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0229 GLENEAGLE DRIVE - Health
229 GIeneagle Drive Centerville A= 192— 144 9 M EAZ?j No.Z-9aSWR UPC 12534 smead com 9 Made In USA O u�� a- �o KID s 1 It-,,q S fo.� - ex- stZJWNAj czv- ALI j TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee �J .CJy Date Definitive Plan Approved by Planning Board Historic - OKH Preservation%Hyannis to '00 Project Street Address "qjq �D �L'a9�P a& Village Owner M ; 9�l Ad r s Telephone 4 A-1 rmit Request k1 W 004 tD etn p sA Pr iAM% ��" 6 ,��1.�— ���--- 1A k rA M�Q(V =i ��4 wol �r+f rPl1'I��r�f� O.rPr1 h II Squarezfeet�ls-t400r:`e�g proposed 2nd floor: e fisting proposed Total new Zoning District tqk Flood Plain Groundwater Overlay Project Valuation So©0• Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address OOq & License# Home Improvement Contractor# Email �41 �1 o 4,2 60.f0u Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ya(106W Wtfo�(- UoA . moako SIGNATURE DATE /,R/�7 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 229 Gleneagle Drive Property Address Cioleck Realty Trust Owner Owner's Name information is required for every Centerville MA 02632 7/18/2013 page. CitylTown 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 I on the computer, use only the tab 1. Inspector: boo key to move your cursor-do not Brian K. Tilton use the return Name of Inspector key. The Building Inspector of Cape Cod r� Company Name PO Box 307 Company Address Eastham MA 02642 CitylTown State Zip Code 508-255-9343 S14392 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this add4 and thatitth_e a information reported below is true, accurate and complete as of the time of the inspe` tion. Thee_hspe on ' was performed based on my training and experience in the proper function and m'ain,enance of.-On sitea sewage disposal systems. I am a DEP approved system inspector pursuant to-M tion 15.`340 of o Title 5(310 CMR 15.000). The system: ' �..,..+ ..Jr ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Lee l-7 LY t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 r i Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 229 Gleneagle Drive Property Address Cioleck Realty Trust Owner Owner's Name information is required for every Centerville MA 02632 7/18/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: All components in place and functioning as designed. The old septic tank before upgrade is still in place but disconnected from service and is not pumped. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): N/A t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 229 Gleneagle Drive Property Address Cioleck Realty Trust Owner Owner's Name information is required for every Centerville MA 02632 7/18/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): N/A C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 229 Gleneagle Drive Property Address Cioleck Realty Trust Owner Owner's Name information is required for every Centerville MA 02632 7/18/2013 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: N/A **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: N/A D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 1I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wM 229 Gleneagle Drive Property Address Cioleck Realty Trust Owner Owner's Name information is required for every Centerville MA 02632 7/18/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 229 Gleneagle Drive Property Address Cioleck Realty Trust Owner Owner's Name information is required for every Centerville MA 02632 7/18/2013 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: 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): 455.9 actual t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Ilt Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 229 Gleneagle Drive Property Address Cioleck Realty Trust Owner Owner's Name information is required for every Centerville MA 02632 7/18/2013 page. City/Town State Zip Code Date of Inspection D. System Information Description: 1500 gal: Septic tank, H-20 dbox with 3 500 gal. leach chambers in series with 4' of stone for leaching field of 33.5' x 12.83'x 2' Number of current residents: 6 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 2011= 370gpd, 2012=452gpd Detail: 165,000 gals used 2012, 135,000 gals used 2011, 47,000 gals. used first half of 2013 Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): N/AGallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: N/A t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 229 Gleneagle Drive Property Address Cioleck Realty Trust Owner Owner's Name information is required for every Centerville MA 02632 7/18/2013 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: N/A Date Other(describe below): N/A General Information Pumping Records: Source of information: Owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: N/Agallons How was quantity pumped determined? N/A Reason for pumping: N/A Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): N/A t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 229 Gleneagle Drive Property Address Cioleck Realty Trust Owner Owner's Name information is required for every Centerville MA 02632 7/18/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 7/10/2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5' feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town water feet Comments(on condition of joints, venting, evidence of leakage, etc.): No evidence of leaks or clogs Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 68"x 10'6"x 5'8" Sludge depth: 14" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 229 Glenea le Drive Property Address Cioleck Realty Trust Owner Owner's Name information is required for every Centerville MA 02632 7/18/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 15" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? Accusludge, Baffle stick&tape measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): System does not appear to have been pumped since install, recomment pumping and system should be pumped at least every three years as preventive maintenance. Grease Trap (locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/A Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 229 Gleneagle Drive Property Address Cioleck Realty Trust Owner Owner's Name information is required for every Centerville MA 02632 7/18/2013 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.): N/A Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/A Dimensions: N/A Capacity: N/A gallons Design Flow: N/Agallons per day Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes ❑ No Date of last pumping: N/A Date Comments (condition of alarm and float switches, etc.): N/A L *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 229 Gleneagle Drive Property Address Cioleck Realty Trust Owner Owner's Name information is required for every Centerville MA 02632 7/18/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): D-box level with speed levelers giving equal flow to chambers, light solids carryover, no evidence of leaks or back up. 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 * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 229 Gleneagle Drive Property Address Cioleck Realty Trust Owner Owner's Name information is required for every Centerville MA 02632 7/18/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ 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.): Lawn over top, no evidence of break out, hydraulic failure or back up. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A I Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM s 229 Gleneagle Drive Property Address Cioleck Realty Trust Owner Owner's Name information is required for every Centerville MA 02632 7/18/2013 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.): N/A Privy (locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �^M 229 Gleneagle Drive Property Address Cioleck Realty Trust Owner Owner's Name information is required for every Centerville MA 02632 7/18/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately AI=30' Bl=46.5' A2=35' 82=40.5' A3=42' B3=39' W DRIVE DWELLING GARAGE �3 A ECK iD Old septic tank 4 Quo �0 Lo. ,a3 NOT TO SCALEO 15ns•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System',Page 15 of 17 ' t' i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 229 Gleneagle Drive Property Address Cioleck Realty Trust Owner Owner's Name information is required for every Centerville MA 02632 7/18/2013 page. Cityrrown 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: 12'+ no water encountered 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: 7/10/2003 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Approved system design plans on file with BOH 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM , 229 Gleneagle Drive Property Address Cioleck Realty Trust Owner Owner's Name information is required for every Centerville MA 02632 7/18/2013 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 DEEP OBSERVATION HOLE LOG SYST Test Hole Depth From Soil Soil Texture Soil Color Sol l Other Number Surface (inches) Horizon (USDA) (Munsell) Mottling (Structure, Stones, Consistency, %Gravel) 1•) B a Si S rc L e �,�� ! Numb( A G �vF ,l Other ��o ,�,.;, ';� ,/ �¢.,a.�r� y %G R akn�i � Via .. 1114 FPIAs;3t.F 2.)Desig >6 - ! �:? " rwsd.:o•:f� . 7' 21,, rA2RVF-L/ L66SF 3.)Septic G � / i T;4 ,, , rt 4.)So i I A c r I r-4'.; v t AFC.-E. i o - 4 E -rug y � V, R ti1cG rep:.: ' 5.)A.Gor Date Of Test �' ` `r'° Use Soil Cl1iss .. . with a perc. rote of less than Percolation Rate Min.%in. for a loading rate of ,• q , ' '.+GPD /s f' Witnessed by r - 4�, J.j , FLOW. PROFILE Top of Foundation Elevation= .,=..�, w r G Finish Grade__....__.._. l Ffnish rade -...... 36"max. j 9"min. 36° i mo X. ...1 flow line to"min. 14" nns bnf fie .' I !t] J \ i46 4C� QdMlR1Y <`' i 1 \ •� LIJ/ 7 p C r• f i A r {� T �` .i• •� Lli •P'•i ., •` '�' .;r .. _t x'S 't n "7� ! f f4' r• \ )rl ,�. 49 i L A PROJECT OF&fq _ JOHN M. ' 1102't)•1 t-ASf 4fM1STk;y�T ZLiJ �� P:Dt . LSSC� g iN .1;411 O'RE1 CIYt` TITLE SEWAGE_ DISP Na.36d00 �; 05AL SYSTEM . ..CE.N77e 1/l U-9` ,VA BENNETT 1L -�'REILLY Inc. - _ Engineering & Environmental `Services.:O 103 Mani Street:-.ItOM 6A ... 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For +`+ valuables,please consider Insured or Registered Mail ■ For an additional fee,a Return Receipt may be requested to provide proof of t delivery.To obtain Return Receipt service,please complete and attach a Return p' Receipt(PS Form,38111 to the article and add applicable postage to cover the fee.Endorse mailpiece Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery. ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a,postmark on the Certified Maii receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an Inquiry. PS Forth 3800,August 2006(Reverse)PSN 7530-02-000.9047 SECTIONSENDER: COMPLETE THIS • DELIVERY ■ Complete items 1,2,'and 3.Also complete A- SigrLl re , item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse J4� 1 'E��X ❑Addressee so that we can return the card to you. B. Received by(P' tedWarne) C. o ory ■ Attach this card to the back of the mailpiece, t I or on the front if space permits. D. Is delivery address different from item 1? ❑ s 1. Article Addressed to: If YES,enter delivery address below: ❑No IZ q 6 OLD L fzvl I / '.'�� w,dn 3. Service Type `� i t' UT P�Certified Mail ❑Express Mail 1 6161 ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (rransfer from service/abeq 1 i:, i ?DyO 7s 3,020 D 0 3 a 3 4 2 9 17 6 6-3 I PS Form 3811,February 2004 Domestic.Reiurn Receipt 102595-0240-1540 | � | | UNITED _^ ` `_ ` ^ al GA Fe6g'Paid Sender Please print your name, address, and ZIP+4 in this box Town of Barnstable Health Division 200 Main Street | — | | | | � | \ | ' � ,-- n ` ` Town of Barnstable Barnstable �OfTHE Taw Ali-Art1P.�iCaCily I;r � Regulatory Services Department BARN STABLE.. "A�s . Public Health Division _ a \�Fb MAY A 200 Main Street,Hyannis MA 02601 2007 Office: 508-862=4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL 7007 3020 0001 3429 7663 r January 13, 2009 Michael J. Ciolek Sr. 248 Old Lyman Road South Hadley, MA 01075 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANI ARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. )? P A144I Z 506 The property owned.by you located at 229 Gleneagle Drive, Centerville was inspected on January 6,2009 by Jaime Cabot, R.S., Health Inspector for the Town of Barnstable. p� Gl This inspection was conducted on the basis of a rental inspection. �p0 The following violations of the State Sanitary Code were observed: 105 CMR 410.300 and 310 CMR 15.00: There were a total of Four(4) bedrooms observed in the dwelling. However the existing septic system was not designed for four Zf74�i bedrooms. It was designed for three bedrooms. 2� You are ordered to correct the violations listed above within sixty (60) days of your receipt of this notice by pulling any required building permits to restore the property to a three bedroom home. You are ordered to remove the bedroom by opening a door-way entrance to the room to a minimum of five feet wide opening. This will bring the total bedroom'count down from four (4) to the appropriate three (3) as designated by your septic permit. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations,please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER O HE BOARD OF HEALTH - Th as A. McKean, R. ., O Director of Public Health Town of Barnstable i 'i _---- ' ��� �d�� s J Y TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date fi 0 / Time: in_�1 :) out Owner M GIA NV-L C_ a Lei= Tenant iL L5, I:4,4 tc Address Address 2-Z VAC. kf- ®(L �r-eA >✓ G MA oZia i Compliance Remarks or Regulation# Yes "O Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 1 1 0 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal ✓ �"S� 16. Sewage Disposal 17. Temporary Housing �� �T 0 18. Driveway Width 19. Number of Tenants Observed 1 PART II 37. Placarding of Condemned Dwelling; } D Removal of Occupants; Demolition Number of Bedrooms 4A ?£A CMS U�SE2v Number of Vehicles Allowed (max) g e o ¢-ace t-S ?'Cg-"-,A VT E� Number of Persons AlloweAmax) :r Person(s) Interviewed k)m lQfs� Inspector If Public Building such as Store or Hotel/Motel specify here Barnstable �oF I roomy Town i n of Barnstable Regulatary Services Department I I • QA FiNSLaRLE 67 ,.'i 9•. Public Health Division Oo i �� , AlED MAC 200 Main Street Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL 7007 3020 0001 3429 7663 January 13, 2009 Michael J. Ciolek Sr. 248 Old Lyman Road South Hadley, MA 01075 NOTICE TO ABATE VI, ATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM.WANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF OARNSTABLE CODE CHAPTER 170. The property owned I you located at 229 Gleneagle Drive, Centerville was inspected on January 6, 2009 by Jaime Cabot,'R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a rental inspection. The following violations of the State Sanitary Code were observed: 105 CMR 410.300 and 310 CMR 15.00: There were a total of Four (4)bedrooms observed in the dwelling. However the existing septic system was not designed for four bedrooms. It was designed for three bedrooms. �/3.j l p� 5-*' You are ordered to correct the violations listed above within sixty (60) days of your receipt of this notice by pulling any required building permits to restore the property to a three bedroom home. You are ordered to remove the bedroom by opening a door-way entrance to the room to a minimum of five feet wide opening. This will bring the total bedroom count down from four (4) to the appropriate three (3) as designated by your septic permit. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations,please contact the Town Health.Division and°ask to speak with the inspector who performed the inspection. PER ORDER O HE BOARD OF HRALTH J Th as A. McKean,R. ., O Director of Public Health Town of Barnstable X 4, /H&W HOBBsR WARRENTn THE COMMONWEALTH OF MASSACHUSETTS I1 I3 06 BOARD OF HEALTH CITY/TOWN W e ,,.LZ N > DEPARTMENT i ADDRESS r�Su-i�GZ` TELEPHONE Fmk Addres `-it i`} 0 N`mac pa t—_ L 4-ig ir-,Qw�. Floor Apartment No. _ No. of Occupants 'A No.of Habitable Rooms___No.Sleeping Rooms y No.dwelling or rooming units No. Stories Name and address of owner_ :eAL_E oC.y- L-r 1AA Q Remarks Reg. Vio. YARD Out Bld s.: nces: Garbage arid Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress: and Obst'n.: 4 ❑ B ❑ F ❑ M Doors,Windows.- Roof Gutters, Drains: Walls: Foundation: ' Chimney - BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin ` STRUCTURE INT. Hall,Stairway: Obsi'n.: Hall, Floor,Wall, Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ N Equip. Repair TYPE: Stacks, Flues.,�Vents: A E i 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,. _ Vehtil. L to . Outlets Walls Ceils. Wind. ' :Doors Floors Locks Kitchen Bathroom 1 tVIP F4,Q Pantry Den Living Room Bedroom(1). 1 Bedroom 2 1 $0 14 Bedroom 3 Bedroom 4 . Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Fues,Ve-ms,Safeties: Kitchen Facilities Sink (�c Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: vwN C� A2�►,$�APv(,1E Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: o'C GDP 0 Q Egress Dual and Obst'n: General Building Posted Q Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT I S GNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF r RJURY." /� INSPECTOR TITLE �!'foc-w DATE 6J TIME A.M. THE NEXT SCHEDULED REINSPECTION �•�"c P.M. l ?Q v� �d . G r p � � Q Iry 1 �• -or �? N �1i' �• ay � (� N z � 0 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signattye item 4 if Restricted Delivery Is desired. X ❑Agent zx� ■ Print your name and address on the reverse Addressee so that we can return the card to you. p yO( O B. Receives b'(Prin ame) r% C-�Q to ofPelivra ■ Attach this card to the back of the mail piece, Yll �t`�l Il ,07 or on the front if space permits. D. Is delive^ dress different from Rem 1? ❑Yes i 1. Article Addressed to: „ p, If YES,ente delivery address below: ❑No x '; uV`lii�u� l �. Gi o l�k Sr. -4 (� Zq(J �C��d Ly ►�v�.a� 20 ad _ �a 3. S rve T certified Mail ❑Ecpress Mall ❑Registered ❑Return Receipt for Merchandise ,� ❑Insured Mail ❑C.O.D. , V 4. Restricted Delivery?P a Fee) ❑Yes 2. Article Number J(rmsfer from service la 7pp6 2150 0002 1038 7442 bel)!. PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M:`- UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • ea I-i T----�v1'5 io✓1 ZZO WI A 02 _ _ i i u k ( 106 .� Certified Mail#70062150000210387442 ,,ems t�►iti Town of Barnstable Regulatory Services • BARMWABLE. 9 MAS Thomas F. Geiler,Director �p�FD MA'1 A Public Health Division Thomas McKean,Director - 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 15, 2008 Michael J. Ciolek Sr. 248 Old Lyman Road S. Hadley, MA 01075 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 229 Gleneagle Drive, Centerville was inspected on 08/13/2008 by Jamie Cabot , Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.500—Structural Elements Peeling paint found on ceilings in bathroom, main floor and second floor You are directed to correct the violations listed above within 24 hours of your receipt of this notice by repairing the peeling paint on the main floor, second floor and bathroom ceilings. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection.. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Q:\Order letters\Housing violations\Rental ordinance\Address.doc I Director of Public Health Town of Barnstable Cc: Health Inspector QAOrder Ietters\Housing violations\Rental ordinance\Address.doc 0v.lO FORM 30 C&W HOBBSR WARREN TM THE COMMONWEALTH OF MASSACHUSETTS {{{ BOARD OF HEALTH 1a2V k���CrE. CITY/TOWN b DEPARTMENT ADDRESS TELEPHONE c..� . Addres ►-��ALR.L���-. ��c pant _ N 11.d.� �c�w�w�wl►Jl�-� �K�cv►ch. Floor Apartment No. No. of Occupants No. of Habitable Rooms_2 No.Sleeping Rooms No.dwelling or rooming units No.Stories_ -- Name and address of owner :Cam► 1.� �6 C)LD Lg11AQ P-0- v—KV( Remarks Reg. Vio. YARD Out Bld s.: nces: 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 yf 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: HEATINGW Chimneys: Central ❑ 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 r VIE06 t4 rAL Va, Q Pantry a Den Living Room Bedroom 1 t Bedroom 2 l30 Bedroom 3 ► -1(0 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, FWes-,V-eTAs.Safeties.- Kitchen Facilities Sink G c Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: v wNJ A2 ,5'TARXjF Wash Basin, Shower or Tub: 1,,ZA L- C _(1 r-I -T& Infestation Rats, Mice, Roaches or Other: p o`C Cjov iq_cj simb EX. Egress Dual and Obst'n: General Building Posted > IC E ,C/td .0 4f,,%P I P Cgtc. Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT 1 S GNED AND CERTIFIED UNDER THE PAINS AND PENALTIESYFP11RJURY. INSPECTOR �• TITLE ��i �-7`I �/�'S ¢.?we— DATE TIME P.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. (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. .,Y ��"�lr�++h^.�.d�..-��'S+'��i-i4.+...c+'w.+a'k'*p�.FY.,,.+,:`..�,.r.�.7•'+•...w'c,�+Y.."'.r^.,.._.....s^rt...'. rM1-..^yz�..:.4•.-v .�—ry.�.n?v'-^Ja......y���ev.�•.-....^' ...4.., r.-• t+ THE COMMONWEALTH OF MASSACHUSETTS i i� � L (�FORM 30 C&W HOBBS&WARREN BOARD OF HEALTH r CITY/TOWN a DEPARTMENT q ZOO H ON S3 �A,r A -t1 t-1 i S t' t/� �Z(OCA ADDRESS II TELEPHONE Address.. LQ > L 0K.. _ Occupant _L_ 11 L 4j C,M,c v,��, Floor -" " Apartment No. -- No. of Occupants ?h No.of Habitab e'Rooms < I° 'No.Sleeping Rooms No.dwelling or rooming units No.Stories Name and v � 1 address of owner :c_NAt,�,,.��EL_ CS y 2—416 C LO Li`t�1A-s P-0 ' �1NOLS { -1 ` A, ��+ Remarks Reg. Vio. YARD Out Bld s.: Hences: ' Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: 1 _ Roof Gutters, Drains: r « Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: i F Dampness: j Stairs: Lighting: 1 STRUCTURE INT./ Hall,Stairway: Obst'n.: --J (/ Hall, Floor,Wall,Ceiling: Hall Lighting: X / Hall Windows: HEATING Chimneys: r Central 1oY -MI N' — E'�ui . Re p air + ; TYPE: f` Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: y 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 t Bathroom Irig N c+, 1 Q05; N% 5 % rJ zk -R_ + Pant A 9=0 v t^ Li W sDen Living Room , I Bedroom 1 Bedroom 2 1 30 Bedroom 3 Bedroom 4 [, Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flue`s;Vent Safeties: Kitchen Facilities Sink --- Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: 2-> A2H S?AP.,Li , n 061 Wash Basin,Shower or Tub: 4i_41 %�:,CA-T r, Infestation - _ Rats, Mice, Roaehesor;Other"..k;3r "� ' Egress`'- �` Dual and Obst'6: I General Building Posted '(�� M�C�S"l it 1n-- ��t n. 2S 4 Gf Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH r MAY MATERIALLY,IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 10.5CMR 410.750 OF THE CODE OR THE Q AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT I S GNED AND CERTIFIED UNDER THE PAINS AND .PENALTIES OF PERJURY." INSPECTOR TITLE DATE fii 0 TIME + f P.M. Q A.M. THE NEXT SCHEDULED REINSPECTION fpc 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, includinggarbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. 9 9 P 9 (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, ( ) . P 9, 9 9 9 P P 9 9 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 Y P 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. 3j 2 V, i (�n-Iwl Ille RVI "X �-M 053 I ` _ TOWN OF BARNSTABLE j LOCATION Y's`tAE SEWAGE # _`;—.a&Z . VELLAGE ASSESSOR'S MAP& LOT - "l �I ! INSTALLER'S NAME&PHONE NO. �►-� - c s'7 L S' SEPTIC TANK.CAPACITY fsC e �LEACHING FACILITY: (type)' (size) & Y NO.OF BEDROOMS BUILDER OR(5� PERMIT DATE:_j 7 —© COMPLIANCE DATE: T—(� —& � 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 i Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet { Furnished by I I DrzK A 3U, ! s � t 13003-5730 Town of Barnstable P# Qt0q0 / `OFINE Tn.-� / G Department of Regulatory Services (/ BnrwsresrE, « Public health Division Date 2� 3 v� 39 0 . 10� 200 Main Street,Hyannis MA 02601 ArEo may. Date Scheduled 6 LVt03 Time t 1, 4M, Fee Pd. Soil Suitability Assessment for Sewage Disposal � 0 S Performed By: M& Y A���A T i n- Witnessed By: $ Ni' `4'N : if, Location Address � Owner's Name 2-2-9 e d(t p t4ov- r comST, C',V e Address Q.®o B019. Assessor's Map/Parcel: i- U.2— I qq Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Land Use Z1E51qFaT-1h Slopes(%) D—3 Surface Stones I�OAI� Distances from: Open Water Body ft Possible Wet Area 't-G00 ft Drinking Water Well • OO ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 116 'n=5� pIT 4 Qi �TEsr'P� 1 LoT Z-L 15,o1�j SF � Gt.�l E�►�t E D6�0V� . Parent material(geologic) ��ZO6et�'CZ.. 00TW&S4 Depth to Bedrock // Depth to Groundwater: Standing Water in Hole: �t Weeping from Pit Face W Estimated Seasonal High Groundwater rs' � fA � �� �.R.J a l +aux t "a. '� »39tti3d.. d. "1'i'rB .U'x'ii:r.Iu,YSna .�`«:'.NaSaf �.-xgi F.=f Rwu . :it; .. Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level— `'�,x}� '.sfl` xe'* rtTgyv.. ±' `BT�' ''.la"1 .azmv Observation Hole# I Time at 9" Depth of Perc 4 Time at 6" Start Pre-soak Time @ 01, Time(9"-6') End Pre-soak ?ZejC.. I10Lf— C-oL AV -PV F— �t►.161 6'tLtt#4 t `-oac>V SO R-S, Rate Min./Inch <Z1AJ1J y L Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) NO Original: Public Health Division Observation Hole Data To Be Completed on Back-----____ Q:HEALTH/WP/PERCFORM . . MIN DCpth' a. .. .:'..,., from Soil Horizon Soil Texture Soil Color Soil ther Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel LOAM 0 -3 at S D I ci V." /�i=U"e. LU �u 'LOMA o Ic7 4 Zo CL �s 0 NU .vax w x_r: dDepthfrom $Ol rl�� S�TeX�re Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel LOAMY AV Vi me 0 ZSAlspy Lq K I Z 2 - 1 C• co >a � toe� 0 it eST- 34 b F G1 Zee"o ! 'r M k !. th'°.ri i �: u1 a < lutt x. :.�, .,:. .. � �. : *.,pan -dt�F:.. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel 5 .-,ti�nr r„��: :...:.a:. J .z,: ::s.:u ,•.,..., ! :, ,�"' a ��n ' :y:.:i r �1:.�....:. ,^,u-...� !,-�q::.;_:�s'�'.'�'iudx,i%!Ci'a:Yi��"ir:in>";x;L"di u�:�N!.r:s !3 amr�," ��5�'�s'�w,3µ.�.ayL.�i¢aus?.��r`*P';e��....9.�c k�«.nA'� ,..w.a�.,�3Citag. .�*: 'v1�,"x�"�,.ns.a,`�.��t.��:xttiar.at s�„m�:... .�1>:.� .,a.._.✓.::r�.�•..���"la....,�a;.r... Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) i Mottling Structure,Stones,Boulders. Consistent %Gravel r Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth,of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Y If not,what is the depth of naturally occurring pervious material? Certification. I certify that on 11-2C7`15 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required train• xpertise and experie scribed in 310 CMR 15.017. Signatu ie� J Date_] Oj Q:HEALTH/WP/PERCFORM _ i TOWN OF BARNSTABLE 1 LOCATION. I +i 7�r���e SEWAGE# N 2-7 VILLAGE �. �1f�iE � ASSESSOR'S MAP& LOT "f��� INSTALLER'S NAME&PHONE NO. �AlrPyy s S./ SEPTIC TANK CAPACITY ,.. LEACHING FACILITY: (type) C: 1j (size) No.OF BEDROOMS E UII..DER O WNE^R' PERMIT DATE:_ .7,-C)3 COMPLIANCE DATE: (� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by <t� 030, _- � n alp o _ 14 No. �3-� 3(p Fee � . + � THE COMMONWEALTH OF MASSACHUSETTS 0. PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLE,s MASSACHUSETTS 01ppYtcattott for Mtgogal *pgtem Con!5tructton Vermtt jSZ "I k Lf Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. ),CA C U_V11_1e_ ��°�.��c,, W\1Ice. (—:®1e-)r, Installer's Name,Address,and Tel.No. r� r Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms_3 Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow c3�® gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) -�, _QA � y Ul,�N CkQ- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this B Xd of Healt _ Signed Date Application Approved by 7 d Application Disapproved for the following reasons Permit No. 3 Date Issued I/ . h.. yr. -a.l •, 1` .. "".- ,A -r f+^.1wF'.�W r. . M�S µyT^..�.} ..» N�e.- H '.�-� ....�l! . o • ,�d � .6. t }. �I�'R'� ,' L ! � ' E • , K �,� t•� �.Wit' °}' +.���� *�' , 0"•• -`I Fee — (� Per THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Of , lication for ig ogar gtem Congtruction permit Jc�2 Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: d Address or Lot No. Owner's Name Address and Tel.No. Location d , , Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /�P� vl0 C i Type of Building: E Dwelling No.of Bedrooms 3 Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other`Fixtures Design Flow 3 4 gallons per day. Calculated daily flow gallons. -Plan Date 'Number of sheets Revision Date Title ` Description of Soil ' Nature of Repairs or Alterations(Answer when applicable) pi. ,k,41 �: �tPG►r�u:G�@_ 0- Date last inspected: �f a� Agreement: ' The undersigned agrees.to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a.Certifi- rcate of Compliance has been issued by this d of Heal 3, Signed deer, /' Date -T 3 ILA pplication Approved by ------ �PRAO Application Disapproved for the following reasons Permit No. � Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Cey iftcate of Compliance e THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( )on by for as ?Zq ;tie.. V rt 4E— has been constructed in accordance with the provisions of Title and the for Disposal System Construction Permit W_!;Ob3—3(02- dated ?—7 O 3 Use of this system is conditioned on compliance with the provisions set orth below: r No. oo i c'! Fee v THE COMMONWEALTH OF MASSACHUSETTS c PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ' xl gpogal *pgteu-��C� on5truction Permit Permission is hereby granted to � r� 1 to 11 D CL to construct( )repair(/>0 an O site Sewage ystem locaft(d at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes-his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within two years of the date below. Date: G Approved by ! "' r ' 1 ' r r , �. �I ��I II �� �.� Y i III III . � - �I ' ''I � �i f' lei -r � _ „_ I .;. ii �i� , , .. ,�� �j �, � - I�j ., I!I a ii li. ,I 1 i �> ,- � i III .. - .... C.��`a-�"�� .,7f ff. ""�� �, .j4. ri, tirt /� ��* * • ..�_^ ,z���,1 `'w�a •. �,, GfiG" ILI lvv -45 •G� ,kCL 't LOOXA/I 7 N I a E4 NA � r w • 'r . - _ °".�� � .,::;� ��`. a e^ . �' x �:o.. �.._�,.�...�.�,1.P .V.� .. _.A• '�.. `--��. x. - — — ..�_a..."+.��...^�w..t..� ale. � r � '... - - ��._.,.,...� bJ � .e.�. � ..•s' 4 o0se cQ�?j o z 1 LO-CATIONr/; / ^}�' SEWAGE_ PERMIT NO. VILLAGE Y v INSTA LLER'S NAME & ADDRESS :.p R LfALDE R OR OWNER � 1,2 DATE PERMIT ISSUED S 2 4� L DAT E COMPLIANCE ISSUED Z S3 t 3 S� F�$....:?:s``.�'........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ......................... ..............OF.....�{nl..%�.:c dV......�.... .. ApplirFation for Uiipooal Mirkii Tome raarthin ami# Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal system — ...............................................................�Go2 r . V'la J CG' f or Q-- •--------------------------- .._.......1.... __...-......�...._ --•-••-•--•.•••--•--•...........-•------------- ...._......---- er Address W ?&f)_ C�+'1`i3UGTId<✓— ...�� — ess Instauer AddEx ansio ttic Size a Grinder feet Type of Building/ q. fee U Dwelling Dwelling—No. of Bedrooms..._._ __. p ( ) g r r Other—Type of Building �X�2C......... No. of persons .............. Showers — Cafeteria Other fixtures .............. W Design Flow... ---_---•--••---.� :_ _- ` Mons per person pevciay. Total daily flow__'..... _(�_.•__________________gallons. '-.. allons Len tl-r.:............. Width..._............ Diameter.-______-______- Depth.........__..... W Septic Tank Liquid capacity g g x Disposal Trench—N . -------------------- Width.................... Total Length........... __. . . ... Total leaching area___.....•......____.sq. ft. Seepage Pit No...... ........... Diameter Depth below inlet..... 2_.......... Total leaching area..' .161�..•sq. ft. Z Other Distribution box ( ) Dosing ) a Percolation Test Res �,�GP�rformed b ._F ........................� Y Date.._..2�_zr Y -- ;y��pp Test Pit No. 1................minutes per inch Depth of Test Pit.- 7"- ------- Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ Ri Description o Soil ... v ---- 4.... 1 7 v w --" (�°-e,�� s -"....................4(()----- ,40-��..........F'Aaw%. v--------------------------------------- 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 iITI.;=. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ';;ued the board of h .Sign d..`#.�-- •-- ..................... Date Application Approved BY•-•••-- F ----- � -•-----------------•--- -•-- `�^_ � 7J1......... Date Application Disapproved for the following reasons:........................................r. .............................. ------....•... ------------------------•-•------....-----------•-•---------....----------•--------------------------------•-•••-------••••--------•--'---•---•-•--•-•-----•••--•••-'--' ............................... Date PermitNo......................................................... Issued.... `= .................. Dite. o FEB..... »emu.....2 3 i" -4 THE COMMONWEALTH OF MASSACHUSETTS '; fl BOARD OF HEALTH ........... OF..... ....... .. . App ira#ion for Diiipaoa.l Vorkg Tons rnrtinn V.rrmit l Application is hereby made for a Permit to Construct ( oSYSr Repair ( ) an Individual Sewage Disposal eWe -__ -•.-J-�-----••f� f� Vr.� VQ• c ItGi * Ad_d_..e_____ -• .. N ............................ ------------- Address •.. •..... •-------•-•................ _Installer Address dType of Building Size Lot............................Sq.n,fee�t�, Dwelling—No. of Bedrooms__.. . ________________ , _________Expansio ttic ( ) Garbage Grinder �s,p •- -- p`�1 Other—Type of Building,t`L�. _. ..... No- of persons________I__________________ Showers Cafeteria ( ) F Pa Other fixtures ..__..__. Design A=... ...........j____..._ _ _gallons per person per day. Total daily flow............. ___________gallons. WSeptic Tank uld capacS�yy lions Length________________ Width__.__._.___.._.. Diam .---_.__±_______ Depth................ x Disposal Tr ch—No____________ ______ id th.................... Total Length................... Total leaching area....................sq. ft. Seepage Pit No. . ... ...... Diameter..................... Depth below inlet...... _______. Total leaching arm___ sq. ft. Z Other Distribution be ( ) Di nk ) �+ t teal eir"- --------------------- Date__ _��� .. a Percolation Test Res ts�sC Performed by.���"�!'.q''��.--- .... 11 - --------------------- a Test Pit No. 1................minutes per inch Depth.of Test Pit-!_�______ Depth to ground water_______________________ Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 04 ----------------- ----._.. ________-- 0 Des,c�r_i'Vtion p Soi ... .0.0...W........-- . ��► ....4 �' °� .. _._. 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 TIT i E `>of tl-;e State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance hassbe'en issued by the board of health. SignedXI----••-------•---------------•••••-----------•----•-----------------------_----- ----------------•------------•-- Date Application Approved By---•-------- ----- _- IZ;*'/ 9:7-V I -Xle Application Disapproved for e f o o 'ng easons:............ = •-••----------•--•-•..................•--••---••---••------------•------------'---------.._..---------•-••-----........................................................---------------------- --•--•-- Date e ail PermitNo......................................................... Issued.-•............................._•••----------. ------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... ..........................OF.....:.1 ........ .. ........ .. THIS IS TO CERTIFY, That the Individual°,Sewage Disposal System constructed (2,4--ar Repaired ( ) by----------- --•--•--------•-•-----------------------------------------•........................................................................................ ................ Installer - /j �yI" a has rbeIAll�cscc "deface w`ifh visib�iiSrf > a e anrtary Co e as escribed in the. application for Disposal Works Construction Permit No._ „-_________. dated_..._::: ..,_. _7 __________________ THE ISSUANCE OF THIS CERTIFICATE SHAL ®T ICE �NSY6tllEp AS A GUARANTEE RANTEE THAT THE SYSTEM WILL FUNCTION,SATISFACTORY. . In ector * _ sii�i�.rv.l2�aiA{tJ, P "... r •:.!, y�j�,.'� .tw�54�F'fy ;5a-+'� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /_ .................OF._.. �j -. I No. ._ ........_ t yy� �jftiyy2 d'�•-� FEE......✓+�-1---•----- r Permission is hereby granted = ::._;._.. ............:..... to Construct (, ) or Repair ( ) an I di >fal wage D/is�posal ystem at No. -•- ---------• T �2, a�d� Construction ' ,street" V�JSF.'l�_..__� rrs as shown n e application for Dispos Works onstruction Permit No_____________________ Da ed___.____f.'`1�'_7 .. ........... - � '" • ,Q .................o� i alt ` DATE----V----------------------------....•-------...-----•----•-----------__......... FORM 1255 HOBBS & WARREN. INC..,PUBLISHERS ' t R, $W i aisr C, P Prrer i Box 1 - -- r�i O SAC V� O TA WC ZZ , t2.45 / Iq EZ,418 V L.or tr,2 3 {o P,2opos�v I yr J pj �� ;(6 tZ&-V. Tap of Dq « ' Q /SaiSsip Fr &Z.4c.z �z.¢�,i 3lvl I I i P,eiv. Ec.9Sg G'��/E�GL E � 21ve c.4rs' 4o�w�aE /1/oT�-�/f377oVS BRSE"t� ©n/ ASSu�-f�'D �ATu�j CERTIFIED PLOT PLAN LOCATION SCALE . ��=3q". . . DATE Ap e.c z7 /'9?8 >e>`VV.�RD �° K,Ell.LEY . ... . . CifiM /� PLAN REFERENCE . 13V!n4 407—*' .?Z . sHaw�i ran/ ,9 I�iu �,� CNA,eL�vt= �� ry�vso.A. ,tea -�o,er rz� .44o. SCE 7Y. . I CERTIFY THAT THE y` SHOWN ON THIS P PCN THE G'ROUND AS SHOWN HE FORMS TO THE SE SAC S OF THE TOWN OF Sp�,�,s Co�vST2uGT/any �HPR��/ WHEN CONSTRUCTED. 3S CA�G.Q ,�oAx> DATE . . . . : . . . . . . . . .. PETITIONER: REGISTERED LAND SURVEYOR 4700 TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS e 4"CAST IRON 12��MAX. • 12"MAX. "'T .reswr► • PIPE (OR 4"ORANGEBURG(OR EOUIV.) EQUIV.)— MIN. PIPE- MIN. —f LEACH ' PITCH I/4"PER. PITCH 1/4�PER.FT. PIT PRECAST ° LEACHING INVf,F�T EL..?.7•.80.. INVERT DLST• INVERT ?� w �? �;�' PIT OR SEPTIC TAN K 3 4L 3 i EQUIV. EL.. . .9%. . . . EL..9... . ' ; >_ INVERT 80X 39 /oo.a. . .. .. GAL. INVEf�T � c~ia 0. .i; 3/4"TO II& g 3o INVERT •, w w EL.. EL 8:8o ,'� u. p: WASHED w STONE p e /o, 6 , WDIA. •• —F DI PROFI LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE -PREM Y SOIL LOG WITNESSED BY : DATE AP*'A. 24 /5V TIME.!., -O.R:� ldAtiG Mc�� BOARD OF HEALTH TEST HOLE I TEST HOLE 2 77-6!"IAs• - Z.G�yr PE,, ENGINEER ELEV. .42. 3 . . . ELEV. .. . . . . . . . . w000toRy e'1 DESIGN DATA ,� SuBSo.t- NUMBER OF BEDROOMS . . �" 3( 330. . . . . . . . . . coyest sa�•o TOTAL ESTIMATED FLOW . . . . . . . . . GALLONS/DAY Pic 7i rr Gaa,ie't. BOTTOM LEACHING AREA SO,.FT. /PIT SIDE LEACHING AREA . . i88 . SQ.FT./ PIT GARBAGE DISPOSAL NvN,1�. .(50% AREA INCREASE) s � TOTAL LEACHING AREA SQ.FT / .� PERCOLATION RATE . . MAN 4SS�,. MIN/INCH NO. .WATER ENCOUNTERED LEACHING AREA PER PERCOLATION RATE . S. o O.FT.- NUMBER OF LEACHING PITS f#1 PST WiTN t in OMA:S'V-kELLEY CO. APPROVED . . . . . . . . . . . BOARD OF HEALTH •Twd• • FEc T of STaw ENGINEERS—S.URVEYORS G�/ 9E.L ,S/DIS ,• 1 346 LONG POND DRIVE DATE . . . . . SOUTH YARMOUTH;MASS. iAGENT OR INSPECTOR � '� (�� ' . 026 �. THOMAS r KELLEY —+ �L CAC"I DZ/VCr iWI) Af'tJ y' v No.242b0 SP/ vS �pn/ST,e✓c7"/on/ Cp �C'/ST PETITIONER fy�/N!S /!74S S, . . . A ' s . A A1.0 Q ........._0........ ......_.......................................................................__................. BEDROOM33 c o� Vco 3'-1" 5'-4" 3'-1- i EXISTING WOOD TRUSSES G C Q to BEDROOM I t EXISTING SECOND "' W M \\ FLOOR FRAMING uj J T C � %S'-8-DOORS e m = x NEW 5'D OPEN 10V2' Q 0/ EXISTING ED OPENING IN SEA"DOOOOR ING 7$-% EXISTING WALL • i � 7 NEW HEADER B In C BEDROOM 2 1 BEDROOM 3 W 11'-8 y BEDROOM 2 NEW OPENING Q; Q Q vim' m NEW 1-WOOD EXISTING WOOD STUD ............... ,__„ .._...,__,,,,.,. THRESHOLD BEARING WALL V QN W J =3 Z— m (n v d W EXISTING SUPPORT BEAM Q &POSTS " BASEMENT LJ LJ LJ 1 First Floor Plan I 1 I rnl Section A 1/ Q F H W � Q J W C) Z 06 N W 2ND FLOOR Z W () BEDROOM W EXISTING FLOOR Z ~ (Y CONSTRUCTION O Z Q Q J ~ C7 . Q O > Q 0w of LL W EXISTING SHEETROCKED 312' EXISTING TOP PLATE WOOD STUD BEARING N WALL BUILD O NEW WOOD HEADER ROWS OF 16d AND Irr MO (�f PLYWOOD SPACER.USING(2)ROWS OF 180 COMMON NAILS I� 18.O.C. INSTALL(2)JACK STUDS&(1)KING STUD AT EACH END OF HEADER-TOE NAIL HEADER TO JACK STUDS AND THROUGH NAIL THROUGH KING STUD TO HEADER W/(4)Sd COMMON NAILS @ EACH END NEW PAINTED COLONIAL CASING NOTE:ALL LUMBER SHALL BE ` 0 0 HEM-FIR NO.2 GRADE OR BETTER NEW PAINTED 1X TRIM 4 W t� O soZ FI - Detail B tit: `l 1 1/2"-1.1 P a h+Of DRAWN BY: TJF JOBS: -- SHEET#, A1.0 t� IIISoil Other E',-DEEP OBSERVATION HOLE LOG 'SYSTEM ,:DESIGN , CALCULATIONS G E N E RA L NOTES Jest Hole. Depth From ,Soil Soil Texture Soil Color LEG ND Mottling uStones, Consistency,Number Surface (inches) Horizon (USDA) "(Munsell) A) Neither driveway nor parking areas are of lowed Existing Contour%Gravel) 1.) Basis of 'Design over septic system unless H-2o components are used. 37- Proposed Contour Num�ber`of bedrooms, 0)Thedesigner will not be responsible for the'system 24x5 E)elsting Spot Grods,FX 'Ot h e r.'IA 5 tf— as designed unless constructed as shown.Arty changes .4 Proposed Spot Grade 2.)Desig-n Daily Sewage 'Flow,J47,� It A m, shall be approved In writing.D. Water Service G.P. W—ohu—C)Contractor shall be responsible for verifying the Overhead Utility Line(s)Gal.�4� CPA vp-t 3.)Sept c Tank Capacity Require( u location of all underground and overhead utilities Underground Utility Line(s)Provided: Gal.IGas Line prior to commencement of work. 9 J't4 orption System Ca'pacit� Test Hole and/or Boring Locotio r 4.)Soi I Abs -ji,T H n R equired, G.RD. S.T. Septic .Tank Provided:f 0 YZ 0 G.P D. D.B. Distribuflon Box t2w ok�)1::�I A EkJ_--7f , , : ' ikl e'. C . I� 1. I S.A.S.'�' Soil Absorption System........... KEY , MAP- no scale'T4 Res. Reserved for System Utility Pole Pla i _d (!�.P...5.)A a e �Di sposo Us 40, -wIthIs-design.— Catch Basin Fire,Hydrant ok Deed 'Bo �Pa g 41 W 451 IWell AssessorsMa. Parcel,I 4 T Date of TeST U S' e Soil Class W I In a H_70 perc. rate of less than Percolation Rate M in./in. or a loading rate of 174: 1 T?4.GPD /3-f.I J/itnessed by , t H)W1 TLOW PROR LE 40 P 4 4'op of Fou n do tion Elevati 51�ir�l Iont Finish Grade= F�Aish Grode=36"Max. 4 S' t:9"min. 36 max. M "A 7A—A flow line TO min. ps i V 4 gas baffle 7 lei r Isar)Gal. Septi c Tank Distribution Box 61i-zo) Y,IL te"r-fo A�,I,Fr--CONSTRUCTION 'NOTES T14�'l L)All construction shall conform to the State 10.) Base aggregate' for leaching facility shall F.44 J,he requirements of consist of 3/4 to 1-1/2" double wa shad stone free Environmental Code,Title 5, and t the local Boldrd of'Hoolth of Iron, fines 'and dust and sh all be Installed from t;V(F1 below the crown of the distribution line to the botfom n to k(s),grease trap(s),dosing chamber(s) -T ——————;A,�LO A" I 'n L,I i-A r. . I and diiin buitio'n'box(as)-shall b I a'set on a lavot stable of the soil absorption Is ystem. Base aggregate shall b a covered wi th a 2 I oya r of 1/8" to 1/2"double base which has been' mechanically co mpocted or on a washed stone free of iron, fin s and dust. f, r-_ f 16 inch crushed'stone bose.� a Ml P�I tj sl"N9, PW W.,ption system 'when distribution Sept!c tank(si shall most ASTM standard C N 41-0 6 0- I I,.) Vent soil absor a at, when located lines xceed 50fe either In whole LA't, 0 P 111>,;OF 0 11 27-� ' nd sall have 'i least,th a !d i Or 0 20 ameter or In, part under dr veways, parking, turning areas,'he rninimum: Aepthi frorn'the bottom of Z> A on a es.h' I T or other impervious material,-,'septic tank toths, Idw,lin,f a.shall be:48" or when dosed. r,r7s 7 r I12.)Soil absorption system shollf be covered With I a P y 4.1-Schedul:e :40 PVC Inlet on'd outfit te"is shall of clean modiurn son minimum of d (excludinq%�--eiis'nd a ininimUtti4f 6"above'the f low I ine of,the opsol-an' i a ,septic tank I I�'.bo s tol I's d ,a n".fh i'c'Os i t a Or I in P t the :'tank r4dtlly Under h of' �d 6 cleariout'nFidnhol 13.) F01sh'grade %hall'be C'M Ox im U'm-of 36".0var the'top of OU system componen ts, Includi:-6.)Ro nq the septic tank,se cover's of the septic tank and distribution distribution 'box dosing chamber-ond soil absorption O s t, _'�over box wi concrete wo fee tlght�rise s and' u _t m, Septic tank S 7sholl have a minimum' cover Inlet a"t le't ass to wit in 6",of f inish 4iode of 9 schedO 40 PVC. or''Shall tonsist 4 I Pipin 9 L OF n' a rn i-n, I'M' U In o q pe sh,oll, be, ldt:d a, 4 *rom' he'�dote Of'installation of F u va oht.,�pi ,the soil orp i <ob tion-system.until (j,,con inuous grdds not less, than -1 receipt of a Ce ificate af,� 17#4 JOHN M do Ii 4h 6 perimeter of the soil absorption -ILLY mp Once, TITLE t 0. ' DISPOSAL �SYSTEM ,Distrlb'utin'��Ilhes' for sioft (ibsotptlon system t CIVIL sys am -shall be staked and 110499d 0 provent�lh SEWAGE,as tog d she -� 6 4,�if b diameter,, schodu'le 40,,P,VO vsc of su�ih or o a for�'O s which miaht If d a t tI-shall be cap p ad at T "'Llno' omage T he sy a M.ond or, s jw requi re InSpection'of T' 'REILLY Ific.U ot�-o p 3 froriFi D-box I re ma in-live I f art 15 The Boafd �of Heal h shall NET RE N'10 I ,construc ion by,on ogWof the Board'of Hoo I th Engineerin_ En �i ro nm e n tal Services'U so4�66si6rpimin syst at (or the designer if thit 7system,requires,,o vorloncil and Ufa &Von iitributI6 9 ,M lu're'suc Oorson to cartif y"ay rec 4 at all W or.test-,D-_b6x to ass hf I n� w Or"r t'i ng ti� oute).6A AM Main Sfiett I r orkl'-hos� been :comp 0 a n wit t 6 forms f 0 -box sh6 I�havo b:minimum sump a' ��6 measured 6cor'donce. ...... . an On,s�- 48 a P 0"Box W7 nVtrt.' M -�opprov oUrs,o be diiii,the outlait otho�.Oeriif dvanc -6630 Offi c tewster, MA 026,31 ,,,5o8-8 6 ax 8 0 Oct _re4uested.�_, �0 t C DATE.: SCALE: BY:. CHECK� �*B NUMBER: