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HomeMy WebLinkAbout0087 GLENEAGLE DRIVE - Health 87 Gleneagle Drive Centerville F/ A = 191 139 1 I i I, 1 t S r �l�ntial►�fo, � 1521/3 ORA 10% P2 7 i � _ 6 ,- L � ,; P 9 i 1�� IISM [� t' �1 t �• `y .A �. .� , !� ��� 'ii� 1" �. �' • �. T f F f{{ i, 7 �f �i <� _.�... ._.:.. .e _ ._ .. -- - _- - r� U o x `t k r I e Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °M •' Ruth Crowel Property Address 87 Glen Eagle Drive Owner Owners Name information is required for every Centerville MA 02632 8/15/2013 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 forms A. General Information on the computer, use only the tab 1. Inspector: 1 key to move your i cursor-do not James Ford o use the return w key. Name of Inspector -} Company Name t t U P.O. Box 49 `^� Company Address el°m Osterville MA s CitylTown 026 . State Ztp Code 508-862-9400 S12482 c ' 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 v luatian by the Local Approving Authority 8/20/1.3 Inspe 's ignature Date The y tem inspec or shall submit a copy of this inspection report to the Approving Authority(Board of H h 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. i J' t5ins•3l13 Title 5 Official Inspection o m: ubsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Ruth Crowel Property Address 87 Glen Eagle Drive Owner Owners Name information is required for every Centerville MA 02632 8/15/2013 page. City/Town State f 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 orin 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will,pass. 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 substantal infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 F = Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 'l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Ruth Crowel Property Address 87 Glen Eagle Drive Owner Owner's Name information is required for every Centerville MA 02632 8/15/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.), ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): i ' ❑ broken pipe(s),are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): a ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): 3 1 ❑ 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 pipes) a're replaced ❑ Y ❑ N ElND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): i 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 i ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 ! Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official , Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '°�a.�,•' Ruth Crowel Property Address 87 Glen Eagle Drive Owner Owners Name required for is every Centerville required for eve MA 02632 8/15/2013 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Ij 1 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 E ® 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 '/2 day flow 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 f i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM a Ruth Crowel Property Address 87 Glen Eagle Drive Owner Owners Name information is r required for every Centerville MA 02632 8/15/2013 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.j 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. El ® 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 p 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 sysfem 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 El El the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-1 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•3/13 - - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 II'' ; 11. Commonwealth of Massachusetts Title 5 Official #Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Ruth Crowe] Property Address 87 Glen Eagle Drive ' Owner Owners Name. information is / required for every Centerville MA 02632 8/15/2013 page. City/Town State Zip Code Date of Inspection C. Checklist f , Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping'information was provided by the owner, occupant, or Board of Health ❑ ® Were any.of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? El ® Was the facility owner(and occupants if different from owner) provided with information on the.proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information t„ Residential Flow Conditions: Number of bedrooms (design:):desi n:): 3 3 Number of bedrooms (actual): DESIGN flow based on 310`CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 I5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts Title 5 Officia'I Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Ruth Crowel Property Address 87 Glen Eagle Drive Owner Owners Name isrequired for every Centerville MA 02632 8/15/2013 page. City/Town State Zip Code Date of Inspection D. System Information Description: ' a Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: _ unavailable 1 Sump pump? ❑ Yes ® No Last date of occupancy: currently Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? El Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? El Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal;System Form - Not for Voluntary Assessments Ruth Crowel Property Address 87 Glen Eagle Drive Owner Owners Name j . information is required for every Centerville MA 02632 8/15/2013 page. City/Town State Zip Code Date of Inspection D. System Informations (cont.) Last date of occupancy/use:; Date Other(describe below): a General Information Pumping Records: a Source of information: wears ago - per owner 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.aAttach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 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 Ruth Crowel Property Address 87 Glen Eagle Drive Owner Owners Name information is Centerville required for every MA 02632 8/15/2013 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: installed - 12/6/04 - per as-built Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on-site.plan): i Depth below grade: 2311 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): 32" Depth below grade: feet t 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 gal. at Sludge depth: r 2° 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Ruth Crowel Property Address 87 Glen Eagle Drive Owner Owners Name information is required for every Centerville MA 02632 8/15/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6 Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 15" Scum thickness 1 2 Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum,to bottom of outlet tee or baffle 15" 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.): There were no signs of leakage. Recommend pumping every 3 years. Note. Grease Trap (locate on sitQ:plan): Depth below grade: feet f Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/a 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 r. Date of last pumping: t Date 15ins•3/13 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 °�M a Ruth Crowel . Property Address 87 Glen Eagle Drive Owner Owners Name , information is required for every Centerville MA 02632 8/15/2013 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 (tapk must be pumped at time of inspection) (locate on site plan): Depth below grade: ; Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain): N/a Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No a' 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 (Sins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Ruth Crowel Property Address 87 Glen Eagle Drive Owner Owners Name information is required for every Centerville MA 02632 8/15/2013 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 even Comments (note if box is level and distribution to outlets equal, any evidence of,solids carryover, any evidence of leakage into or out of box; etc.): The liquid level in the D-box was normal. t 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.): N/a Y * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins•3/13 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 Ruth Crowel Property Address 87 Glen Eagle Drive Owner Owners Name information is required for every Centerville MA 02632 8/15/2013 page. City/Town a State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits., number: ® leaching chambers number: 5- infiltrators i 10'x3T ❑ leaching galleries . number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There were no signs of failure. A camera was used for the inspection l t H Cesspools (cesspool must be'pumped as part of inspection) (locate on site plan): Number and configuration N/a Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Ruth Crowel Property Address 87 Glen Eagle Drive Owner Owners Name information is reG uired for every Centerville MA 02632 8/15/2013 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.): Y 5 it • f Privy(locate on site plan): Materials of construction: Dimensions Depth of solids k Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/a i S ' 0 a. } t t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Ruth Crowel Property Address 87 Glen Eagle Drive Owner Owner's Name information is required for every Centerville MA 02632 8/15/2013 page. City/Town State ZipCode Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal'System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate. where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the areal below ❑ drawing attached separately t, p o f y� 30 35 � 3� 3 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 d. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal'System Form - Not for Voluntary Assessments Ruth Crowel Property Address 87 Glen Eagle Drive Owner Owners Name information is required for every Centerville MA 02632 8/15/2013 page. CitylTown 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: 30' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design.plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Using topo and water contours maps a ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: I You must describe how you established the high ground water elevation: see above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 ell Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Ruth Crowel Property Address 87 Glen Eagle Drive Owner Owners Name information is required for every Centerville MA 02632 8/15/2013 page. City/Town 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 S 1 yl g I l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 0 .� tee_ CIO iv a ZZ INN VVI +I .i 1 } 1 ,3 9� xh-C � � y I . ..em....--,._.�_....,....Y._.m._.._.._.......�...�.....�.:.A��. I .n..»...,.�......_.,.w.�....,.,...-�...�.-:....»—.v..nr....._c.ava.,m.....o-.,..........�.... 1 tA p � ;� { CD CIN 1 --_- DZ5 Ii . i Q � � I } i , 9 � a, H 1 a a a4 � a � I r FORM30 CH W HOBBSS WARRENTM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE TH CITY/TOWN a P v v DE ARTMENT I 1 ADDRESS ^M SVBy`0W �ld'1 TELEPHONE P Address 0 `I JN� vvOccupant Floor Apartment No. No.of Occupants No.of Habitable Rooms__—No.Sleeping Rooms No. dwelling or rooming units No.Stories Name and address of wnn _ q o 6 Remarks Reg. Vio. YARD u Bld s.: Fences: Garbage and Rubbish ' Q Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s)' ELECTRICAL Panels, Meters,Cir.: \ ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REP9,RT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERM INSPECTOR TITLE o r A.M. DATE��s 0� TIME ` I� P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises,shall be deemed conditions which may endanger or impair the health,or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbagebr trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements,of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. a . 24 s FORM30 C&W HOBBS&WARREN'" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE A IT CITY/TOWN W DEPARTMENT 1444 " ri n ADDRESS TELEPHONE Address Occupan Floor Apartment No. No. of Occupants °L— No. of Habitable Rooms—No.Sleeping Rooms No. dwelling or rooming units_ No.-Stories Name and ad ress of owr I 6, Remarks Reg. Vio. YARD Out Bld s.:'Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress: and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s), ELECTRICAL Panels, Meters,Cir.: � ❑ 110 ❑ 220 Fusing, Grnd.: J AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 0 Bedroom 4 Hot Water Facil. Su .Ten.,Gas,Oil,.Elect.: 1 Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REP IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES 0 ERJU ' INSPECTOR TITLE DATE 5 —N t 4 © TIME C THE NEXT SCHEDULED REINSPECTION P.M. t 3 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local h official to order repair or correction of such violations pursuant to 105 CMR 410.830 through 410.833 nor shall failure to health p 9 include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity; pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower`or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. 1. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. • `OF THE T SS "JT Town of Barnstable f y O .� . . �� Public Health Division f �� .� 200 Main Street `i® pITNEY BOW ES MAV A Hyannis, MA 02601 1 ._ 02 1 A QJ A�90 0004606238 MAY16 2008 7006 2150 0002 1041 8863 MAILED FROM ZIP CODE 02601 ,C\j ❑ INSUFFICIENT OD O� A AT R TEMPTED NOT DRESS ` a S ❑NOT DEL�V�' 4/ WN ❑p s� ERggLE AS STREET THEN �, I UNABLE TO FORWARD DRESSED 77 a NIXIE 274 SAC 1 oe os✓,aD✓os x RETURN TO SENDER � j UNCLAIMED UNABLE TO PORWARD $E: 028g0140020® 1 '' 09891-11O293,- 4--1116-38 11 _ ' =J`"?"�'�:1ah�� �� ��� ({�It►�Itl{�{{ii{{�e��a�{{l{1��{{�t��{�ii��itli)�e�{{�ii�{ilk{ I SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY y" I ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X ❑Agent I ■ Print our name and r n t I y address o he reverse ❑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. 1. Article Addressed to: D. Is delivery address different from Item 1? ❑Yes I I I I If YES,enter delivery address below: ❑ No 3. Se ce Type Certified Mail ❑goress mail U ❑Registered CDOF?etum Receipt for Merchandise'; ❑Insured Mail ❑C.O.D. 7 X 5'3(O J� 4. Restricted Delivery?aD a Fee) [3 Yes 2. Article Number 7006 2150 000 2 1041 8863 } ransfer from service/abe4 I _ i i e •� .. - - omestic Return Receipt 102595-02-M-1540 —:.ma Town of Barnstable Regulatory Services * BARNSTABLE., ' MASS. Thomas,F Geiler,Director 16 0 ti F_ ` ii `�ArFDMA�A` - PublicHealth Division- Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Certified Mail:7006 2150 0002 1041 8863 May 15, 2008 Carlos Goncalves 3922 Pallas Way High Point,NC 27265-3637 EMERGENCY CONDEMNATION AND ORDER TO VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L.'c.11 l sec: 127A and-127B ,,105 CMR 400.000: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter II: Minimum Standards of Fitness for .Humans, Timothy B. O'Connell., Health Inspector for the Town of Barnstable, on May 14, 2008 conducted an investigation of a dwelling unit located at 87 Gleneagle Drive Hyannis. The owner's name of this dwelling unit is Mr. Carlos Goncalves. The tenants name is Jamie Gonclalo and family(lower unit) and Joe Higashi and family(upper unit). Based on the results of that investigation, the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.831 (D), (E) the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling, which give rise to the emergency finding of unfitness and determination of immediate danger, include: 410. 750: Conditions Deemed to Endanger or Impair Health or Safety 410.750 (C) Failure to provide electricity. No electricity present. Based upon these findings any and all occupants are hereby ordered to vacate and the landlord/owner is ordered to secure the subject dwelling within 48 hours of Q:\Order Letters\Condemnations\87 gleneagle Dr.doc receipt of this order. If any person refuses to leave a dwelling or portion thereof, which was ordered vacated she may be forcibly removed by the local Board of Health (Massachusetts General Laws C. 127B), or by local police authorities at request of the Board of Health. Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from$10-$500. Each day's failure to comply with an order shall constitute a separate violation. Once vacated this unit may not be occupied without the written approval of the Board of Health. Any person needing access to the inside of the dwelling must get permission from the Board of Health prior to entry. The following violations of the State Sanitary Code were also observed: 105 CMR 410.300 and 310 CMR 15.00: There were a total of six (6) bedrooms observed in this dwelling; four(4) were observed on the first floor, (2)two were observed within the basement. However, the existing septic system(permit# 2004-638)was not designed for six bedrooms. It was designed for three (3) bedrooms. This home must be restored to a three (3) bedroom home. There were two family apartments observed within this home although this home is in a single zone according to Town of Barnstable Building Department. This home must be restored to single family home. Note: This is an important legal document. It may affect your rights. PER ORDER OF TH BOARD OF HEALTH s A.McKie n, CHO\R Director of Public Health Town of Barnstable Q:\Order Letters\Condemnations\87 gleneagle Dr.doc THE COMMONWEALTH OF MASSACHUSETTS ti FORM30 C&W HOBBS&WARRENTnn -- i A� BOARD OFHE NTH CITY/TOWN r. DEPARTMENT x• Aq ADDRESS TELEPHONE � Address �wOccupant_ '� Floor Apartment No. No.of Occupants No. of Habitable Rooms�r_-_No.Sleeping Rooms _X_ No.dwelling or rooming units--No.Stories -;Narae and address of owner � � p f Remarks a YARD OuTBId s.: Fences: t t7 v' Garbage and Rubbish , u Containers: ., - Drainage -- _. __. -- -— -�__: �_---• --., � _� _ _. ;._.....�. .� _ _ �. ,__ . ,._._. Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ,I ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls:. . Foundation: Chimney: BASEMENT Gen. Sanitation: Dampness: Stairs: ' .. Lighting: STRUCTURE INT. Hall,Stairway Obst ri Hall; Floor;Wall,,Ceiling: Hall Lighting:' r 1 Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair , TYPE: Stacks, Flues,Vents: PLUMBING: Su ply Line: Waste Line.:❑ MS _ ❑ ST_" O P _ - I{°:W Tank s Safety-and Vent(s) ELECTRICAL Panels, Meters,Cir.: n If \ ❑ 110 ❑ 220 Fusing,Grnd.: d (C 1 AMP: Gen.Cond. Distrib. Box: ` C/ Gen. Basement Wiring: r DWELLING UNIT-. Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom(1)- Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other.- Egress Dual and Obst'n: General Building Posted / Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE.HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPQRT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR TITLE / A.M. DATE !L/- 0� TIME ( � P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises,shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation,any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of Ieadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. 'i. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410,550. numerated in 105 CMR 410.750A O (P) Any ether violation of 105 CMR 410.000 not e ( )through' ( )shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. TM THE COMMONWEALTH OF MASSACHUS.ETTS FORM 30 &W HOBBS&WARREN 4 ,;.. :. . . BOARD OF HEN TH CITY/TOWN r DEPARTMENT ADDRESS - M SV 6 yo TELEPHONE �r• � Address Occupant Floor Apartment No. No.of Occupants - ;No:of Habitable�Rooms fro..Sleeping Rooms�_ No. dwelling or rooming units No.Stories Name and address of owwer �o . YARD.,..- 16� -{ Remarks ✓Reg. Vio _...._:.. _ �-,�. - �.= OutBld-s:;tFences: Garbage and Rubbish J Containers: Drainage x infestation Rats'or othe(:` y - - STRUCTURE EXT. Steps,Stairs, Porches:11 ' Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: , Chimney: f, BASEMENT Gen.Sanitation: `` $' Dampness: , G Stairs: Lighting: STRUCTURE INT. Hall,Stairway: T. i y Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: _ Central- L Y ❑,N .-Equip. Repair-,,, TYPE: Stacks, Flues,Vents: ' PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vents 1 ELECTRICAL Panels, Meters,Cir.: I�t�-�.— _._ D-110-. ❑220.. . _ Fusing,Grnd.: ` AMP: Gen.Cord.Disfrib.Box`:' ,. Gen. Basement Wirin DWELLING-,KNIT , .. �... a r' Ventil. Lgthg. Outlets Wails Ceils. Wind Doors Floors Locks ` Kitchen Bathroom Pantry i Den Living Room Bedroom 1 1 t ) 62 Bedroom 2 Bedroom 3 IS oft AA Bedroom 4 Z, {{ '-F S T Elect.,:Hot Water ' enG ` , Stacks, Flues,Vents,Safeties.- Kitchen Facilities Sink ' Stove Bathing,Toilet Facil. Vent.,Plumb.,Sanit'n.: Wash Basin,Shower or Tub: i Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: '. General Building Posted Locks on Doors: Y1 ONE OR MORE'OF THE VIOLATIONS CHECKED ABOVE IS`A CONDITION.WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING'OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE. - AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REP.Q T IS SIGNED AND CERTIFIED UNDER THE PAINS AND w` 'E PENALTIES OF�ERJU 3'' INSPECTOR /' TITLE DATE ! 5 e 1 40 TIME ll 'P.M. A-k THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. DATE APPEARANCES BARNSTABLE FIRST DISTRICT COURT Issuing Officers, Christine�P�alkowsk�, Kathy Schiavo (BPD) Noticed on December 17, 2007. Files to BPD on 12/17/07. Christine has copies from previous court dates. 9:00 AM ARRAIGNMENTS and/or PTH 0-) Barnstable First District Court DATE OFFENDER BAR NUMBER ISSUING OFFICER 1/18/08 Carlos Goncalves 76305 Stanton _ 2/1/08 Candace McKeone 72607 Giangregorio 2/1/08 Thomas Saliga 76170 Giangregorio 2/4/08 Patrick Page 76164:76166 Giangregorio 2:00 PM CLERK'S HEARINGS (ab_ Barnstable First District Court DATE OFFENDER BAR NUMBER ISSUING OFFICER 11:00 AM SHOW CAUSE HEARINGS CcD_ Barnstable First District Court (Vt Friday of each Month effective 11/2/07) DATE OFFENDER BAR NUMBER ISSUING OFFICER 2/1/08 Douglas Williams 76042:76043 Edson 2/1/08 Danelle Dumas 69486:69487 Lewis 2/1/08 Robert Davalos None Issued Giangregorio Note: Please see Sgt. Caiado or Det. Morse @ 8:45 AM at Barnstable First District, Court Clerk's Office,for ARRAIGNMENTS or at 1:45 PM at Barnstable First District,Court Clerk's Office,for CLERK'S HEARINGSISHOW CAUSE HEARINGS,to discuss case details. I 'C LA. q/loi s/caforms/courtdateappear.doc Revised 2/20/07 Citizen Web Request Page 1 of 3 y -° y ..,i7 t7 'As: �.-Y ''- :.C%I ICis_•} cit iz Request Mar-a ,,,., a A er J � Request Information I E Request ID:: 21985 Created: 7/16/2008 8:27:43 AM E Status: Assigned To Staff Assigned To: O'Connell, Timothy I Health Office i Anonymous: Yes Request Category: Chapter II : Housing j Substandard edit i Estimated 7/18/2008 Change Estimated Tun July 2008 Auk Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat ( 29 30 1 2 3 4 5 6 7 8 9 10 11 12 f E 13 14 15 16 17 1-8 19 j 20 21 22 23 24 25 26 27 28 29 30 31 1 2 E 3 4 5 6 7 8 9 Created By: Wadlington, Ellen Priority: Medium edit ` Health Office _Citation Numbers: � edit Requestor Information Re uestor Request q q DETAILS: LOCATION: 87 GLENEAGLE DRIVE Centerville, Ma 02632 Request Parcel Number W" House has uninhabitable stickers Map: 191 Block: 139 Lot: 000 on two doors; one family moved out, one stayed; now another family has Parcel_Look_u_p moved in. http://issgl2/lntemalWRS/WRequest.aspx?ID=21985 7/16/2008 Citizen Web Request Page 2 of 3 Edit Requestor Information Track Request Progress Request Work History: -Internal Note History: System entry on 7/16/2008 8:27:43 AM ( Assigned to O'Connell,Timothy Enter work progress: € Enter internal note: (Viewed by everybody) (Viewed internally only) E € I f A E '? � Spell Check SpeN Ghec�k '� 1 Add document or image link: .. , OWSP You can also type in a folder name to see everything in th 2 folder Current Links: Time worked on request 1,0 Response timeFO Time entries are in hour s. Exaaiples of tirne enl,es 1.;25, 0.5, 035, 1, 15, 0.2 5, -L Response time: Measured frorra the creation Care Lo yo, r first actions on the requesL, Do not include nights ve=ekeids, and holid<ay5 in iespcnse tune for most departn-yen, C. Save Changes i Check to notify town employee below to review this request. Save changes and notifyHealth Office citizen* Close request Cabot, Jaime - Brief message to reviewer Close request and notify citizen* _ ; 1 ."notify works if erEaE address �,zjas raven 3 l http://issgl2/IntemalWRS/WRequest.aspx?ID=21985 7/16/2008 Citizen Web Request Page 3 of 3 ' 1. Update Spe14 Check Public Use: Printer Friends Version Internal Use: Printer Friendly Version. http://issgl2/lntemalWRS/WRequest.aspx?ID=21985 7/16/2008 NAME OF OFFENDER } �,,,, --]BAR AR 763 0 ,5 TOWN OF ADDRESS OF OFFENDER k7 6,1 6 �r I BARNSTABLE CITY,STATE,ZIP CODE k f/ '' pf tHE►q,. MV/MB REGISTRATION NUMBER - 'l•Q; OFFENSE ,p^ i NAR\S7'ABIX. • F „k,,� 1 1 MASS. 8' `L- !/I. t t V Ce A /Y"L 6.,)r ': RI & �0� '.d J w O �6}q• �i J Ill, r e 1 4 1 '0 A F $*1 r I > TIME AND DATE OF VIOLATI ,1/ LOCATION OF VIOLATION 2M w NOTICE OF M. I P.M.)ON <_ i 20 to -7 fir�r�rgr� r t ' SIGNATURE OF E FORCI .FfSON �. ENFORCING DEPT. 1 BADGE N0. !, W VIOLATION 4--• ..: ' ° 7)Jf l�- r� `D ._. o OF TOWN I HEREB'ACKNOWLEDGE RECEIPT OF CITATION X a ORDINANCE t0 obtain sign lure of offender. u m t 9 �` THE NONCRIMINAL FINE FOR THIS OFFENSE IS S,� {� � Date mailed C_. 1—, w LU OR YOU HAVE THE FOLLOWING A TERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL DISPOSITION WITH NO RESULTING CRIMINAL RECORD. w to EG U LATIO N (1)You may elect to pay the above fine,either by appearing in person between 6:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, w before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or posts note to Barnstable Clerk,P.O.Box 430, Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. a (( pp ggyy yyso 6ARNSTABLE DIVISION,COURT COMPOUND,MAINrSTREET,1ARNSTABLE,by 02630WAttnn21D Noncriminal RHea ngs and enlose DEPARTMENT,copy othis citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature EN NAME , FF0D q, +.,.J � i:i4 BAR 76463 ' TOWN OF ADORE o 1✓ BARNSTABLE CITY S ATE.ZI CODE hti Y�60- qDATE RISE/ph, MV/MB AEGISTRATID14 NUMBER ,F,�ENSE �: HARNSIART.E.p• �((`1{' fp+�j!J' yL(,Y. .�1+t /p' YY,,.. /hy�',//� MASS. O • . r�'w> ." r /"� �t,M1.^ "' �R, ,�' 1 I • _.Art''/ ! a .ago• �e o • rEc rAn+ I�t�V' r P `�.�-�i+"r'" � 0 ( ' )I' � > TIME AND DATE OF VIOLATION w LO p OF TION NOTICE OF (A.M./ P. ^ ON 203 �'1�?P SIGNAT 0 .ENFBRCIN ,B .� CING DEPT BA E N0. W VIOLATION l 10 �. _� o OF TOWN �,I Hf BY ACKNOWLEDGE RECEIPT OF CITATION X ' a ORDINANCE w' Unable to obtain si natur f,fender. ►a— Date mailed •' THE NONCRIN�INAL FINE FOR THIS OFFENSE IS S W W OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. W REGULATION 1 You ma elect to a the above fine,either b appearing in a ( ) y p y y pp g person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, Iy before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P. Box 2430, � Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE ggDATE OFou yTHIS NOTICE. d BARNSTABLE DIVISIONou desire to ,COURT COMPQ,7ND,MAI this matter in a noncriminal NrSTREET,BARNSTABLE,do so MA 02630 Alnwritten21D Noncriminaluest to RICT COURT Hear Hearings d enclose a copy FIRST of,this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the y hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option'above,confess to the offense charged,and enclose payment in the amount of$ Signature --'_'----_ NA jn4 OF OFFENDER BAR 76462. 1 r TOWN OF G� Ey a BARNSTABLE CITY ATE,ZIP,C E /� ' M,r,, a ,,r ry J Of NSE (/'��/f^�' .I/�' �rY+(J //g7�rr},(��py/w //�y j/'� /.��t�j�7• � NAN\:'1'ARI.k:. � �j I'���K � A � ,1 E. • i •iLi✓1 4. G•� lr i� ♦f�G^`Y l�� w HA5S. (�I �67q.'�� d. O TIME AND DATE OF VIOLATION L �IjaN OF LATIO ,f� // W NOTICE OF i (A.M.if ON .2 7 ,20 0 • ,rt f� !'� 7� V11Fe' SIGNATURE qq RCMG ERS ENFA� "~ � ._ �CING DEPT BADGE`N0. W VIOLATION i y / <afI tOF TOWN ~ I HEREBY ACKNOWLEDGE RECEIPT OF CITATION X li ORDINANCE .Unable to obtain sign to a cif oder. C � THE NONCRIMINAL FINE FOR THIS OFFENSE IS aS W Date mailed w OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. w REGULATION a (1)You may elect to pay th.Cise above fine,either by appearing in person be or ytween mailing8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, w Hyanni,MAB02601 bW THN TWENTY-ONE(in 21)DAYS OF THE DATE OF THIS NOTICE.money order or postal note to Barnstable Clerk,P.O.Box 2430, a (2)If you desire to contest this matter in a noncriminal proceedin ,yoy may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature TOWN OF BARNSTABLE BAR-W 592 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager (lnr 1i 3 0r(t 10,, Irr iA 1: C-vC h 1,,P A Address of Offender 97 (4er► �,�.}�. .r• )0 MV/MB Reg.# Village/State/Zip t e,, r,,,'Ile JInA 0 2&3 :2 Business Name &#d �G/pm, on q /1� / 20 L) 7 Business Address 4 Vej Signature of Enforcing Officer Village/State/Zip f�_ /•/ Location of Offense k7 61en ro,lr Or,,s, ,ti/ Enfoicing Dept/Division1 Offense ) Uw r o �/+^S �� �p ► " ( n[YP 17 y- t/,,A 41a�e' Facts rr" 1Vf e 40 r0049 l' 01*,�A I L/101'T A C/A,c 0101+1 MJk reoit c�r or FP ce 1 yh �Jt��•tiv�C/A�� ���lP S• � � ��,� � ��11/,� � This will serve only as a warning. Attthis/time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action byrthe Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE' BAR-w 1,5928 Ordinance or\Regulation ` WARNING NOTICE Name of Offender/Manager (C^, (S f .,r,t , �tr .., { ��� Address of Offender � �t'.^ raa � +J r c MV/MB Reg.# Village/State/Zip C "C'. C1 Business Name .id t�m/pm,.• on V/ f 120 U'7 Business Address Signature of Enforcing Officer Village/State/Zip Location of Offense k 4__?� /1 � �r � �C �- ('1 t✓-N'.� )4 Enforcing Dept/Division " A Offense v 'f v ' f p� Facts Cr, I w t c 4o i edl r rlro� t � �✓�t,it A r �f st 414 r',�-+, tmV'j f r-11 4 007 . r f C't e (1J ve t" r�r.� f-,�?� S. f nA^ Gt�, 'This. will serve only as a warning. Attthisftime no legal action has been taken. I-t;°>,is" the goal of Town agencies to achieve voluntary _compliance of Town Ordinances, Rules and Regulations...- .-Education efforts and warning Y notices are attempts' Nto gain voluntary compliance. Subsequent violations,'will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCII DEPT,- ia(>Cd-7 { DATE APPEARANCES BARNSTABLE FIRST DISTRICT COURT Issuing Officers, Christine„Palkowskr,, Kathy Schiavo (BPD) Noticed on December 3, 2007. Files to BPD on 12/3/07 9:00 AM ARRAIGNMENTS and/or PTH (d-) Barnstable First District Court DATE OFFENDER BAR NUMBER ISSUING OFFICER 12/6/07 Jennifer Eldridge 76046:76050 Edson 12/7/07 Gregory Apone 74403 Police 12/11/07 Patrick Page 76164 Giangregorio 12/12/07 Troy Bigelow 70461:70462 Karle 12/13/07 Evan Brann 76044:76045 Edson 12/14/07 Michael Macheras 72650/72576-78 Edson 2:00 PM CLERK'S HEARINGS (d_) Barnstable First District Court DATE OFFENDER BAR NUMBER ISSUING OFFICER 12/6/07 Thomas Saliga 76170 Giangregorio Karen Stearns 76171 Giangregorio 11:00 AM SHOW CAUSE HEARINGS (a- Barnstable First District Court (1st Friday of each Month effective 11/2107) DATE OFFENDER BAR NUMBER ISSUING OFFICER 12/7/07 Carlos Goncalves 76305 Stanton Paul Broyer 70039 Stepanis Austin Holmes 76339 Edson Note: Please see Sgt. Caiado or Det. Morse @ 8:45 AM at Barnstable First District, Court Clerk's Office,for ARRAIGNMENTS or at 1:45 PM at Barnstable First District,Court Clerk's Office,for CLERK'S HEARINGSISHOW CAUSE HEARINGS,to discuss case details. q/loi s/caforms/courtd ateappear.doc Revised 2/20/07 f- 8k 22411 Ps20 *60365 10-18-2007 a 11 -21m Record and Return to: HomEq Servicing 4837 Watt Ave,Ste.100/Mailcode:CA3501 North Highlands,CA 95660 03 Colston bt05-7 2-1 78 ASSIGNMENT OF MORTGAGE Know that,for valuable consideration,Mortgage Electronic Registration Systems,Inc.as a nominee for New Century Mortgage Corporation( ASSIGNOR ),hereby sells,assigns,and transfers to Deutsche Bank National Trust Company as Trustee under Pooling and Servicing Agreement dated as of March 1, 2007 Securitized Asset Backed Receivables LLC Trust 2007-BRI Mortgage Pass-Through Certificates Series 2007-BRI ( ASSIGNEE ),whose mailing address is 1761 E.St.Andrew Place, Santa Ana,CA 92705 the Assignor s interest in a certain mortgage made by Andreia L. Goncalves and Carlos E. Goncalves to Mortgage Electronic Registration Systems,Inc.as a nominee for New Century Mortgage Corporation dated November 2, 2006 and recorded in the Barnstable County Registry of Deeds in Book 21511, Page 24, describing land therein as: Date of Transfer:August 18,2007 87 Gleneagle Drive,Centerville MA 02632 Mortgage Electronic Registration Systems, Inc. as a nominee for New Cen Mortgage Corporation,Assignor Dated: OCT 1 2 2007 By: ninge 1ssts an ecre Its: CORPORA E ACKNOWLEDGMENT St\the ) Co ) ss. e _ day of in the year 2 before me, the undersigned, personally ap ,personally kn to me or proved to me on the basis of sary evid ce, which were drivers licenses to be the indiv' uai whose name is subscribed to the wstrument a d acknowledged to me that he executed the,sa in his capacity and on behalf of M Electronic strafion Systems,Inc. as a nominee for New tury Mortgage Corporation and ths/her signature the instrument,the individual,or the person upon ehalf of which the individual accuted the instrum t,and that such individual made such appearance b ore the undersigned in the Cf in the State of Notary Public y commission expires: a I . Bk 22411 Pg 21 #60365 � t State of California } County of Sacramento } ss. On OCT 12 ZOO before me Jo Tonya Blechinger Cook ,personally appeared , personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s)whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies) and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted,executed the instrument. Witness mv hand and official seal. `�rA J. Cook J. COOK y 'a COMM.# 1703685 s No signature 5 ; NOTARY PUILIC,CALICORUTAp SACRAMENTO CO.0 �'1+►�*"�` EXP. DEC 4, 2010 BARNSTABLE REGISTRY OF DEEDS I ' MLS Page 1 of 3 Listing Summary Listing#20701627 87 Gleneagle Dr, Centerville, MA 02632 Active (02108107) DOM/CDOM:36/1 $449,000 (LP) Beds: 3 Baths: 4 (4 0) (FH) Sq Ft: 1814 Lot Sz: 0.390ac Town: Barn Yr: 1977 Remarks :Picture, Beautiful spacious home with in law -- m potential. Main kitchen has granite counter tops and pickled wood floors i with breakfast bar. Dining area with crown molding and patio door to large .W deck. Upstairs has a home office and a room of your choice. Walk out lower i level with living room and fireplace and � a bar area. Kitchen and dining area and 2 additional rooms and a full bath. k i Additional Pictures �Wsfi K�'d�y WIN -r_ `; Pictures 13 See Maps Agent Theresa M Perella (ID:U1174)Primary:508-292-3876 Office Perella Real Estate Co..Inc.(ID:PERE)Phone:508-292-3876,FAX:413-525-4435 Property Type Single Family Property Subtype(s) Single Family Status Active(02/08/07) Town Barnstable Commission Sub Agent Comm. Buyer Agent Comm. Dual Agent Comm. Dual Var Comm 0% 2.5% 2.5% No Facilitator Comm 2.5% Listing Type Excl.Right to Sell Owner Name Carlos&Andreia Goncalves County Barnstable Tax ID 191-139 Beds 3 Baths (FH) 4(4 0) Structure(approx sq ft) 1814 Sq Ft Source Field Card Lot Sq Ft(approx) 16988 Lot Acres(approx) 0.390 Lot Size Source (Field Card) Year Built 1977 Publish To Internet Yes Listing Date 02/08/07 All Office Remarks Call Theresa Perella for showings(508)292-3876 Directions To Property Route 28 to Old Stage Road and take a right on Gleneagle Drive#87 Call Theresa Perella for showings at(508)292-3876 Listing Page 1 Commission-Other 0% Showing Instructions Appointment Req.,Call Listing Office,Yard Sign - 7 General Page i Zoning Residential http://ccimis.rapmis.com/scripts/mgrgispi.dll?APPNAME=Capecod&PRGNAME= 3/16/2007 y ♦ Vk. ri wink 17777 5^t RZ C t4 } FA. . of, a: i 1; m Y 2 �t a� t it i I � `'4�� �. .3F �}.rye• •.rfi g k des 1 I Y •� r .. IT Al go , +F zcv x+ 99i .ys Lly F� UNITEDSTATES OS' TAL HERO USPS Home I FAQs ZIP Code Lookup Find a ZIP + 4® Code By City Results You Gave Us HIGH POINT, NC Lookup Another ZIP CodeTm entries 1-6 of 6 ZIP CodeT'O Matches in HIGH POINT, NC 27260 27261 (PO BOX) 27262 27263 27264 (PO BOX) 27265 entries 1-6 of 6 Related Links Business or Residence Lookup Calculate Postage Print Shipping Labels Calculate postage for your Print shipping labels from Yellow Pages letter or package online! your desktop and pay online. Find a business nationwide. Rate Calculator Click-N-Ship® White Pages Other Postage Find a residence nationwide. Site Mao ucntaci:Us F0111;s Gov't:services Jots Privacy Policy I erens of Use N V#oral 3 Preriier A COL.fits Copyright@ 1999-2007 USPS.All Rights Reserved. No FEAR Act EEO Data FOIFa M USPS-Home I FAQs ZIP Code Lookup Find a ZIP + 4® Code By Address Results You Gave Us PALLAS WAY HIGH POINT NC Lookup Another ZIP CodeTm Your search terms matched more than one address. If you provide additional information (apartment or mail stop,for example)we can give more accurate results. entries 1-5 of 37 Show All < Previous Page I Next Page> Matching Addresses ZIP+4 Code 3903 PALLAS WAY 27265-3653 Mailing Industry Information HIGH POINT NC 3903 PALLAS WAY APT(Range 1A- 1 H) 27265-3654 Mailing Industry Information HIGH POINT NC 3903 PALLAS WAY APT(Range 2A-2H) 27265-3654 Mailing Industry Information HIGH POINT NC 3903 PALLAS WAY APT (Range 3A-3H) 27265-3654 Mailing Industry Information HIGH POINT NC 3909 PALLAS WAY 27265-3628 Mailing Industry Information HIGH POINT NC entries 1-5 of 37 Show All < Previous Page Next Page> Related Links Business or Residence Lookup Calculate Postage Print Shipping Labels Calculate postage for your Print shipping labels from Yellow Pages letter or package online! your desktop and pay online. Find a business nationwide. Rate Calculator Click-N-Ship® White Pages Other Postage Find a residence nationwide. r•y ��al�p� t Site tvtarl Contact Us =orms Gov'[Ser•ices Jots Privacy Policy T'^trns of Use National&Prernier Accounts i Copyright@ 1999-2007 LISPS.All Rights Reserved. No FEAR Act EEO Data FOIA Z2�ff tlN �'tEDSTATES.. Past& : e: USPS Home I FAQs ZIP Code Lookup ,arch BY'Addres: >> �e h By Cat�r � �;.a Corn te y F�rtd`A[I rtrs s art��iP Cott � Find a ZIP Code by entering an address. i (You can also search for a partial address,such as"Main S eet, Fairfax,VA.")If We're sorry!We were unable to process your request. The address was not found. Please check the addres below. `mot You may want to utilize the Yellow Pages and/or W ite Pages below. i . * Required Fields b *Address 1 3299 PALLAS W Address 2 2C FApt,Hoar,suite,etc. .._.................."""""" ..,.�,...,...,.,,.... * 9 QV * City HIGH POINT r ..b. * State NC Find state abbreviation ZIP Code $ g3g .............. .......... Related Links Business or Residence Lookup Address Information Web Tools Get Maps Online Services(AIS)Product Access online tools Boost your business Yellow Pages Standardize your address to verify addresses, with customized maps Find a business nationwide. database or find detailed calculate postage, and reports. White Pages address information. and more. Find a residence nationwide. PCnM-W)by switchboard Site Mao Contact Us Forms Gov't Services Jambs Privacy Policy Terms of Use National&Premier Accounts Ca ri ht@ 1999-2007 USPS.All Rights Reserved. No FEAR Act EEO Data FOIA �I �' PY 9 9 _.......... ............ _....._. __..... ................ ......._.......t.............................. .. ........... .....W............................................. ........... ____.....__ .....____.. _....___. ......._......._.. ... ............ .. ........... ...._........i �c1HE ro Town of Barnstable tia Regulatory Services = Bnxxsrna[.E, 9 MASS. $ Thomas F. Geiler, Director �p 1639•A10 'Eo► ' Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Certified Mai1:7006 2150 0002 1041 8863 May 15, 2008 Carlos Goncalves 3922 Pallas Way High Point,NC 27265-3637 EMERGENCY CONDEMNATION AND ORDER TO VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L. c.111, sec. 127A and 127B, 105 CMR 400.000: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter II: Minimum Standards of Fitness for Humans, Timothy B. O'Connell., Health Inspector for the Town of Barnstable, on May 14, 2008 conducted an investigation of a dwelling unit located at 87 Gleneagle Drive Hyannis. The owner's name of this dwelling unit is Mr. Carlos Goncalves. The tenants name is Jamie Gonclalo and family(lower unit) and Joe Higashi and family (upper unit). Based on the results of that investigation, the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.831 (D), (E)the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling, which give rise to the emergency finding of unfitness and determination of immediate danger, include: 410. 750: Conditions Deemed to Endanger or Impair Health or Safety 410.750 (C) Failure to provide electricity. No electricity present. Based upon these findings any and all occupants are hereby ordered to vacate and the landlord/owner is ordered to secure the subject dwelling within 48 hours of QAOrder Letters\Condemnations\87 gleneagle Dr.doc receipt of this order. If any person refuses to leave a dwelling or portion thereof, which was ordered vacated she may be forcibly removed by the local Board of Health(Massachusetts-General Laws C. 127B), or by local police authorities at request of the Board of Health. Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from $104500. Each day's failure to comply with an order shall constitute a separate violation. Once vacated this unit may not be occupied without the written approval of the Board of Health. Any person needing access to the inside of the dwelling must get permission from the Board of Health prior to entry. The following violations of the State Sanitary Code were also observed: 105 CMR 410.300 and 310 CMR 15.00: There were a total of six (6)bedrooms observed in this dwelling; four(4) were observed on the first floor, (2)two were observed within the basement. However, the existing septic system (permit# 2004-638) was not designed for six bedrooms. It was designed for three (3) bedrooms. This home must be restored to a three (3) bedroom home. - There were two family apartments observed within this home although this home is in a single zone according to Town of Barnstable Building Department. This home must be restored to single family home. Note: This is an important legal document. It may affect your rights. PER ORDER OF TH BOARD OF HEALTH s A. McKe n, CHOIR Director of Public Health Town of Barnstable 5 Q:\Order Letters\Condemnations\87 gleneagle Dr.doc TOWN OF BARNSTABLE BOARD OF HEALTH s��� o U(� ARTICLE 11:MINIMUM STANDARDS FOR HUMAN HABITAT ON Date � ()7 �`--�►�� � V�l��'l�i • ��<fi?'� �Gv►�C. av✓K j Owner Tenant Address (e ii Address 4 Complionce Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 1 3. Bathroom Facilities ✓�� �� �r�' 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities S. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 3) 12. Exits ? D GPM f ) 13. Installation and Maintenance of Structural ( ,i Elements 14. Insects and Rodents i l 15. Garbage and Rubbish Storage and Disposal ' 16. Sewage Disposal 17. Temporary Housing �( PART II 37. Placarding of Condemned Dwelling; r C 'i1- ,,,j( Removal of Occupants; Demolition Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here V W S.. H � Logged I to Citizen Request Management Monday, April so 2007 T(3blrfVtstanto€id Route to Users Search Requests Create Requests Request Information Request ID: 20778 Created: 3/15/2007 8:24:58 AM Status: Assigned To Staff Assigned To: Stanton, David Health Office Anonymous: Yes Request Category: Title 5 : Section 353-7 Sewage edit Estimated 5/1/2007 Change Estimated Awr May 2007 Jun Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 Created By: Stanton, David Priority: Medium edit Health Office Citation Numbers: edit Requestor Information Requestor Request DETAILS: LOCATION: 87 GLENEAGLE DRIVE Centerville, Ma 02632 Request Parcel Number Block: 139 Lot: Anonymous complaint of property Map: for sale, which has an illegal second kitchen (which can be seen on the Parcel Lookup MLS site) MLS says 3 bedrooms but there are about 8 bedrooms in the house. For sale by Parella Real Estate. Septic not big enough. Email: Edit Requestor Information Track Request Progress I 1 Request Work History: Internal Note History: Entered on 4/6/2007 11:47:50 AM System entry on 3/15/2007 8:24:25 AM: by Stanton, David Assigned to Stanton, David On 4/6/07 DS went to said location. No answer at doors. Neighbor came over and said System entry on 3/15/2007 8:53:22 AM: he thought someone new moved in. As DS was ready to leave a lady opened the front door. -Please Review- email sent to Edson, Linda She just moved in. Doesn't know who owns - house. She rents. Husband will call DS with System entry on 3/21/2007 9:28:53 AM: info. She said 3 bedrooms upstairs. Awaiting to hear back from tenant to see if it is a new Estimated completion changed from owner. Will have Caitie send them an order to 3/20/2007 to 3/22/2007 register rental. update delete System entry on 3/22/2007 8:15:05 AM: Estimated completion changed from 3/22/2007 to 3/23/2007 System entry on 3/23/2007 8:29:32 AM: Estimated completion changed from 3/23/2007 to 3/26/2007 System entry on 3/26/2007 7:38:38 AM: Estimated completion changed from 3/26/2007 to 3/27/2007 System entry on 3/27/2007 7:41:51 AM: Estimated completion changed from 3/27/2007 to 3/28/2007 System entry on 3/29/2007 9:07:17 AM: Estimated completion changed from 3/28/2007 to 3/30/2007 System entry on 3/29/2007 10:43:52 AM: Estimated completion changed from 3/28/2007 to 3/30/2007 System entry on 3/30/2007 7:38:26 AM: Estimated completion changed from 3/30/2007 to 4/2/2007 System entry on 4/2/2007 7:38:16 AM: Estimated completion changed from 4/2/2007 to 4/3/2007 System entry on 4/3/2007 8:04:38 AM: Estimated completion changed from 4/3/2007 to 4/4/2007 System entry on 4/4/2007 7:40:53 AM: Estimated completion changed from 4/4/2007 to 4/5/2007 System entry on 4/5/2007 7:35:11 AM: Estimated completion changed from 4/5/2007 to 4/6/2007 System entry on 4/6/2007 8:33:50 AM: Estimated completion changed from 4/6/2007 to 4/9/2007 System entry on 4/6/2007 11:47:50 AM: -Please Review- email sent to McKean, Thomas System entry on 4/9/2007 8:18:49 AM: • Estimated completion changed from 4/9/2007 to 4/10/2007 System entry on 4/10/2007 7:36:10 AM: Estimated completion changed from 4/10/2007 to 4/11/2007 System entry on 4/11/2007 8:20:27 AM: Estimated completion changed from 4/11/2007 to 4/12/2007 System entry on 4/17/2007 1:28:33 PM: Estimated completion changed from 4/12/2007 to 4/18/2007 System entry on 4/18/2007 7:46:42 AM: Estimated completion changed from 4/18/2007 to 4/19/2007 System entry on 4/19/2007 8:04:39 AM: Estimated completion changed from 4/19/2007 to 4/20/2007 System entry on 4/20/2007 8:11:00 AM: Estimated completion changed from 4/20/2007 to 4/23/2007 System entry on 4/23/2007 8:24:45 AM: Estimated completion changed from 4/23/2007 to 4/24/2007 System entry on 4/24/2007 2:02:37 PM: Estimated completion changed from 4/24/2007to 4/25/2007 System entry on 4/25/2007 7:32:59 AM: Estimated completion changed from 4/25/2007 to 4/26/2007 System entry on 4/26/2007 8:13:07 AM: Estimated completion changed from 4/26/2007 to 4/27/2007 System entry on 4/27/2007 8:01:17 AM: Estimated completion changed from 4/27/2007 to 4/30/2007 System entry on 4/30/2007 8:02:43 AM: Estimated completion changed from 4/30/2007 to 5/1/2007 Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) .q i I _............. ,...,., .., .......... ....... .._,....., id ...... ...., .,,_....., ._....m. ...+ SpeIlCheck ,. Sperm C�h ck -Add document or image link: Browse * You can also type in a folder name to see everything in the folder Current Links: Time worked on re uest: 27 ! Response time: 1 OO.Ot *Time entries are in hours. Examples 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. t , Save changes Check to notify town employee below to review this request. c; Save changes and notify citizen* Health Office __.......... ........ ............ ......._..._... .... ......._ E . Agostinelli, Joan Close request and notify citizen* Brief message to reviewer: *notify works if email address was given r p to ,Spe(ICheck� t Public Use: Printer Friendly Version Internal Use: Printer Friendly Version TOWN OF BARNSTABLE I�'i LOCATION- �� '�'l6," ��C/�� l�� SEWAGE # ,-)6b y 63tk VILLAGE —z"7466',���f'� ASSESS R'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1000 LEACHING FACILITY: (type) `ZS (size) 1°k 7 X• �3 ~ NO.OF BEDROOMS BUILDER OR OWNER PERMTT DATE: 11 I(J COMPLIANCE DATE: 1 11114t Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by � _.�. 6� � � � 'G ��n �.. e ® � Y s tpV� V— � ^� �, ` v � ���� ' � , ,�y�.�� 6_� a �- ` No. sue'" J� • � ,_ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS s 01ppYication for 30f6poof bpgtem Construction Permit Application for a Permit to Construct( . j Repair)Upgrade( )Abandon( ) Complete Systemdividual Components Location Address or Lot No. 3t g—+ G°I `����� Owner's ame,Address and Tel.No. Assessor's Map/Parcel Cec,��k1R PA R Co'eL.C'S G=O caz vv_s j i�3Ms Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 'Roam 6 GSM � �t1Ay �nt,i�G` SJCs. -atec�-a �-539-191G(o Type of Building: Dwelling No.of Bedrooms Lot Size 11,2S-- sq.ft. Garbage Grinder Other Type of Building (Jrnp No.of Persons 4 Showers( ✓j Cafeteria( ✓S Other Fixtures 1_ai-jrj.0_Y, sr,J k Design Flow er gallons per day. Calculated daily flow \,SO gallons. Plan Date Number of sheets 1 Revision Date ""-- Title Size of Septic Tank Fkk Sk. y a, _Type of S.A.S. x Description of Soil On Nature of Repairs or Alterations(Answer when applicable) 7�Q2c -6 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 th Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b th' ea Signed / Date Application Approved by Date I Application Disapproved for the following reasons "- Permit No. OW 3 J?� Date Issued ?�f No. di- ''Wig J f► .` � ' �....7t Fee�IJ�O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: r es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS{ 01ppYication for Migoi nl *psstem Congtruction Permit Application for a Permit to Construct( . )Repair)Upgrade( )Abandon( ) El Complete System�ndividual Components Location Address or Lot No.� / �' Owner's Name,Address and Tel.No. Assessor's Map/Parcel CQ<,�er�\ (A A Cam¢-Lt�S C�cat ve5 J 1 1 '5RM� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �UCtiCQ� �S�t- Z�aCCc1V0.�c� SHAY �'nUrCLX?i`�211'tiG� GCS. 5Q8 -24�-a r.%"-„,,, Type of Building: Dwelling No.of Bedrooms Lot Size iT'} sq.ft. Garbage Grinder 1 Other 'Type of Building No.of Persons Showers(✓) Cafeteria } Other Fixtures LA UA'TAQY, "t ipr Y Design Flow ?,� gallons per day. Calculated daily flow 3 k a0 gallons. Plan Date- 1 An Number of sheets I Revision Date Title Size of Septic Tank EKer ?42 \\ —Type of S.A.S.I!Xs ' C, V j /►.1TtLres-ides Description of Soil oat-, Nature of Repairs or Alterations(Answer when applicable) t 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 a Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi B Hea th. Signed Date Application Approved by Date D Application Disapproved for the following reasons Permit No. L/=4p 3 4R, Date Issued a THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Cei� ficaALe of Corn—Barre THIS IS TO CERTIFY, thatte On-site Sewage Disposal System Constructed( )Repaired OC )Upgraded( ) Abandoned( )by�3 �1,l. at has been constructed in accordance with the provisions of Title-5 and the for Disposal System Construction Permit No. '2 u o`4 b 3&dated 1.1 Installer Designer f The issuance of this er Jmit shall not be construed as a guarantee that the s, ste will fJ nction as d�signed. r Date ()�1 Inspector No. ( �Feel0.._.. . .. ..."._. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 1Wi!5po$a1 *p.5tem Con!gtruction Permit Permission is hereby granted to Con truct( )R air( Upgrade( )Abandon( )t System located at �p ,Qa yk r �'1)I and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the da((e of�rmi Date: 1'a G Approved TOWN OF BARNSTABLE LOCATION �'� e- 4;4- SEWAGE # 2 00 LE VU.LAGE s ASSESS R'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1000 LEACHING FACILITY: (type) 10 ZS (size) 1 o k 3 7,rI3 NO. OF BEDROOMS BUII.DER OR OWNER bS PERMITDATE: j I I o y COMPLIANCE DATE: a Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by ii i 3 . Town of Barnstable fIHE h, o Regulatory Services Thomas F. Geiler, Director ��� Public Health Division p'F% 39. Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: O Designer: �4� U. C Installer: _ T Address: , Address: T On v1 1 was issued a permit to install a (date) (in ller) nn septic system at based on a design drawn by (a ss) v , o C` dated 1 ( b Lo�_. esigner) 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. tti OF A�qS Installers Signature) o� S'cy. (Installer's )g o� CARMEN' SHAY No 1181 esigner's Sign re) (Affix De e ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVIS N. 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 I TOLAA FAALE® 1NSPFCT.ICN COMMONWEALTH OF MASSACHUSETM E UME OFFICE OF ENVIRONMENTAL AM4P6 DEP,k] T NT OF ENVIRONMENTAL PRO`I`E1 IN wzwi "ARCELLOT TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE S9WACE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: f97 7DEC IVE 2 0 a �a, er�a NW=e! Owner's Address: 8 20 04 Bate of Inspection:-� TOWN OF BARNSTABLE Ip ( � ) ���- G �y HEALTH DEPT. rFaeaixc b#' tt3 CCt*o>•: 3e aY Company Name: Mailing Arddms: ol �'Fal��yf .� d A "O y�S36 Telephone Number: Sfl-S/9-S S-0505- CERTIFICATION STATEMENT i certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper f faction and maintenance of on site sewage disposal systems.I am as DEP al►provtd sysiew in peetot pursuant to Section.15340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Teeds Further Evaluation by the Local Approving Authority Fads Inspector's Slgnature: Date: — ? •y q The system inspector shall submit a copy of this inspection report to the Approving Auftrity{Board of Health iir DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of l o 000 gpd or greater,the inspector and dw system owner shall submit the report to the 8W01M late regional office of the DEP.The ortgma{should be sent to the systeat owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments SVS er1 �aa 5 J"c•J o f aGk Q j's 60 A we", 4:fo �e�-elv 4w// af dtr- ecTso **"ibis report only describes tonditions at the time of inspection and under the ronditiovs of use Itt that Uwe-rhis iwspecfiou does Dot address huw the system will perform,in the future under the same or different conditions of use. page 2 of I i OFFICIAL INSPECMN FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSbRFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(,continued) Property Address: Z owner. Date of us on: ivapectieu Summstry: Check A,B,C,D orl J ALWAYS Complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described hi 310'CivfR 15.303 or in 310 CNfR 15304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditiod0ly Passes: orasoce s�szezrs avattrxsaersts as d�crt'bet8 iv tFze'°Coaditidire4 Peas"secxiga aeel3 Yo be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Bcraid-of Health,will pass. Answer yes,no or not determined(Y.N ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20r years old*or the septic tank(whether metal or not)is structurally unsound,exbjbits substantial infiltration or exftltration or tank failure is went.System will pass inspection if the existing tank is replaced with a complyi ag septic tank as approved by the Board of Health *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation ofsewege backup orbrdak`out or high static.water level in the distribution box due to broken or obstructed pipe(s)or.due to a brokers,settled or uneven distribution box.System will pass inspection if(with spprt>vs1 of Board ofHesFtlt): broken pipes)are replaced obstruction is removed distt'ftiutiou box is leveledorreplaeed N-D explain: The system required pumping more th=4 times a year due to brok=or obstrumd pipe(s).The system will pass inspection if(with approval of the.Board ofliealthJ broken pipes)are replaced obstruction is removed hrD explain: .r Page 3 of l I OFFICIAL INSPECTAON FORM-NOT FOR VOLUNTARY ASSESSMENTS• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: f'7 6/en g"e Ce ra.Jje Owner: Date of inspection: I - 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 CIYIR 25.303(1)(b)that the system is not f4ac lotting in a mannerwhich will protect public health,safety and the environment. Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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 rank and SAS and the SAS is within a Zone I 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 feeE or more from a -private water supply well".Method used to determine distance snit'system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or Less than 5 Ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of I I OFFICIAL INSPECTjON FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSUTRFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: - Date of Inspection: /-R(0-0y D. ,System Failure Criteria applicable to all systems: You must indicate 1yes"or"no"to each of the following for ail inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool D`charge or ponding of effluent w 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 ��/1.i ss quid depth in cesspool is le than 6"below invert or available volume is less than%:day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number /of times pumped _ i/ Any portion of the SAS,cesspool or privy,is below high ground water.elevation. Any portion of cesspool or privy is within I00 feet of a surface water supply or tributary to a surface /water supply. y portion of a cesspool or privy is within a Zone 1 of a public well. y portion of a cexspout or privy is within 50 feet of a private water supply well. Arty 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 tbie well water analysis, performed at a DEP certified laboratory,for conform bacteria and volatile organic compounds inulle ates that the well is free Irom pollution from that faeiiity aad the presexice of ammonia igh—ogee and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria ale Wggeftd.A copy of the sinsilyiis must be attached to this form.] (z as N10)The system Ends.I have determined that one or more of the above failure criteria exist as. described in 3I0 CUR I5303,therefore the system fails.The systems ow-ner 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 mush serve a facility,with a design flow of 10,000 gpd to 15,000 *pd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to Iaige systems in addition to the criteria above) yes no the system is within 400 feet-of a surface drinking water supply _ the syste»i is with in 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 CMk 15.304.The system owner si}vuld contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTN FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B. CHECKLIST - Property Address: $�t✓�p�BctS�e �t` Date of isspeeiinu: / 'b Chuck 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 tl/— Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as Batt of this inspection? Were as built plans of the system obtained and examined.?(If they weir:not available no to as NiA) 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 files or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scutu? Was the facility owner(and occupants if differ=from owner)provided with information on the proper Pro P P maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no ^ xisting in&rmation.For example,a plan at the Board of Health. VT t/E___, Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)j Page 6 of 11 OFFICIALV INSPECT N FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM_ PART C S=STEM INFORMATION Property Address: D A ect /s . Lf s Owner: Date of Ynspectiou: - FLOW COil�ITIONS AESIDEi—r Ai. Number of bedrooms(design): 4 Number of bedrooms*tual): DESIGN flow based on 3 G x 15.203(for example: !10 gpd x#of bedrooms): yyo Number of current residents: Does residence have a garbage grinder(yes or no):/v0 Is laundry on a separate sewage system(yea ar no):7Q [if yes separate inspection required] Laundry system inspected(ygs or no):`,�14 Seasonat use:(yes or no):•�W t ,� Water meter readings,if available(last 2 years usage(gpd)): P� Sump pump(yes or no):A/o Last date of occupancy: CfJMMERCIAE.ANDUSTRIAL Type of establishment: Design flow(based on 310 04R 15.203)e god Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no): Water mew feadmgs,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as par of the.,inspection(yes or 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) ____Tight tank _,_-Attach a copy of the DEP approval ____Other(describe): Approximate age of all compouenis,date installed(if known)and souruc of information: 45 2z Were sewage odors detected when arriving at the site(yes or no): AO Page 7 of I I OFFICIAL INSPEC 4ON FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM. PART C" SYSTEM INFORMATION(continued) Property Address: 87 G 1kn eroale Owner: Date of Inspection: BUULDING SEWER(locate on site plan) Dcpth below glade: 31'— � Materials of construction:_cast iron j%40 PVC_.other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) b k.,-pdo: 7" Material of construction:C concrete metal fiberglass_polyethylene —other(explain) If tank is metal list age:. Is age confirmed by a Certificate of Compliance(yes or no):_ (attach a copy of certificate) �� Dimensions: fl X__/l���^ 1 Soo (oa( Sludge depth: Sl'• Diamnce from top of sludge to bottom of outlet tee or baffle: ?q Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom.of scum to bo of outlet tee or baffle. '!e.- / tto How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structutal integrity,liquid levels as related to outlet invert,evidence of leakage,etc.); GREASE TRAP:_(locate on site plan) Depth belowgra&. Material of construction: concrete Metal--fjMg)aas—Polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last"pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage;etc.): Page 8 of I! OFFICIAL INSPECN FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: .V 61en Owner: Date of Inspection• TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(Iocate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: Design Flow: gallons/day Alarm present(yes or no): Alarm Icvel: A1aEtii i:o Svor2ciug aides{yes or uo): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:—],—/(if present must be opened)(locate on site plan) Depth of liquid Ievel above outlet iaver= Comments(note if box is level and distribWon to outlets equal,any evidence of solids carryover,any evidence of le Se into or out of box,etc : e ox 1A &crd c�►d: �v h PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes orno): Comments(note condition of pump chamber.condition of pumps and appurtenances,etc.): I A, Page 9 of 1 I OFFICIAL INSPECMN FORM—NOT FOR VOLUNTARY ASSESSMENTS, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Vfilegearle T C'entertlil e Owner: Date of Inspection: /-off(^04 SOIL ABSORPTION SYSTEN1(SAS)-. Z(( sate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number. leaching chambers,number leaching galleries,number. leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number. _^innovative/aherttative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,danV soil,condition of vegetation, etc.): _ A07 �'s l�e�e C"I( at 4-;v4 a cJ`� CESSPOOLS: (cesspool must be pumped as part of inspection)(iocate on site plan) Slumber and configuration Depth—tap of liquid to inlet invert: Depth of solids layer- Depth of scum layer. Dimensions of cesspool: Materials of construction: Indication of groundwater inflow.(yes or no): Comments(nots condition of soil signs of hydraulic fa8rue,level of ponding,condition of vegetation,ew.): PRIVY: (locate on site plaaj Materials of construction: Dimensions: Depth of'solids: " 'Comments(note condition of soft,signs of hydraulic failure,level of ponding,condition of vegetation,etc.}: Pare 10 of l l OFFICIAL INSPECT N FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: &IemetrAI& Ce•t ter u:� Owner:_ Date of Inspection: lady SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or� bet hmarks.Locatc an wclla within 100 feet.Locate where public water supply enters the building. 0 7' - n-a F E !� i Page I I of I I OFFICIAL INSPECTON FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: VUeaeq /e u' e Owner. Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water +feet Picasc indicate(check)an methods used to determine the high ground water elevation: reviewed- ,,,Obtained from system design plans on record-If checked,date of design plan reviewed: VQbserved site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: ,0hecked with local excavators,installers-(attach docutnentation) Accessed USGS database-explain: You must describe h w u establ' ed the h nd water elevation: / l To+As� rs� a,rns ��e ty og �o� l..ra�-e�- N2�i.� 5hac�5 q,^�l�n�tya7eY' 3' 6" o ck Title 5 Insvection Form 6/15/2000 I 1YIL% g fo" a r tr 'e r •• s COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION . OW NM 5J0 V� TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY,1133 SUBSURFACE SEWAGE DISPOSAL SYSTE F PART A CERTIFICATION MAY 1 0 2002 ABLE Pro Address: 87 Gle Centerville TOWN of BARNT Property n Eagle Ctill HEALTH DEPT. Owner's Name:Janet Faureau Owner's Address: Same 4-4,7— Date of Inspection: 3/29/02 i Q I MAP O l Name of Inspector: Timothy Lovell PARCEL * 139 Company Name:Accurate Inspections Mailing Address:550 Willow Street LOT W.Yarmouth,MA. Telephone Number: 508-771-3700 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to.Section 15.340 of Title 5(310 CMR 15.000). The system: X _Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signat Date: 3/31/02 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent,to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 87 Glen Eagle Drive Centerville Owner:Janet Faureau Date of Inspection: 3/29/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: _N/A One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. _N/A The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or infiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: _N/A Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): Broken pipe(s)are replaced Obstruction is removed Distribution box is leveled or replaced ND explain: N/A The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): Broken pipe(s)are replaced Obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART A CERTIFICATION(continued) Property Address:87 Glen Eagle Drive Centerville Owner:Janet Faureau Date of Inspection: 3/29/02 C. Further Evaluation is Required by the Board of Health: _N/A 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: _N/A Cesspool or privy is within 50 feet of surface water _N/A Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _n/a_ 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. _n/a The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _n/a_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _n/a_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**.Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:87 Glen Eagle Drive Centerville Owner:Janet Faureau Date of Inspection: 3/29/02 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _x Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _x_Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —x_Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool —x_Liquid depth in cesspool is less than 6"below invert or available volume is less than '/Z day flow —x_Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. _x_Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _Any portion of a cesspool or privy is within a Zone 1 of a public well. _x_Any portion of a cesspool or privy is within 50 feet of a private water supply well. _x_Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _No (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either`yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No The system is within 400 feet of a surface drinking water supply The system is within 200 feet of a tributary to a surface drinking water supply _The system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR is one mv- --`--- -----�'---'� ---`--"t- ---'---�-`- --'--� _nr__ _P.1- T----`---` Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:87 Glen Eagle Drive Centerville Owner:Janet Faureau Date of Inspection: 3/29/02 Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes No _x_Pumping information was provided by the owner,occupant,or Board of Health _x_Were any of the system components pumped out in the previous two weeks? _x _Has the system received normal flows in the previous two-week period? _x_Have large volumes of water been introduced to the system recently or as part of this inspection? _x _Were as built plans of the system obtained and examined?(If they were not available note as NIA) _x _Was the facility or dwelling inspected for signs of sewage back up? _x_ _Was the site inspected for signs of break out? _x _Were all system components,excluding the SAS,located on site? _x_ _Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the ba es or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ _x_Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no x _Existing information.For example,a plan at the Board of Health. _x_ _Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:87 Glen Eagle Drive Centerville Owner:Janet Faureau Date of Inspection: 3/29/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_3_Number of bedrooms(actual):_3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):_330 Number of current residents:_1 Does residence have a garbage grinder(yes or no):_no_ Is laundry on a separate sewage system(yes or no):_no_ [if yes separate inspection required] Laundry system inspected(yes or no):_no_ Seasonal use: (yes or no):_no Water meter readings,if available(last 2 years usage(gpd)):Go00) 6Zav GA-/ Sump pump(yes or no):_no_ Last date of occupancy:_Current COMMERCIALANDUSTRIAL Type of establishment: N/A Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): _ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Barnstable Sewer Was system pumped as part of the inspection(yes or no):_no_ If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _x_Septic tank,distribution box, soil absorption system _Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 9/29/77 Were sewage odors detected when arriving at the site(yes or no):_no_ Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 87 Glen Eagle Drive Centerville. Owner:Janet Faureau Date of Inspection: 3/29/02 BUILDING SEWER(locate on site plan) Depth below grade:_3'4" Materials of construction:_cast iron _x_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): Piping loks in good condition,No sign of leakage SEPTIC TANK:_x (locate on site plan) Depth below grade:_1'6" Material of construction:_x concrete_metal_fiberglass_polyethylene_other (explain) If tank is metal list age:_Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 1500 Gal Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 6" Distance from top_of scum to top of outlet tee or baffle:_8" Distance from bottom of scum to bottom of outlet tee or baffle:_12" How were dimensions determined: Field Measurements Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Recommended pumping every 2 years,no sign of leakage,tee's are in place levels are fine GREASE TRAP:_N/A (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (Explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:87 Glen Eagle Drive Centerville Owner:Janet Faureau Date of Inspection: 3/29/02 TIGHT or HOLDING TANK:_N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:_x (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_0"_ Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): No sign of sludge carry over,levels are at invert out, no sign of leakage. PUMP CHAMBER:_g (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): • Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 87 Glen Eagle Drive Centerville Owner:Janet Faureau Date of Inspection: 3/29/02 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type Leaching pits,number:_2_ Leaching chambers,number: Leaching galleries,number: Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): No ponding No sign of hydraulic failure,Levels in leaching pits were between 11/2 and 2'below invert system is in good working order at time of inspection CESSPOOLS:_N/A (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:_N/A (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.): I Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:87 Glen Eagle Drive Centerville Owner:Janet Faureau Date of Inspection: 3/29/02 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. "7�5PI- 0 '-,IU;All 1; • Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:87 Glen Eagle Drive Centerville Owner:Janet Faureau Date of Inspection: 3/29/02 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 12+_feet Please indicate(check)all methods used to determine the high ground water elevation: _x_Obtained from system design plans on record-If checked,date of design plan reviewed: July 12 1977 Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation:_ According to the design plan soil logs done on 6/9/77 there was no water at the depth of 12'witnessed by Paul Murray Barnstable BOH -4--e IL vr 0 C-1 rl 7 J q i Fr Ir E 71 S m Jh Ir 0 Y ... �_.._._..�._.. ..r,�. a� pp __.._ ___._..__.._..�.__—��_.�...��._.__�.�._-_v .�__.__.__._.�..___._��_.—_ _��.v�..___. .._..e._...._ � 4�_._._____� -.._.___._.�_._�._._...._. ........__..__ ..... . ........._._..._.__._.-.,..... �,.� -. -r.,.....__ � m Y � � li _T__.r_-_----________.�_���_�_ ��._�._..y.�._____..______._T._.___.__.__ _____ i 3 >® �� .�__ .__.______ �..._.____._....�.� �e.____ _ .�.�._._.�_.__.�_ .__�.�__,.�_. �____.__,�_�__.�...�__._.�_�,..�.�__ .�.___r,�.___._,__�_.ti_T__. f®P _._.___..________-__.._._ __-_ _ ____�.m_�__.__., �._.._____����__. __.__.__��_.._.__.______,___�_____. � �- ___________.____._.. ..___.___.� �.__�,e_ �.___..,wm_�______�_.,.___�i_,�_._._ ._�.__._.�.____._�_� __..__ _..�._�.__y..__ ���.�..:. � �� ___�.___ . .______� - __e_:_____��_____.�__��_�._.___w_�_� �� �� -- �� �__.._____.__.__� ___.�.__�_____� __ _ � �__.__�_.�___.___._____�_._.M���_��____ � _�_�.._e � �_�._.. �. (� C' 1 ___.,.....____---- __._.___�.__��_--y._..____-,�_� _.__..__._ . s..__.._ ___...___... __.___ --._.____..__ ..�___.__.__-__-._.___ _,.. __._..____,.__..__._._ _.__-_____ 3 Tt A00ty) a i . _...1. _. SMOKE DETECTORS REVIEWED "VOISIAIO BARNSTABLE BUILDING DEPT. D E W FIRE DEPARTMENT DATE 4-0 BOTH S,'GiiATURES ARE REQUIRED FOR PERMITTING. Zh d EzdSf101 910VISNVVG do Nmo, CARBON MONOXIDE ALARMS MUST BE INSTALLED PER MASSACHUSETTS BUILDING CODE f i..� 6 v` tV k CO goo" P1 L�A .......... (Pf) t a y� I _ CD i'�C9U�1 v 1 y� C. ' 3 � Y a a � t a 1, a j •.� f 4. !y k 1 �Y !ti Lk 17906 P2Y284 =130000 11-10-2003 a 08 a 54cx DISCHARGE OF MORTGAGE Mortgage Electronic Registration Systems,Inc. holder of a mortgage From CARLOS E GONCALVES Property 563 STRAWBERRY HILL ROAD, Address CENTERVILLE,MA 02632 to Mortgage Electronic Registration Systems,Inc.dated 12/20/2002 recorded with BARNSTA13LE County Registry of Deeds on 12/23/2002,for the state of Massachusetts in Book 16130,Page 191,Doc#117275 acknowledge satisfaction of the same. i WITNESS my hand this 24 day of October,2003. Mortgage Electronic Registration Systems,Inc. By: -�i'tn� Dalila Jhter Assistant Secretary By: Vicki Hosko Assistant Secretary State of CALIFORNIA County of LOS ANGELES On 10/24/2003,before me,Larita Travis,Notary Public,personally appeared Dalila Javier and Vicki Hosko,both personally known to me(or proved to me on the basis of satisfactory evidence)to be the persons whose names are subscribed to the within instrument and acknowledged to me that they executed the same in their authorized capacities, and that by their signatures on the instrument the persons,or the entities upon behalf of which the persons acted, executed the instrument. Larita Travis,Notary Public My commission expires 12/19/2006 LARlTA IRAVIS a COI11mUon#1390M Notary Pubic—CC9 fomla Los Angeles Coutlty OMYOWMEOWDOO19,2006 Mail Recorded Satisfaction To: DOCID#000219963942005N CARLOS E GONCALVES 990 PHINNEYS LN Document Prepared By: CENTERVILLE,MA 02632 CTC Real Estate Services 1800 Tapo Canyon Road MSN SV2-88 Simi Valley,CA 93063 (800)540-2684 BARNSTABLE REGISTRY OF DEEDS No.._....`. 7,r-_ Fins.....� ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ .............. -----------OF......41... .4FPII 467.......................................... ApplirFation for Disposal Works Tonstrurtion Famit Application is hereby made for a Permit to Construct (>() or Repair ( ) an Individual Sewage Disposal System at: ...... . �............. .. ........---------------------..........----- • .......................................... Loca io -A es ..................................•----•--or•Lot No. ...� � . ....................... ............................................... Ow r Address a ......... . ........ .. ....a.. ....... .e---------------------------------- .---------......---...------------.... .....------.................-----------.... Instal a Address d Type of Building Size Lot.Z_7 Z_-F7 .......Sq. feet Dwelling—No. of Bedrooms...- ....................................Expansion Attic (r) Garbage Grinder (Ale.) per., Other—Type of Building ............................ No. of persons.....---.................... Showers ( ) — Cafeteria ( ) W ' Other fixtures -••-•-•-••---•••••......•.••• - W Design Flow............. l6.............:..........gallons per person per day. Total daily flow.........33a........................gallons. WSeptic Tank—Liquid capacity Z-4ko...gallons Length................ Width................ Diameter------------.,,-- Depth................ x Disposal Trench—No. .................... Width.................... Total Length................. Total leaching area....................sq. ft. Seepage Pit No-------Z.......... Diameter...6..`b Depth below inlet....CA........ Total leaching area.;!4.....sq. ft. Z Other Distribution box ()C) Dosing tank ( )/ 94, 1 L . - .?�1 - 7 7 Percolation Test Results Performed by.......T.....�� [ - --••------------------------------------ Date........................................ a� Test Pit No. 1 �minutes per inch Depth of Test Pit--L�a`....... Depth to ground water..Noa/i;�.-._.- . Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................---- ---------------------------------------------------------------------•------...----•-------------................................................... O Description of Soil..o.��- k/OOD- ..$�Sut =SoiG---•--. ! ./ ...........................�'` S! 't� ---------------------------------------------------------------------------------------•------.......---------------------------------------••••-- w x -•-•-•-••-••---------••--•-••----•••••••-••-••••-••-•--•-•-•--------••--•--••---••••......••--••••-----••-•----••---•------••••-----••-••••-•••--•-••-•-••---•-••••-•-••-•......--•--•-•------•-•------ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -•----------•-------------------•--•---------------------------•--••--------------...............----.....-•----------•----•-----------------------------------------------------------------------•... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of 1 Ith..` Sig ,t. -�� .......... ..............*...... ...-------- Date Application Approved By �.%�� .............................. ...7_n/-� 7-7---••-•--•- ,4 Date Application Disapproved for the following reasons:/-/... ................................................../--._....--.--/--- ......... ..----•--------------------•-•---•--------.........--------------•--...--- 4'° - ` ..-_/._... -.._ ..�� e..1..1f.....I... -( h -Date PermitNo.................................................. --- � Issued_....................................................... l Date j 77 �0 No. ........7r ..... Fxs....�.......�fl............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ .T.o..w.N..............OF..... iv.sT BG App iration for Dhipos ai Works Tnnitrnrtinn Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: GLE7VEx�GGL Lam• C�I/i�� loT Lo .... ddres -••-••• •••------••-----or•Lot No. .. - �. .. ....:. .......................... O er Address W ✓ Inst ll Address Q Type of Building Size Lot2_7 0-'5'-'7 ..Sq. feet Dwelling—No. of Bedrooms.......................................Expansion Attic (� ) Garbage Grinder ,Vj.) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................................... Design Flow.........//0 gallons per person per day. Total daily flow.........���________________________gallons. 1:4 Septic Tank—Liquid capacity!-so__gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width...................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter---- Depth below inlet.... ........ Total leachin area_ . ft. Other Distribution box X Dosing tank �• Z ( ) g ( ): W Percolation Test Res�s��,Performed by....... ....1(f..--Et r ----------------- Date—..................................... Test Pit No. 1......2......minutes per inch Depth of T st Pit.................... Depth to ground water........................ (14 Test Pit No. 2................minutes per inch Depth of Test Pit.....................:Depth to ground water........................ f4 K O !2 Z¢ Lim;? Lo. ss dsoiG... j� ...........orb Co! .......... Description of Soil VS�yn'?� �� ......................-................................................. W UNature of Repairs or Alterations—Answer when applicable._.............................................................................................. --•-----•--------------------- ............................................-........................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITTIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in g �' �.v�t w, C •�._ �operation until a Certificate o Compliance has been issued by the board of health. Si d---/ --------- - C ------•-•-------------•----•--- •------•--------. .. ------•-- A44 Dat 7 �Application Approved 4 -- ./2 -- e7 --------- 1 Date Application Disapproved for the following reasons:....................................................----........................................................ .............................-..............................-......-......-.................................-........................................................................................... Date PermitNo.------ ---•--•-•----•.............................•-_. Issued------------------•------•------•--------•--•-•---•--- ' Date ` THE COMMONWEALTH OF MASSACHUSETTS ik BOARD OF HEALTH /(r �Yn �rr#ifirtt#�e laf (�unt��i�nr�e �- ` S TO 9TR I That the Individual Sewage Disposal System constructed ( ) or Repaired by... ` •' _ . . __•- Inst ler _ - at. has been installed in accordance with the provisions of F 5 of The State Sanitary Code as descr in the t application for Disposal Works Constr'uction;Permit: V' '7-�_�.............. dated.....7...................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE_............................. ____________________•-- • ----......... Inspector---................................................... ......................... x THE COMMONWEALTH OF MASSACHUSETTS hB'Q1-R:D F HEALTH tt �............. .....................OF................... .............._..............:..................No.�.._3 -••--_... > FEE../s tirn 1 rk n rn Ilan rrndt Permis ion is herebygranted.. = �'`" ✓� e to Constr )yam pair ( )/ an ) di ual, evt�age �G�1osa1 Syst at No...--• --- ---1 `�=sue= �� / Street ., > as shown on the application for Disposal Works Construction PDated.__./.....................................' -. 7-1 Board of Health DATE----------` ........................................' FORM 1255 HOBBS & WARREN, INC., PUBLISHERS t i} sysr m Ar BorC N o I ,�tis9-iNG i f'w+✓�yq-rr'o.v 45 r �' 7 r. /c3o.oo CERT!Ei ED- 'LOT PLAN LOCATION .C`cN1/iGs: . /i9!4 s s... ... SCALE "1?ATE .�t�/. /a /977 PLAN :R& CECE . .. 47� ,• Gl. La7, 8 EUud ARL7M ;BBC, .Zea R' ' ` . No.2510(i 40 Br�T9 1 CERTIFY THAT THE `tS7"�l1tG..:. v�!A4 ! suli� SHOWN ON THIS PLAN IS,LOCATED ON THE MOUND AS SHOWN.HEREON AND THAT It.CONFORMS-TO-THE' SETPACK REQUIREMENTS OF THE TOWN.OF WHEN-CONSTRUCTED. DATE ,v y. 1d).9.77 PETITIONER: Doy�7vrCK bR �3MT y/ ,r RE4ISTERE2_LAND 3UR OR t L. /aa,v 0 7 1 TOP OF FOUNDATION CONCRETE COVER :,1 CONCRETE COVERS . ° �1nl1ll�1T ° 10°MAX. 101,MAX. ► °'. 4°CAST IRON 4"ORANGEBURG(OR EQUIV.) e PIPE -MIN. PIPE- MIN. ° PITCH 1/4"PER. PITCH 1/4'PER.FT PRECAST N VERT ° LEACH I N G o 96 00 /Soo 6G INVERT INVERT p e = , PIT OR SEPTIC TANK EL.?96Z DIST. EL•9S TILZ- EL. EQUIV. o IN, INVERT BOX 6' w ,uj EL ;." 3/4��T0 I I/2 o' p6;79 INVERT ti 0 �• EL."/ � WASHED e EL.93.ny w a•• STONE �— ° �--W D IA. IO'DIA. AIV" PROR LE OF GROUND WATER TABLE .SEWAGE DISPOSAL SYSTEM { NO SCALE 4 SO L LOG WITNESSED BY DATE V;1917. 7. . TIME. . .. . . . . . . . ..!yam BOARD OF HEALTH TEST HOLE I TEST HOLE 2 ENGINEER ��•� . . . . . PETITIONER DESIGN DATA o �) NUMBER OF BEDROOMS 3 GARBAGE DISPOSAL .. . .No�/6'• . . TOTAL ESTIMATED FLAW . . GALLONS/DAY � 4 BOTTOM LEACHING AREA . .7� . . SQ.FT / PIT R h 144 — — — SIDE LEACHING AREA . !f38� �? . . SQ.FT./PIT !VQ. .WATER ENCOUNTERED I (tss ?Na,v NUMBER OF LEACHING PITS . . . '?. . . . . . I PERCOLATION RATE .. .z. . . MIN./INCH �— TOTAL LEACHING AREA . . . �'� . . SO.FT. APPROVED la-f,:sBOARD OF HEALTH !_ ��� l DF M THOMAS E. KELLEY CO. I DATE . . . . �. . . . . . •.• THO S �� LAND SURVEYORS AGENT E 346 LONG POND DRIVE N .24260 SOUTH YARMOUTH, MASS. GISTEQ` 02664 FS d6 I PETITIONER �oHE�/�c1G ��ZPoN7�' S/ONAL 24'-0" �— 3— — — -- 21'-0" O 1 CD = O — cn D rn O I 1 O W /v p O II -� O z y Ff a N O EXISTING HOUSE 24'-10" I,-5,- 3'-2 r' N 2 1'-G" ii 6� i i I ul C . N 110 I O i 1 1 z c; Z rn D TM I^, H_) 9 ;� ' r n _ �— I � z rn b rn II rn I ' O O z 14'-G 1/2" N n n 22 45 - V, rn rn rn f� , o IMMN z rn F- i r+ nQP ➢ 70 � G� rn VENT PIPE (0 Least 24 inches tall) SECTION A -A MIU I *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C, t4ue fin Schedule PVC w/Charcoal Odor Filter ALL OUTLET PIPES FROM THE �� +� 10' min. from PROFILE VIEW OF ADDITION TO LEACHING SYSTEM ALL OUTLET BOX SHALL TH Existing Foundation house to septic tank 12• D-BOX cover must be SET LEVEL FOR AT LEAST 2 FT. CONCRETE COVER s TOP OF BULKHEAD = ELEV. 100.00 (Assumed) Septic tank coven must be wn 6 in. of finished grade 3" of i/8" - 1/2" Washed Peostone yX within 6 in. of finished grads 3 4" to 1 1 2 " Washed Crushtrd Stone "�" '' v .•. 2- Gradet 4 s 7 over is Tank - 99.00 Grade over D-Box- 98.75 ode over SAS - 98.75 / 3 - 5'OUTLET `""' t Lri . _ Sept /^ ��--��•`+{ KNOCKWTS - 4"PVC (CAPPED)INSPECTION PORT TO BE 75.5• i + tY INLET INSTALLED AND TO BE WITHIN 6' Of GRADE r \ W11E1 ) ¢ h i 6• e T S 0.02 3 HOLE H-10 �j a' ST. BOX 3' Maximum Cover Top Load- Elev. -94.47 n Top OF System- Elev. -94.00 '•.'• .yn, 2 ! - f 0 11.5 EXIST. S-0.01 or Greater EXIST. PIPE I` N 1,000 GAL. pp S- 0.01' per foot A y15.5 4" - 'CH. 40 Te FROM EXIST. FOUNDATION SEPTIC TANK 0 20 t\ al 1 � s j d 10" Effective Depth 1.75- b rn H-10 rn 0 5 Units E 6,25' 30' PLAN SECTION CROSS-SECTION t of $t f d CONCRETE FULL FOUNDA m 04 r }' ' II .t rn 0.83' (10 inches) 3 3' 31,25 0 SYSTEM PROFILE 6 In.of 3/4'-1 1/2• n if 1- 372 5' 3 HOLE H-10 DISTRIBUTION BOX j > 04 ( f °PeE MAag, c compacted atone i 0 y > tE265- Effective Length NOT TOSCALENot to Scale - S °' Il S4' 4' SOIL ABSORPTION SYSTEM (SAS)6 in.of 3/4•-11/2• 1 30 INFILTATROR HIGH CAPACITY (H-20 LOADING)/ GEORGE ❑'BRIEN GENERAL NOTES compacted stone Effective Vtdtn ( )OR EQUIVALENT Not to Scale NOTE: ALL COMPONENTS MUST HAVE RISERS TO WiTHIN 6" BELOW GRADE w o 1. Contractor is responsible for Digsafe notification Bottom or rest Hole 1 Etev.-67.00 m NOTE. OVERALL HEIGHT OF INFILTRATOR IS 18" FFECTIVE HEIGHT IS 10" and rotection of all underground utilities and pipes. No Groundwater Observed O 128" � P g P�P 2. The septic tank and distri ution box shall be set F 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. 4. This system is subject to inspection during installation a by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance PERCOLATION TEST with Title V of the Massachusetts state code, the approved plan , and Local Regulations. f 00.03 6. If, during installation -the contractor encounters any Date of Percolation Test: NOV. 29, 2004 soil conditions or site conditions that are different Test Performed By: CARMEN E. SHAY, R.S., C.S.E. from those shown on the soil log or in our design Rdsults Witnessed By. WAIVER (per BARNSTABLE B.O.H.) installation must halt & immediate notification be EXCAVATOR: Shay Environmental Services, Inc. made to Carmen E. Shay - Environmental Services, Inc. Percolation Rate: Less Than 2 MPI ® 42" 19, 7. No vehicle or heavy machinery shall drive over the 4 septic system unless noted as H-20 septic components. 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. Test Hole \\ TEST HOLE #1 10. All solid piping, tees & fittings shall be 4" diameter No. 1 ELEV= 98.50 Schedule 40 NSF PVC pipes with water tight joints. DEPTH SOILS ELEV. \� 7' 37.25' 16' 11. Municipal Water is Connected to ALL OF The Residence and Abutting 0 98.50 `�\ Properties Within 150 Feet. Loamy M: }�ti'r , .,i�. •,�' t; .•a 4 Sand , A N, q• I* • - THE PROPERTY LINES ARE APPROXIMATE AND to vR 3/z \� �i. + r.,a.. 'six 4" PVC COMPILED FROM THE SURVEY PLAN 0"-7" A► 97.90 `\ \'i ...� "� '1'�''�'j"' ^^a``"''"1'' ENTITLED " SUBDIVISION PLAN OF LAND IN CENTERVILLE, MA FOR \ VENT 9g CHARLENE L. JOHNSON, BY BARNSTABLE SURVEY CONSULTANTS Loamy M \\ Sand p� \ F-B ��' DATED JUNE 1, 1972, PLAN BOOK 260, PAGE 71 10 YR 5/6 � Failed `� AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN 8. Leach Plt Failed 7"-28" 96.25 � . Leach Plt,''- IT SHOULD BE USED FOR NO PURPOSE OTHER THAN Silt �- THE SEPTIC SYSTEM INSTALLATION. Loom 2.5 Y 8/4 PROJECT BENCH MARK EXISTING LEACH PITS TO BE PUMPED OUT AND FILLED IN PLACE OR 28 -42' c, 95.00 TOP OF BULKHEAD 4 .6' REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION Medium ELEV. = 100.00 (Assumed) IST. 1000 gal. NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE Sand 2.5 Y 7/4 __..- _-- __- ptic Tank FROM THE EXISTING LEACH PITS TO BE DISPOSED -- - OF AS PER BOARD OF HEALTH SPECIFICATIONS. R . LOT #9 NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY 'ef�'�/`�9 ^ ASSESSORS MAP 191 PARCEL 139 all LEGEND i .ra ti3•,i I1' LOT #7 Perc 1 i '.•i EXISTING #Depthto Perc: 42" to 60" ; i 3 BEDROOM 104X1 DENOTES PROPOSED Perc Rate= Less Than 2 MPI 1 I HOUSE Groundwater Not Observed I I SPOT GRADE No Observed ESHWT #87 x 104.46 DENOTES EXISTING ADJUSTED H2O Elev. = None I ai SPOT GRADE PL PROPERTY LINE I : I LOT #8 r urns PROPOSED CONTOUR iI l I I I i`w 17,257 Square Feet +/- - - - - - -97 EXISTING CONTOUR I I 1 _ __ DEEP TEST HOLE & 2-18' DIAM. ACCESS MANHOLES PERCOLATION TEST LOCATION 6 - - ---98 = - 6 FOOT STOCKADE FENCE ASPHALT - �\ b i DRIVEWAY �.'� I �\ 1 \ I r INLET OUTET I �Oo.00, I �\ PLOT PLAN THE ACCESS COVERS FOR THE SEPTIC TANK, j t• •« r..^ •� R'r: ?} .' , '�•:••''•1.\.•�:.�� -�.:�•�- ��- �- - -���, DISTRIBUTION NCH COMPONENT 6NESS BELOW FINISHED CP/ ( I , / � \ BOX , OF PROPOSED SEPTIC SYSTEM UPGRADE GRADE SHALL BE RAISED TO WITHIN 6' OF I STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE. \ /' \ I , \. i \ PREPARED FOR PLAN VIEW INSTALL TUF-T1TE GAS BAFFLES OR EOUALS --------- --L--- 3-24' REMOVA VE' C A R L O S G 0 N C A LV E S ABLE COVERS AT 4' :. . #87 GLENEAGLE DRIVE 3• 'min. clearance ' (40 FOOT RIGHT OF WAY) t3' min.T-{2' minLi Inlet it tier 13 •Y CENTERVILLE, MA INLET -- -1------ e'min. _ OUTLET 10• min. eveF 14• n. s -r �. --- �_ s -7• Design Calculations s5 jo g a' min. Number of Bedrooms: Equivalent to 330 Gal. y . p )/Day (330 Gal./Da Miner Title V OF PREPARED BY: � �•�'ei Liquid uld depth s r/� /� /�,�/��j u/� Y Garbage Grinder: No C IN CyG rA LJ L 1 ►" A�lll1 l Leaching CapacityProposed: 330 Gal./Day Minimum (Min. Per Title V) v' , x: >,• .,.. :'- •+•, •: ',. •• ' " ''i Septic Tank - 2 x 330 Gal./Day = 660 USE EXIST. 1,000 GAL. Septic Tank. 0 20 40 5 SH ENVIRONMENTAL ,SERVICES, INC. 6'-0" 4 -10' SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch CROSS SECTION END--SECTION Bottom Area: 0.74 gal/sq. ft. x 370 sq. ft. = 273.8 gallons I No. P.O. BOX 627 Sidewall Area: 0.74 gal./sq. ft. x 78 sq. ft. 58 gallons �F �� Providing: = 331.80 gallons Sa�sTE�a EAST FALMOUTH, MA` 02536 TYPICAL 1000 GALLON SEPTIC TANK � ,> ANI TARP TEL/FAX : 508-548-0796 NOT TO SCALE Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING,,A 0.83' (10 INCHES) EFFECTIVE DEPTH, SCALE: 1 =2O TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE SCALE: 1 =20 DRAWN BY: CES DATE: NOV. 30, 2004 ON THE ENDS. NO STONE UNDER. PROJECT#SD664 FILENAME: SD664PP.DWG SHEET 1 OF 1