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Home My WebLink About0010 HITCHING POST LANE - Health 10 HITCHING POST LN., CENTERVILLE A= ' i U21214 55LCoPC , Nasriees.ON Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments x 10 Hitchinq post In Property Address Juan Marichal _ Owner - - ----------------------- --- -._...------ Owner's Name information is Centerville ma Q2632 11/7/2014__ required for every — --------------.__.—.-------___-- page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1- Inspector: key to move your cursor-do not Michael DiBuono use the return ----------------- ----- key. Name of Inspector DiBuono Sewer and Drain ed Company Name 8 Johnspath Company Address re � S Yarmouth MA 02664 City/Town State Zip Code 508-•364-9587 S113522 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 Evaluation by the Local Approving Authority — f --- — --- -- --- ---- - 11/18/214 111spector'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. It 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, [his inspection does not address how the system will perform in the future under the some or different conditions of use. !6 ne 16 title 5 0 al{ pection POM Suhsuftco Se ege Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments g� 10 Hitching post In Property Address Juan Marichal Owner -- ---------_----------`------_—_..---------------------------------------- - Owner's Name requir atifor a Centerville ma 02632 _ 11/7/2014 required for every — -----------_-----_-----�-_..._-_ ._--- page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) - - - - -- - - - Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist, Any failure criteria not evaluated are indicated below. Comments: The system contains a 1000 gallon concrete septic tank and a 1000 gallon concrete 6x8 leaching pit. Staining inside pit indicates the level has never been higher than half way full. System passes. 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, exhihlts substantial infiltration or exfilhation or tank failure is imminont. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Roard 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 U ND (Explain below): 15tns•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Hitchinq post In Property Address Juan Marichal Owner Owner's Name information is Centerville ma 02632 11/7/2014 required for every _ -_ _ 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 (coot.): ❑ 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 (Fxplain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval('if the Board of Health): ❑ broken pipe(s) arty replaced ❑ Y ❑ N ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below), C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ CB55pool or privy iS Within ;iQ feet of a bordering vegetated wetland or a salt marsh Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 1? . ` commonwealth ofMassachWsefts ~��N �� Official � Inspection �� Q�� ~�� 4�� N�� 0°W�� Title �� ~�8NN�� wm@ 0ww*� ��p��oy Form www ' � �� Subsurface Sewage Disposal System Form 'Not for Voluntary Assessments 10H|tohin8 post In ---�---'----'----------'------ ---- ----' rmpwnyHdu�s JuanW1ahcha| OwnerOwner's Name--________ ______________________________________________________________ information is required for every Centerville page. mo,.m°" State Zip Code Date mInspection 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 m manner that protects the public health, safety and environment: [] The systern has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet ofe surface water supply or tributary 0ma surface water supply. F� The system has a septic tank and SAS and the SAS io within o Zone 1 ofo public water supply. [] The nye0anc has e septic tank and SAS and the SAS is within 50 feet ofa private water supply well. L] 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 we||°° ' Method used to determine distanoe: 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 � | 03 or|eom than 5 ppm, provided that no other failure mib/ho are triggered. A copy of the analysis must bw attached to this form, 3. Other: � D) System Failure Criteria Applicable to All Systems: You must indicate"Yms" o,"Nn"to each of the following for all inspections, Yes No F� �� Backup nf sewage into facility or system component due boovodnadedor �� .� clogged SAS orcesspool | | �� Discharge orpnnd|ngofo�|uentfo the su�aceo/the ground orou�aoewaters �� ~ due toan overloaded or clogged SAS orcesspool [7 �� Static liquid level in the distribution buxahoveOut/at inve�due toanu*ar|oaded ~~ �^ qr clogged 8�8orcesspool Liquid depth in cesspool is |eau than S" below invert or available volume is |eu» than Bd8 O /o~.'yo Title smnua!Inspection r"m Subsurface xcvi" ~*�Pp./mmmm-page^m`r Commonwealth of Massachusetts u N Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Hitchinost In ----gp---- ».....-......... --- --— — -- --- —— - Property Address Juan Marichal Owner -- - --- ----- - --------------- Owner's Name ----------------___ information is Centerville ma 02632 11/7/2014 required for every ------ - — - — ----------------------- page. CityrTown 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. ❑ ® 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 1.00 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 15ins•3113 Title 55 Official Inspection Form,Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Hitching post In Property Address Juan Marichal Owner - — s Na. .._ ------ - - ---- ----- - ---- -- ---- --- Owner's Name information is required for every .Centerville - _ _ _ _ ma 02632 11/7/2014 - — ---- --------------- ----------- page. CityfTown 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? H ❑ 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): 330 _ 15ins 3113 Tile 5 Official inspection Form.subsvrface sewage Dispusal Systern-Page 6 of 17 Commonwealth or Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 10 Hitqhing post In Property Address Juan Marichal Owner __ _ - _- - --- ------------------- ----------------_---...------ Owner's Name information is required for every Centerville ma 02632 11/7/2014 page. City/Town City/Town State Zip Code Date of Inspection D. System Information Description: The system contains a 1000 gallon concrete septic tank and a 1000 gallon concrete 6x8 leaching pit. Staining inside pit indicates the level has never been higherthan half way full. System passes. Number of current residents: - -- -- -- 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 ( d NA Detail: House has been vacant for some time. Sump pump? ❑ Yes ® No Last date of occupancy: 2009 Date Commercial/Industrial Flow Conditions: Type of Establishment: ----------- ------ - Design flow(based on 310 CMR 15.203): Gallons per day(gpa) —+ - - Basis of design flow(seats/persons/sq.ft., etc.): ------------- - - ---- --- Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available, ------- ------ - ---------- 15ms•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 -Commonwealth w, Massachusetts ��~^�� x��~�~~��% Inspection �� @8��r �� 8NQ*�N�=8 �m ��N��v � N-��owmm SUbwurfonmSevvmQeDispooa| BystemmFonn - NothorVo|untaryAaoeenments 10Hitching post| _ _ ........ _ ------------.........-------_-_ Property Address Juan M } h | _ _____-__---__ owner Owhe�uNome information is Ce�emi||e ma 02632 11�Y2O14 mqui�d�rowa� -----' page. upp/u°" State Zip Code Date~Inspection D. Syste0Q Information (cont.) Laatda�nfoocuponcy/uae� — Date Other(describe below)� ___' - ' - � ' - - General Information Pumping Records: Source cfinformation: Was system pumped ae part uf the inspection? El Yea N No If yes, volume — - ' � o�wn How was quantity pumped determined? Raauo.n for pumping: Type ofSystem: Septic tank, distribution box, oni| absorption system F] Single cesspool D Overflow cesspool �l Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) El Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to bo obtained from system owner)and a copy oflatest inspection of the |64 system by system operator under contract Tight tank- Attach a copy cf the DEPapproval. El Other(describe): �=.,=, Title 5 Official inspection Form:Subsurface Sewage Disposal System'Page omn � 0N Commonwealth of Massachusetts _ Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •'° 10 Hitching post In Property Address Juan Marichal Owner -_— — ----------- - Owner's Name information is Centerville _ _ _ma 02632 11/7/2014 required for every � — ---��----........-------.---_-- page. CityrFown State Zip Code Date of Inspection ---------------- —. D. System Information (cost.) Approximate age of all components, date installed (if known) and source of information: 28 years Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 18"s 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.): No evidance of the tank leaking_Concrete baffles are in place. Septic Tank (locate on site plan): Depth below grade: 1 ft feet _._..... Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gallon Sludge depth: 3"s Isms•3113 Ti!ie.5 Official Inspection Form:suosurtace Sewage Disposal System•Page 9 of 1 i Commonwealth of Massachusetts Titte .5 Official Inspection Form Subsurface sewage Disposal System Form -Not for Voluntary Assessments .10 Hitching post In Property Address Juan Marichal Owner ------ Owner's Name information is Centerville ma 02632 11/7/2014 required for every _ -- __-----____-- page. City/Town State Lip Code Date of Inspection D. System Information (cost.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 24"s Scum thickness 3"s Distance from top of scum,to top of outlet tee or baffle 42 s Distance from botto.n of scum to bottom of outlet tee or baffle "Sludge stick How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Baffles are in_place. Tank is at normal level. Grease Trap (locate on site plan): Depth below grade: NA feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: -- -- -- Scum thickness ---- ----- Distance from top of scum to top of outlet tee or baffle - ------------- Distance from bottom of scum to bottom of outlet tee or baffle -- Date of last pumping: ------------------_--- - Date t5ins•3/13 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts - Title 5 Official Inspection Form x Subsurface Sewage Disposal System Form Not for Voluntary Assessments 10 Hitching post In Property Address Juan Marichal Owner Owner's Name information is required for every Centerville ma- 02632 11/7/2014 --- ----- -- _ --- -- - -- — --- _----_ 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.): Levels are normal. Baffles are idace -- -- --- - — ....-- .-...--- --------------- -- Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: — - --- -- Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: - Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach Copy of Current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 i of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Hitching post In --- - ---------. -- Property Address Juan Marichal Owner Owner's Name ------------- -- -- ----- --------__ information is Centerville ma 02632 11/7/2014 required for every _ -- -----------.----- ---- ---- -- ------ page, CityrFown State — Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No Dbox 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.): ----------- -- 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.): 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•313 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 10 Hitching post in _ Property Address Juan Marichal _ _ _ _ _.._-- -- .---- -- ----------------— Owner Owner's Name information is Centerville ma 02632 1117/2014 required for every --- — ---- -- -- -- --------------- page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: 1 6x8 ® leaching pits number: — ❑ 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.): staininginside�t indicate the level has not been over the half full mark. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration - — - - Depth -top of liquid to inlet invert - "— Depth of solids layer — ---- —..-.._ Depth of scum layer Dimensions of cesspool Materials of construction ---- — - Indication of groundwater inflow ❑ Yes ❑ No 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts - -W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Ko 10 Hitching post In — G'1A/ SV Property Address Juan Marichal Owner. O ---i.-- -- wner's Name — information is Centerville ma 02632 11/7/2014 required for every _ .__ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No break out or ponding.. Privy (locate on site plan): Materials of construction: -- - - - —----- Dimensions -------- Depth of solids --- ---- - --- - Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): — -- ...-....._------........................— — -----......--- — -- t5ins•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal Systam•Pago 14 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �29' 10 Hitching post I —-- - -- - --- ----- Property Address Juan Marichai Owner Owner's Name information is Centerville ma 02632 11/7/2014 required for every _-_-_ — _-. - -- 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 i a a 1 I L I I I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Hitching post In Property Address Juan Marichal Owner ---- ------ --------- Owner's Name information is required for every Centerville ma 02632 11/7/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 15 +ff feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: - -- — —-- Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation.- Hand augered down five ft inside dry leach pit. NGWE 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 o117 Commonwealth of Massachusetts I - - Title 5 Official Inspection Form F, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e �< y 10 Hitchinq post In Property Address. Juan Marichai Owner --------------------- Owner's Name information is Centerville ma 02632 11/7/2014 required for every .- 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 1 r Inspection Form Agency Name,Address, Phone SSC 105 CMR 410.000: Chapter II, Minimum Standards of Fitness for Human Habitation Date May 1,2014 Time 2:30 pm #Occupants NA # Children< 6 Years Address 10 Hitching Post Lane Unit# City/Town Centerville Occupant Name NA Phone#NA Owner Name Harold L.Adams Phone# Owner Address 66 Howe Street City/Town Framingham, MA Zip 01701 #Dwelling/Rooming Units in Dwelling #Stories Floor Level of Unit #Sleeping Rooms 4 per Assessing Office #Habitable Rooms(.400) Inspector Timothy B.O'Connell, R.S. Title Health Inspector If violations are observed and checked,describe them fully on Page 3. Area or Type of Violation Possible Code ✓if Responsible Party Element Use blank boxes for ones not listed Section(s) Violation Observed Owner Occupant. Exterior,Yard Locks 480 x x & Porch Posting, ID, Exit signs/emergency lights 481,483,484 Handrails,steps, doors windows, roof 500,501,503 X x Rubbish—storage and collection 600,601 Maintenance of Area 602 x x Common Light,windows 253,254,501 NA Areas& Entry Egress 450,451,452 NA Handrails 503 x x Interior Halls Floors,walls ceilings 500 Not known &Stairs Hallways, railings,stairs S03 Not known Light,windows 253,254,501 Not known Bedroom 1 Location(circle): Front Rear Middle Left Middle Right Floor Level of Unit Ventilation 280 Not known Ceiling height 401,402 Not known Windows,screen 501,551 x x Bedroom 2 Location(circle): Front Rear Middle Left Middle Right Floor Level of Unit Ventilation 280 Not known Ceiling height 401,402 Not known Windows,screen 501,551 x X Bathroom Toilet,sink, shower,tub,door 150 Not known Smooth, impervious surfaces 150 Not known Lights, outlets,ventilations 251,280 Not known Floors/walls 504 Not known Kitchen Sink,stove,oven;good repair, impervious and smooth, 100 Not known space refrig Rev. 5-6-10 Page 1 of Area or Type of Violation Possible Code ✓if Responsible Party Element Use blank boxes for ones not listed Section(s) Violation Observed Owner Occupant Lights,outlets,ventilation,windows,screens 251,280,501,551 Not known Kitchen,cont. Ceiling height 401,402 Not known Floor 504 Not known Living room Lights, outlets,ventilation 250,280 Not known and Dining Ceiling height 401,402 Not known Room Windows/screens 501,551 x x Basement Maintenance 500 Not known Watertight 500 x x Lighting 253 Not known Water Source(circle): Public(x) Private Must be potable 180 Quantity, pressure 180 Not known Responsible for paying MGL ch 186 s 22, metering 354 Not known Hot Water Fuel Type(circle): Natural Gas Oil Electric Other Temp.: Of Location taken: Quantity, pressure, 110 F min, 130 max 190 Not known Venting 202 Not known Heating Type(circle): Forced Hot Water Forced Hot Air Steam Electric No portable units 200 NA "Habitable room and every room with toilet,shower,tub" 201 • 68F7amto11 pm, 64F11:01pmto6:59am, x x except6/15-9/15 • 78 F max in heating season/measure 5 feet wall,5 x x feet floor Venting, metering 202,354,355 Not known Electrical Type(circle): 110 220 Amp: Amperage,temporary wiring, metering 250,255,256,354 x x Drainage, Type(circle): Public Private Plumbing Sanitary drainage required and maintained 300,351 Smoke&CO Required &operational 482 Not known Detectors Pests Free of pests(rodents,skunks,cockroaches, insects) 550 Not known Structural maintenance and elimination of harborage 550 x x Asbestos or 353,502 Not known Lead Paint Curtailment 620 Access 810 Other Rev. 5-6-10 Page 2 of Referral: ❑ Electric ❑ Fire ❑ Plumbing ❑ Building ❑ Other This inspection report is signed and certified under the pains and penalties of perjury. Inspector Signature Occupant or Occupant's Representative Signature Reinspection Date Time Written description of any violation(s)checked above Include Area or Element, code citation and a description of the condition(s)that constitute the violation. You may include remedies that would be an acceptable means of achieving compliance with 105 CMR 410.000. NOTE: *indicates that this housing inspection has revealed conditions which may endanger or materially impair the health, safety, and well-being of any person(s) occupying the premises Area/Element, Code Citation and Description of Violation Acceptable Remedies Gas service and electrical service disconnected. Oil fill pipes are not present therefore heating system must not be working. (i.e. no energy source) Dwelling not secure from unlawful entry. Due to multiple broken windows and open back door. Deck located at the back of dwelling in disrepair. Missing boards, missing steps, incorrect railing system. Large holes observed in the siding located at the back of dwelling. Missing gable vents. Many missing screen and screen doors. Dwelling not rodent proof. Rev. 5-6-10 Page 3 of To: Scali, Richard Cc: Anderson, Robin Subject: Hitching Post Lane/State Sanitary Code Violations Attached please see the report from Health Inspector Timothy O'Connell R.S. -----Original Message----- From: O'Connell,Timothy Sent: Thursday, May 01, 2014 4:18 PM To: McKean,Thomas Subject: << File: model-housing-inspection-report-form.doc>> Timothy B O'Connell, R.S Health Inspector Town of Barnstable 200 Main Street Hyannis, MA 02601 (508)862-4646 Email: timothy.oconnelI@town.barnstable.ma.us 2 Scali, Richard From: Weil, Ruth Sent: Tuesday, August 05, 2014 10:55 AM To: Scali, Richard Cc: McKean, Thomas; Anderson, Robin; Perry, Tom; Daniel A. Less Esq. (Daniel.Less@state.ma.us) Subject: RE: 10 Hitching Post Lane/ State Sanitary Code Violations Dear Richard: Assistant Attorney General, Daniel Less, has filed a complaint in the Barnstable Superior Court asking that a receiver be appointed in order to bring the property located at 10 Hitching Post Road, Centerville in compliance with the State Sanitary Code. That hearing is scheduled for Friday, August 22nd at 9 a.m. Dan has requested that the individual who can testify to the State Sanitary Code violations should be at the hearing. (Because this is a new type of action for the Barnstable District Court, Dan is unsure whether testimony will be necessary but wants to be prepared if the Judge wants to hear testimony). Once you have identified the individual who is most knowledgeable on the subject, Mr. Less will contact that individual to review his/her testimony. Thanks for your help. Best, Ruth Ruth J. Weil Town Attorney Town of Barnstable 367 Main Street Hyannis, MA 02601 508-862-4620 (telephone) 508-862-4724 (fax) The information contained in this electronic transmission ("e-mail"), including any attachment (the "Information"), may be confidential or otherwise exempt from disclosure. It is for the addressee only. This Information may be privileged and confidential attorney work-product or a privileged and confidential attorney-client communication. The Information may also be deliberative and pre- decisional in nature. As such, it is for internal use only. The Information may not be disclosed without the prior written consent of the Town Attorney's Office of the Town of Barnstable. If you have received this e-mail by mistake, please notify the sender and delete it from your system. Please.do not copy or forward it. Thank you for your cooperation. -----Original Message----- From: Scali, Richard Sent: Thursday, May 01, 2014 4:40 PM To: Weil, Ruth Cc: McKean, Thomas; Anderson, Robin Subject: FW: Hitching Post Lane/ State Sanitary Code Violations Ruth: Here is a partial report from the Health Dept done today. Building will be going out there tomorrow afternoon and will report further from their point of view. Richard -----Original Message----- From: McKean,Thomas Sent: Thursday, May 01, 2014 4:30 PM 1 �+ ORM30 HOBBS&WARREN,INC. THE COMMONWEALTH OF MASS ACHUSETTS 7 O DOFH A T / a CIT /T WN ' q ES e U a ' ADDRESS c 2 p �, ��/� ��TF� H NE ' li ' l 1� 1 vT� S" p �(s a Address ccu an floor Apartment No: No."of Occup t No.of Habitable*Rooms No.Sleeping'Rooms No.dwelling or rooming units No.Stories ,.� AIM9 4 /r Name and address of owner 6 Remarks Reg. Vlo. jf YARD Out Bld s.: Fences: 11 ry Garbage and Rubbish 0/70I Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: EIBDF ❑ M Doors,Win ow : MT- Roof Gutters, rains: Walls: Foundation:Chimney: - BASEMENT Gen.Sanitation: Dampness: p Stairs: Li htin : STRU URE INT. Hall,Stairway: Obst'n.: JA Hall, Floor,Wal Ceilin' : � Hall Lighting: Hall Windows: HEATING Chimneys: l Central ❑ Y ❑ N Equip. Repair Q l� TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vents : ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 —Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: - Gen."Basement Wirins 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, FI s,Ve ts, afetie 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 ISIA CONDITION WHICH 'MAYwMATERIALLY IMPAIR THE HEALTH OR SAFETY MD-WELL—BEING-OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF-THE -CODE-OR THE AUTHORIZED INSPECTOR.(See Over)` "THIS INS CTION REPORT, IGNED AND CERTIFIED UNDER THE PAINS AND PENALTI S PERJURY." s INSPECTOR E. o, A.M DATE TIME = P. A.M. THE NEXT SCHEDULED REINSPECTION P.M. I THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) DATA 410.750: Conditions 'Deemed to Endanger or Impaii-Realth 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 these 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 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential..to fall within this .category in any given situation but may not ' .do so in. every*case•.and therefore cannot be included-in this listing. O Failure to include shall in no way be, construed as.a determination that other violations may not be foundVtohfall within this category. Nor shall failure ,.to include affect the duty of�the local health official to order repair or 1 correction off Oeie df`ftation(s) pursuant to`410 Clot 4104830 through 410.833 nor shall it affect tte legalobligation' of the�peraon;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) Shut-off and/or failure to restore electricity or gas. (D). - Failure to supply the electrical facilities required by 105 CMR 410.250(B); 410.251(A), 410.253(A), 410.253(B) and the lighting in common area required by 105.CMR 410.254. , f . '(Z) Failure to provide a safe supply-of water. (F) Failure to provide a toilet and maintain a sewage system-in operable condition as required by 105 CMR 410.150(A)(1) and 410.300. = (G) .Failure to provide adequate.,.exiCM for the obstruction of any exit, pessageway,or common area caused1by an object, including garbage or trash, which prevents egress in'case� of an emergency 105 CMR 410.450 and 410.451. ' y 01) Failure to comply with the security-requirements of 105 CMR 4170.480(D). (I). Failure to comply with-any provisions of 105 CMR 410.600 .through 410.602 =..Alch:results in.any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects for other pests or otherwise contribute to accidents or to the creation or ,-:spread of disease. ` (J) The presence of lead-based paint on a dwelling or dwelling unit in .volation'of=the Massachusetts Department of Public Health Regualtions for Lead Poisoning Prevention and.Control 105 CMR 460.000. :(Bj '.Soof, "foundation, or other structural defects that may expose the Occupant or. anyone else to fire, .burns, shock, accident or, other dangers or fapaste nt to health -or difety. . • �L) Failure to install electrical, plumbing, heating and gas-burning "facilities in accordance with accepted-plumbing, heating, gas-fitting and alectrical wiring standards or failure to maintain such facilities as ore required by 105 CMR 410.351 and 410.352 so as to expose the occupant of anyone else to fire, burns, shock, accident or other danger or impairment =`to. health or safety. (tQ - Any of-the following conditions which remain uncorrected for a period e of five of more days following- the notice to or-knowledge of the owner + of said' condition or conditions: 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 operable. (2) - failure to provide a washbasin and a shower or bathtub as required ' -in,105-CMR- 410.-150"(A)(2) and�4IQJ_50(A)_(3)_andsan_v_defar—r-whAr+- 11yaUS AIndad + #"-0L'T£$' saa,i Tsgo1 :.c_09`9T$.:TaAVJ!' c 00'Tb"H�3d '`00'£b .gsa44V "06'Ot a�ue,CaeuoOaK;00'OT$ a�tn:zag'~:saa3 --,VK; `KVHOHIYIF94 -_`132[919"3MOH"99- * I"Q'IOHdH' -_•,cSInIE�QH`30' apogs.... o�austcI- Tsnsn pus 4SpT agq--ge-Su-CAR 6T,Xq-I zauueu- ' �uueoTTo aq�'.ui *uotq�s `stgq_UT_ZI�ZZ -QPI{d'SHObIIniRS ak 3o �do� pagsaq s ^-pus an.zq~-s::pan.zas' I'-ms0€:TI qs 16/101£0` uo 'gegq-,u.zngaj-pup ' a3xs ss 'xesaWN z " 0 L L E-F,L9 • L OL L 0 dW`wey6uivaead 0 LN xo8.0•d• luampedea 9,111JayS RlunoO xesalppiw X3�� ' T"ET°�o The Town of Barnstable s, gT,ffi ; Department of Health, Safety and Environmental Services MM& 101 9�,�� Public Health Division 367 Main Street,Hyannis,MA 02601 Office 508-790-6265 Thomas A.McKean FAX 508-775-3344 Director of Public Health January 16, 1997 Harold L. Adams 66 Howe Street Framingham, MA 01701 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE H, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 10 Hitching Post Lane, Centerville was inspected on January 15,1997 by Donna Miorandi, Health Inspector for the Town of Barnstable because of a complaint. The following violations of the Town of Barnstable Rental Ordinance Article 51 and the State Sanitary Code were observed: 410.500: The roof is in disrepair. It is leaking and has caused the living room ceiling to fall in. 410.352(B): The bathroom floor tiles are missing exposing subfloor to moisture, thereby causing weak floor around tub. 410.352(A): The refrigerator leaks water onto floor. 410.500: Missing top stair of bulkhead. You are directed to correct the above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall.constitute a separate violation. cd/dm/q You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH Oa,& Thomas A. McKean Director of Public Health cd/dm/q f r NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00. STATE SANITARY CODE II. MINIMUM STANDARDS OF FTTNESS`FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE ARTICLE 51 d o � o /Qproperty owned by you located at 1®� inspected on by .�[ NPVA ATO4�/�Health Agent for t Town of Barnstable because of a complaint. The following violations of the Town of Barnstable Rental Ordinance Article 51 and the Sanitary Code II were observed: 8 a o 0 Soo 300 led a t D r g b.r`�'M S �• CC' a ' �® 35X k k k «y You are directed to correct the violation of within 24 hours of receipt of this notice by You Are also directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40:OO for'the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. Enclosed are citation numbers due to violations observed on PER ORDER OF THE BOARD OF HEALTH r. Thomas A. McKean Director of Public Health Town of Barnstable k Y y 1�Y fti 1 � • J h . ''`eft 5�{ S`• t Of FORM30 HOBBs&WARREN,INC. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �o I Or 4APj ��A L-E cirviTowN I IT W DEPARTMENT ADDRESS L c �� Tj ELEPHO . V/LJELEP Address B� �!I�NI�IC' PU�i ll �- A Occupant /�(1I>O2/F� Floor Apartment No. No.of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No.Stories //,� �p Name and address of owner AA s �� r � - S I®. Remarks Reg. vlo. /) YARD Out Bld s.: Fences: /y Garbage and Rubbish �� ®� Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Wind Roof do 1)/ I k .— -J-ry Gutters,'Drains: _ - ' Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: � 6 r _�, n Stairs: ,-Ind 1,111 ( IF P5!/1 Liqhting. STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,wali;,ceilin : Hall Lighting: Hall Windows: '/7-154)/�, 0M v HEATING Chimneys: (W ('Gli in1�C Central El ❑ N E ui . Repair r _ 1CT�1 ' "�� j _ I Wr TYPE: Stacks, Flues,Vents: PLUMBING: Su ply 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 bAri•4rW1 n- -I' Q-)t L a /1)51 W - Xx , n Pantry Den - - — Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents;Safetie%_ Kitchen Facilities Sink Stove _ .. I .. 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 REPORTS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." o INSPECTOR ° YI•TLE &Ai V1 �. DATE I I TIME / ' P.M. ' A �� A.M. THE NEXT SCHEDULED REINSPECTION P.M. l 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 these 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 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential to fall within this category in any given situation but may not do so in every case and therefore cannot be included-in this listing. Failure to include shall in no way be construed as.a determination that other violations 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 'dif the")violation(s) pursuant to�410 CMR 410..830 through 410.833 nor shall it 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) Shut-off and/or failure to restore electricity or gas. (D) . Failure to supply the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253(A), 410.253(B) and the lighting in common area required by 105 CMR 410.254. (B) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage system in operable condition as required by 105 CMR 410.150(A)(1) and 410.300. (G). ,Failure to provide adequate exit-, 6or the obstruction of any exit, passageway or common area caused by an object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450 and 410.451. (R) ' Failure to comply with the security requirements of 105 CMR 41'0.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.6.02 -_'t&:Lch results in any accumulation of garbage, 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 lead-based paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regualtions for Lead Poisoning Prevention.and Control 105 CMR 460.000. (�) hoof, 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 dafety. (L) Failure to install electrical, plumbing, heating and gas-burning iacilittas in accordance with accepted .plumbing, heating, gas-fitting and electrical wiring standards 'or failure to maintain such facilities as age required by 105 CMR 4i0.351 and 410.352 so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment health 'or safety. (K) 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: ($) ' 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 operable. (2) failure to provide a washbasin and a shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3) and any defect which renders them inoperable. Q) any defect in the electrical, plumbing, or heating system which makes such.system or any part thereof in violation of generally accepted plumbing heating,• gae-fitting, or electrical wiring.standards that do not create an immediate hazard. .0)_ 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 05 CMR 410.550. (M) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A) through (M) shall be deemed to be a condition which may endanger or materially i�poir the health or safety and well-being of an occupant upon the failure of the ocmer to remedq said condition within.the time co ordered by the board of health. r No..1.�--• .... FER .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - (34 of— ......O F...... ._ --------------------- ApphrFatiuu for Bhipviitt1 Marko Tonotrurtioaa Pprauit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal system --.-.• - . ...--_- - y Locat' n-Ad dress / [ • Lot No 1-ner Address Installer Address / / Type of Building Size Lot__ ( /,.?_-�___Sq. feet a Dwelling No. of Bedrooms--•-•--•--•--•••_____________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________•__-_:•••--•-•-- No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ---------- W Design Flow. .............. -__ a lions per person per day. Total daily flow....__...�._;I.. ------------------gallons. WSeptic Tank Liquid capacit .-._.__ llons Length................ Width---------------- Diameter---------------- Depth_______--------- Disposal Trench—No. .................... Wid h_________ dotal Length____________________ Total leaching area____.._....____.____sq. ft. Seepage Pit No._-.f-------------- DiameterLTepth-below inlet.................... Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_______________--__-_. f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water___________-_-_-_____._. 9 ................... --------- ................ ----- oDescription of Soil...... _ •• •-- -A._G � • 0. ------------------=------------------------------------------------------- •••-- Nature of Re airs or Alterations—Answer when applicable U P PP +® -- -••-........-••--- -------- ------------- ----------------------•------------------------------------------------------------------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage.Disposal System in accordance with the provisions of Article 1I of the State Sanitary Co e— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been sue y t b h i Date Application Approved BY X./ 1 7.3------------ Date Application Disapproved for the following reasons: --------------------------------------------------------------------------••-- -••--•••••••---•••••-•••-•••----------------------•----------••-•---------••-•---••••----•-•••-•••-•-------•--••--•--------•--•-•••••-•-•-------•-••--•--------....---------------------------------•-•. O •- � . Date Permit No.- ..3-2.....•---- Issued---- ----•- '1 ate �J , No.: •.31-- ---- r; THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF ,,HEALTH d w>. n sir t Appliratiou for Biiipasal Works, To'witrurtion lirrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at t` V r Locatr n-Address 'ma' s '8e Lot No ! _ -- - . ................................ or W Ef Installer Address U Type of.Building Size Lot.-i_�s; - +_Z.S . feet . q a—. DwellingN.o. of Bedrooms- -----------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther— ype of Building ----___--------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------------------•--•-----------------.--.- ............. Design Flow_______________ r allons per person per day. Total daily flow---------- W Sept�,q '' ,, a;«iq r cit *� Length - - - Depth -gallon~. x D sposalT encl;1 NoaY1tr.zaUidthns Len y' Total Length idth------------- Total leaching area-:De nh-_._._sq. fi. Seepage Pit No..... .............. Diameter/,�.��.. elow inlet..............._---- Total leaching area------------------sq. ft. z Other Distribution•box ( ) `Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit-------.-__-•__-____ Depth to ground water..------_-_--_-__-.--_- r3, Test Pit No. 2----------------minutes per inch Depth of "Pest Pit-_--_-_-----_-____ Depth to ground water-_------_--:--._--.----. a --•----•--•----------------------------------- --•----•-------------•---------------------•--........................................................ 0 Description of Soil------. .................... ---------------------------------------------------------------------------------------------------------- U .----------••••••---------------•--.....---•--------••••--•••-•--------------------•----......---•--------------•••-----------••••--------•--••--•-----------•-••--•-----............................... W 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 Article XI of the State Sanitary Code—The imdersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu 1, e board f he th. Signed.--.... . -. D t ate Application Approved By----- ---- �, ------------------ • Date Application Disapproved for t a lowing ye¢sons_____________...._.............._______r ..._____:.._....._..-__--__-_-_-_ /, �_ •--•-----•---••---•-----------•-------------------•----•----------.a..------------------------.........................................................................-------------- --------------- Date, PermitNo.•;... 7-------•-••------------------------•-- Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS a .� BOARD OF HEALTH . -J THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( for Repaired ( ) f Installer fir! r ti +. " n 77 has been installed in accordance with the provisions of Article XI of The�State Sanitary Code as described in the application for Disposal Works Construction Permit No..... _ .777................... dated---_ ---------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARAN$WTHAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE_-4t, r ............. Inspector------------------------------------------------------------------- ....----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH g9 �.�. s ^ .._._ 3 7.,r w w/7 o..,fir', y .... FEE-"--``-•=----•-----`f-._..... Permission is'hereby granted*..,,,.*Q-b€,A!TR. J 4 fJ{ .............. ---- --- ...................................... to Construct ( ,•or Repair, ( )..an Individual Sewage Disposal System P at No................ ,._ a ,� r I, Street as shown on the application for Disposal Works Construction Permit No.�A;,'_ __ -_ ' Dated-_--:' 't `' ,••. --------- ---------------------- -- ............. oar of Health DATE..... 1}_ ,e•.__ . FORM 1255 HOBBS & WARREN, INC P,,,iJ'F