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0080 CLIFTON LANE - Health
80 Clifton Lane Centerville P 247 007 i No. 42101/3 ORA dto, s-,-9 0 ® 4 1000 'Q r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not.for Voluntary Assessments M 80 Clifton Lane Property Address Ilma Monteiro Owner Owner's Name information is required for Centerville Ma. 02632 2/11/2009 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)4218-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further aluation by the Local Approving Authority 2/11/2009 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time.of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. LA j n t5ins-09/08 Title 5 Official Inspection 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 M 80 Clifton Lane Property Address Ilma Monteiro Owner Owner's Name information is required for Centerville Ma. . 02632 2/11/2009 every page. City/Town State Zip Code Date of Inspection. B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 80 Clifton Lane Property Address Ilma Monteiro Owner Owner's Name information is Centerville Ma. 02632 2/11/2009 required for every page. CityTTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing'to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Clifton Lane Property Address Ilma Monteiro Owner Owner's Name information is required for Centerville Ma. 02632 2/11/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 lest than 6" below invert or available volume is less than %day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 80 Clifton Lane Property Address Ilma Monteiro Owner Owner's Name information is required for Centerville Ma. 02632 2/11/2009 every page. Cityrrown 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 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•09108 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 forQVoluntary Assessments M 80 Clifton Lane Property Address Ilma Monteiro Owner Owner's Name information is required for Centerville Ma. 02632 2/11/2009 every 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 ® ❑ 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? El ® 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? ® El information the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System ,Information . Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 80 Clifton Lane Property Address Ilma Monteiro Owner Owner's Name information is Centerville Ma. 02632 2/11/2009 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1000 gallon.septic tank,distribution box and three 500 gallon leaching chambers. Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes E No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2007:103,000 g ( y g (9P ))' 2008:105,000 Detail: 2007:282gpd 2008:287 gpd Sump pump? ❑ Yes ® No Last date of occupancy: 2/11/2009Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑. Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 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 80 Clifton Lane Property Address Ilma Monteiro Owner Owner's Name information is required for Centerville Ma. 02632 2/11/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for,pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ 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•09108 Title 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 80 Clifton Lane Property Address lima Monteiro Owner Owner's Name information is required for Centerville Ma. 02632 2/11/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed if known) n pp g p ( o ) and source of information: new leaching installed 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2'feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage,etc.): Joints appear tight.No evidence of Ieakage.System vented through the leaching chambers. Septic Tank(locate on site plan): 2 Depth below grade: . feet Material of construction: - ® concrete ❑ metal _ ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 611. t5ins•09/08 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 M 80 Clifton Lane Property Address Ilma Monteiro Owner Owner's Name information is required for Centerville Ma. 02632 2/11/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 2611 7' Scum thickness 6" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle life 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.): Pump septic tank every two years.lnlet and outlet tees are in.place.No evidence of Ieakage.Tank appears to be structurally sound. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments 80 Clifton Lane Property Address Ilma Monteiro Owner Owner's Name information is required for Centerville Ma. 02632 2/11/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) locate on site plan): P P P ) ( P ) 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•09/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Clifton Lane Property Address lima Monteiro Owner Owners Name information is required for Centerville Ma. 02632 2/11/2000 every 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 No . 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 Ievel.Box has three outlet laterals with equal distribution.No evidence of solids carryover.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 80 Clifton Lane Property Address Ilma Monteiro Owner Owner's Name information is required for Centerville Ma. 02632 2/11/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2-500gl. LC ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No signs of hydraulic failue.Chambers were dry at time of inspection.Stain line observed 9" below invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth=top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 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 M 80 Clifton Lane Property Address Ilma Monteiro Owner Owner's Name information is required for Centerville Ma. 02632 2/11/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of'vegetation, etc.): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer I Custom Map Abutters Map size . ® ® ZOOM-OutJ1111111JIn O 9 d�' O 4 pz c�h ©n \ �CU ``'`ov V Y Pil7 .. J r` r' a t% is .. ....... Set Scale 1" _'20 I Aerial Photos I MAP DISCLAIMER (`nrndrinhf 9fVlq_9MR TnuJn of Q—nefahlc KAA All rinhfe meant, httD://www.town.barnstable.ma.us/arcims/anneeoann/man.asl)x?bronertvID=247007&man... 2/10/2009 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Clifton Lane Property Address Ilma Monteiro Owner Owner's Name information is required for Centerville Ma. 02632 2/11/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of leaching 1 V 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: 2004 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built Card ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 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 80 Clifton Lane Property Address Ilma Monteiro Owner Owner's Name information is required for Centerville Ma. 02632 2/11/2009 every 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 ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Qizen Web Request Page 1 of 4 fs'fi z a ., x Ali L! Changes saved Request Information Request ID: 21520 Created: 1/7/2008 1:19:44 PM Status: Closed Assigned To: O'Connell, Timothy Health Office Anonymous: No Request Category: Estimated 1/9/2008 Change Estimated Dec Jznuary 21f)k-JS Feb Completion Completion Date: Date: Sun Mon T o Wed Thu Fri Sat 30 31 _> 2 3 4 E:, 6 7 8 S 0 11 1.2 1.3 14 1.3 1.6 1.7 1.8 191 20 21. 2? 23 25 26 27 28 29 36 31. :1 4 5 6 7 8 Created By: Shea, Sally Priority: Medium Building Dept Citation Numbers: �Requestor Information �Requestor _--- _...----- __......_------ _ _.......... Request Parcel Number CALLER REPORTS THAT AT 80 �f2-47 007 Lot: 000 AND 89 CLIFTON THERE ARE TOO MANY PEOPLE LIVING THERE WITH Parcel Lookup T GARBAGE EXPOSED OUTSIDE. THERE ARE 7 CARS THERE AT NIGHT ON UNREGISTERED. AT LEAST 10-12 i http://issgl2/intemalwrs/WRequest.aspx?ID=21520 4/10/2008 Critizen Web Request Page 2 of 4 CARS IN TOTAL. CALLER REPORTS THERE ARE ROOMS BEING RENTED THERE AT BOTH PROPERTIES. CALLER REPORTS OVERCROWDING AND STATES THAT IT IS DIFFICULT ITO PASS DOWN THE STREET PARKING ON BOTH SIDES OF THE CURB. Email: Track Request Progress l Request Work History: Internal Note History: Entered on 1/9/2008 7:57:35 AM System entry on 1/7/2008 1:19:45 PM: by O'Connell,Timothy i e Related.__Request 21519. On 1-8-08 went to said property and - knocked on door. I was greeted by person who System entry on 1/7/2008 1:33:31 PM: lives in basement half of dwelling. I was allowed access into this part and observed 4 Assigned to O'Connell,Timothy bedrooms all without proper egress. I was told j - -�-- from RG from zoning that this home owner System entry on 4/10/2008 7:58:34 AM: who lives in top half was trying to get into amnesty program. I was told there are three Request Closed by oconnelt bedrooms in top half so that makes it a total of 7 bedrooms in this home. Although it has a septic for 4 bedrooms (2004-393). I will send out letter that stating that they are in violation j of 410.450 Means of egress. I will also work with LE on the amnesty route. Furthermore, I I gave my card to tenant to have owner call me. i ! i Entered on 1/23/2008 8:57:16 AM by O'Connell,Timothy i � 9 I have a meeting set up for 1-25-08 with owner, LE from zoning and building dept rep. 1 i by OrConnell/T5mo0h8 3 29:24 PM y ' y ! On 1-25-08 went to said property with LE i from building/zoning. We had a meeting with owner's daughter and we discussed some options to deal with two many bedrooms. LE is also going to work with her on zoning issues. We gave her thirty days to figure out what she is going to do. I Entered on 4/8/2008 3:20:31 PM by O'Connell, Timothy j E i http://issgl2/intemalwrs/VvRequest.aspx?ID=21520 4/10/2008 Citizen Web Request Page 3 of 4 Birst team went to property on 4-3-08 Entered on 4/10/2008 7:57:36 AM by O'Connell,Timothy This house is going into foreclosure. Owner can not afford home. RG has told realtor about l illegal kitchen and bedrooms. Will close. Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) i i i 3 �F$ j Spell Check'r ' Spell^�Gheck �« d xh . i ti i Add document or image link: You can also type in a folder name to seep everything in the folder Current Links: g-� 1 U:Mealt �_I..irn O. Cr nefl, cilfton\ r:\OrdererHousing � srr . t}cfftonc.ent,doc Time worked on request 5 00 Response time: 1 Time entries are in hours. «ar: es of time entries: 1,25, 0.5, 0,75, 1., 3.5, 0,25, 0.10 Response time: Measured from the creation date to your first actions on the request. Do not include nights, weekends, and holidays in response time for most departments, Reopen Reopen and notify citizen Reopem Public Use: Printer_Frien_ly Version http://issgl2/intemalwrs/WRequest.aspx?ID=21520 4/10/2008 CERTIFIED MAIL. .L,3" .8'f.A .025""A..!2.E..F Town of Barnstable ,,, h , Public Health'Division MAS9. PI �'. d' � .,3� 200 Main Street { o ,. r Hyannis, MA 02601 02 1 A ....,...:.< 0004606238 JAN14 200008 MD FROM ZIP CODE 0 ' 005 1160 0000 0191 0119 l � 'r LL Mo �-� � o - ® f a pj z cen1�<v- V+ ( fie M N1)(IE 0229 DC 1 �D0 O21OWO9 RETURN SENDER UNCLAIMED j 1, UNABLE TO FORWARD 11 j DC: 02601400200 *2822-16367-14-06 �� r ;j.r• ,` 2601 4002 �"IIIIPIIll�I11(�111111��1�11'lllll��i IIIIIII�I111'�1111�1'll COMPLETE THIS SECTION ON DELIVERY' SENDER: COMPLETE THIS SECTION ■ Complete items 1,2,'and 3.Also complete A. Signature r' item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse ❑Addressee r° I so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery` ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from Rem 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No I I L M i9/ �orJ ��ri a ; I I � L C,AA,&r V 111 3. Se Type01 Certified Mail ❑0 ress Mail ?# ❑Registered Retum Receipt for Merchandise I ❑Insured Mail ❑C.O.D. I / I 4. Restricted Delivery?(Extra Fee) ❑Yes � I 2. Article Number I �� 7005 1160 0000 0191 0119 (Transfer from service label) V i 4 (4 4 I; PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 t tt t�tiht �Y�-r 1 4 z rtt't T ttt 1 tTTt '—T -it T _1..i.— Certified Mail#7005 1160 0000 0191 0119 o4 TKE:r Town of Barnstable p� Regulatory Services * IlARNSTA6LE, + 9 a�Ass Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 r January 14, 2008 Ilma Monterio 80 Clifton Lane Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at-80 Clifton Lane, Hyannis,was inspected on January,9;2008 by"Timothy O'Connell,Health'.:Inspectoufor tlie'Town of Barnstable. This inspection was conducted on-the basis of a complaint The,following violations;of the State Sanitary Code were observed 105 CMR 410.450—Means of Egress. Observed four(4)rooms being used as bedrooms within basement of home without proper second means of egress as required by 780 CMR 3603.10.4.1of the Mass State Building Code. 105 CMR 410.300 and 310 CMR 15.00: There were a total of seven (7) bedrooms observed in this dwelling. However, the existing septic system (permit # 2004-393) was not designed for seven bedrooms. It was designed for four (4)bedrooms. You are directed to correct the violations listed above within twenty-four(24) hours of your receipt of this notice by ceasing and desisting the use of said.rooms within the basement as bedrooms. You are also ordered to remove beds from said rooms. You are ordered to remove three (3) of the bedrooms from the basement by removing,entrance doors and by,gpe ipg all door-way entrances to each room in the basement to minimum of five feet wide openings. This will bring the total bedroom ,count down froth (7)'s66 to'the°appropriate(4y four as designated by your septic permit:'You musfe ther complete`the-above alterations to the bedrooms,'or up.` ' grade the'current septic'system-to°represent the current'number•ofbedrooms. Due QAOrder letters\Housing violations\Rental ordinance\80 clifton.doc to the fact you are not within the Zone of Contribution to public water supply wells you are eligible for this second option. This will entitle you to be able to keep the current number of bedrooms. This must be done with proper permits and engineered plans and be completed within two (2) years of your receipt of this letter if you choose this option. 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 OARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Timothy O'Connell, Health Inspector QAOrder letters\Housing violations\Rental ordinance\80 clifton.doc �� � \� M ' � , � ' � � � � � � Clitizen Web Request Page 1 of 3 NAM io MYN h,.d.,., .•„. s .ram ....-.,..n.,s'A...._. t � .'+°' eu�"` rLogg,ed As: Citizen Request Management rt'r.� �", .,._S 0A f� Request Information Request ID: 21520 Created: 1/7/2008 1:19:44 PM Status: Assigned To Staff Assigned To: O'Connell, Timothy Health Office Anonymous: No Request Category: edit __..___...._.._.._...._._........ _....................____...._----- — Estimated 1/9/2008 Change Estimated Dec January 2008 Feb Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat ( 30 31 1 2 3 4 5 6 7 8 910 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 Created By: Shea, Sally Priority: Medium edit Building Dept Citation Numbers: edit Fequestor fnformation Requestor Request Parcel Number p I CALLER REPORTS THAT AT 80 Block Ma 247 : 007 Lot: 000 AND 89 CLIFTON THERE ARE TOO MANY PEOPLE LIVING THERE WITH Parcel__Lookup GARBAGE EXPOSED OUTSIDE. !THERE ARE 7 CARS THERE AT NIGHT (ON UNREGISTERED. AT LEAST 10-12 CARS IN TOTAL. CALLER REPORTS http://issgl2/lntemalWRS/VVRequest.aspx?ID=21520 1/7/2008 i Citizen Web Request Page 2 of 3 r THERE ARE ROOMS BEING RENTED THERE AT BOTH PROPERTIES. CALLER REPORTS OVERCROWDING AND STATES THAT IT IS DIFFICULT TO PASS DOWN THE STREET PARKING ON BOTH SIDES OF THE CURB. Email: Edit Re uestor Information Track Request Progress Request Work History: Internal Note History: System entry on 1/7/2008 1:19:45 PM: j Related._Re_uest._21519 S System entry on 1/7/2008 1 33 31 PM Assigned to O'Connell,Timothy Enter work progress: Enter internal note: Viewed by everybody) (Viewed internally only) W........ I J ____.►. __.a ___. o _ Ck 0 h SpeII Cheek �� Spel ,17", l eCheck 1 LI I' ` � l -Add document or image link: : B rowse YOU can also type in a i'oider r r e to see every hind in the folder l Current Links: Time worked on request: Response time: x: Time e'ritrFE'S are in `t"?c711t"ti, lw'Xt`T3}leL< of time entries: 1..25, 0,5, 0,75, 1, 3.5, 0.25, 0.10 http://issq l2/lntemalWRS/WRequest.aspx?ID=21520 1/7/2008 I Citizen Web Request Page 3 of 3 Response time: Measured from they creation date to your first actions can the request, o not include nights, weekends, and holidays in response time for most departments. Save changes - Check to notify town employee below ' to review this request. r Save changes and notify Health Office citizen* _.. _. ... t_ ., ! Agostinelli, Joan r Close request and notify citizen* Brief message to reviewer: i "notify works if ernail address kj%;as giver) Up adad to ' ....... __... I „V, N, E Speli Checkf. 1 Public Use: Printer Friendly Version i Internal Use Printer Friendly Version http://issq l2/lntemalWRS/VYRequest.aspx?ID=21520 1/7/2008 Parcel Detail Page 1 of 3 � ga Lac) E.C1 In As: Detail Tuesuey,jan-i Darce' Lookup Parcellnfo Parcel ID'247-007 Developer LOT 15A Lot ...... Location 80 CLIFTON LANE Pri Frontage 75 Sec Sec Road Frontage _.._---------..... .. _-..-..-_ __._-_.__.__ _�._.______.__.__. ,__K_ village ICENTERVILLE Fire District 11C-O-MM Sewer Acct Road Index 10323 :IR�� rn r Interactive Mapr 56 Owner Info _.... Owner IMONTEIRO, ILMA Co-owner .......... ......... ...... Streetl 1$0 CLIFTON LN Street2 ............................._..._..... CityCENTERVILLE State MA zip 02632 Country US Land Info .. ....... .... ...... ..... . . .... Acre i0.17 Use Sin le Fam MDL-Q1 Zoning RB Nghbd Q106 Topography 'Level Road Paved utilities Public Water,Gas,Septic Location Construction Info Budding I of I Year ___..... Roof - Ext Bui6 1972 Struct GablefHip Wall EWood Shingle __. ---:-....�-.. Effect 1350 Roof Asph/F GIs/Cmp AC None Area Cover' Type .._ ....._ y Style?Raised Rand Int,Dr wall Bed 4 Bedrooms Wall: �tm .�. Rooms Model Residential Int _._ __ Bath;1 µFull + 1 Floor Rooms Grade;Average Minus Heat Elec Baseboard Total T TypeJ Rooms http://issgl/intranet/propdata/ParcelDetail.aspx?ID=17326 1/8/2008 • Parcel Detail Page 2 of 3 u z7 1 01, Heat .. Found- ¢e t 4s stones 1 Story FUei Electric atio Poured Cork Permit History Issue late Purpose Permit Account Insp Date Comments Visit History _. .................... Date Who Purpose 4/6/2005 12:00:00 AM Jason Streebel Meas/Est 12/10/2001 12:00:00 AM Paul Talbot Meas/Listed 10/15/1991 12:00:00 AM ME Sales History ........... .. ...._._ ._. Line Sale Gate Owner Bose/Page Sale P 1 12/17/2004 MONTEIRO, ILMA 19357/120 2 7/18/2002 BEZERRA, JOSE 15376/266 3 12/4/2000 BEZERRA, JOSE & FRANCISCO E 13403/167 ; 4 9/15/1984 SHAPETON, MARK & MARGARET ETALS 4252/279 5 GALLAGHER, PHILIP J & E C 1552/181 rvAssessment History _. ._.__ ...._..._.___ .._.__._...._.___._.._.._.._ Save Year Building Value XF Value OP,Value Sand Value Total Pares 1 2007 $120,400 $20,800 $0 $157,600 2 2006 $101,400 $20,800 $0 $160,500 3 2005 $95,100 $20,600 $0 $155,400 4 2004 $77,800 $20,600 $0 $105,700 5 2003 $70,100 $20,600 $0 $40,700 6 2002 $72,500 $20,600 $0 $40,700 7 2001 $72,500 $20,600 $0 $40,700 8 2000 $55,700 $18,200 $0 $30,100 9 1999 $55,700 $18,200 $0 $30,100 10 1998 $55,700 $18,200 $0 $30,100 11 1997 $75,500 $0 $0 $23,400 12 1996 $75,500 $0 $0 $23,400 http://issql/Intranet/Propdata/ParcelDetail.aspx?ID=17326 1/8/2008 +Parcel Detail Page 3 of 3 13 1995 $75,500 $0 $0 $23,400 14 1994 $69,900 $0 $0 $30,100 15 1993 $69,900 $0 $0 $30,100 16 1992 $64,900 $0 $0 $33,500 17 1991 $69,600 $0 $0 $60,300 18 1990 $69,600 $0 $0 $60,300 19 1989 $69,600 $0 $0 $60,300 20 1988 $48,900 $0 $0 $23,700 21 1987 $48,900 $0 $0 $23,700 22 1986 $48,900 $0 $0 $23,700 Photos http://lssgl/intranet/propdata/ParcelDetail.aspx?ID=17326 1/8/2008 Rodger Roberts AO.Box 1557 Hyannis, Massachusetts 02601 ph. (508)-778-1898 fax(508)-790-9732 March 30,2005 Montelro 80 Clifton Lane. Centerville,Massachusetts Rodger Roberts proposal to upgrade septic system to Title V for a seven bedroom dwelling,consists of utilizing a existing 1500 septic tank with three chambers,installing two additional c ambers with stone surrounding per Title V. and Barnstable codes. Price quoted includes all engineering work plans,site vist and approvals. Price includes all permits,piping,pumping,town inspections,trucking,sand,stone,labor and machine work. Any fencing,shrubs,trees selectively removed and replanted if required,all included.. Existing lbach pit will be pumped and filled with clean sand or removed. System will meet Board of Health approvals Site area will be left backfilled,smooth and level no landscapeing No underground irrigation replacment or repair is in this contract. Quote is a guaranteed set price. Price: $4700.00 Deposit $1700.00 Please allow three weeks+or-for permitting and sch. 0-11 $3000.00 To be paid to Rodger Robertson day of completion and delivery of Certificate of Compliance. Respectfully submitted; Date jb oberts pric s,specifications and conditions are satisfactory and are hereby accepted. Date Vb Si ed Date Please sign both copies and return one to us.Thank you for your consideration. "_Citizen Web Request Page 1 of 4 5 1 JF - F ag r _ - 9?. y�.hx04a5f" f"X zY A � L-ogyed In As: A FOWN\Oucanndt Citizen Recuest Management L to User's `+E?.a:'..,. Re. E.;st.'; C re. to pe i=`;.1e.:-s Request Information [( Request ID: 21520 Created: 1/7/2008 1:19:44 PM ! Status: Assigned To Staff Assigned To: O'Connell, Timothy Health Office Anonymous: No Request Category: edit Estimated 1/9/2008 Change Estimated Dec January 2008 Feb Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri I Sat 30 31 1 2 3 4 5 6 7 8 9 10 11 12 j 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 i 3 4 5 6 7 8 9 Created By: Shea, Sally Priority: Medium edit Building Dept Citation Numbers: edit Requestor information - Requestor Request Parcel Number CALLERBlock 0070 CALLER REPORTS THAT AT 80 p: 247_. F __ l Lot 00 AND 89 CLIFTON THERE ARE TOO MANY PEOPLE LIVING THERE WITH Parcel_Lookup GARBAGE EXPOSED OUTSIDE. THERE ARE 7 CARS THERE AT NIGHT ION UNREGISTERED. AT LEAST 10-12 (CARS IN TOTAL. CALLER REPORTS htt ://iss 12/internalwrs/WRe uest.as x.ID-21520 4/3/2008 P q q P Citizen Web Request Page 2 of 4 THERE ARE ROOMS BEING RENTED THERE AT BOTH PROPERTIES. CALLER REPORTS OVERCROWDING AND STATES THAT IT IS DIFFICULT TO PASS DOWN THE STREET PARKING ON BOTH SIDES OF THE CURB. Email: Edit Re...uestorIn_formation Track Request Progress 1 Request Work History: Internal Note History: . ..... Entered on 1/9/2008 7:57:35 AM System entry on 1/7/2008 1:19:45 PM: by O'Connell,Timothy Related Request 21519 Om 1-8-08 went to said property and ,y knocked on door. I was greeted by person who System entry on 1/7/2008 1:33:31 PM: I lives in basement half of dwelling. I was j allowed access into this part and observed 4 Assigned to O'Connell,Timothy bedrooms all without proper egress. I was told from RG from zoning that this home owner who lives in top half was trying to get into amnesty program. I was told there are three bedrooms in top half so that makes it a total of 7 bedrooms in this home. Although it has a septic for 4 bedrooms (2004-393). I will send out letter that stating that they are in violation of 410.450 Means of egress. I will also work with LE on the amnesty route. Furthermore, I gave my card to tenant to have owner call me. f update delete i Entered on 1/23/2008 8:57:16 AM by O'Connell, Timothy I have a meeting set up for 1-25-08 with owner, LE from zoning and building dept rep. update delete ' Entered on 1/25/2008 3:29:24 PM by O'Connell,Timothy On 1-25-08 went to said property with LE from building/zoning. We had a meeting 9 with owner's daughter and we discussed some options to deal with two many bedrooms. LE is http://issgl2/intemalwrs/WRequest.aspx?ID=21520 4/3/2008 -' -C't'zen Web Request Page 3 of 4 also going to work with her on zoning issues. We gave her thirty days to figure out what she is going to do. update delete .......................................................................................... Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only ............- ............................. ........................-.............-..............- ............ .......... Spell Ch6tk. Spell e Kw"�� 7�: -r� og ............. ............ ................ ------- .................--- Add document or image link: Browse You can also type in a folder name to see everything in the folder Current Links: n\ Remove: Time worked on request: 3.00 Response time: Tine entries are in, hours, Examples of time entries: i..25, O 5,�5, 0- 3.5� 025, 0.10 Response time: Measured from the creation date to your first actions on the request, Do not include nights, weekends, and holidays in response time for most departments. ................... ...................................................................-............. .............................. ................................................--...........- ........... .............. .................. Save changes I Check to notify town employee below to review this request. Save changes and notify Fe—a — citizen* (7, Close request Barrett Caitlin Brief message to reviewer: C; Close request and notify citizen* �`'noflfy vvorks it email address was given Spell Check Public Use: Printer Friend) Version http://issql2/intemalwrs/WRequest.aspx?ID=21520 4/3/2008 -�� TOWN-OF BARNSTAB LOCATION ,p® CCa Pf'OR- G�� �� �16A EWAGE VILLAGE C.er-et vr e- ASSESSOR'S MAP & LOT*^cPw o25P7 INSTALLER'S NAME&PHONE NO. PA17--0ove SEPTIC TANK CAPACITY 119D 1P LEACHING FACILITY: (type) ;"ia�1>!!2 '.eG is (size) l-2- x n NO.OF BEDROOMS Y BUILDER OR OWNER e Z &,01 PERMITDATE: Z 0 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1I 1 a-y V3 �IT Town of Barnstable Regulatory Services Thomas F. Geiler, Director t BARNSTABLE, 9� MASS. �e� Public Health Division '°rFc may" Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Designer: ^ Installer: c �1�� Address: �(`�� (��� Address: _TnciA\-Pq 2d On 8 �US &�_��""'Was issued a permit to install a date (installer) 11 septic system at e�o C I�� 2—M, 1�based on a design drawn by �l (address) dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. �\A DF l},gss (Install 's Signature) o� CARMEN, s, SHAY No. 1181 6z'_Y0AA 0 giPGI.STERA (Designer's ignature) (Affix aA ,+ p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form TOWN OF BA.RNSTAB LOCATION 0P49 CLa ® Lem W 1 EWAGE aY7 VILLAGE C-0-fe— u� ASSESSOR'S MAP.&LOT INSTALLER'S NAME&PHONE NO. ?Affr0or.,G' SEPTIC TANK,CAPACITY LEACHING FACILITY: (type').,�a G.LG�s (size) NO.OF BEDROOMS _Y BUILDER OR OWNER PERMITDATE: f y COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) - Feet Furnished by 19 A y3 . 6- j4 Ok C0=%10X%1 AI.TH OF MASSACHUSETTS =crms OFFICE OF ENNm0S1E,.\-TAL AFF-AJRS _ DEPARTMENT OF ENVIRONMENTAL PROTECTION O\'=RZYM STR7_Z7.BOSTO\)dA 0210i- .-wr t6I'��2 silk TR1'DT COL Secrete_n ARGEO PALL CELLLCCi DA17D B STp_-vc Go.-emor SYSTEM tNS Commats,s:one- SUBSURFACE SEWAGE DISPOSAL PECitON FORM PARTA CERTIFICATION PropenyAddrazz: 80 Clifton Lane Na-inOtOwna►.Mark . hapeton Centerville Addrassollo—""_5Z=45 Rrnar7l a�� Newton Date of lnspeetion: Name of ampector IPlease Primp WIII. E. Robinson Sr. 1 am a DEP approved s inspector Rao Seetion 15.340 of ram 5 gmCMR 15.000) Gornpany Hanna: Wm• E . Robinson e t is Service Mailing Address: PO Box 0 9. Centerville. MA Telephone Number: 7(; CERTIFICATION STATEMENT I certify that 1 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 sew a disposal systems. The system: _ asses Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails inspector's Signature: 4j I ,/-�_ Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority Ieoard of Health or DEP►within thirty 130)days of completing this inspection. If the system is a shared system or has a design flow of 10.000 gpd or greater.the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to tfre system owner and copies sent to the buyer. if applicable. and the approving authority. NOTES AND COMMENTS i ,j �. � i cam Pypc I of I1 w SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTIDM FORM PART A CER. ICATIOM Icart6roedl NopatyAddress: 80 Clifton Lane, Centerville Owner: Shapeton Date of Inspection: //_ g WSPECTIDN SUMMARY: Check B, C, of D: A. PASSES: 7ve not found any information which indicates thafany of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDRIONALLY PASSES: One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system. upon completion of the replacement or repair,as approved by the Board of health,win pass. Indicate s.no. or not determined(Y.N,or NO). Describe basis of determination in all instances. N "not determined',explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance lattached)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 oxfiltrution. or tank failure is imminent. The system will pass inspection If the existing septic tank is replaced with a complying septic tank as approved by the Board of health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if Iwith approval of the Board of Health). broken pips(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipels). The system will pass inspection if(with approval of the Board of health): broken pipe(s)are replaced obstruction is removed Jj 2/7.8. Pale 2 0!I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icontin+ed) PropertyAddress:80 Clifton Lane, Centerville owner: Shapeton Date of inspeeoon /^8—s-c� 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 it the system is failing to protect the public health. safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES N ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) S TEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FU CTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for eoliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 31 THEP PaRc3or11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icantinuedl Property Address: 80 Clifton Lane, Centerville owner: Shapeton Date of Inspeebon: D. SYSTEM FAILS: You mu indicate either "Yes" or "No" to each of the following: have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this etermination is identified below. The Board of health should be contacted to determine what will be necessary to correct the failure Yes o Backup of sewage into 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 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 112 day flow. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipelsl. Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I 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. RGE SYSTEM FAILS: You m t indicate either "Yes' or "No' to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes 0 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) The ow er or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of he Department for further information. '^a', Cow C PaRr 4 of I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST . Prop"Add►ess80 Clifton Lane, Centerville Owner: Shapeton Date of hupwbon: Check if the following have been done: You must indicate either `Yes- or -No- as to each of the following: Yes i No . _ Pumping information was provided by the owner,occupant,or Board of Health. None of the system components have been pumped for at least two weeks on&the system has been mceiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this / inspection. _ As built plans have been obtained and examined. Note if they are not available with N1A. _ The facility or dwelling was inspected for signs of sewage back-up. The e system does not receive non-sanitary or industrial waste slow. _ The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge. depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. For example, Plan at B.O.N. _ Determined in the field (if any of the failure criteria related to Part C is at issue. approximation of distance is unacceptable! / 115.302(3)(b)) 1� _ The facility owner (and occupants,if differeru from owner) were provided with information on the Propermaintanaaro-0f SubSurface Disposal Systems. Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTBN INSPECTION FORM PART C SYSTEM INFORMATION 4opertyAddress: 80 Clifton Lane, Centerville Owner: Shappeton Dote of Inspee>>dn: FLOW CONDITIONS RESIDENTIAL: Design flow: 411'1 Og.p.d./bedroom. Number of bedrooms(design): Number of bedrooms lactual):-,/ Total DESIGN flow. L/ A/b Number of current residents: d,// Garbage grinder lyes or no): A,O Laundry(separate system) lyes or no): IL-0; If yes,separate inspection required Laundry system inspected lyes or no; Seasonal use (yes or no):,4C-5 Water meter readings. if available (last two year's usage(gpd): 1 QAA dR , 000 Cfal Sump Pump(yes or no) /-o 1998 38, 000 gal. Last date of occupancy: C MERCIALIINDUSTRIAL: Type of establishment: Desig flow: apd 1 Based on 15.203) Basis f design flow Greas trap present: (yes or no)_ Indust ial Waste Holding Tank present: (yes or no) Non•s nrtary waste discharged to the Title 5 system: (yes or no)_ Water meter readings. if available: Last ate of occupancy.- 0 : (Describe! Last to of occupancy GENERAL INFORMATION PUMPING RECORD an�jVice of information: System pumped as part of inspection: (yes or no)-Luo If yes volume pumped: gallons Reason for pumping TYPED SYSTEM Septic tank distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes. attach previous inspection records.if any) I;A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed lif known)and source of information: Sewage odors detected when arriving at the site: (yes or no g r)Y ) /" -_ -�`y G' � ' _ ' Page 6of11 i SUBSURFACE SEWAGE DISPOSAL SYSTIRN INSPECTION FORM PART C SYSTEM INFORMATION Ieen*awd) 14opertyAddres$0 Clifton Lane, Centerville owner: Shapeton Date of Inspection: /ya BU INC SEWER: (Locat on site plan) Depth elow grade:_ Meter 1 of construction:_cast iron_40 PVC_other lexplain) Disto Ma/ter' from private water supply well or suction line Die eter Co ments: (condition of joints, venting, evidence of leakage,etc.) SEPTIC TANK:_ / loocate on site plan) Depth below grade: Material of construction: vEoncrete_metal_Fiberglass _Polyethylene_otherlexplain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:&� Scum thickness: I_a„ %� Distance from top of scum to top of outlet tee or baffle:__ r Distance from bottom of scum to bottom of outlet tee or baffle:13 Now dimensions were determined: 0 :omments: Irecommendation for pumping, condition of inlet and outlet tees or.bbaffles, depth of liquip level in relation to outlet invert, structural integrity. evidence of leakage. etc.) 1CT-CY�� L''b ) �-d si a� T y GR E TRAP: (locate n site plan) Depth b low grade:_ Material f construction:_concrete_metal_Fiberglass _Polyethylene_otherlexplain) Dimensio Scum thic ness. Distance tr m top of scum to top of outlet tee or baffle: Distance tr m bottom of scum to bottom of outlet tee or baffle: Date of las pumping: Comments: Irecomme ation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence leakage. etc.) re v_S ", L. 70 PaRc7of11 SUBSURFACE SEWAGE DISPOSAL SYST04 INSPECTION FORM PART C SYSTEM INFORMATION Nwnitiwasso brop"Add►ess: 80 Clifton Lane, Centerville owner: Shappeton Dace of hupection:';/— TW OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) floc to on site plan) Depth below grade:_ Materi I of construction:_concrete_metal_Fiberglass_Polyethylene other(explain) Dimen ions: Capaci y: gallons Desig flow: gallons day Alarm present Alarm level: Alarm in working order: Yes_ No_ Date f previous pumping Coin ents: (co ition of inlet tee, condition of alarm and float switches. etc.) DISTRIBUTION BOX: C/ (locate on site plan; Depth of liquid level above outlet invert:__ Comments: (note if level and distribution is equal, 8dr of solids carryover, evidence of leakage into or out of box, etc.) PUMP HAMBER:_ (locate n site plan! Pumps working order: (Yes or No) Alarms n working order (Yes or No) Comm ts: Inote c nditron of pump chamber, condition of pumps and appurtenances, etc.) =':v Pale 8 of 11 . SUBSURFACE SEWAGE DISPOSAL SYSTEM NSPEC'TION FORM PART C SYSTEM INFORMATION(candratid) Topi"Address: 80 Clifton Lane, Centerville Owner: Shapeton Date of Inspection: / SOIL ABSORPTION SYSTEM(SAS): -V (locate on site plan,if possible:excavation not required,location may be approximated by non-intrusive methods' If not located, explain: Type: leaching pits. number:_ leaching chambers,number: leaching galleries. number: leaching trenches. number. length: leaching fields. number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) TAS 6 is 'S !b 74- CESSPOOLS:_ (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. inflovr (cesspool must be pumped as part of inspection; Comm nts Incite c ndition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Mater als of construction Dept of solids: Dimensions: Coin ents: Ino condition of soil. signs of hydraulic failure. level of ponding, condition of vegetation, etc.) PaF(9 of I I SUBSURFACE SEWAGE DISPOSAL SYSTEM NSPECTRM FORM PART C SYSTEM NFORMATION feonortindl 'Irop"Address: 80 Clifton Lane, Centerville jwner: Shapeton Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) J UfV �yt 1L J I � d4 �l PaRt.10ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART C SYSTEM WFORMATION leondnuadl ropwty Address: Owner: 80 Clifton Lane, Centerville Date of h to n NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Deep Groundwater depth: Shallow Moderate SITE EXAM Slope Surface water Check Cellir Shallow wells t Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: -Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions VChecked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators. installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Y «':=SE:. 9/2/9E Page 11of11 No. V�V FEE _ COMMONWEALT14 OF MASSACHUSETTS Board of Health, 1�5�@��rC, MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑Complete System ❑Individual Components Location ' an4wtil lie Owner's Name Map/Parcel# Z4-+ d0 Address Lot# -OF 15A Telephone# Installer's Name A—mm- Designer's Name V Address VV.t1. V"e l2 Address t M Telephone# Telephone# AkAra Type of Building —r�eS Agn V.,ax Lot Size r=�6 q•Soo s ft. Dwelling-No.of BedroomsA(' ��}� Garbage grinder V Other-Type of Building "�/ � No.of persons�Showers (�afeteria Other Fixtures A Design Flow (min.required) 44 Q 4 gpd Calculated design flow 46 Design flow provided 44-60 gpd Plan: Date 4. Number of sheets , Revision Date � 11 Title O ® C. Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation D DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Insnerties� --••�-✓f' ,-••j...,...�__.ti�--.,,..,. r.,.,,,,��J. ,r.a^>ew.ri'ay..:.,C....,.:H•r'�d`�.i��^�-`t'y .^+w �'.••,-�3`.�•f''",'•rs .`.•:f`.:"i:.,,,,,,✓�..,.—e�,:w^ -...-. �..,••.f..: ' ' r No.� " FEE 2t.y ka 0 COMMONWLALT14 F TWJ to J ",ems ai'•.. . �;•�_ ~ Board of Health, Lper► APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION, PERMIT . s Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ❑Complete System ❑Individual Components Location -*6`0 i iIkno 44. 0 U'l Owner's Name Map/Parcel# 4� , d� Address_, iTQ Lot# x fl Telephone# •Installer's Name �, CQl1Q Olt Designer'-s^N�ame Address �.�• Address " Telephone# 4.;x6 CZA U 4LA Telephone# a _ �L� -��� 02 St" 1 r Type of Building Q S�k i�Q O s 0.� Lot Size ' s�d C7 sq.ft. Dwelling-No.of Bedrooms TClll �) Garbage grinder NIA - Otlier-Type of Building None ` No.of persons -5 Showers (po,175feteria(e Other Fixtures Design Flow(min.required) 4.40gpd I,Calculated design flow 4440 Design flow prodded 4-� gpd Plan: Date J 4- Number of sheects ! Revision Date Title \ CU(� C� 2 ap�--k c 1 t!5" C.' e r, o.()C\ycAe. t t Description of Soil(s) � I Soil Evaluator Form No. Name of Soil Evaluator Ca em rv� JAfkY Date of Evaluation c� DESCRIPTION OF REPAIRS OR ALTERATIONS k ~r The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. d Signed Date 4 k�� In, _ectio�rxs" _ W lore-- No. ���� " FEE�T Board of Health, (?10 r^J4 we MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by: 1QG SDf L , at i) f i��i•-4 nL A o (P/14Pn'1 1.P has been installed in accordance with the pr)ovis ons of 310 CMR 15.00 (Title 5) and t approved design plans/as-built plans relating to application No.PUd7 , dated N Approved Design Flow (gpd) • r � Installer 1 Designer: Inspector: KV Date: l/.1/07 The issuance of this permit shall not be construed as a guarantee that the system will function as designed. FEE C®MMONWEA OF MASSAC14USETTS (Board of Health, j w MA. ➢ IS POSAL SYSTEMCONSTRUCTION PERMIT Permission'is hereby anted to; onstruc ( ) Repair( ) U grade Abandon( ) an individual sewage disposal system at �v /DIY L/Y ® , (�, U, 7 as described in the application for Disposal System Construction Permit No.---z7Q —' 'a ed k Provided: Construction shall be completed wi in t ree years of the date of s p•rmit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date /07 Board of Health r Town of Barnstable IMRNSTAU "MASSM Regulatory Services 9.5 ,��� % 3 Thomas F. Geiler,Director Public Health Division Thomas McKean, Director . 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 22, 2003 Jose Bezerra �j 80 Clifton Lane (s, ) Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND ARTICLE 51 OF THE TOWN RENTAL ORDINANCE. The property owned by you located at 80 Clifton Lane, Centerville, was inspected on August 19, 2003 by David Stanton R.S., Health Inspector for the Town of Barnstable, because of a complaint. ' The following violations of the State Sanitary Code was observed: A05 CMR 410.500: Owner's Responsibility to Maintain Structural Elements. (Free �✓ from chronic dampness) Mold was observed in several locations throughout the lower o level of the dwelling. Mold was observed in the following locations: The kitchen p 3� 3 ceiling,bathroom, bathroom door frame/trim, bedroom ceilings, and carpeting. �05 CMR 410.500: Owner's Responsibility to Maintain Structural Elements. Kitchen ceiling was observed partially patched near the cabinets, with unfinished rough /1005 ts CMR 410.500: Owner's Responsibility to Maintain Structural Elements. Some of the bathroom ceiling tiles were observed loose. 105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements. The toilet was observed working improperly. 105 JCMR 410.500: Owner's Responsibility to Maintain Structural Elements. Several areas of loose and peeling wallpaper were observed. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice, by removing the mold and the source of chronic dampness causing the mold to grow in the dwelling, finishing the ceiling repair in the kitchen so it is smooth and free of defects, repairing or replacing the loose bathroom ceiling tiles, repairing the toilet or septic system so the toilet operates properly and by Q:Health/Order letters/Housing violations/80 Clifton.doc Y making the walls smooth and free of loose wallpaper. Per our phone conversation on 8/22/03,you were having the septic tank pumped. 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 $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF T E BOARD OF HEALTH as A. McKean, R.S. Director of Public Health Town of Barnstable CC: Wellington Martins, Tenant Q:Health/Order letters/Housing violations/80 Clifton.doc (DomesticU.S. Postal Service CERTIFIED MAIL RECEIPT , Only; ru rl 0 F F C 1 A L U E nu N Postage $ • 3-7 DM Certified Fee �z0 3 ��Jl Return Reeipt Fee (Endorsement'equired) p Restricted Delivery Fee Cn p (Endorsement Required) p Totat Postage&Fees $ �" N 0 a D, Sent To sa p�v ---------- ose- Be z e m�, Oor PO Apt No.; C/l ,n (� Q or PO Box No. OV --- ..... ------�.e� � p Cny,State,Z/Pt 4 1 e 0 6 3a ,0 Certified Mail Provides: 1 ■A mailing receipt ■A unique identifier for your mailpiece ■A signature upon delivery ■A record of delivery kept by the Postal Service for two years Important Reminders: ■Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. ■Certified Mail is not available for any class of international mail. s NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is, required. ■For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery'. ■If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certifi2d Mail receipt is not needed,detach and affix label with postage and mail., IMPORTANT.Save this receipt and present it when making an mqulry. PS Form 3800,January 2001 (Reverse) 102595-M-01-2425, L Health Complaints 18-Aug-03 Time: Date: Complaint Number: 4236 Referred To: DAVID STANTON Taken By: RITA Complaint Type: HOUSING Article X Detail: Business Name: Number: 80 Street: CLIFTON LANE o Village: WEST HYANNISPORT Assessors Map_Parcel: �a P Complaint Description: LANDLORD LIVES UPSTAIRS AND HIS KITCHEN AND BATHROOM IS CAUSING C�/ LEAKAGE INTO THE DOWNSTAIRS APT. CAUSING A MOLD ONTO A RUG THAT HE �✓"' HAD TO REPLACE AND ALSO ON THE lam- , CEILING. SOME OF THE WINDOWS DON'T Oa. /757 D /��7 /��j CLOSE PROPERLY AND THERE IS A CEILING FAN IN THE LIVING WHICH ISN'T L WORKING. HE IS AFRAID OF ANjG ELECTRICAL FIRE. THERE ARE STAINS ON / l SOME OF THE WALLS SHOWING SIGNS OF WATER RUNNING DOWN WALLS. HE HAS TRIED TO SPEAK ABOUT THIS TO -fold , LANDLORD WITH NO RESULTS. HE WOULD (JI UQ b�u�l, ALSO APPRECIATE A QUICK RESPONSE IF o_ POSSIBLE AS HE WORKS IN N.Y. AND �h HOLDING OFF RETURNING TO SETTLE u d VJA-f THIS MATTER.. ` Actions Taken/Results: Investigation Date: Investigation Time: r I _ Y Health Complaints 21-Aug-03 Time: Date: Complaint Number: 4236 Referred To: DAVID STANTON Taken By: RITA Complaint Type: HOUSING Article X Detail: Business Name: Number: 80 Street: CLIFTON LANE Village: WEST HYANNISPORT Assessors Map_Parcel: Complaint Description: LANDLORD LIVES UPSTAIRS AND HIS KITCHEN AND BATHROOM IS CAUSING LEAKAGE INTO THE DOWNSTAIRS APT. CAUSING A MOLD ONTO A RUG THAT HE HAD TO REPLACE AND ALSO ON THE CEILING. SOME OF THE WINDOWS DON'T CLOSE PROPERLY AND THERE IS A CEILING FAN IN THE LIVING WHICH ISN'T WORKING. HE IS AFRAID OF AN ELECTRICAL FIRE. THERE ARE STAINS ONE SOME OF THE WALLS SHOWING SIGNS OF WATER RUNNING DOWN WALLS. HE HAS TRIED TO SPEAK ABOUT THIS TO LANDLORD WITH NO RESULTS. HE WOULD ALSO APPRECIATE A QUICK RESPONSE IF ,` A, POSSIBLE AS HE WORKS IN N.Y.AND HOLDING OFF RETURNING TO SETTLE THIS MATTER.. Actions Taken/Results: Investigation Date: Investigation Time: 1 LF310-04 R310-04 RESIDENTIAL LEASE Apartment— Condominium —House jot�n J ,2003, BY THIS AGREEMENT made and entered into onpad herein referred to as Lessor, between UO` �wv-+l�S herein referred to as Lessee. and I,JJZI�I�'�`%+0� Lessor leases to Lessee the premises situated at �Cj C 1 �DI.v,JC ' S t -r ItO O X"' �in the City of �`J a^'� Im 5 P� ,County of L) ' State.of (-mil S S K}cl�V SS�S , and more particularly described as follows: 4y Qj ec� h ,+k c con , I i'�t �-Gln� 1 (1 V ��rv�-°a r o o together with all appurtenances,for a term of years, to commence on 20 O 3 > and to end on 31s F bed2,mbp- ., , 200� , at k2%oo?t-% o'clock . m. 1. Rent. Lessee agrees to pay, without demand, to Lessor as rent for the demised premises the sum of 0 Y\L-�'Ap uS o��CL�S Dollars ($ per month in advance on the �i day of each calendar moth beginning �olnn U , City of 20 03 , at `3O C t 1 +O,n 1 m I _ Jr I00 ti or at such other lace as Gtn�,Yw State of S �� }(�0�3��JSS , P Lessor may designate. M�C R an Jam /0-2) 2. Security Deposit. On execution of this lease, Lessee deposits with Lessor receipt of which is acknowledged CU , (f 3�p *S M°' Dollars ($ �� ), P by Lessor, as security.for the faithful performance b Lessee of the terms hereof, to be returned to Lessee, without interest, on the full and faith u pe ormance by him of the provisions hereof. 3. Quiet Enjoyment. Lessor covenants that on paying the rent and performing the covenants herein contained, Lessee shall peacefully and quietly have,hold, and enjoy the demised premises for the agreed term. 4. Use of Premises. The demised premises shall be used and occupied by Lessee exclusively as a private sin>;le family residence,and neither the premises nor any part thereof shall be used at any time.during the term of this lease by Lessee for the purpose of carrying on any business,profession,oT trade of any kind,or for any purpose other than as a private single family residence. Lessee shall comply with all the sanitary laws,ordinances, rules, and orders of appropriate governmental authorities affecting the cleanliness,occupancy,and preservation of the demised premises, and the sidewalks connected thereto,during the term of this lease. Q 5. Number of Occupants. Lessee agrees that the demised premises shall be occupied by no more than O persons, consisting of $ adults and ? children under the age of years, without the written 0 consent of Lessor. 6. Condition of Premises. Lessee stipulates that he has examined the demised premises, including the grounds and all buildings and improvements, and that they are, at the time of this lease, in good order, repair, and a safe, clean, and tenantable condition. 7. Assignment and Subletting. Without the prior written consent of Lessor, Lessee shall not assign this lease, of sublet or ,grant any concession or license to use the premises of any part thereof. A consent by Lessor to one assignment, subletting, concession, or license shall not be deemed to be a consent to any subsequent assignment, subtetting,,concession,or license.An assignment, subletting,concession,or license without the prior written consent of Lessor,orb assignment or subletting by operation of law,shall be void and shall,at Lessor's option,terminate this lease. NOTICE:Contact your local county real estate board for additional forms that may be required to meet your specific needs. Page I Rev. 12/01 G 1992-2001 Made E-Z Products,Inc. This product does not constitute the rendering of legal advice or services.This product is intended for informational use only and is not a substitute for legal advice.state laws vary,so consult an attorney on all legal matters.This product was not necessarily prepared by a person licensed to practice law in your state. ZAAB I6kherwise provided by writtenagreement between lessor and Lessee, de the property or Lessor auu rcuMuiii U11 UIC derr4sed premises at the expiration or sooner termination of this lease. '9. Dathage to Premises. If the demised premises, or any part thereof, shall be partially damaged by fire or other casualty not due to Lessee's negligence or willful act or that of his employee,family, agent,or visitor, the premises shall be promptly repaired by Lessor and there shall be an abatement of rent corresponding with the time during which, and the extent to which,the leased premises may have been untenantable; but, if the leased premises should be damaged other than by Lessee's negligence or willful act or that of his employee, family, agent,or visitor to the extent that Lessor shall decide not to rebuild or repair,the term of this lease shall end and the rent shall be prorated up to the time of the damage. 10. Dangerous Materials. Lessee shall not keep or have on the leased premises any article or thing of a dangerous, inflammable,or explosive character that might unreasonably increase the danger of fire on the leased premises or that might be considered hazardous or extra hazardous by any responsible insurance company. 11.Utilities. Lessee shall be responsible for-arranging for and payingfor all utility services required on the premises, except that `�Qc,�lin CAPr t(- ' {�h0� 1C ��(� rtic,,, tt,-?�tNhall be provided by Lessor.(lMh°�� «��) 12. Right of Inspection. Lessor and his agents :hall have the right at all reasonable times during the term of this lease and any renewal thereof to enter the demised premises for the purpose of inspecting the premises and all building and improvements thereon. 13. Maintenance and Repair. Lessee will, at his sole expense, keep and maintain the leased premises and appurtenances in good and sanitary condition and repair during the term of this lease and any renewal thereof. In particular, Lessee shall keep the fixtures in the house or on or about the leased premises in good order and repair; keep the furnace clean; keep the electric bells in order; keep the walks free from dirt and debris; and, at his sole expense, shall make all required repairs to the plumbing, range, heating, apparatus, and electric and gas fixtures whenever damage thereto shall have resulted from Lessee's misuse,waste,or neglect or that of his employee,family, agent,or visitor. Major maintenance and repair of the leased premises, not due to Lessee's misuse,waste,or neglect or that of his employee, family, agent, or visitor, shall be the responsibility of Lessor or his assigns. Lessee agrees that no signs shall be placed or painting done on or about the leased premises by Lessee or at his direction without the prior written consent of Lessor. 14.Animals. Lessee shall keep no domestic or other animals on or about the leased premises without the written consent of Lessor. 15. Display of Signs. During the last 30 days of this lease, Lessor or his agent shall have the privilege of displaying the usual "For Sale" or"For Rent" or "Vacancy" signs on the demised premises and of showing the property to prospective purchasers or tenants. 16. Subordination of Lease. This lease and Lessee's leasehold interest hereunder are and shall be subject, subordinate, and inferior to any liens or encumbrances now or hereafter placed on the demised premises by Lessor; all advances made under any such liens or,encumbrances, the interest payable on any such liens or encumbrances, and any and all renewals or extensions of such liens or encumbrances. 17. Holdover by Lessee. Should Lessee remain in possession of the demised premises with the consent of Lessor after the natural expiration of this lease, a new month-to-month tenancy shall be created between Lessor and Lessee which shall be subject to all the terms and conditions hereof but shall be terminated on 30 days' written notice served by either Lessor or Lessee on the other party. 18.Surrender of Premises. At the expiration of the lease term,Lessee shall quit and surrender the premises hereby demised in as good state and condition as they were at the commencement of this lease, reasonable use and wear thereof and damages by the elements excepted. 19. Default. If any default is made in the payment of rent, or any part thereof, at the times hereinbefore specified, or if any default is made in the performance of or compliance with any other term or condition hereof,the lease, at the option of Lessor, shall terminate and be forfeited,and Lessor may re-enter the premises and remove all persons therefrom. Lessee shall be given written notice of any default or breach, and termination and forfeiture of the lease Page 2 theretor„pnd without becoming liable to Lessee for damages or for any payment of any kind whatever, and may, at ... -his discretion, as agent for Lessee, re-let the demised premises, or any part thereof, for the whole or any part of the ` then unexpired term,and may receive and collect all rent payable by virtue of such re-letting,and,at Lessor's option, hold Lessee liable for any difference between the rent that would have been payable under this lease during the balance of the unexpired term,if this lease had continued in force,and the net rent for such period realized by Lessor by means of such re-letting. If Lessor's right of re-entry is exercised following abandonment of the premises by Lessee, then Lessor may consider any personal property belonging to Lessee and left on the premises to also have been abandoned, in which case Lessor may dispose of all such personal property in any manner Lessor shall deem proper and is hereby relieved of all liability for doing so. 21. Binding Effect. The covenants and conditions herein contained shall apply to and bind the heirs, legal representatives, and assigns of the parties hereto, and all covenants are to be construed as conditions of this lease. 22. Radon Gas Disclosure. As required by law, (Landlord) (Seller) makes the following disclosure: "Radon Gas"is a naturally occurring radioactive gas that,when it has accumulated in a building in sufficient quantities, may present health risks to persons who are exposed to it over time.Levels of radon that exceed federal and state guidelines.have been found in buildings in every state.Additional information regarding radon and radon testing may be obtained from your county public health unit. 23. Lead Paint Disclosure. "Every purchaser or lessee of any interest in residential real property on which a residential dwelling was built prior to 1978 is notified that such property may present exposure to lead from lead- based paint that may place young children at.risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence quotient, behavioral problems and impaired memory.Lead poisoning also poses a particular risk to pregnant women.The seller or lessor of any interest in residential real estate is required to provide the buyer or lessee with any information on lead-based paint hazards from risk assessments or inspection in the seller or lessor's possession and notify the buyer or lessee of any known lead-based paint hazards. A risk assessment or inspection for possible lead-based paint hazards is recommended prior to purchase." 24. Other Terms: � QO S)p j(cw� a konlf�{ p co�t jPV NUC4_TLy �3� �N�—►sNr�NT u,l,tt SAY � 1. 00 aoo3 1b xAy Is+ o� Aoo3.i NE -%0,) 1T tw(tt gkso i3e t?.eSp�Nstbt� FpR-TNE Et�c�rlc f�tllC tieu� � _T�oµ �&A j IS} To cx{�3e� 3t5k" jV t, te"Arit u)ttl FAI l2dos-°DOU4 u- �40PAh 4-k_� eto At tc: r3iIt ( Hecl_ e ) Wit Be- ?Alb b� �flt�D�nrp. Fromm Notl Ise- T-e Dec wt ! +he, to"JAN+ watt . 1,0�"� d((.aAA, 42WAN� wlll p� +ham �lec�ci c- atll Cwe� ) y IN WITNESS WHEREOF,the parties have executed this lease the ai Ptt above Less �— Lessee tom/` Lessor Lesseq NOTICE: State law establishes rights and obligations for parties to rental agreements.This agreement is required to comply with the Truth in Renting Act or the applicable Landlord Tenant Statute or code of your'state. If you have a question about the interpretation or legality of a provision of this agreement, you may want to seek assistance from a lawyer or other qualified person. Page 3 ZAAB c, Barnstab'le Assessing Search Results Page 1 of 2 �? � " ' y t u✓" y6 Home: Departments:Assessors Division. Property Assessment Search Results 80 CLIFTON LANE 2003 Owner Information: Owner Name Property Sketch Legend BEZERRA,JOSE& FRANCISCO E Map/Parcel/Parcel Extension 247 /007/ Mailing Address BEZERRA, JOSE& FRANCISCO E 4 5 - 80 CLIFTON LN CENTERVILLE, MA. 02632 x 2004 Owner Information (as of January 1, 2003) Owner Name r y" BEZERRA, JOSE Address 80 CLIFTON LANE ,,,' 2004 Total Assessed Value $204,100 2003 Assessed Values: Appraised Value Assessed Value Building Value: $70,100 $70,100 Extra Features: $20,600 $20,600 Outbuildings: $0 $0 Land Value: $40,700 $40,700 Interactive Property Map: Map requires Plug in: Totals:$ 131,400 $ 131,400 I have visited the maps before Show Me The Map April 2001 photos availablemg aftmr-T fog Sales History: Owner: Sale Date Book/Page: Sale Price: SHAPETON, MARK&MARGARET ETALS 9/15/1984 4252/279 $58,000 GALLAGHER, PHILIP J&E C 1552/181 $0 BEZERRA,JOSE&FRANCISCO E 12/4/2000 13403/167 $ 160,500 2003 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $ 1,235.16 Town Fire District Rates Other Rates 9.40 Barnstable 2.88 Land Bank 3%of Town Tax http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/Asse 8/20/03 Barnstable Assessing Search Results Page 2 of 2 C.O.M.M. FD Tax $202.36 C.O.M.M. 1.54 Cotuit 1.88 Land Bank Tax $37.05 Hyannis 2.89 West Barnstable 1.96 Total: $ 1,474.57 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 0.17 Year Built 1972 Appraised Value $40,700 Living Area 1104 Assessed Value $40,700 Replacement Cost $82,430 Depreciation 15 Building Value 70,100 Construction Details Style Raised Ranch Interior Floors Carpet Model Residential Interior Walls Drywall Grade Average Grade Heat Fuel Electric Stories 1 Story Heat Type Elec Baseboard Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 4 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 1 1/2 Bathrms Total Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value BLA Bsmt Liv-Aver 968 $20,600 $20,600 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) ` UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/Asse 8/20/03 No. � Fee 50 .00 ' THE COMMONWEALTH OF MASSACHUSE Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE} MASSACHUSETTS ZIpplication for Mfi6po5al 6potem Construction Permit Application for a Permit to Construct( )Repair(x )Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. 80 1 on Lane Owner's Name,Address and Tel.No. 7 71—6 2 6 7 Centerville Mark Shapeton 50-56 Broadlawn Par Assessor'sMap/Parcel ¢ 02f Unit 417 Chestnut Hill 2210 02167 Installer's N e,Address,and Tel.No. Designer's Name,Address and Tel.No. W 1 Robinson Septic Service PO Box 1089 Centerville 02632 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( no Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) Title 5 leaching consisting of D-Box and, three maximizers . Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed by t is B d of Healt Signed e Date Application Approved by Date /�*'�"r a- Application Disapproved for the following reasons Permit No. X Date Issued "� i F-- TOWN OF BARNSTABLE LOCATION (� G/ l A-- SEWAGE # VII.LAGE ^�'' ASSESSOR'S MAP & LOT - INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /© LEACHING FACILITY: (type) 3"' C d /� S (size) NO.OF BEDROOMS J _ BUILDER OR OWNER: _z� PERMTTDATE: /% `/ ' ` COMPLIANCE DATE: t Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bo om of Leaching Facility Feet Private Water Supply Welland Leaching Fac' ty (If any wells exist Feet on site or within 200 feet of leaching fa ty) Edge of Wetland and Leaching Facility any wetlands exist Feet within 300 feet of leaching facility) Furnished by r t �y4 Civ lC 1 i i P ` 3 j g � �4 No. !' , Fee $5 0-0 0 6 THE COMMONWEALTH OF MASSACHUSE Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE MASSACHUSETTS -.- ZIpprication for Migaal *pzten� Construction Permit pplication for a Permit to Construct( )Repair(x )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 80 1 on Lane Owner's Name,Address and Tel.No. 7 7 1—6 2 6 7 Centerville Mark Shapeton 50-56 Broad.lawn Park �ssessor'sMap/Pazcel Unit 417 Chestnut Hill :Q22{:F 02167 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. W E Robinson Septic Service PO Box 1089 Centerville 02632 t Type of Building: c Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ng Other Type,of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures �. t; Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Descriptjon of Soil sand Nature of Repairs or Alterations(Answer when applicable) Title 5 leaching consisting of D4,Box and three maximizers. U Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed by t 's B d of Healt Signed Date�GL3 Application Approved by Date Application Disapproved for the following reasons Permit No. `� Date Issued / THE COMMONWEALTH OF,MASSACHUSETTS Shapeton B*Ffl F-ABLEMASSACHUSETTS 7' Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired (xx)Upgraded( ) Abandoned( )by at 80 Clifton Ln, Centerville has been constructed in accordance with the provisions of T,tlp 5 and the ffor D's osal System Construction Permit No. �` � dated �m ✓ �T Installer W ? Robinson Septic Service Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date �,� - (51 - Inspector erl d` / d9 a� -----------------------------------Fee ------------------------ No. Fee $50 -00 a THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Shapeton lwiopogal 6potem Construction Permit Permission is hereby grante to Construct( )Repair( x)Upgrade( )Abandon( ) System located at �0 Clifton Lane Canterv e _ ,sf ns a er : W E o inson Septic Service and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 a41the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this ermit. Date: "/;Fr` Approved by NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT 067 ENGINEERED PLANS) I, William E. Robinson.,, Sr ,hereby certify that the application for disposal works construction permit signed by me dated //--: !z , concerning the property located at 80 Clifton Lane Centerville, meets all of the following criteria: V*/ There are no wetlands within 100 feet of the proposed leaching facility. There are no private wells within 150 feet of the proposed septic system. * There is no increase in flow and/or change in use proposed. j�/There are no variances requested or needed. Y* If the proposed leaching facility will be located with 250 feet of any wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) B)Observed Groundwater Table Evaluation(according to Health Division well map) j SIGNED: DATE LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). 'd �� J �j,dG�� ��6� `-'/ 10. V IS k J. oG' O � d � Q� �ATOWN OF BARNSTABLE LOCATION ®. �` f`�6 A SEWAGE # 1 . VILLAGE G L� T' ) ASSESSOR'S MAP& LOTS -�r0 INSTALLER'S NAME&PHONE NO. rO _ SEPTIC TANK CAPACITY 19 t'r--<) LEACHING FACILITY: (type) —7- C e 17aa S (size) //6" ;I_ NO.OF BEDROOMS BUILDER OR OWNEkj` a- .�' yo PERM T'DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum,Adjusted Groundwater Table to the Bo om of Leaching Facility Feet Private Water Supply Welland Leaching Fac' ty (If any wells exist on site or within 200 feet of leaching fa ty) Feet Edge of Wetland and Leaching Facility any wetlands exist within 300 feet of leaching facility) Feet Furnished by e i!(- ti t UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.&10 • Sender: Please print your name, address, and ZIP+4 in this box• Public Health Division Town of Barnstable 200 Main St. Hyannis, Massachusetts 02601 i SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si nature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the Card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter deliveraddress below: ❑ No -J( (fr�j 3. Service Type j IIw p Allbertified Mail ❑Express Mail 32 ❑Registered 'Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7001 194� ��04 9042 2126 (Transfer from service labeg PS Form 3811;'August 2001 Domestic Return Receipt - 102595-02-M-1540 *NOTE: PIP VENT PIPE fO Least 24 Inches tail) _ ALL OUTLET PEES FROM THE ( ^• !kmk '� 10 min. from ALL ES ARE TO BE 4 SCHEDULE 40 P.V.C. Schedule 46 PVC w/Charcool Odor Filter SECTION A A DISTRIBUTION Box SHALL BE ' � a SET LEVEL.FOR AT LEAST 2 FT. 12' �� Existing Foundation house to septic tank PROFILE VIEW OF LEACHING SYSTEM 00NC 'Eoo ,fY t,/ Septic tank covers must be within 6 in. of finished grade •,r/. «� : 3 - 5'OUTLET .y�':"-,:..m.s. 2 Grade over Septic Tank - 100.00 Grade over D-Box- 100.00 over SAS- ELEV- 100.50 / '�. KNOCKOUTS _f s �•t,r f/k"ir..ti�cr..r�.,t sr..,. ,d f�-- t/a- ►..n.a rro.so�. 8 mat Ln ✓' • 5.5" OUTLET ,"� l 12' Ms.Ei - �� 2ean6aiawR Y ..:..+.._..... �` � S .. 4.02 S-0.10 3 HOLE H-10 {> L s, ia, EXIST. OR GREATER DIST. BOX 3' Maximum Cover Top of SAS-Etev.=96.75 �' 2' i 00 C ft pt 12' X ST. TER S- 0.010' per foot 15.5' palter t,n J is � 1UJ V) ,000 GAL t 4" - SCH. 40 Te sEPTrc TANK �, C3 C3 ED a PLAN SECTION CROSS-SECTION 1 w H-10 <n M �, O Effective Depth Q O t7 777�jpp���JJJ/// 3 Unit E + one etwe = 29.5' FULL FOUNDA a>i II o..edn. o, m ID o C N ; 0) °' `° o 2.75 ..' 29.5' 2.7 3.5'- -5'- -►-3.5' j t 1 1 e 3 HOLE H-10 DISTRIBUTION BOX SYSTEM PROFILE s in.af 3/a'-, ,�Y m 1 compacted stoneJ 4' u > 35 Not to Scale c a) v 12' 1 Effective Length NOT TO SCALE 1�oit ' Arm m+M4a -I J Effective Vldth ; ...` r'9 0`�'29t64�-Ra-�-d.'dd3h SJ4l�df dfEO„..-p oT� {} - c >c > •SOIL'ABSORPTION SYSTEM (SAS) 6 Q /� - �a 6ln.of.3f4m t 2' "o b 500 C ING UNITS / WIGGINS PRECAST GENERAL NOTES NOTE: ALL COMPONENTS MUST NA `RISERS TO WITHIN 6" BELOW GRADE comps stone qd/K m t to Scale 1. Contractor is responsible p'' Bottom of Test Hole t �Ie�.=es.00 - ( � for bigsafe notification �( and protection of all underground utilities and pipes. f r0 Groundwater - Test Hole 1 Dev.= NONE OBSERVED ✓ 2. The septic tank and distribution box shall be set level on 6 of 3/4"-1 1/2" stone. 3. Backfill should be.clean sand or gravel with no stones over 3" in size. PERCOLATION TEST 4. This system is subject to.inspection during installation r C by amen E. Shay - Environments! Services, Inc. 5. The contractor shall install this system in accordance Date of'Percolation Test: hJLY 12, 2004 with Title V of the Massachusetts state code, the approved plan Test Performed By. Carmen E. Shay, R.S.. C.S.E. and Local Regulations. Witnessed By. WAIVER (per BARNSTABLE B.O.H) 6. if, during installation the contractor encounters any EXCAVATOR: Shay Environmental Srvcs.. Ina Percolation Rate: 2 MPt ® 40' LOT #18A soil conditions or site conditions that are different LOT #14A LOT #16A from those shown on the soil log or in our design installation must halt & immediate notification be made to Carmen E. Shay Environmental Services, Inc. - ---' 7. No vehicle or heavy machinery shall drive over the Test Hole f septic system unless noted' as H-20 septic components. No. 1 8. Install Tuf-rite gas baffles or .equals on all outlet tee ends. DEPTH SOILS ELEV. _ ' I 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. 0 loaoa; _ 10. All solid piping, tees '& fittings shall be 4" diameter Sand Schedule 40 NSF PVC pipes with water tight joints. 10 YR 3/Z 75.00 11. Municipal Water is Connected to The Residence and Abutting 10.-12" As 99.001 104 _-7 ------ ----104 Properties Within 150 Feet. Loamy 20.5' 35' 9.5' Sand yam/ I1� THE PROPERTY LINES ARE APPROXIMATE AND r--, _•1 COMPILED FROM THE SURVEY PLAN GENERATED BY Medium I �� '�i! �::`� 4" PVC Sand BEARSE & KELLOG, BARNSTABLE, MA ENTITLED j }-�� =�� =�ty� Vent Pipe II "CRAIGVILLE BEACH ESTATES, BARNSTABLE, MA" j 10 YR 7/4 j 104---- 1' EXIST. SAS APPROX.1 , 30'- 132 ✓�I•-- ----'---- ----J i DATED MARCH 11, 1952. IT SHOULD BE USED FOR NO PURPOSE C' PROJECT BENCH MARK � OTHER THAN THE SEPTIC SYSTEM INSTALLATION. CORNER OF BULKHEAD ' 2 0 EXIST. 1000 gal. ELEV. = 100.00 (Assumed) Septic Tank O 1 NOTE: NO WETLANDS ARE PRESENT WITHIN 200 FEET OF PROPERTY. I i O i ' SCREEN ROOM cj EXISTING SAS TO BE PUMPED & FILLED IN PLACE ELEV = 100.00 Dear ON SONotUBE O t OR REMOVED IF FOUND TO BE NECESSARY TO INSTALL NEW SAS. , LOT #18A t NOTE: ANY _ ------r ---- ---_. __ _ __��. �- _ -.._.__ ---- •--- - <:. zz _- - ., - -_ _.__ _ -- - - STRIPPED OUT_SOIL CONTAINING L,EACHATE - - & FROM THE EXISTING SAS TO BE DISPOSED LOT #13A EXISTING OF AS PER BOARD OF HEALTH SPECIFICATIONS. Perc 1 O 4 BEDROOM Depth#to Perc: 40" to 58" O HOUSE i LEGEND Perc Rate= 2 MPI #80 li Groundwater Not Observed , No Observed ESHWT 11 104X 1 DENOTES PROPOSED ADJUSTED H2O Elev. = None �o ��'� I / SPOT GRADE LOT #15A I x 104.46 DENOTES EXISTING j 7,56 Square Feet SPOT GRADE t/- 1 1 GRAVEL ' PL PROPERTY LINE tt ��. �\\\ t DRIVEWAYI 75.00' � ttt - 96r PROPOSED CONTOUR PT i - - - - - -97 EXISTING CONTOUR - o ------------------------------------- �� 1�--=-�� -- -- 00---------- --------------- DEEP -TEST HOLE & EDGE OF PAVEMENT (APPROX.) EDGE OF PAVEMENT (APPROX.) PERCOLATION TEST LOCATION 2-18'DIAM_ ACCESS MANHOLES Cp -- 6' CID �--• 6 FOOT STOCKADE FENCE ASSESSORS MAP 247, PARCEL 007 Lit 1V_.I (40 `FOOT RIGHT OF WAY) ^> '� P LOT P L�AN INLET �A ri k` OUT ET j t THE ACCESS c FOR THE C06A TANK, OF PROPOSED SEPTIC SYSTEM UPGRADE T DISTRIBUTION BOXOX AND LEACHINGG COMPONENT •.:. :^"r 'T.-`'•�, SET DEEPER THAN 6 INCHES BELOW FINISHED PREPARED FOR .•-- - - '.•.-1-"1.':`-•. •• GRADE SHALL BE RAISED TO W7M 6" OF STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE. I E R PLAN VIEW INSTALL TUF-TITE GAS BAFFLES OR EQUALS 1 A/I'Y I R. V O.J E LJ E E R R A 3-24' REMOVABLE COVERS AT #80 CLIF ON LA NE 3+min. clearance 1� �:r C E N T E R V I L L E M A INLET8' min��2' min. Inlet to outlet 6'mb. In. 17 u ,�a Ie�el OUTLET Design Calculations REPARED BY: S. _� Number of Bedrooms: 4 Bedroom EXISTING __ Garbage Grinder: No Z�OF MA E 4'-0" min. _n v - 1 - b Liquid depth Leaching Capacity Required: 440 Gal./Day (MIN. PER TITLE V) `tj 880 USE EXIST. -1,000 GAL. Septic Tank. -o� CARME _ � E* w Septic Tank : - 2 x 440 Gat./Day = CAR�l7 'N ,S'ffA Y. - _J Using percolation rate of <2 min./inch SERVICES, INC. SOIL.ABSORPTION AREA 0 Y 0 ENVIRONMENTAL SER C Bottom Area: 0.74 gal/sq. ft. x 420 sq. ft. 311 gallons �•r 0 20 40 50 4' -10• Sidewall Area: 0.74gal./sq. ft. x 188 s . ft. = 139 0. 1181 P.O. BOX 627 q gallons O . ; CROSS SECTION END-SECTION- G►5TE Providing: = 450 gallons !. �c�" /` EAST FALMOUTH MA 02536 Use: (3) PRECAST 500-C UNITS, HAVING A 2' EFFECTIVE DEPTH, - - TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES AND F TEL/EAX 5Q$--J4$-0796 Ay.f ItRLP'' TYPICAL 1000 GALLON SEPTIC TANK 2.75' OF WASHED STONE ON THE ENDS. SCALE: 1 "=20' 1 "=20' DRAWN BY: CES DATE: JULY 14, 2004 NOT TO SCALE UNITS TO BE SEPARATELY PIPED AND TO BE SEPARATED 2' APART. PROJECT#SD602 FILENAME: SD602PP.DWG SHEET 1 OF 1