Penir..illiurn/A spergillus types " Pithomyces R-Rusts i00,000 _ _. ... _.._.._. ......... i ( z' t 10;000 J .. S ., .�M.,...... .... .._ .. ... _ _ .. ...... j 3 ° s 1,000 -- .. ...... _—.._... 1 ... g ( r 3 ✓" f S`3 M 7 3 _,.,.._............. ................ .. a'41, I !4 a 'S 1 o ...... ...... .. �s -------.................. y ............ pp .. ........... F s.... N�: 'M `s� t� _. W, jai ,az",.,. ! .. < s s . ...... .. .y 4.r #'• �a £ _,. I �_._... � u ..c� �_............ _. .._. 585-1:Jillian's hm-(buret 585 2.)Elli an s Rm =Dis:nrbod L;nanrnEa�ts:� Note Clrapt.ical c ut}gut nra E.nric-state dl,e:irnportnncu oreertain m ri Uc i genera. P 19icrobiology Ser:ices,Inc. E;4Lab lD'465,512,Page I EMLab P&K 1936 Olney Avenue,Cherry Hill,NJ 08003 (866)871-1984 Fax(856)489-4085 www.emlab.com Client: NAUSET ENVIRONMENTAL Date of Sampling: 09-11-2008 SERVICES Date of Receipt: 09-12-2008 C/O: William M. Vaughan Date of Report: 09-22-2008 Re: 585 -Rayle CULTURABLE AIR FUNGI REPORT Lab ID-Version$ Air vol. Medium Dilution Fungal ID Colony CFU/m3 % Location (L) Factor Counts 2054672-1 60 MEA N/A Acrodontium 8 133 7 585-3 Aspergillus sydowii 18 300 17 Jillian's Wall Aspergillus versicolor 42 700 39 Chaetomium globosum 1 17 1 Cladosporium 19 317 17 Mucor 1 17 1 Mucor plumbeus 1 17 1 Paecilomyces variotii 4 67 4 Penicillium 15 250 14 §Total: 1,800 Comments: 2054673-1 60 MEA N/A Aspergillus versicolor 1 17 2 585-4 Cladosporium 12 200 21 Hall Wall Non-sporulating fungi 1 17 2 Penicillium 44 733 76 §Total:970 Comments: The Limit of Detection is the product of a raw count of 1 and 100 divided by the percent read.The analytical sensitivity (counts/m3)is the product of the Limit of Detection and 1000 divided by the sample volume. t A"Version"greater than 1 indicates amended data. §Total has been rounded to two significant figures to reflect analytical precision. Attachment C Ecology and Pathology of Species Reported Ecology and Pathology of major species reported Page 1 NOTE: Characteristics of the major species found at levels above 10% and listed above have been collected from the University of Minnesota, Aerotech Laboratories, Inc. and Environmental Microbiology Lab,Inc. websites and from information provided by P&K Microbiology Services,Inc. ascospores ECOLOGY - A general category of spores that have been produced by means of sexual reproduction. Many ascospores can germinate and later produce asexual spores (conidia). To further complicate matters, some asexual fungi can also become sexual under specific conditions, these are considered ascomycetes. PATHOLOGY-This generalized group contains potential opportunistic pathogens and toxin producers. They are suspected allergens, though not yet proven. Aspergillus species ECOLOGY—Spores from this genus are commonly found in outdoor air,but less frequently than Cladosporium, Penicillium, Basidomycetes or yeasts. (Their spores are difficult to differentiate from Penicillium spores hence they are reported with those spores when only microscopic identification is requested,rather than culturing.) PATHOLOGY—Of the more than 150 species and varieties of Aspergillus, some are known to cause diseases in animals and humans. Several species are commonly isolated in buildings. Many Asp. species can produce mycotoxins depending on the substrate on which they are growing. Antigens of Asp. species are available commercially. Aspergillus sydowii ECOLOGY-In general Aspergillus species are commonly found in the outdoor air and,as a group, are common on water-damaged materials.Aspergillus sydowii is one of the species commonly isolated indoors, especially in water damaged buildings. PATHOLOGY-While many species of Aspergillus produce mycotoxins,Asp. sydowii has no reported mycotoxin. They are associated with allergic reactions. Aspergillus versicolor ECOLOGY - Air samples occasionally find it at higher levels indoors than outside. It has a wide ecological niche and can grow on many substrates. It.probably is the most frequently isolated Aspergillus species in North America. It has been reported from soils,plant parts, paper pulps, photographic optics and other substrates. It is one of the species commonly found in a water-damaged environment. PATHOLOGY-While it has been isolated from animal and human tissue,its pathology has not been proven. It can produce mycotoxins like nidulotoxin, sterigmatocystin and cyclopiaxonic acid. Under rare circumstances these toxins can cause diarrhea and upset stomach. i Ecology and Pathology of major species reported Page 2 basidiospores ECOLOGY - Sexual spores from a variety of molds. PATHOLOGY- Some basidiospores have been shown to cause allergies and asthma. Cladosporium sp. ECOLOGY-They are the most commonly identified outdoor fungus (48-60 species). The most common ones include Cladosporium elatum, Cladosporium herbarum,Cladosporium sphaerospermum, and Cladosporium cladosporioides. C. herbarum is the most frequently found species in outdoor air in temperate climates. Since it is a"dry" spore formed in very fragile chains,it is easily dispersed,hence often found in air samples. The outdoor numbers are reduced in the winter and are often high in the summer.While often found indoors their numbers are less than outdoor numbers,implying that the outdoor environment is the source of these spores. Indoor Cladosporium sp. are commonly found on the surface of fiberglass duct liner in the interior of supply ducts, on windows with occasional condensation and on wall surfaces in high humidity conditions or occasional condensation. A wide variety of plants serve as food sources for this fungus. It is found on dead plants, woody plants,food, straw, soil, paint and textiles. They are common in soils, dead organic matter and the air. These fungi can decompose cellulose and are considered "ubiquitous." PATHOLOGY - The ability to sporulate heavily, ease of dispersal, and buoyant spores makes this fungus.the most important fungal airway allergen;causes asthma and hay fever in the Western hemisphere. They are a rare human pathogen. They can cause mycosis and produce greater than 10 antigens (initiators of allergic response) available commercially. They are a common cause of extrinsic asthma (immeadiate-type hypersensitivity: Type I allergen),Type III hypersensitivity pneumonitis: hot tub lung,moldy wall hypersensitivity, etc. Acute symptoms include edema and bronchiospasms, chronic cases may develop pulmonary emphysema. Hyphal fragments = These structures are broken parts of mold and fungal filaments (hyphae) or structures. They can be irritating to sensitized individuals. Penicillium sp. ECOLOGY - A wide number of organisms have placed in this genus. Identification to species is difficult and expensive.They are often found in aerosol and soil samples. They are a ubiquitous saprophyte (meaning they live on dead or decaying organic matter) and are found everywhere. they are commonly found in temperate regions in soil,food,cellulose and grains as well as on living vegetation. They are also found in paint and compost piles and soils. They are commonly found in water-damaged dry wall, damp latex paint, carpet, wallpaper, and on interior fiberglass duct insulation. PATHOLOGY -They may cause hypersensitivity pneumonitis and/or allergic alveolitis in susceptible individuals. They are reported to be allergenic(skin). Some species can produce mycotoxins. They are a common cause of extrinsic asthma (immeadiate-type hypersensitivity:type 1). Acute symptoms include edema and bronchiospasms,chronic cases may develop pulmonary emphysema. Can cause allergic reactions to sensitized people and are associated with mycotic keratosis in humans. Ecology and Pathology of major species reported Page 3 Here are some links to general mold-related web sites and resources. Molds - �;��,�w� p ._ov/,iag ��ac_�kc1s [provides link to mold resources] New York City Department of Health: "Guidelines on the Assessment and Remediation of Fungi (Mold) in Indoor Environments," Centers for Disease Control: htt:):// a�w.c(ic. Tov/iiioldt(larii)riess 111act4.htni ._..._._l__...___....._.._......_.._..............._.........______._.___...........__..._...�..._....__._._....... ----- Minnesota Department of Health: Mold in Homes �;-����.1reE�ltl��.state-.rtirr.usJd i�`sJ�;l�l�ti al rfif:�rlrnohl�s.l�trrrl ;4 T Town of Barnstable Regulatory Services + BARNSTABLE. 9 MASS. Thomas F. Geiler, Director 1639. �0 ' Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Certified Mai1:7006 2150 0002 1042 0873 September 26, 2008 Katherine Rayle 79 Autumn Drive Centerville, MA 02632 ORDER TO VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L. c.I 11, sec. 127A and 127B, 105 CMR 400.000: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter II: Minimum Standards of Fitness for Humans, Timothy B. O'Connell., Health Inspector for the Town of Barnstable, on June 19, 2008 conducted an investigation of a dwelling unit located at 79 Autumn Drive, Centerville. The owner's name of this dwelling unit is Mr. Michael Cavic. The tenants name is Katherine Rayle. Based on the results of that investigation and an E-mail received from Dr. William Vaughn, the Barnstable Health Department finds that the main floor bedroom on the right(A.K.A Jillian's Room) is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.831 (D), (E) the Health Department further finds that the conditions within the bedroom are such that the danger to the life or health of the occupants of the subject bedroom is so immediate that no delay may be permitted in making this finding. Conditions found within the bedroom, which give rise to the emergency finding of unfitness and determination of immediate danger, include: 410. 750 (P) Conditions Deemed to Endanger or Impair Health or410. (P) Conditions Deemed to or Impair Health or Safety On 9-11-08 Dr. Bill Vaughan conducted air sampling of Jillian's room and determined said room to have elevated mold spores. The dominant spore type is Penicillium-' Aspergillis which is the common indicator for moisture/leak-induced mold growth indoors. He also recommended that the room should not be occupied until the remediation process has been conducted within this room. Q:\Order Letters\Condemnations\79 autumn e Dr.doc Town of Barnstable y3�€ p1HE r Regulatory Services Thomas F. Geiler„Director � � Public Health Division * BARNSPABLE, � MASS. g Thomas. McKean, Director 200 Main Street FD MA'S Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 f September 25, 2008 Michael Cavic 130 Sachem Drive Centerville, MA 02632 PARTIAL CONDEMNATION NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II-MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at 79 Autumn Drive, Centerville, MA was inspected by Health Inspector Timothy O'Connell on June 19, 2008 and again on September 9, 2008. These inspections were conducted due to complaints. The following violations of the State Sanitary Code were observed: 105 CMR 410.500- Owner's Responsibility to Maintain Structural Elements: Mold observed on bedroom ceiling (a.k.a "Jillian's room") located on main level of said home. See note below. 105 CMR 410.500- Owner's Responsibility to Maintain Structural Elements: Roof contained. large amount of moss and appeared to be worn in many areas._ 105 CMR 410.831(E)- Dwellings Unfit for Human Habitation: Hearing: Condemnation: Order to Vacate: Demolition: Until all violations have been corrected, the bedroom has been deemed unfit for human habitation and has been issued a condemnation. The condemnation only applies to Jillian's bedroom and not the rest of the house at this time. You are directed to correct the violations listed above within seven (7) days of your receipt of this notice by pulling any required building permits (if applicable); by conducting mold remediation of said room in accordance to industry standard protocol— IICRC S520. Although, the Town of Barnstable Health Division is waiting on more air sampling data which may result in additional remediation. *NOTE: On 9-11-08 Dr. Bill Vaughan conducted air sampling of Jilians room and determined said room to have elevated mold spores. The dominant spore type is Penicillium-Aspergillis which is the common indicator for moisture/leak-induced mold growth indoors. r ' 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 could result in a fine of up to $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER.ORDER OF TH BOARD OF HEALTH Thomas A. McKean, R.S., CHO , Cc: Katherine Rayle Cc: Timothy O'Connell, Health Inspector Page 1 of 2 -------------- Forwarded Message: -------------- From: "Nauset Environmental Services, Inc." <nesinfo@capecod.com> To: <jessechase79@comcast.net> Subject: RE: inspection+-Lab results I Date: Mon, 15 Sep 2008 20:45:11 +0000 l Katherine, The lab discovered that they screwed up by not rushing out the samplt23,00 alysis Friday.... Be that as may be the results have come in ande d mold spores in Jilian's room — above 2,700 under quiet conditions and abov nder disturbed conditions (see attached raw lab report). The fa or of ten increase fo the use of the fan clearly shows the presence of"settled spore,lCond'ition callingfor clan .I THE dominant spore type is. en/cillium Asper illus(at 3-96° , the common indicator for moist re/leak-induced old growth indoors. The informal uideline" is to have values below 1 000 to reduce the irritation of the general public and pr obably lower for allergic folks. SO I will be recommending that there be mold remediation of her room — at least— by a mold professional (see attached list) following industry standard protocol — IICRC S520. NOW we have to wait to see if my wall cavity sample points to the source... JTFrankly I would also recommend that Jillian not sleep in that room if at all possible until this gets resolved. I am still working until the last minute so call if you wish to talk. ------ -- Bill Vaugha ��- ti _ Phone. 508 47-9167 FAX: 508-255-0738 C� -50 -----Original Message----- 7 From:jessechase79@comcast.net[mailto:jessechase79@comcast.net] Sent: Saturday, September 13, 2008 8:38 PM To: nesinfo@capecod.com Subject: RE: inspection Dr. Vaughan, Sorry to bother you again, but I was just re ding some inf and found this from a case that people lost due to insufficient evidence. If th samples yo have already taken come back to show whatever they do(if its"bad" so to speak)what exa tly is that test they are talking about (BV]I have no idea. I would need to see the website in October when I come back. BUT the data so far are strong and may get stronger... and is it actually helpful? Oh and the landlord had his"roofer buddy"come out and the guy told him that the roof wasnt leaking, there were no water spots and that the mold was from no exhaust fan in the bathroom????[BV]That's what a buddy would say. YES, there needs to be an exhaust fan in all bathrooms AND that it be used- GEE maybe the landlord is responsible for installing one??? . However, the pattern I saw of deeply discolored sheathing above the stained bathroom ceiling and deteriorated roofing above the sheathing says to me that there is moisture coming from above as well. IF we moved away the items stored in the attic, we could examine the ceiling from above and look for staining.... I thought-you had said that water was leaking from the roof? Have a good weekend and I wont bother you anymore:) Katherine "V m�. i0008/ 9/15/2008 I a { 4 Certified Mail#7006 2150 0002 1041 9099 �4zr rOwti Town of Barnstable O,n Regulatory Services �.* DARNSTAet.L 9 MASK $ Thomas F. Geiler, Director °o 1e39. , Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Ge- June 19, 2008 Michael &Helen Cavic 130 Sachem Drive Centerville, MA 02632 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 79 Autumn Drive Centerville, was inspected on June 19, 2008 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint made to the Town of Barnstable Health Department. The following violations of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Mold-like growth throughout unit due to chronic dampness; water-damaged ceiling throughout unit. The following violations of the Town of Barnstable Code were observed: 1� 70-4—Certificate of Registration. Rental property is not registered with the Town of Barnstable Health Department. You are directed to correct the violations listed above within twenty-four(24) hours of your receipt of this notice by registering rental property by completing enclosed application and submitting the appropriate fees for 2008. You are directed to correct the violations listed above within thirty (30) days of your receipt of this M QAOrder letters\Housing violations\Rental ordinance\79 Autumn Drive.doc notice by removing all mold-like growth, repairing water-damaged ceiling and preventing source of chronic dampness causing mold. 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 AscKean, R.S., CHO Director of Public Health Town of Barnstable Q:\Order letters\Housing violations\Rental ordinance\79 Autumn Drive.doc McKean, Thomas From: Geiler, Tom -, Sent: Friday, September 19, 2008 3:11 PM To: McKean, Thomas Subject: FW: Katherine Rayle Complaint Tom; Please have someone contact this person and investigate there complaint. It sounds as if it is a health issue if there is a an issue. Let me know the outcome. -----Original Message----- From: Wheelden, Linda Sent: Friday, September 19, 2008 2:07 PM To: Geiler,Tom Cc: Klimm,John; Lynch,Tom Subject: Katherine Rayle Mr. Geiler, et al, Upon arriving to the Town Manager's Office, with her entire family of 2 Children and 2 Adults, including other support people, the individual who addressed these issue-was Katherine Rayle of 79 Autumn Drive, Centerville c#508-367- 7530, who rents from Mike Cavic of 130 Sachem Drive, Centerville c#508-737-3032, states the following info and is anticipating a return call from you and a visit from the Building and /or Health Inspectors, regarding the property Rayle rents from Cavic--- "Mold, Toxic for entire family. Owner formerly notified and stated non-compliance. Air Tests quality 23 times allowable limits. Absolutely no other avenue to pursue or to proceed for safe habitat. Burden of proof to Renters. Told 'find another place to live'etc. Doctors bills &visits include neurologists. All rooms contaminated. Inquired of any housing assistance for the family, to sleep in and live at, until something else happens." Thank you for following up on this matter directly with Mrs. Rayle. I am faxing an email she left to forward to your department as well for further information. Linda Wheelden, TMO 1 Page 1 of I O'Connell, Timothy From: bzbydac@aol.com Sent: Wednesday, September 24, 2008 4:03 PM To: O'Connell, Timothy Subject: Wall cavity results for Rayle 79 Autumn Thim, Here are the wall cavity results for Katie Rayle Client: NAUSET ENVIRONMENTAL Date of Sampling: 09-11-2008 SERVICES Date of Receipt: 09-12-2008 C/O: William M. Vaughan Date of Report: 09-22-2008 Re: 585 - Royle CULTURABLE AIR FUNGI REPORT Lab ID-Version$ Air vol. Medium Dilution Bacterial ID Colony CFU/m3 % Location (L) Factor Counts 2054672-1 60 MEA N/A Acrodontium 8 133 7 585-3 Aspergillus sydowii 18 300 17 Jillian's Wall Aspergillus versicolor 42 700 39 < SPAN Chaetomium globosum 1 17 1 style="FONT Cladosporium</div> 19 317 17 Mucor 1 17 1 -SIZE: Mucor plumbeus 1 17 1 9pt; Paecilomyces variotii 4 67 4 COLOR: Penicillium 15 250 14 black; §Total: 1,800 FONT- FAMILY: Times"> Comments: 2054673-1 60 MEA N/A Aspergillus versicolor 1 17 2 585-4 Cladosporium 12 200 21 Hall Wall Non-sporulating fungi 1 17 2 Penicillium 44 733 76 §Total:970 Comments: The Limit of Detection is the product of a raw count of 1 and 100 divided by the percent read.The analytical sensitivity(counts/m3)is the product of the Limit of Detection and 1000 divided by the sample volume. A"Version"greater than I indicates amended data. §Total has been rounded to two significant figures to reflect analytical precision. Find phone numbers fast with the New_AOL_Yellow.Pages! 9/24/2008 FORM 30 C&w HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH dttr/fOWN W a DEPARTMENT ADDRESS GSM g0 y`0� ` TELEPH NE c Address _ Occupant_ Floor Apartment No. No.of Occupan No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units N St ries Name and address of owner " emarks 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: of Dampness: Stairs:Lighting: 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 Bedroom 1 Bedroom 2 (/ Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: 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 T PAINS AND PENALTIES OF PFRqJJAY.11 / INSPECTOR TITLE— DATE � TIME 1__ ^ A.M. THE NEXT SCHEDULED REINSPECTION P.M. 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 health, 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. (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. - Certified Mail#7006 2150 0002 1038 6865 P�6*-Era Town of Barnstable Regulatory Services vIR MASS. Thomas F. Geiler, Director �"arfio .,m Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 29, 2007 Michael &Helen Cavic I �- 130 Sachem Drive 190 Centerville, MA 02632 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 79 Autumn Drive Centerville, was inspected on November 16, 2007 by Meredith Morgan, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint made to the Town of Barnstable Health Department. The following violations of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Mold-like growth throughout unit due to chronic dampness; water-damaged ceiling throughout unit. The following violations of the Town of Barnstable Code were observed: 170-4—Certificate of Registration. Rental property is not registered with the Town of Barnstable Health Department. You are directed to correct the violations listed above within twenty-four(24) hours of your receipt of this notice by registering rental property by completing enclosed application and submitting the appropriate fees for 2008. You are directed to correct the violations listed above within thirty (30) days of your receipt of this Q:\Order letters\Housing violations\Rental ordinance\79 Autumn Drive.doc notice by removing all mold-like growth, repairing water-damaged ceiling and preventing source of chronic dampness causing mold. 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 Q:\Order letters\Housing viol ations\Rental ordinance\79 Autumn Drive.doc NAM O OFF@N�R� i BAR 7 6 4 5 4 TOWN OF ADDRESS OFkENDE �'AC jj'e P'1 J. BARNSTABLE CITY,SILILT d�E.ZIP CO E 1 { Lki A. p,• OF jrjlSE)1' ,�/}��')/// TL �'�fy� �}r.�/�(/'�}. /dry/�J\�7{E /�!�N(/�,/ /� d• ,y} NAX IAT%. 1:.O 7.0 -7..i•� � ..7'� 1i1. rade ! W � i 1.�1,6(� \✓{ (` f I11 ;�� 0 NAlS. 91- t63 9 ►�, ( TIM'A,NO D�A�T��,OF VIOLATION LOCATION F VIOLATION Z NOTICE OF ^`.itJ / P.M. ON i� 201�} u�" i.} l� t„ 1d✓�.°i!1'e rR SIG OF NICfI PE N F,W60kt ING DEPT. - B D E N0. W VIOLATION 1 ,(�f � �� 1 '� c OF TOWN IREBY ACKNOWLEDGE RECEIPT OF CITATION XUJI ORDINANCI uliable to obtain Si nat ur of fender. Q a THE NONCRIMINAL FINE FOR THIS OFFENSE IS Sng Date mailed LU OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL wa DISPOSITION WITH NO RESULTING CRIMINAL RECORD. w REGULATION 1 You may elect to a the above fine,either b appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holida excepted, Q () Y pay Y PP 9 pe 9 Y. 9 P w before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or posts note to Barnstable Clerk,P. Box 2430, d Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. UNSTABLE you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST RNSTABLE DIVISION,COURT COMPOUND,MAIN STREET ARNSYABLE,MA 02630,Attn:21D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature NAME O O FENS R76459 TOWN OF ADDRS F FENDEB_ m ~�,,r„ Cht BARNSTABLE CITIOATE,ZIP COD+.GGE 1J�+ j�' ,�,/,y HAH\SiAH.IE. w MA 04, uy0s ryk;;i � CV� � ` �` � ry� �� JJIlyn l• .639• d f tl�y: .jaw .•�y`+�� ^'�Jy ,,rp \J �`hJ�p/r'"'� O TIME2!A�p�VIOLATION LOCA N 0 VIOL TION r LU Z NOTICE OF (�(�P (AM' , P.N►4 N y� 20 _. . . ySIGNAT(RE.OF NFOA VIOLATION 0 OF TOWN �J ~ I REBY ACKNOWLEDGE RECEIPT OF CITATION X i a ORDINANCE 1A Unable to obtair�si natur of ffender. `,t < THE NONCRIMINAL FINE FOR THIS OFFENSE IS S Date mailed w OR YOU HAVE THE I LOWI G ALTeRNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. w REGULATION 1 You may elect to a the above fine,either b a earin in Q ( ) y pay y pp g person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, ly before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O Box 2430, Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. d (2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST ARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET BARNSTABLE,MAD 2630,Attn:21 D Noncriminal Hearings and enclose a copy of this P_ citation for a hearing. 3 If you fail to a the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to j, () y pay q g y y pp g pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ;� ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature Citizen Web Request Page 1 of 3 }R oz 1 s 6'* — 7'{�'��;�� teal€ieft e tManagement �;; Request Information Request ID: 21435 Created: 11/16/2007 11:48:49 AM Status: Closed Assigned To: Morgan, Meredith Health Office Anonymous: No Request Category: Chapter II : Housing Substandard Estimated 11/20/2007 Change Estimated November 2007 .-- Completion Completion Date: Date: s= on F ue ''__ed 'Thu FriSat 30 31. t _. 3 4 18 19 20 '1 2'2 23 2'4 I Created By: Wadlington, Ellen Priority: Medium Health Office I Citation Numbers: L_.........................................................................................................................................._.............._........................................_..............................._...................._........_.............._......_.._........_............ Requester Information Requester j Request Parcel Number Map: I 8 Block: 059 Lot000�^ ( Furnace in basement blew up and caused water problem in basement, this was fixed; water heater blew up, �.1-Lo k.up Parcel_L.o...oku.p problem fixed but left a big problem E with mold in the basement; the roof leaks and has caused excessive mold in ceilings in bedroom and bathroom. I Have not had any remedies to the http://issq l2/intemalwrs/WRequest.aspx?ID=2143 5 6/18/2008 Citizen Web Request Page 2 of 3 mold problem. There are two children ages 3 years and 8 months residing -- ----in house who are both very ill. Email: t F Track Request Progress Request Work History: Internal Note History: Entered on 11/19/2007 2:45:16 PM System entry on 11/16/2007 11:48:49 AM: by Morgan, Meredith Assigned to Morgan, Meredith 11/16/07 inspected by MM. Property is an KK, unregistered rental unit. Significant mold like Entered on 11/19/2007 2:45:16 PM growth observed throughout home. Several by Morgan, Meredith apparent leaks with stained ceiling throughout home also observed. The downstairs appears Owner Michael Cavic 508-737-3032 to be a seperate rental unit.The tenant stated - - —that her brother is living down there for the System entry on 2/21/2008 3:05:07 PM: time being. RG of building has been made aware of the situation. Request Closed by morganm Entered on 2/21/2008 3:05:07 PM E by Morgan, Meredith As of 2/21/08 2 tickets for not registering the rental unit and an order letter had been issued to the property. Enter work progress: Enter internal note: : Viewed by everybody) (Viewed internally only) !i! E Spell Cheek SpeII Gheck u j� E i i Add document or image link: F Br LA s m. You cFln also tyoe J;r- a. folder to see everytihing in the fdde http://issgl2/intemalwrs/VvRequest.aspx?ID=21435 6/18/2008 w. Citizen Web Request Page 3 of 3 £.:,Weep, I...ii a<s: Time worked on request £1.00 Response time: 5.00 Time entries are in moors, Examples o IirT= ntnos: 1,25, 0.5, 0.75, 1, : .5, 0,25, -0 Response tilme casuref 'from', the creation dabe to your first actions on the request, I o not include nick s, y,eeken .`s, and holidays in re--spo;lse tin-le for most £per;> ti Tents, Reopen C Reopen and notify citizen Reopen, Public Use: Printer Friendly Version Internal Use: Printer_Friendly Version http://issgl2/intemalwrs/WRequest.aspx?ID=21435 6/18/2008 i Certified Mail#7006 2150 0002 1038 6865 QF,THE All Town of Barnstable Regulatory Services k RA is �' QAs Thomas F.Geiler,Director d0 t53g. �� Arf°nor °' Public Health Division Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 29, 2007 Michael &Helen Cavic 130 Sachem Drive Centerville,MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II —MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABL& CODE CHAPTER 170. The property owned by you located at 79 Autumn Drive Centerville, was inspected on November 16, 2007 by Meredith Morgan,Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint made to the Town of Barnstable Health Department. The following violations of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Mold-like growth throughout unit due to chronic dampness; water-damaged ceiling throughout unit. The following violations of the Town of Barnstable Code were observed: 170-4—Certificate of Registration. Rental property is not registered with the Town of Barnstable Health Department. You are directed to correct the violations listed above within twenty-four (24) hours of your receipt of this notice by registering rental property by completing enclosed application and submitting the appropriate fees for 2008. You are directed to correct the violations listed above within thirty (30) days of your receipt of this Q:\Order letters\Housing violations\Rental ordinance\79 Autumn Drive.doc notice by removing all mold-like growth, repairing water-damaged ceiling and preventing source of chronic dampness causing mold. 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: Timothy O'Connell, Health Inspector Q:\Order letters\Housing viol ations\Rental ordinance\79 Autumn Drive.doc e Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection One winter Street,Boston,Ma. 02108 John Grad D.E.P. Title V Septic Inspector P.O. Box 2119 Teaticket, MA 02536 wILUAM F.wELD (508)564-6813 Governor ARGEO PAUL CELLUCCI U.Governor / SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ' CERTIFICATION — 'qPR 1 y� �j �5� ,3 1 Property Address: 79 Autumn Dr.Centerville � ►\a �1 —Address of Owner: �98 Date of Inspection: 417198 (If different) Name of Inspector: John Graci Mice Elman I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: - _ 8 CERTIFICATION STATEMENT 1 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: x Passes This Inspection Is based on crlterla dented In Title V Conditions P SSeS code 310 CMR 16=.My endings are of how the system Is y performing at the time of the Inspection.My Inspection does _ Needs Fu he Evaluation By the Local Approving Authority notlmpNsnywwmntVorgummnteeoftherongevltyofthe Fails septic syatsm and any of Its components ussrul life. Inspector's Signature: Date: 418/98 The System Inspector shall s/bmit a copy of this Inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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. INSPECTION SUMMARY: Check A, B,C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. 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 Cdlhpliance(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 conforming septic tank as approved by the Board of Health. (revised OM97) One Winter Street a Boston,Massachusetts 02108 is FAX(617)556-1049 a Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 79 Autumn Dr.Centerville Owner: Mike Elman Date of Inspection:V7198 _ Sewacte backup or.breakout.or. hiah.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled 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 removed 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. f) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and 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 presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D) SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: _ I have determined that the system violates one or more of the following failure criteria as defined 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 in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. SAS is in hydraulic failure. (revleed 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 79 Autumn Dr.Centerville Owner: Mike Elman Date of Inspectlon:417198 D]SYSTEM FAILS(continued) Yes No 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). Numbers 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: 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 bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04127197) I. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 79 Autumn Dr.Centerville Owner: Mike Elman Date of Inspection:417!99 Check if the following have been done:YOU must indicate either"Yes"or"No"as to each of the following: ,c_ — Pumping information was requested of the owner,occupant,.and Board of Health. x None of the system components have been pumped for at least two weeks and the 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. x As built plans have been obtained and examined. Note if they are not available with N/A. x The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _x— — The site was inspected for signs of breakout. x — All system components,excluding the Soil Absorption System,have been located on the site. x The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing Information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is unacceptable)[15.302(3)(b)] (revleed 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 79 Autumn Dr.Centerville Owner: Mike Elman Date of Inspection:417199 FLOW CONDITIONS RESIDENTIAL: d./bedroom for S.A.S. Design flow: 33D g p Number of bedrooms: 3 Number of current residents: 0 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd): rda Sump Pump(yes or no): No Last date of occupancy:-Of months ago COMMERCIAL/INDUSTRIAL: Type of establishment: rda Design flow:It gallons/day 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: rds Last date of occupancy: rda OTHER:(Describe) rda Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped In the last year. System pumped as part of inspection: (yes or no)No If yes,volume pumped:0 gallons Reason for pumping: Na TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes,attach previous Inspection records,if any) UA Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components,date Installed(If known)and source Information: New system wee Instslled 2 years ago. Sewage odors detected when arriving at the site:(yes or no) No (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 79 Autumn or.Centerville Owner: Mike Elman Date of Inspection:47199 SEPTIC TANK: x (locate on site plan) Depth below grade: 1's" Material of construction:x concreate_metal_FRP_Polyethylene—other(explain) If tank is metal, list age nla . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: Le•5••H5'rw4'10^ Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle:25" Scum thickness:+" Distance from top of scum to top of outlet tee or baffle:5" Distance form bottom of scum to bottom of outlet tee or baffle:17" How dimensions were determined: Measured 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.) Septic ten*and ell components are structurally sound Recommend pumping system every two years for makdenance. GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: _concrete_metal_FRP_Polyethylene_other(explafn) Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle:-rda Date of last pumping;v. 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.) rda BUILDING SEWER: (Locate on site plan) Depth below.grade: 2- Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction line? Diameter: nle Qjmments:(conditions of joints,venting,evidence of leakage,etc.) (revised 0427197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 79 Autumn Dr.Centerville Owner: Mike Elman Date of Inspection:417108 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade:ria Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: n1a Capacity: nia gallons Design flow: nla allons/day Alarm level:_Ws larm In working order? Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) da DISTRIBUTION BOX:x (locate on site plan) Depth of liquid level above outlet invert: Liquid levelwithbottomofpips Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage Into or out of box etc.) D43ox Is struedesiy sound. PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)No Alarms in working order(yes or no)Yea Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) rda (revised 04117187) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 79 Autumn Dr.Centerville Owner: Mike Elman Date of Inspection:4#7ro8 SOIL ABSORPTION SYSTEM(SAS):x (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: nfa Type: leaching pits,number: rda leaching chambers,number:nta leaching galleries,number: nia leaching trenches,number,length: 2-Wtrenches leaching fields,number,dimensions:ft overflow cesspool,number:nta Alternate system: nra Name of Technology:_Na Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) The gas appears to be Functioning property. CESSPOOLS: (locate on site plan) Number and configuration: rda Depth-top of liquid to inlet invert:rda Depth of solids layer: nFa Depth of scum layer: nk Dimensions of cesspool: nla Materials of construction: rda Indication of groundwater: rda inflow(cesspool must be pumped as part of Inspection) rda Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) rda PRIVY: (locate on site plan) Materials of construction: rda Dimensions: nta Depth of solids: rda Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) rda (revised 0427W) ' r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 79 Autumn Dr.Centerville Mike Elman WIN SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes Into house) � av� AC ab :aye ! of 20 (r.wi.edoamer) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 79 Autumn Dr.Centerville Mike Elman WIN Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property,observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers x Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts (revisedOd)l7197) page I* eI 39 J ASSMOPSMAAI'NJ. No. / PARCEL N0: Fee THE COMMONWEALTH OF MASSACHUSETTS V/ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for Mtoogal broem Couttruction Vermtt Application is hereby made for a Permit to Construct( )or Repairkl-l'an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. C � M Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. P cw. Type of Building: Dwelling No.of Bedrooms I? 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 Description of Soil Nature of Repairs or Alterations(Answer when applicable) r\T� 'T". G 6-Al- C�pmC 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 En�ealth. al Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board oSigned � Date ��A 4 Application Approved by Application Disapproved for the following reasons Permit No. Date Issued 2R / 6 Y FeOTC/ l` No. a THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS Application for Mtgpogal *pgtem Congtructton Permit Application is hereby made for a Permit to Construct( )or Repair4--.*)'an On-site Sewage Disposal System at: Location Address or Lot No. L vT S0 Owner's Name,Address and Tel.No. [MC�n a.? Installer's Name,Address,and Tel.No. n Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 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 Description of Soil Nature of Repairs or Alterations(Answer when applicable) L n Z t r %^fik L/ " 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 Envir mental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of ealth. Signed L',— Date �/a7�9 6 Application Approved by Application Disapproved for the following reasons Permit No. �'� �' 1 Date Issued e!f, i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE-. MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced(�)o by Q)** for ` M has been constructed in accordance with the provisions of Title-5 and the for Disposal System Construction Permit No. dated �y Use of this system is conditioned on compliance with the provisions set forth below: `'I _ C-I I, No. rAbb` ` 40 117 Fee or THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwigogal *pgtem Congtructton Permit Permission is hereby granted to �-- to construct( )repair( Van On-site Sewage System located at Xi AV t VM ti 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. All construction must be completed within two years of the date below. Date: Approve CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated gla 7 concerning the property located at 2q k4u"'-rj meets all of the following criteria: There are no wetlands within 300 feet of the proposed septic system •�There are no private wells within 150 feet of the proposed septic system The observed groundwater table is 14 feet or greater below the bottom of the leaching facility q� ere is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED: DATE: . 1 02 LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. s � � �' �� XG r � S I c-n �� I C, //�� TOWN OF BARNSTABLE LOCATION / I li �r� SEWAGE# VILLAGE U A ASSESSOR'S MAP &LOT g" INSTALLER'S NAME&PHONE NO. G) M �IrE-X-V� SEPTIC TANK CAPACITY r 6 QQ C~C'L w 01I t ►9'_ LEACHING FACILITY: (type) �/� l��c. �'� (size)_ �' '� _GrLU� NO.OF BEDROOMS BUILDER OR OWNER �ll;�c.2� �.� PERMITDATE: �� ��I COMPLIANCE DATE: Separation Distance Between the: jj��{{ Maximum Adjusted Groundwater Table and Bottom of Leaching Facility&4 Feet Private Water Supply Well and Leaching Facility (If any wells exist 6 on site or within 200 feet of leaching facility) A;v -4- Feet Edge of Wetland and Leaching Facility(If any wetlands exist within`300 feet of leaching facility) 14 Feet Furnished by .�' �� �w C%x 43 ILI i� 5�