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0019 LONGBOAT DRIVE - Health
19 Longboat Drive Centerville P A = 193 156 olb UPC 12534No.2-153LOR HASTINGS, CNN ,) I I SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. a re item 4 if Restricted Delivery is desired. Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. Received by( Printed Narne), C. Date of Delivery ■ Attach this card to the back of the mailpiece, 5'Z� 1 /(a-t- or on'#the front if space permits. V D. is delivery address �1? ❑Yes 1. Articie,Addressed to: ❑No If YES,enter deliv A. r9� a- ,John & Jason Viola P.O. Box 389 3. Servi Type sAr...� Centerville, MA. 02632 0�red Mail ressM I ❑Registered ❑Return Receipt for Merchandise ❑Insured Mall ❑C.O.D. 4. Restricted Delivery?(Extra Fee) 0 Yes 2. Article Number ; 7005 1160';00001 0190 97481 (Transfer from service labeo " FPS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE FYa-;GLqss Mail ......... 3ge Fees1aid epost '! • Sender: Please print your name, addre's"s,' P l.-+'4! -.-4f`i'this Town of Barnstable Health Department 200 Main Street Hyannis, MA. 02601 , III.Ind thil,'111,111111111 1111 1JI111 Ili!III I IdIj i I 1111A J TOWN OFBARNSTABLE v }' LOCATION SEWAGE# 2poq--®S 2. VILLAGE �,���e,��, ASSESSOR'S MAP&PARCEL 03 INSTALLER'S NAME&PHONE NO. SCE�76-`7003 SEPTIC TANK CAPACITY 1000 gjj.. y PAS o I.w• �I. ,,.�.t LEACHING FACILITY:(type) b ;�, s�®; (size) NO.OF BEDROOMS OWNER `/od�� Assou��cs PERMIT DATE: I/I /09 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 BYl .:�/ [�!� r A9 7-5' g► ZG' AFWIJT OF IAOUS�5 Ai Ze;' g2 3o6 AN z9 j,, fay 5 °� A5 394 95 33 01 � g6 SZ° 02 A8 33` 68 Z9' �9 tip' 6 3 O VFWT 4 O ZtiSDbCT loN po&� .—. — — D-Sox 7 Cl I 1 FOR MAIL-IN REQUESTS Please mail the completed application form to the address below. Also, please include the required fee amount(see fees at bottom of this page). Make check payable to: Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 1 200 Main Street Hyannis,MA 02601 To get a rental registration application form, click here. To be able to access this form,your computer must have Acrobat Reader. Most computers have Acrobat Reader,and it will usually activate itself automatically. If your computer does not have Acrobat Reader,you can download a copy of it by going to the Adobe website. • FEES Fee: $90.00 Per Unit plus $25 for each additional rental unit on the same property, with the same owner. For further assistance on any item above, call (508) 862-4644 • Town of Barnstable OFZME T Regulatory Services Barn do Thomas F. Geiler, Director ;mericaCity Public Health Division III BARNSTABLE, MASS. Thomas McKean, Director 2�Q7 039. A`0 200 Main Street ED Mpl Hyannis, MA 02601 Office: 508-862-4644. Fax: 508-790-6304 September 7, 2010 John& Jason Viola 2167 Falmouth Road Centerville, MA. 02632 RE: Assessors (map-parcel) 193-156 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register in accordance with Chapter 170 of the Town of Barnstable Code with the Town of Barnstable Health Division. According to our records, you own the rental property at 19 Longboat Drive, Centerville, MA. 02632. Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at www.town.barnstable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2010 fees included. Please contact me to schedule inspection of the property as soon as possible. If there are tenants presently occupying the property please provide the contact information being sure to include a daytime phone number for all tenants. For your use an occupant's permission form has been included to allow for inspections to be performed in the tenant's absence. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of $100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4072. Thank you in advance for your cooperation. Teresa Wright Division Assistant Health Division Direct#508-862-4072 got ,';'Tealth Master Detail' Page 1 of 1 YHealth Master Logged In As: TOWN\wrightt Health Muster Detail Tuesday, Septem Application Center Parcel.Lookup Parcel Septic Perc Well Fuel Tank Parcel: 193-156 Location: 19 LONGBOAT DRIVE, CENTERVILLE Owner: VIOLA, JOHN T &JASON Business name:j Business phone: Rental property: F—i Deed restricted: 5 Number of bedrooms :' Contaminant released: fJ Fuel storage tank permit: F- Save Parcel Changes Y„!II Return to Lookup Parcel Info Parcel ID: 193-156 Developer lot: LOT 10 Location: 19 LONGBOAT DRIVE .Primary frontage:86 Secondary road: Secondary frontage: Village:CENTERVILLE Fire district:C-O-MM Sewer acct: Road index:0915 193156_1 Asbuilt Septic Scan: 193156 2 Interactive ma ~y p p 1931563 Town zone of contribution:AP (Aquifer Protection Overlay District) State zone of contribution:OUT Owner Info Owner: VIOLA, JOHN T & JASON Co-Owner: Streetl: 2167 FALMOUTH ROAD Street2: City:CENTERVILLE .G g �1 State: MA Zip: 02632 Cc Deed date: 1 14 2009 U r Deed reference:C187754 Land Info Acres: 0.36 Use: Single Fam MDL-01 Zoning: RC Neighborhood: 0 Topography: Below Street Road: Paved Utilities: Public Water,Gas,Septic Location: Construction Info Building NoYear Built Gross Area Living Area Bedrooms Bathrooms 1 1982 2548 1056 3 Bedrooms 2 Full + 1H Buildings value: $112,000.00 Extra features: $15,600.00 Land value: $105,700.00 http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=193156 9/7/2010 UGS.`P,o,!5tal Service,., CERTIFIED MAILTPA RECEIPT (Domestic Mail Only;Noansurance Coverage Provided) For delivery information visit our website at www.usps:conia_,, 1,.. OFFICIAL USE OrP O: r0 1 • • i PS Form 3800June 2002 See Reverse for Instructions Certified Mail Provides:■ A mailing receipt as anaal zooz eunC'ooee w,od Sd e A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ® Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. ® Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece,Retum Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. e 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 e? Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information Is not available on mall addressed to APOs and FPOs. T � --o 5� ao No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Disposal 6pBtem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade(A Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 19 Latj C,.g0p,; D�tV E Owner's Name,Address,and Tel.No. r�zv< 3 eENTe V1 L 0-Lr.32 Assessor's Map/Parcel M PA cE 5 V ooi h �Sdc>ctraTS Installer's Name,Address,and Tel.No. 90, y-tt Designer's Name,Address,and Tel.No.17-we-sr cQo ss Fiat. , dL63`4 En9+nicr,.� I�or�1-� l.t C FeR6sTo LE O2icr� Type of Building: 51N G-LC- F/aa�n�Ly Dwelling No.of Bedrooms 3 Lot Size 1$,00 H sq.ft. Garbage Grinder( ) �►0 Other Type of Building It, No.of Persons Showers( ) Cafeteria( ) Other Fixtures N/'A Design Flow(min.required) 310 gpd Design flow provided 3419 gpd Plan Date -21- �t Number of sheets Revision Date 1y/N Title PRC;oosC� 5e:PTte SYSTEM Vp F_A0e PLpN Size of Septic Tank i000 q allo Type of S.A.S. }o>" Fr FtJJ olasj.a JAS©r-s Description of Soil Nature of Repairs or Alterations(Answer when applicable) s cz 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 Certificate of Compliance has been issued by this Board of Health. Date -( -C, Application Approved t Date 311 Application Disapproved by Date for the following reasons I Permit No. G0 "{��j'a- Date Issued � -- ----------------- - -- - — a,..a..,ti.,,_M,r....-.-..,...,.-,-,�..,•....rA17--,_...•,,...:..,..,-,.�,._.. !"�+...,T.:. ..+n..;v-.i'rw:.w..:Fw.-��..:i;,w•;yi+wyr,.�.,�j1M„F `s w..eee+ Y � ..t,r '^r.v ...... .E .. � . - - —� UGC� ���k {• � e , r, No. _Q J�r3L.,+r«, F^ F_ ` f ems-` Fee Q� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: -,; PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Misposai bpttem Construction permit Application for a PermitN�Construct( ) Repair V) Upgrade OO Abandon( ) ❑Complete System ❑Individual Components Pe ess or Lot No. 19 LaN / Owner's Name Address,and Tel.No. 13oAT• p(l;svt. gor 384 p/Parcel M A NT t.3P,14► &-P-C-E 1 S VIOL.A ASsoc IATZ S o t6 3 Z me,Address,and Tel.No. gox H'LZ Dl:NN,sPoRT Designer's Name,Address,and Tel.No. IZ ueIT c9 o ss FI`�f� -rAKAcIA " Ot63q E,,.g r',� Wo,- !, !`.N� r-alw3TOALE 0Zc44 soa-1176-1003 fr c" TF SOS -'y7'1�S 1 Type of Building: SING-LE PAM iLy Dwelling No.of Bedrooms 3 Lot Size 15,00 y sq.ft. Garbage Grinder( ) N O Other Type of Building NIX No.of Persons Showers( ) Cafeteria( ) Other Fixtures N/p { Design Flow(min.required) 33C5 gpd Design flow provided �y 7,R - gpd, - ' Plan -:.Date •'L1-O 9 Number of sheets 2. Revision Date N/N Title PRoposl:rn Septic. SySTLsM VPCr•Ii)kDt PLAN Size of Septic Tank Iona Type of S.A.S. Fr.4, y,j� „� �' 6 o ns c � usors Description of Soil Nature of Repairs or Alterations(Answer when applicable) ra,tnnse Date last inspected: Agreement: j 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 Certificate of Compliance has been issued by this Board of Health. Date Application Approved y+ Date 3//a Application Disapproved by Date for the following reasons Permit No. r-�,Cy l --c rj'a- Date Issued �- - - - - - - -------------------------------------------------------------------------------------- . (� THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE MASSACHUSETTS 3ll�l Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(X Abandoned( )by r1,LL J T TTo.kaeM. at (9 Log%A 1a0-1 N't w e 61 AeLv (� Q _ has been constructed in accordance p with the provisions of Title 5 and the for Disposal System Construction Permit No.Q00-q-G�jc dated �i�� )C, 7 Installer (�'1,c�.r,� '3- `�a�.L Designer #bedrooms "Z Approved design flow �y"�.�:, gpd The issuance of this pe . it shall not be construed as a guarantee that the sys et'm will tiomas designed. Date .��ZZ6:i Inspe(ct-or �_r-�� -- -------------------------------------------- - - --- - - -- - ------ ---- - - ----- --------. ,. No.r- '"'" pvr� Fee DQ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposai bpstem Construction 3permit Permission is hereby granted to Construct( ) . Repair( ) Upgrade(A Abandon( ) System located at ]9 Lam,,,L nO J br-sk,. Ce..��, ��® MK o-7 C;I Z 4 1 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must a completed within three years of the date of this permit. Date �c�/� Approved by l .....� _bed room _ bed room oil tank ! bath room room. I i ....... ........jI bed room _ bath !I � room bath room NI living room kitchen water-------------------- � meter 3. r� door c:� holler CI I' ele panne) hase � t I t f I®or. Cl DRN Apr 06 09 02:10p EARTH & STONE LLC 5083940872 p.1 03/17/2009 12:42 5064775313 Town of Baran#able ftalstory Services "am"F.Ceder►Director l Pubac Stab Dwkion McKean,I)kc or Thomas no Main Street,Bywwb.MJ►.Owl p": 501-790-6304 ofum -" Duce: 3t Sewage Permi## Aseewr's map lP.dre t (Ylr-C t=ea Pq, ,1+tre �4 ua c i^ An " ax Is�c �l�dgss!s f 2 (J+f� �'rZ�r gad I U Address: ���• �aX Z2 on was issuod a potmit to itlstall a - ' a 1 _ t (installer) t c at t i.a�+e►*+o�4-'��f +t,_ 4 based on a drsip drown by t.W '� t: dated i ced*.thm the septic System refereueed above was iw%Ucd sabetaa+t�r Am to .. {�i, which may inslnde minor approved changes such as Lrteml rt9oeation o the box�o 0r septic rank. IGot& y. that the septic Sys aetn reforeneed above was inaballod with aw�c:r cl g� i.e. get tbo 10,lateral relocation of the SAS or any vertical raloeetion of say component of t mgiic system) but in acewdAnce with State 8t Local Regale ON, Plan ttviaioa or cMW as-built by desWer to fallow. tH of PETER T. �+ McENTEE CD y C-% CIVIL 4 ,Q A1o.35109� � Ess10 AL ECG (ma's sigaatmre) (Aft Doi cam CQtaPU.RM WII�[. *T�` AF IS9phD ilN1'Q..�QTH YH1S FORM Alm �1CAt n'1�T CARD ABE 1 Q.)jM&Wg1pdeDMip W CardfK&dm Porn 3-2&-WA c � /1/' I/ , ( (�, V✓ .�. - i ,...n FORM30 C&w HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BQARD OF Hgr LTH CI tTOWN W -WhOlAk V. gD6P T EN xn ADD S 1-11 M 5y0y`0 1 d r TELEPH E Address 1011 . jy Y _ Occupa _ d�6 �a. '. Floor Ap me o. No.of Occu nts ���Q'� No.of Habitable Rooms No.Sleeping Room_ No. dwelling or rooming units No. tories Name and address of owner_ ( _ V F4 Remarks Reg. Vio.�'),�)!" _ 1 YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage r Infestation Rats or other: MHR Q STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof on n Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 zTqq Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin, Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS I PE REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENAL- I Y " INSPECTO TITLE i® A. DATE TIME D® 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,shali be deemed conditions which may endanger or impai'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-viol ation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued-to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the-ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202' (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254., (E) Failure to provide a safe supply of water. ' (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. t CERTIFIED MAIL. Town of Barnstable, z � l 8 IIARNSTABIE, Public Health Division `e0> 200 Main Street �FDMP'° Hyannis, MA 02601 :>4. 7006 0810 00000 3525 U S. �. y rj a CD N In is, 0 W 1 Y NIXIE: 0.29 5C :L 02 05 r3:L./07 '. RETURN To SMNDER INSUFFICIENT ADDRM&s UNAMLE TO FORWARD SC: 02601400200 *0969-00316--10-40 IIIlltlll ➢ ➢ It➢II(tilt➢IlitIIIII,tlltilllll➢I ll,t➢➢,1„11➢,➢ ' I SENDER: • •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse .X ❑Addressee so that we can return the card to you. B. Received by(Printed Name) T;�� ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes I If YES,enter delivery address below: ❑No ype I ,,�1 3. ice T M ,,, ,kck 104 o�S.S�f XWertified Mail ❑Express Mail I ❑Registered '�2 Retum Receipt for Merchandise ❑Insured Mail.;: ❑C.O.D. 4. Restricted Delivery?Pft Fee) ❑Yes 2. Article Number i (Transfer from service label) 7006 0 810 0 0 0 0 3 5 2 5 0083 PS Form 3811,February 2004 Domestic Return Receipt P 102595-02-M-1540 I t'?'TLt`Y"•. 1.µ Certified Mail#7006 0810 0000 3525 0083 `oFsHE l ti Town of Barnstable Regulatory Services IARNSMABM Thomas F. Geiler, Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Mr. Mark Patrick Daley May 8, 2007 24 Amelia Drive- - Nantucket, MA 02554 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 19 Longboat Drive, Centerville, was partially inspected on May 7, 2007 by David W. Stanton R.S., Health Inspector for the Town of Barnstable because of a complaint. The following violation of the State Sanitary.Code was observed: 105 CMR 410.450: Means.of Egress: Adequate egress was not provided in the two basement bedrooms per the Massachusetts State Building Code. The code-reads specifically: "105 CMR 410.450: Means of Egress: Every dwelling unit, and rooming unit shall have as many means of exit as will allow for the safe passage of all people in accordance with 780 CMR 104.0, 105.1, and 805.0 of the Massachusetts State Building Code." However, it is noted that the correct reference to the Massachusetts State Building Code for egress is 780 CMR 102, 103, and 1010. During the complaint investigation on 5/7/07 the tenants were given verbal notification of an exit order at the end of the investigation by the Building Inspector to immediately vacate the illegal basement bedrooms for sleeping purposes due to lack of adequate egress. The following violation of the Town of Barnstable Code was observed: 170-4 of the Town of Barnstable Code: Owner's Responsibility to Register Rental Unit. The unit is not currently registered with the Town of Barnstable Health Division. You are ordered to correct the violations listed above by immediately ensuring that.no occupants sleep in the two basement bedrooms. You are also ordered to register the rental unit with the Town of Barnstable Health Division within Five (5) days of your receipt of this notice..Furthermore, you are ordered to either bring the bedrooms in the basement up QA Order letters\Housing violations\19 Longboat Drive.doc to code with all necessary building permits or by eliminating the bedrooms in the basement with all necessary building permits within fourteen (14) days of your receipt of this notice. You may request a hearing before the Board of Health if written petition requesting same is received. 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. PER ORDER OF THE BOARD OF HEALTH Donald Desmarais, R.S. Health Inspector Town ofBarnstable Cc: Carol Flaherty, Tenant Tom Perry, Building Commissioner Chief John Farrington, COMM Fire Department Tom Lynch, Director Barnstable Housing Authority QA Order letterMousing violations\19 Longboat Drive.doc ti'i �"<y*i::-F-Jk-.-;�-f-+V.-ti'fi>.+s�%;.:-+y`'+�a`'v1J�:.'!L'y✓`.:Dw�;'`� .wi'14v ;.ys,;yu .:�Lj`�j'iC'�'*�yd�.'s" t�'it-::�`d�"jY �y;^L� ,!''✓r; F;... , TOWN OF BARNSTABLE C. N'1 n B BOARD OF HEALTH — )</4.1 6 l ARTICLE 11:MINIMUM STANDARDS FOR HUMAN HABITATION 7 Date 7 U Owner _ h�o 1_4 Tenant rr,if 0 Address L/ ° �r �rG1t ��. 1' (All 169 Address I Ili (4 � Complionce Remarks or Regulation Yes No Recommendations 2. Kitchen Facilities rf CAM G LC!! 3. Bathroom Facilities ) �/A/ c� lup,r C rjwc!',rci C�A., 4. Water Supply y f 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use � �f �' C/60/11 r�(.A&(c r 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 6 17. Temporary Housing PART II 37. Placarding of Condemned Dwelling; �p� I Removal of Occupants; Demolition Person(s) Interviewed v Carol Inspector A)IV. If Public Building such as Store or Hotel/Motel specify here ' I Certified Mail#7006 0810 0000 3525 0083 Town of Barnstable Regulatory Services sncxscnc ; Thomas F. Geiler,Director MAS& y ` Public Health Division Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Mr. Mark Patrick Daley May 8, 2007 24 Amelia Drive Nantucket, MA 02554 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 19 Longboat Drive, Centerville, was partially inspected on May 7, 2007 by David W. Stanton R.S.,Health Inspector for the Town of Barnstable because of a complaint. The following violation of the State Sanitary Code was observed: 105 CMR 410.450: Means of Egress: Adequate egress was not provided in the two basement bedrooms per the Massachusetts State Building Code. The code reads specifically: "105 CMR 410.450: Means of Egress: Every dwelling unit, and rooming unit shall have as many means of exit as will allow for the safe passage of all people in accordance with 780 CMR 104.0, 105.1, and 805.0 of the Massachusetts State Building Code." However, it is noted that the correct reference to the Massachusetts State Building Code for egress is 780 CMR 102, 103, and 1010. During the complaint investigation on 5/7/07 the tenants were given verbal notification of an exit order at the end of the investigation by the Building Inspector to immediately vacate the illegal basement bedrooms for sleeping purposes due to lack of adequate egress. The following violation of the Town of Barnstable Code was observed: 170-4 of the Town of Barnstable Code: Owner's Responsibility to Register Rental Unit. The unit is not currently registered with the Town of Barnstable Health Division. You are ordered to correct the violations listed above by immediately ensuring that no occupants sleep in the two basement bedrooms. You are also ordered to register the rental unit with the Town of Barnstable Health Division within Five (5) days of your receipt of this notice. Furthermore, you are ordered to either bring the bedrooms in the basement up Q:\Order letterMousing violations\19 Longboat Drive.doc to code with all necessary building permits or by eliminating the bedrooms in the basement with all necessary building permits within fourteen (14) days of your receipt of this notice. You may request a hearing before the Board of Health if written petition requesting same is received. 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. PER ORDER OF THE BOARD OF HEALTH Donald Desmarais, R.S. Health Inspector Town of Barnstable Cc: Carol Flaherty, Tenant Tom Perry, Building Commissioner Chief John Farrington, COMM Fire Department Tom Lynch, Director Barnstable Housing Authority QA Order letters\Housing violations\19 Longboat Drive.doc 1 Jt, I� TOWN OF BARNSTABLE ) BOARD OF HEALTH i ARTICLE I1:MINIMUM STANDARDS FOR HUMAN HABITATION Date o i Owner rnr Tenant CGJ`UI �. Address Address 4 L Complionce Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities �}� 3. Bathroom Facilities bedroomt+ r'ne LN7A Ot 4 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use f QJ 4vm- �dow', k , 1.74 12. Exits bJiJe —NPw ,lard 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal L 17. Temporary Housing PART II I 37. Placarding of Condemned Dwelling; 20 Removal of Occupants; Demolition Person(s) Interviewed C,(6ry .� Inspector If Public Building such as Store or Hotel/Motel specify here I 12 AIN e Logged In As: Parcel i Friday, May 4 2007 Parcel Lookup Parcellnfo Parcel ID,193-156 DeveloLoot l LOT 10 .............. _..... ............. ._ Location 19 LONGBOAT DRIVE Pri Frontage 86 Sec Sec Road - Frontage I- ......_ �.__-. _ ._..... village;CENTERVILLE Fire District IC-O-MM ----_.-_._.__................_ .............-__...._ ...... . Sewer Acct Road Index 10915 Interactive Map ;. I it W9Jk Owner Info Owner DALEY, MARK PATRICK Co-owner Streets 19 LONGBOAT DR Street2 City CENTERVILLE State MA zip 02635 Country USA Land Info Acres 0.36 use Single Fam MDL-01 Zoning ;RC Nghbd 0106 . ._..�� _._ _._... ......._ _ Topography Below Street Road `Paved ...... ...................-............. ....... utilities,Public Water Gas Septic Location Construction Info _._.. ......... ........ ......... __. __ ......... ............... ...... ... ...... Building of Year Roof i .. .. __-._ ______ Ext __.__.. _.- Built _1_982......_.. Struct`Gable/Hip (Clapboard Wall .. Effect Roof"" AC 1280Asph/F GIs/Cmp None Area Cover Type# Style Ranch Int Drywall Bed 3 Bedrooms Wall', ry Rooms Model Residential Int i Hardwood Bath 12 Full + 1 H Floor Rooms r f Heat= Tota l Grade"Average Q 3i IHot Water #6 Rooms Type Rooms ✓ Stories!1 Story Heat Oil Found-iPoured Conc. Fuel ation _ Permit History _........ _ ._ _ .. .... Iissue Daze I Purpose Permit# I Amount I Insp Date I Comments II f Visit History Gate Who Purpose 9/1/2004 12:00:00 AM Paul Talbot Meas/Est 12/21/1999 12:00:00 AM Paul Talbot Meas/Listed 8/28/1998 12:00:00 AM Lloyd Kurtz Sales History Line Sale Date Owner Book/Page Sale Price 1 5/25/2004 DALEY, MARK PATRICK C173123 $310,000 2 2/15/2001 TUCKER, LAURA A C160665 $174,900 3 3/12/1999 THIBODEAU, PETER M & MONIQUE M C152307 $125,000 4 5/15/1996 MYERS, THEODORE J C140763 $97,000 5 10/15/1982 BUFFUM, RICHARD S& BARBARA C89846 $58,000 6 4/15/1982 DUCHESNEY $9,000 - Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2007 $128,700 $15,000 $500 $167,700 $311,900 2 2006 $120,900 $15,000 $500 $171,000 $307,400 3 2005 $115,800 $15,000 $600 $136,400 $267,800 4 2004 $94,100 $15,000 $600 $156,800 $266,500 5 2003 $85,200 $15,000 $600 $45,100 $145,900 6 2002 $85,200 $15,000 $600 $45,100 $145,900 7 2001 $85,200 $15,000 $600 $45,100 $145,900 8 2000 $45,200 $14,400 $0 $30,600 $90,200 9 1999 $45,200 $14,400 $0 $30,600 $90,200 10 1998 $41,500 $14,400 $0 $30,600 $86,500 11 1997 $99,700 $0 $0 $20,400 $120,100 12 1996 $99,700 $0 $0 $20,400 $120,100 13 1995 $99,700 $0 $0 $20,400 $120,100 14 1994 $91,000 $0 $0 $30,600 $121,600 15 1993 $91,000 $0 $0 $30,600 $121,600 16 1992 $103,400 $0 $0 $34,000 $137,400 17 1991 $98,500 $0 $0 $54,400 $152,900 18 1990 $98,500 $0 $0 $54,400 $152,900 19 1989 $98,500 $0 $0 $54,400 $152,900 20 1988 $59,300 $0 $0 $19,500 $78,800 21 1987 $59,300 $0 $0 $19,500 $78,800 22 1986 $59,300 $0 $0 $19,500 $78,800 Photos Stanton, David From: nicole viera[nviera@peoplepc.com] Sent: Wednesday, May 09, 2007 5:54 PM To: Stanton, David Subject: 19 longboat dr, centerville The letter we received today states that the downstairs basement of our home cannot be lived in.I was living in one of the downstairs bedrooms. I am lookin for housing and i need a letter stating that the basement is inhabitable in order to get emergency housing. if you could please have a letter ready by 9 A.M tomorrow morning i can come and pick it up. . Thank You Flaherty/Ocupents 19 Longboat Dr Centerville PeoplePC Online A better way to Internet http://www..peoplepc.com a 1 aU=A .. t0 f o Home I Hein I Sign In =1� Track&Confirm FA Qs "rack & Confirm Search Results Label/Receipt Number:7006 0810 0000 3525 0083 .„-- Status: Unclaimed Track&Coiifirm Your item was returned to the sender on May 29,2007 because it was Enter Label/Receipt Number.not claimed by the addressee. Additional Vainibg �Rera�ta?to uspscoof Rome ........ ......._... oti icaf an Options Track&Confirm by email Get current event information or updates for your item sent to you or others by email POSTAL-INSPECTORS site reap contact us government services jobs National & Premier Accounts Preserving the Trust Copyright v f 999-2004 LISPS.All Rights Reserved.Terms of Use Privacy Policy N , TOWN OF BARNSTABLE "It-'-A-7 joN 9 n cx ©/�7� '�l�f SEWAGE# i"II,LAGE ASSESSOR'S MAP&LOT/M lA INSTALLER'S NAME&PHONE NO. l CApe �5e p 4 r L (�O n s f SEPTIC 'TANK CAPACITY l,0 0a Add LEACHING FACILITY: (type) e2 49�5 '� (size) y a NO.OF BEDROOMS - BUILDER OR OWNER PEF-IITDATE: J(. COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site cr 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=2.o h�- t= -l��v�s� � � No. Fee THE COMMONWEALTH OF MASSACHUSETTS- PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for ;3i.5pozar *pztem Cowaruction Permit Application is hereby made for a Permit to Construct( )or Repair((✓f an On-site Sewage Disposal System at: Location Address orrL Lot ^No. L�� Owner's Nam`e_,Address and Tel.No. 1 Y L60L l n r�L CC�fV�t -,�I tii_ 0 ,, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ____>0 (Sect.V& tky Type of Building: Dwelling No.of Bedrooms 7— Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flower gallons per day. Calculated daily flow —3-31D gallons. Plan Date Number of sheets Revision Date Title Description of Soil mf 5 1 Nature of Repairs or Alterations(Answer when applicable) EK IT_/�7,' rt 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 t ' Board Signed Date Application Approved by Application Disapproved for the following reasons Permit No. �j�o '" 7 Date Issued No. '6 Fee - THE COMMONWEALT l F-MASSACHUSETTS-���, PUBLIC HEALTH DIVISION TOWN O� `'BARNSTABLE} MASSACHUSETTS : . 0(pprication for Migpogal pgtem Construction Permit Application is hereby made for a Permit to Construct( )or Repair(l/ran On-site Sewage Disposal System at: Location Address or Lot No. A Owner's Name,Address and Tel.No. -5, Installeer�'s Name,Address,and Tel.No. Designer's Name,Address and Tel.No. N Type of Building: Dwelling No.of Bedrooms `7 Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 157---"- gallons per day. Calculated daily flow r33,0 gallons. Plan Date Ntimber,of sheets Revision Date Title IN Description of Soil Nature of Repairs or Alterations(Answer when applicable) =:w c,7-A ` +O~-a o -M f::K17 i!2 r- civkn Date last inspected: r 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 b t Board o H Signed Date 3 Application Approved by /Application Disapproved for the following reasons Permit No. 9G 7 3 Date Issued 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that t - ite Sewage Disposal System installed( )or repaired/replaced(✓)on by for J as C, c. rrr�'• has een constructed in accordance with the provisions of"title 5 and the for Disposal System Construction Permit No. 6 2 dated .3 - a -J9 l Use of this system is conditioned on compliance with the provisions set forth below: f Awizv No. `� �J Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Migogar *p'gt`em Construction Permit Permission is hereby granted to to construct( )repair( \�J'an On-site Sewage System located at jCi L,o,�_r, w7" !?=e_ 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: 3 ' �a " ro Approved by CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION I,EItN11-1' (WITHOUT llESWNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated 'rl`',",=c , concerning the property located at IC 5.— Al— iLe"Ll— meets all of the following criteria: • There are no wetlands within 300 rector the proposed septic system • Thcre arc no private wells within 1 SO rector the proposed septic system • The observed groundwater table is 14 reel or greater below the bottom or the leaching facility • There is no increase in flow and/or change In use proposed • There are no variances requested or needed. SIGNED: DATB: �S` LICENSED SEPTIC SYSTEM INSTALLER IN 714E TOWN OF BARNSTABLE NUMBER IAttach a sketch plan or the proposed system. Also irthe licensed Installer posesses a certified plot plan, this plan should be submilledl. �AIV�U� '.� �:, V ��,� �. < < �• ,,, TOWN OF BARNSTABLE LOCATION 1 0% L r m q gngTr paid SEWAGE # VILLAGE -� �ev�0((� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. Dirt() SEPTIC TANK CAPACITY ety S� r _ IO7TU Z011`pA_) LEACHING FACILITYAtype) ,94t-C"�_ PVT (size) SEGO w�( NO. OF BEDROOMS PRIVATE WELL OR BUILDER OR OWNER �ti1'Ul(Jy �6c��-Pik DATE PERMIT ISSUED: a -/ DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �, w LOCATION /D SEWAGE PERMIT NO. VILLA E INSTALLER'S . NAME i ADDRESS acz BUILDER ' OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED / �_�'� k b nl r t ' L 7 Fmc � THE COMMONWEALTH OF MASSACHUSETTS + BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Mipaual Works Tutuitrurtiun Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (___I�an Individual Sewage Disposal System at: ................L T--.............. .....G ....0_ ---•--•-- ...` ......_.. ...... ---•----- Loca ion- or Lot No............. o7e -dress�f ..................................................... [ " 1 Installer Address U Type of Building Size Lot..................... ....... feet Dwelling—No. of Bedrooms... ....................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e� yp of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) � Other fixtures ...... W Design Flow............. ................gallons per person per day. Total daily flow......3-.3. .......................gallons. WSeptic Tank—Liquid*capacity............gallons Length..........:..... Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........L----------- Diameter..../'0......... Depth below inlet...&f........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit........-_.......... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ •------------------------------------------- P Descriptionof Soil...............................................................................................................................•----•-•--------•------•-------•---•---• x U ---•----------•---•-----•---••----------•---------•---------------------•-----------•-----------•----------------•------•---------...--•-----•---------................................................ W x ---------------- --------------------------•----•--------------------------•----------•--------•----------•---------------------•----------•----•---- . ------------------ -------------- U Nature of Repairs or Alterations—Answer when applicable._.._- .i9_____ova__._../U�_..t,I r�:�Iou/ t9---- ------------------------- ........... G P `'���--- a/ ¢.... T -�:w................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a:Certificate of Com be the boar of health. igned ---------- ............. ........................ --- .Cj-� ce h ApplicationApproved BY . .. .---'-- - ------------.............................................................................. ---���2 Z-/�1.2 Date ` Application Disapproved for the following reasons- --------- ------------------ - ------------------- -- ----------------------------- - ----------- --------------- -------------------------------------------------------- ---- ------------- ........................................ Date Permit No. ....... �-:..-'.2.�..-� -- ---- -------- -- Issued .-- � `L�f�.'1.2-r..--------------- Date �u THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Diupuual Works Tunwtrttrtiun Fautit Application is hereby made for a Permit to Construct ( ) or Repair (--' 'an Individual Sewage Disposal System at c� ................1-?. .�'... .........p.r----�J:t'r-C._.--•-----•--•• -•--•----•----- v!r --•-------------..................-------•---•-•--.............-- Locaatiion•Add or or Lot No. YV Owner Address -�-.-• ,.a -- . Installer Address Type of Building Size Lot............................Sq. feet I—. Dwelling—No. of Bedrooms.._.�?...................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildin a YP g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures -----•---------------------------------- W Design Flow__•..._......e-_ .........•......gallons per person per day. Total daily flow........3.._-3.__G0.......................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------.l----------- Diameter...../_0......... Depth below inlet...�........__... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------- ..................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 --------------------------------- --•••-.....-•--••-•••---•••-••-•---•....--•---•--•--------._...-----------------•-••---••••••-----••-••••--•---------.--••- 0 Description of Soil........................................................................................................................................................................ x U .................................•-•-•---••-••---------•--•-•-•--------•-•----•-----••-•-------•--•--------••--••••--------••-•••----••-•••--•-•---•---•-•-•----•....-----••------•••---•--------------- w x ----------- ---------- ----------------------------- ••-•--. ---------•--••--••-•-----•--•-•-•••••----•--•--•------------............----•-....... ---•-•-•-----••--••-•••-••--•-•---........._--•••- U Nature of Repairs or Alterations`{Answer when applicable.______ .4...._O,{i?- -------ba7 ?7__Cd het....Gu/ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued.-by the boar(, of health. > ned �— g /........... .......�----.- -... d %Application Approved By --------------------------- ----------------------------------- ------------------ -- 5. 2 Z//JL..��.Z Dace F Application Disapproved for the following reasons- ---- ------------- ----..............--------------------- ----------------------........------------- --- -------------------- ---- -------- ------------ -------------------- ....--....... --- .--. ----........---- -------- ---- .....----------............ Da[e Permit No. 2 — 2 J-H..................... Issued ..-....... - .. z .�7.2---.. ate .. Dace . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (ger#if rate of Cnomplinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �--� by ....... . L .. -.5 J .f �• ------------------- - ------ ----------------------------------------------- ------------- ----------------------------- ............ Installer <.�— at ................ J.�{.....-.. _-D.it- ------.1 .b--WT -------0_i(1�C ............ ..................................................--------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. r...�9.2��ydated ........ �2� 1 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE'C NSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----------------......................-------------------------------------------------------------- Inspector ....................---. --------..........,------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No. �z .. Zl#" FEE... .............. RaVosal Workii Tunutrudiutt rrndt Permission is hereby granted...... Gl:k . ..LfG______________________ -----................................................. to Construct ( ) or Repair ( -A Individual Sewage Disposal System at No............... ......6.a.e�L! ......-ta G-e-0 T1 ----.--• ••-•--•-•---•-•••-••-•---•-•-••--••-•-••-••-••--•-••••......••--....--•-.---•- Street as shown on the application for Disposal Works Construction Permit.-No z2).y... Dated..___ .7 2/---g Z--- --•-- ----------------------------.. 1�iyr DATE. 2 Z �' Board of Health .....`-' L............. -------------------- FORM 36506 HOBBS Q WARREN.INC.,PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF . HEALTH .ToW?nJ......................OF....75AUx QM:C------ ......... ------------------------•- Apphratinn for ,Diipnii al Worbi Tomitrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal ��System at: • ....-. ::r...�o ..........- enTe u.t1j.Z4. ......=oT-••- ..................... ....O( r La • Address or Lot No. r a.�. �'S.td_.3�.k_. C2.l�i�_.. �. 4.?��1�`1C)�j ......S-o�c�,4a�T.....-...QR i.Qf,...................................... Owner ° / Address Installer Address d Type of Building Size Lot......15�q9.?.,t'......Sq. feet U Dwelling—No. of Bedrooms...... _Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria a Other fixtures _•------------------------------------•---•••---•--- W Design Flow........ --5-5...............gallons per person per day. Total daily flow_._._.__33_�_________________________gallons. WSeptic Tank—Liquid capacityl0_S2d...gallons Length.....I........ Width.....��_________ Diameter________________ Depth__1_____.___- x Disposal Trench—No_ ___________________- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____ ______________ Diameter.......$_......... Depth below inlet.....___.?....... Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank ( Percolation Test Results Performed by Y c,C_e-`-j ---` VU. � P:tlkvrc�� Date__`��lo_�_� a Test Pit No. i______v _minutes per inch Depth of Test Pit____________________ Depth to ground water.lYor•.247!Wp (i Test Pit No. 2................minutes per inch Depth of Test Pit___________-_______- Depth to ground water________________________ P4 --•-------•------------•--••---------------------------------------------------------•------------------------------------•---------•------------------------ 0 Description of Soil--------�,4-t�Sl............................................................----------------------------------•-----------------------------------._........._._•. x W ------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature of Repairs o: Alterations—Answer when applicable----------------------------------------------------------------------------------------------- ... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTL y g g p y of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has be i sued b the b�oaard of alth. Signed.- �. �1 ��•--�� Date Application Approved By........... .r! :.-,/,�� ....................... 7 --••- Y�� ��- ._..-- Date Application Disapproved for the following reasons-------------------------------------------•------___-------------------------------------------------••••------ ---------•---------------------•----•-------------------------------------------------•--------------------•-•••••--•••-----•-•••••---••••----•--------------••••-•-•-----••••---••-••--•----....__.._ Date Permit No... --------------•---------------•-------- Issued Date .J • l_ Ivo. .......... F�$.... .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Allp iration for Mipo Taal Workii Tnnitratrtiun firrmit " Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: q ,. l Ut.J-4�L'-a., Al--- L'... k� 5„tl -- --....t_vT O -•-••--- ..............................•-------------•-------------•---••................-- �cy Lo ' n•Address or Lot No. ....................................... Owner Address AA Installer l Address PQ „+ VType of Building Size Lot......K51Q.9 3......Sq. feet Dwelling—No. of Bedrooms......... ...............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures ..----...--•------------•-----•----- ---- W Design Flow..........- ___a_ _______________gallons per,person per day. Total daily flow__._._._3 .........................gallons. W Septic Tank—Liquid ca acit lnQO=`. gallons Length-----I......._ Width------:_........ Daameter________________ llepth_-'I.......... xDisposal Trench—No. .................... Width..................... Total Length2/................. Total leaching area....................sq. ft. Seepage Pit No----- ..:...... Diameter...... .......... Depth below inlet;k__..___?....... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank '-' Percolation Test Results Performed by....... `f.............. Test Pit No. 1...... _.minutes per inch Depth of.Test Pit .. ............ Depth to ground water_ T_{ QCI� 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..............._........ Ri -•--------------------------•-•--•-•-•-------------•-•---...------------.............--..........---......................................................... DDescription of Soil...........A_.M9....•-•---------------•-----•----.........---•---------------------------••--•------••---•--- x -----•-------------=-------•---------•-------------- .. W UNature of Repairs or Alterations—Answer when applicable................................................................................................ -•----••------------•-----•----•---•-------•---------------•----------------------•-..........-•--•------------•----------------••---------------------•--------------••............................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with t'.�+. the provisions of f^IT �.s, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be' i sued b the board of ealth. Signed..-- ° a ------ -- " Date Application Approved By........... .... • :' _g*....... ------------------'------- Date Application Disapproved for the following reasons_________________________________________________________________________________________________________________ •-------------------•---------------------•--•-------•-••--•_.._..---•-..................................................... PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... TWrtifiratr ,af Tuntplianrr THIS IS TO CERTIFY, That the I ividual Sewage Disposal System constructed ( ) or Repaired ( ) by .. ..............�!.. ► t . --•-.............------•-•••-••-•-•-•-•-----................-••-----••--. -------------------------------------------•--------- } staller 1 at...L�t.. 0......li b.. . 4.T_.`�.V ----�-! .4n�t_"" U t•1_ ..... has been installed in acco�with the provisions of TITLE j of Ae State Sanitary Code as described in the application for Disposal Works Construction Permit No----- "Z"_"_.t-171_____---__- dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................................................s-- )lc tt.�_ Inspector...............................�,_�.1�.-------------.---------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t ......................._OF............................................................................... FEE.. , .......... �i��rar�aal nrk� �nn��ratr�a�n rrnti� •. _ - - --- Permission is hereby granted................... to Construct ( ) or epair ( ) an Individual Sewage Disposal Systpp at No.).bT..4..140.-- 12.J b6_oT-- .... E- d 13_.l t._1 -•. Street j as shown on the application for Disposal Works Con`st uction Permit No..................... Dated______________-____-_-__--________---•____ --------------------------------------------- g rd of Health DATE ------------- "- �{�, 2 11 FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS COMMONWEALTH OF MASSACHUSETTS I q" s EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION 'ye MAP PARCELi 5 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FOR1 ,,, - PART A r CERTIFICATION ZZ t sm Property Address: 119 Z e kp of or (.„ � as eryP Owner's Name: 14 v T�,- e Owner's Address: f 2 //�/�" % y/r� N Date of Inspection: 2 q— o el 111 —j rn Name of Inspector: (please print) / /i a e/ Company Name: ®,f't' ��. � ,S" ,f,f- Mailing Address: /119 GL"-r14 5 . E Nnrw.iG ^4 yzd�ff` Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systenns. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: e/- Zg-1 5/ 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 subinit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how,the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of I 1 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: .l l Date of Inspection: -- Inspection Sun-rfflry: Check A,B,C,D or E J ALWAYS complete all of Section D — A. System Passes: i/I have not found any information which indicates that any of the failure criteria described in 31*0 CMR 15.303 or in 310 CMR 15.304 exist. Anv failure criteria not evaluated are indicated below. Comments: 11 1 T ,L J-)e r 7 /N a:C 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 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. ND explain: 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 tmeven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are.replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more dean 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: L 4"re v ,il Date of Inspection: kg-- 0q -�_ C. Further EVaTtUation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to detennine if the system is failing to protect public health safety or the envirotument. 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 diarsh 2. System will fail unless the Board of HeAth (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 detennine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for colifonn bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and tutrate nitrogen is equal to or less titan 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: % 1.0:4 j o YXydl e Owner: -T`&af Date of Inspection: 41=- Z f ~o-i D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: t 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 suuface 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 i/Liquid depth in cesspool is less than 6"blow invert or available voltune is less than%2 day flow Required pumsping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Z Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is witlun 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%veil. Any portion of a cesspool or privy is within 50 feet of a private water supply,%veil. Any portion of a cesspool or privy is less thin 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _AID_(Yes/No)The system fails.I have detennined 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 detennine 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• You must indicate either"yes"or"no" to each of the followring: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large systems has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D slsall upgrade the system in accordance with 310 CMR 15.304.The systens owner should contact the appropriate regional office of the Department. Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B / CHECKLIST Property Address: v o r Owner: L o Date of Inspection: q- 4F- .-09 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,=kNEftlihe SAS, located on site? _ Were the septic tank inanholes uncovered,opened,and the interior of the tank inspected for the condition baffl of the es or tees,material of constriction,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 detern fined based on: Yes i no �/ Existing infonuation.For example,a plan at the Board of Health. _ Detennined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) 1310 CMR 15.302(3)(b)) Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 19 &a Owner: Date of Inspection: y- 2$ a y 4 FLOW CONDITIONS kt�RESIDENTIA � — Number of bedrooms(design): Number of bedrooms(actual): _ DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): '4/C/O Number of current residents: -)— Does residence have a garbage grinder(yes or no): �v Is laundry on a separate sewage system(yes or no):Ali [if yes separate inspection required] Laundry system inspected(yes or no): ,&d Seasonal use: (yes or no):_Ivo Water meter readings,if available(last 2 years usage(gpd)): Zoo. = 3 —4 Sump pump(yes or no): / Last date of occupancy: vr��N7 COMMERCIA L/IND USTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft.etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part eff the inspection(yes or no): !jp If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM e/ Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) —Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Appro mate age of all comp nests,date installed(if known)and source of infortation: 1`e4o Were sewage odors detected when arriving at the site(yes or no): A u a Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 400 j u D(, , Owner: C z Date of Inspection: q- 2-1- o e/ BUILDING SEWER(locate on site plan) s Depth below grade: �!-. Jf Materials of construction:_cast iron ✓40 PVC_other(explain): Distance from private water supply well or suction line: Z�s✓s. Comments(on condition of joints,venting evidence of leakage,etc.): All gzpao( SEPTIC TANK: locate on site plan) Depth below grade: /�• S Material of construction: ✓oncrete_metal_fiberglass_polyethylene _otlier(explain) If tank is metal list age:_ Is age continued by a Certificate of Compliance(yes or no):_(attach a copy of certificate) p . Dimensions: 1 H S�7 �� 1✓ �' Sludge depth:3 Distance from top of sludge to bottom of outlet tee or baffle: ,3 Scum thickness: 2- " Distance from top of scum to top of outlet tee or baffle: 6 Distance from bottom of scum to bottom of outlet tee or baffle: 1 Z „ How were dimensions determined: f?'1 e 41'V Y,—e4 Continents(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): �eD A�h T r a!� /✓4 GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recontntendations, inlet and outlet tee or baffle condition, stractaual integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Z 7. A v; e Owner:_ �g lr4 X t- er Date of Inspection: V- %-9 - cW a TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of constriction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no)-. Alarm level` Alann in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:__�/(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:./, c: /t �e% w��� �1 �a" �' �/�`'`'� �`'✓ ��'r� 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 or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps aid appurtenances,etc.): Page 9 of i l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: we114 Or. Owner: i a vfc, Date of Inspection: _ m T SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number-. 'L leaching chambers, number: leaching galleries,number: leaching trenches,numuber,length: leaching fields, number, dimensions: overflow cesspool, number: innovative/aiternative system Type/name of technology: Comments(note condition of soil. signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cesspool must be pupped as part of inspection)(locate on site plan) Number and configu n,tion: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of constriction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids.- Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ° Owner: Lavr,; %vdee- Date of Inspection: =V, 2 T-O Y SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells xvithin 100 feet. Lute where public water supply enters the building. AA G'A 2 s Page 11 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 9 LU✓� �� p�; tie � Owner: L al ker Date of Inspection: V_ y g- o'y _ = SITE EXAk--.".- - - Slope Surface water Check cellar Shallow wells Estimated depth to ground water !Z feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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) L11 Accessed USGS database-explain: You must describe how you established the high groundwater elevation: + g , tr lti -- i` 1 war eQ c /- e� l�u�re� df NPR/ 4 1 � , { 7 t • - SEC - ., COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEG PAUL CELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 19 LONG BOAT DR. CENTERVILLE MAP 193 PAR 156 L 10 Name of Owner n/a Address of Owner: TED MYERS Date of Inspection: 1120/99 Name of Inspector:(Please Print)John Graci I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: John Graci Title V Septic Inspection Mailing Address: P.O.Box 2119 TeaTicket,Ma.02636 Telephone Number: (508)664-6813 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes Conditionally Pa ses Needs Further falu ion By the Local Approving Authority Fails Inspector's Signature: a Date:1/23/99 The System Inspector shall bmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS Septic System passes Title V Inspection.All components are structurally sound and functioning properly.The leach pits were 1/2 full at the time of the inspection.Recommend pumping system every two years to prolong the system's usefull life. revised 9/2198 Page 1 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 19 LONG BOAT DR.CENTERVILLE MAP 193 PAR 166 L 10 Owner: n/a Date of Inspection:1/20/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. ND The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. NO Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _ broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced ND The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _ broken pipe(s)are replaced obstruction is removed revised 9/2/9B Page 2 of 11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 19 LONG BOAT DR.CENTERVILLE MAP 193 PAR 166 L 10 Owner: n/a Date of Inspection:1/20/99 C. FURHTER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 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 ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) 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 AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but•50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nLa_(approximation not valid). 3) OTHER n/a revised 9/2/98 Page 3 of 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 19 LONG BOAT DR.CENTERVILLE MAP 193 PAR 156 L 10 Owner: n/a Date of Inspection:1/20/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Wa. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 19 LONG BOAT DR.CENTERVILLE MAP 193 PAR 156 L 10 Owner: n/a Date of Inspection:1/20/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste Flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 19 LONG BOAT DR.CENTERVILLE MAP 193 PAR 166 L 10 Owner: nla Date of Inspection:1/20/99 FLOW CONDITIONS RESIDENTIAL: Design flow:J40 g.p.d./bedroom Number of bedrooms(design): 4 Number of bedrooms(actual):nLa Total DESIGN flow: nLa Number of current residents:I Garbage grinder(yes or no):NQ Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):M Seasonal use(yes or no):DLO Water meter readings,if available(last two year's usage(gpd): Wit Sump Pump(yes or no): NQ Last date of occupancy: nLa COMMERCIAL/INDUSTRIAL Type of establishment: n(a Design flow: nLa gpd(Based on 15.203) Basis of design flow: n& Grease trap present:(yes or no):M Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available:n& Last date of occupancy: n& OTHER: (Describe) Wa Last date of occupancy: nla GENERAL INFORMATION PUMPING RECORDS and source of information: n1a System pumped as part of inspection:(yes or no):NO If yes,volume pumped nLa- gallons Reason for pumping: nta TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: nta APPROXIMATE AGE of all components,date installed(if known)and source of information: Original system installed in 19R2 with a nit installed in 1996 Sewage odors detected when arriving at the site:(yes or no): NQ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 LONG BOAT DR.CENTERVILLE MAP 193 PAR 156 L 10 Owner: n/a Date of Inspection:1/20/99 BUILDING SEWER: (Locate on site plan) Depth below grade: ZLE Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: Town Diameter: nta Comments: (condition of joints,venting,evidence of leakage,etc.) nLa SEPTIC TANK: X (locate on site plan) Depth below grade: n& Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) nta If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NQ Wa Dimensions: L 8'6"H 5'7"W 4'10" Sludge depth: L Distance from top of sludge to bottom of outlet tee or baffle: 3E Scum thickness:1 Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: Jr How dimensions were determined: Measured Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) Septic tank and all components are structurally sound and functioning properly Recommend pumping system every 2 years for main GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) Wa Dimensions: n/a Scum thickness: iVA Distance from top of scum to top of outlet tee or baffle:-WA Distance from bottom of scum to bottom of outlet tee or baffle nla Date of last pumping: nla Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) nta revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 LONG BOAT DR.CENTERVILLE MAP 193 PAR 156 L 10 Owner: n/a Date of Inspection:1/20/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: nla Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) Wit Dimensions: Wa Capacity: Wa gallons Design flow: nla gallons/day Alarm present: NO Alarm level:j3L& Alarm in working order:Yes—No—: NO Date of previous pumping: WA Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n& DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:quid level with bottom of pipe Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) The D-box is structurally sound. PUMP CHAMBER: NO (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) Wa revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 LONG BOAT DR.CENTERVILLE MAP 193 PAR 156 L 10 Owner: n/a Date of Inspection:1120/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: WA Type: leaching pits,number: 2-1000 gallon leach pits leaching chambers,number: -La leaching galleries,number: -a& leaching trenches,number,length: Wa leaching fields,number,dimensions: nLa overflow cesspool,number: Wa Alternative system: n& Name of Technology: _aLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PITS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY THE LEACH PITS WERE 1/2 FULL AT THE TIME OF THE INSPECTION. CESSPOOLS: _ (locate on site plan) Number and configuration: nLa Depth-top of liquid to inlet invert: Wa Depth of solids layer: Wa Depth of scum layer. Wa Dimensions of cesspool: nLa Materials of construction: nta Indication of groundwater: Wa inflow(cesspool must be pumped as part of inspection)Wa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nla PRIVY: _ (locate on site plan) Materials of construction:nLa Dimensions:Wa Depth of solids: nLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nLa revised 912/90 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 LONG BOAT DR.CENTERVILLE MAP 193 PAR 166 L 10 Owner: n/a Date of inspection:1120/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a I� I� A,�a3C TIP3yh a` Atl 3� revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 LONG BOAT DR.CENTERVILLE MAP 193 PAR 166 L 10 Owner: n/a Date of Inspection:1/20/99 NRCS Report name: nLa Soil Type: n(a Typical depth to groundwater: ji& USGS Date website visited: n& Observation Wells checked: NO Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps Checked pumping records Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS f� revised 9/2/98 Page 11 of 11Aw H. ;1 ��FTHE Tp� Town of Barnstable y � Regulatory Services BARNSTABLE, # Thomas F. Geiler,Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 FACSIMILE TRANSMITTAL DATE: May 16,2007 NUMBER OF PAGES INCLUDING COVER: 2 TO: Nicole Viera FROM: Caitie Barrett PHONE: 508-428-0640 PHONE: (508)862-4644 FAX PHONE: 508-778-4648 FAX PHONE: (508)790-6304 cc: ❑ Urgent X For Your Review ❑ Reply ASAP ❑ Please Comment NOTES/COMMENTS: Good Afternoon Nicole, Following is the letter from the Health Department regarding the property at 19 Longboat Drive, Centerville. Caitie Barrett Health Division Rental Program Coordinator #508-862-4072 Direct Line JAFax Covecdoc oft„ETow Town of Barnstable ti Regulatory Services Department + UARNSTABLE, + n 59. Public Health Division -t7 i639• �� AF�0 M a, 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO May 16, 2007 Nicole Viera 19 Longboat Drive Centerville, MA 02632 RE: 19 Longboat Drive, Centerville Dear Nicole: Please be aware that the rental unit located in the basement of 19 Longboat Drive, Centerville has been deemed uninhabitable by the Town of Barnstable Health Department as a result of an inspection performed on May 7, 2007 by Health Inspector David Stanton, R.S. The area may still be used as a living or family room, as well as for storage and laundry purposes, however it is not to be used as a sleeping area for there is not a means of emergency egress. Should you have any questions regarding this,please contact the Health Department. Sincerely, as McKean Public Health Director FAX PHONE:508.771M648 FAX PHONE: (508)790-6304 cc: ❑ Urgent X For Your Review ❑ Reply ASAP ❑ Please Comment NOTES/COMMENTS: Good Afternoon Nicole, Following is the letter from the Health Department regarding the property at 19 Longboat Drive, Centerville. Caitie Barrett Health Division Rental Program Coordinator #508-862-4072 Direct Line J;1Fax Cover-doe NOIi33NNOO 33IWISOd3 ON (b-3 d3MSWU ON (6-3 J,Sna (2-3 -1Id3 3NI-1 W do 9NUH (T-3 Wdd3 d03 NOSE=:3°i ----------------------------------------------------------------------------------------------..... ..._.... ZiZ 'd >10 8b968LL80ST6 X1 AWW3,4 1;'::':3 ---------------------------------------------------------------------------------------------------------------- 351dd l-inS3�3 (dnoaq) SS36GGU NOI ldO 3QO A '-3-T(J Hi-ld3H• dO (IdUGH 33Sd1SWdUg Ill r ( Wd00:2 L002'9T'J,k1W ) iaOd3d l-inS3�1 NOIiuoiNnWWOO ' T 'd C ?I Z ��sTti Town of Barnstable Regulatory Services Department • UARNSTABLL "'ASS i639• Public Health Division �0 AjfO""P�A 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO July 30, 2007 Carol Flaherty 19 Longboat Drive Centerville, MA 02632 RE: Rental Inspection for the Town of Barnstable Code Chapter 170 - Rental Properties. Dear Carol: In accordance with Chapter 170 of the Town of Barnstable Code, we will be conducting an inspection of the rental property located at 19 Longboat Drive, Centerville on August 1, 2007 at 2:OOPM. This inspection will be done on the basis of the new rental ordinance for the Town of Barnstable where all un-licensed rental properties are to be registered and inspected by the Town of Barnstable Health Department. Should you have any questions regarding this inspection, please do not hesitate to call the Town of Barnstable Health Department. Respectfully, Caitie Barrett Division Assistant Rental Program Coordinator #508-862-4072 Health Complaints 10-Jan-06 Time: 11:03:00 AM Date: 1/9/2006 Complaint Number: 18612 Referred To: DAVID STANTON Taken By: JOAN AGOSTINELLI Complaint Type: CHAPTER II HOUSING Article X Detail: ILLEGAL OPERATIONS Business Name: Number: 19 Street: LONGBOAT Village: CENTERVILLE Assessors Map_Parcel: Complaint Description: There is an overcrowding problem at this house. Assessor's have it as a three bedroom house. There is a minimum of 4 cars at night. There are 6 cars some of the time overnight. There is supposed to be 3 children and 2 adults. Actions Taken/Results: DS WENT TO SAID LOCATION. SPOKE WITH TENANT(CAROL FLAHERTY) SHE CLAIMS THE HOUSE IS LEGAL, AND BEING FUNDED BY THE STATE (SECTION 8) DOES NOT KNOW WHY THE TOWN WASTES MONEY ON BOGUS STUFF WHEN HER CHILD NEEDS MORE MONEY FOR SCHOOL. SHE STATED THAT 5 CHILDREN AND 3 ADULTS LIVE THERE, AND THE STATE IS AWARE OF THIS. SHE STATED THERE ARE 5 BEDROOMS IN THE HOUSE. WHEN DS GETS TIME, HE WILL TRY AND CALL THE STATES SECTION 8 GROUP TO SEE IF HE CAN GO DOWN AND INSPECT WITH THEM TO ENSURE THAT THE HOUSE IS UP TO CODE, THE NUMBER OF BEDROOMS AND USE OF SPACE IS LEGAL, AND THE SEPTIC IS ADEQUATE. THEY 1 �x Health Complaints 10-Jan-06 ALSO NEED TO POST A RENTAL SIGN IN THE FRONT YARD PER TOWN OF BARNSTABLE CODE. Investigation Date: 1/9/2006 Investigation Time: 2:45:00 PM 2 _..Barnstable Assessing Search Results Page 1 of 2 45 f E x Home: Departments:Assessors Division: Property Assessment Search Results 1 Owner: TUCKER, LAURA A Property Sketchy Legen Map/Parcel/Parcel Extension 193 /156/ � ri Mailing Address �n3a3 TUCKER, LAURA A %DALEY, MARK PATRICK 19 LONGBOAT DRY CENTERVILLE, MA. 02632 " �p� yflhnwt� 2005 Assessed Values: Appraised Value Assessed Value y,Y;•'' Building Value: $ 115,800 $ 115,800 Extra Features: $ 15,000 $ 15,000 Outbuildings: $600 $600 Land Value: $ 136,400 $ 136,400 Interactive Property Map: ap requires Plug in: Totals:$267,800 $267,800 1 have visited the maps before Show Me The Man f�.I April 2001 photos available Salves History: ` ()� Owner: Sale Date Book/Page: Sale Price: DALEY, MARK PATRICK 5/25/2004/// C173123 $310,000 TUCKER, LAURA A 2/15/2001 C160665 $ 174,900 THIBODEAU, PETER M&MONIQUE M 3/12/1999 C152307 $ 125,000 MYERS,THEODORE J 5/15/1996 C140763 $97,000 BUFFUM, RICHARD S&BARBARA 10/15/1982 C89846 $58,000 DUCHESNEY 4/15/1982 $9,000 2005 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Land Bank Tax $48.61 Town Fire District Rates Other 1 $6.05 Barnstable-Residential $2.12 Land B. Barnstable-Commercial $2.80 C.O.M.M. FD Tax(Residential) $270.48 C.O.M.M.-All Classes $1.01 Cotuit FD-All Classes $1.28 Town Tax(Residential) $ 1,620.19 Hyannis-Residential $1.52 Hyannis-Commercial $2.39 http://www.town.bamstable.ma.us/Assessing/AssessO5/displayparce103.asp?mappaY=19315... 1/9/2006 i4., Barnstable Assessing Search Results Page 2 of 2 W Barnstable-Residential $1.44 W Barnstable-Commercial $2.10 Total: $ 1,939.28 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 0.36 Year Built 1982 Appraised Value $ 136,400 Living Area 1056 Assessed Value $ 136,400 Replacement Cost$ 130,091 Depreciation 11 Building Value 115,800 Construction Details Style Ranch Interior Floors CarpetHardwood Model Residential Interior Walls Drywall Grade Average Heat Fuel Oil Stories 1 Story Heat Type Hot Water Exterior Walls ClapboardWood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 3 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 2 1/2 Bathrms Total Rooms 6 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value SHED Shed 80 $600 $600 FPL1 Fireplace 1 $2,700 $2,700 BFA Bsmt Fin-Aver 924 $ 12,300 $ 12,300 Property Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area (Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/Assessing/Assess05/displayparce103.asp?mappar=19315... 1/9/2006 Health Complaints 10-Jan-06 Time: 2:14:00 PM Date: 7/21/2004 Complaint Number: 17583 Referred To: DONNA MIORANDI Taken By: DENISE WITTER Complaint Type: CHAPTER II HOUSING Article X Detail: UNSANITARY CONDITIONS Business Name: � Complaint Description: Caller said mold is everywhere. Said its growing up the walls and carpet and the landlord wont do anything. Landlord is Carl Anderson. Caller said there are mushrooms growing in the closet. Actions Taken/Results: DZM called the complainant from the road on 7/22/04 to see if I could get in at the time or on Friday morning but the complainant would not come to the phone and a young girl on the phone said she was sleeping and wouldn't get up. I told them to call me on Friday morning but have not heard from them as of yet. 08/09/2004-DZM did an inspection after the housing authority failed it for 4 bedrooms. There are two kitchens in the house and no operating smoke detectors. DZM shall issue a letter to owner. DZM has notified Lt. McNeely of COMM Fire Dept. about no operating smoke detectors and Jeff Lauzon of the building dept of these violations. Jeff Lauzon and Lt. McNeely are scheduled to go out today at 2:30 pm (8/10/04)to do an inspection and possibly install smoke detectors. On 8/12/2004, Carol Flaherty called Thomas McKean complaining 1 r Health Complaints 10-Jan-06 the mold is very bad; her throat is closing-up. TM attempted to call the landlord Carl Anderson at(508)432-4488 at Carl's Boat Yard - but was told that he is out on a boat in Nantucket with an "Illustrious Senator" He will try to reach his cell phone this morning to return TM's call but indicated he probably would not be calling TM back. At 9:25 a.m. Paul Dineen called and told TM that he doesn't want the landlord there alone intimidating He indicated that the mold is spreading everywhere (on the blinds, wall, carpet, ceilings, garage,). 8/16/04 Dale- Letter to Karl Anderson (written by Donna) reviewed, 7days to comply, and sent out. Spoke to Thomas Lynch at about 2:25pm about problem and FAX copy of letter(K. Anderson) to Tom. Mr. Lynch stated he would fax the PHI report to the Health Div. Called Karl Anderson and left a message about 4pm. He called back around 4:10pm and we talked about the problem and his time line for complying. 08/17/2004-dzm GOT ANOTHER PANICKY PHONE CALL FROM TENANT, OWNER WAS COMING ON SITE TO DO THE WORK. DZM WENT TO THE HOME AND MET OWNER'S WORKER, FRANK. TOLD HIM IT HAD TO BE DONE PROFESSIONALLY AND SHALL CALL OWNER TODAY , 8/18/04 . On 8/24, Carol Flaherty left a threatening message on TM's voice mail indicating she will be filing a suit against the BOH. Paul Dineen also left a message on TM's phone requesting a return call. TM then immediately attempted to return Paul Dineen's call on 8/24 but had to leave a message on his answering machine informing him that the seven day deadline had not been reached yet. Later the same day 8/24, called again and talked to Joan Agostinelli, telling Joan that Donna informed her that a hearing would be held to condemn the home. I told Joan I had no knowledge of such a conversation. The seven day deadline had not been reached at this point and normally there is a process of issuing an order, then fines to the landlord if the repairs are not made as ordered. Joan then informed that the seven day deadline had not been reached yet. On 8/24 at 4:35 p.m., TM received a 2 Health Complaints 10-Jan-06 Nextel call from Sally, the caller indicated she was a lawyer, Dianne Caggaino, who indicated the clean-up and repairs were not made. On 8/25/04, TM called Karl Anderson's answering machine and left a message that this is the second time calling him without receiving a return call-urging him to return TM's call. Lynette Walker(apparent representative of the owner) called TM back at 11:30 on 8/25 -to state that on 8/17 at 10:00 a.m. workers attempted to make corrections. On 8/17/04 the owner and workers observed the basement closets which contained mold and mildew. While the owrkers were there, they attempted to clean and make repairs. They installed two portable dehumidifier units while onsite. However, when they attempted to correct the mold problem in the basement closet, the tenant( would not allow the workers to remove the clothing and food from the closet. Lynette stated that admitted to the Karl Anderson (the owner) that she observed the mold last December 2003 but did not inform anyone about it [NOTE: the Health Division did receive a complaint or an inquiry from Paul Dineen on February 4, 2004- see compaint number 17252]. Lynette stated that the occupants rented the house, not the basement exclusively. "They should be living upstairs, not necessarily downstairs." There is sufficient room for the number of people on the lease to be living upstairs only, she stated. She further stated: the rental application lists only four people: Paul Dineen is not on the application or on the lease. [NOTE: However, a timeline was received by FAX from Lynette on 8/26 which listed five people who moved -in on September 2003]. Lynette further stated that last September, the owner gave the tenants a dehumidifier for the basement which has since disappeared. Lynette explained that on 7/19/04 the tenant received a "non-renewal of lease" and was to move out before September 30th 2004. [NOTE: On 8/26, the tenant stated she never received such a notice]. Lynette stated that since then the occupant reported complaints to agencies rather than to the landlord. On 8/26/2004, TM received a 3 Health Complaints 10-Jan-06 telephone call from karl Anderson asking what he should do- now that the occupant would not allow the worker access into the closet to correct the problem. TM suggested that he make another attempt to correct the violations by arranging another appointment with Ms. Flaherty. TM called and she agreed to allow the workers in on Monday August 30th at around 10:00 to 11:00 a.m. TM called Karl Anderson back and the date and time is set for the appointment. On 8/26/2004 at approximately 3:15 PM, TM received a FAX from Lynette requesting (for a second time) a ten day extension along with handwritten report from Frank Heller and a typewritten time-line report (indicating the worker posted the name address, and telephone number sign, cleaned all accessible surfaces, and brought two dehumidifiers) and what he attempted to do to correct the problem. On 8/26/2004 at approx. 3:30 p.m,. Paul Dineen and came into the Health Division Office. TM told that he will telephone Karl Anderson this evening to request a more detailed report as to what was actually corrected. TM told that he will telephone Karl Anderson this evening to request a more detailed report as to what was actually corrected. At 5:45 PM on 8/26/04, TM attempted to call Karl Anderson, and left a message on his answering machine. Also at 5:48 PM on 8/26/04, TM retrieved a voice mail message from Lynette indicating Karl Anderson hired Emergency Contractors Company (phone number 888-7750) to go to the house on Monday morning to rectify the remaining violations. TM called Curt at Karl' Boat Shop 9/23/04 at 9:40 a.m. left a message for Karl Anderson or Lynette to call me back this morning. At 3:40 p.m., TM called Karl's Boat Shop again and spoke to Frank . TM was told that Karl is in Connecticut and Lynette should be back in 5 minutes. Later that day 9/23, Lynette called back and left a message that the mold is rermediated. A report should be available from Emergency Contractors Inc. Director of Public Health Thomas McKean called Emergency Contractors 9/23/04, spoke to Mary and was told Tom Tobin was out sick, 4 Health Complaints 10-Jan-06 no info available today. Mr. McKean called Emergency Contractors Inc. again on 9/24/04. Mr. McKean was then referred to Mr. Thomas Tobin who stated "that job wasn't much of anything" at 190 Swift Avenue Osterville. The carpet was wet; it had some mildew in areas. The carpet and pad were both removed. There was a small portion of mold inside a closet- portions of the wall &floor were removed there. The rest of it was fine. Mr. Tobin stated that he was there yesterday with a moisture meter and the readings were 10% in some parts of the basement and 12% in other parts. Mr. Tobin stated he gave it a "clean bill of health" yesterday 9/23/04. Investigation Date: 8/9/2004 Investigation Time: 3:35:00 PM 5 31 � No. I a 3 - 5 tP Fee�y THE COMMONWEALTH OF MASSACHUSETTr,� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Impool *Wem �Congtruction Vertnit Application is hereby made for a Permit to Construct( )or Repair((/f pan On-site Sewage Disposal System at: Location Address or Lot No. 10"�� Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. tkv Type of Building: Dwelling No.of Bedrooms 3 — Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 33� gallons. Plan Date Number of sheets Revision Date Title Description of Soil M�f� l�ti Nature of Repairs or Alterations(Answer when applicable) "�'tA.55rWA` '-u F1r7i5rYt-- 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 b t ' BoardqLHeafthA Signed Date Application Approved by Application Disapproved for the following reasons /� G1 Permit No. 7, �o '" T 3 Date Issued 3 r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that t Llnzsite Sewage Disposal System installed( )or repaired/replaced(V"')on _ �- (P by ;� S for as has en constructed in accordance with the provisions o itle 5 and the for Disposal System Construction Permit No. 7 4O dated .3 — -2 --1 Use of this system is conditioned on compliance with the provisions set forth below: r (� � Fee�_ ASSESSORS MAP N0; PARCEL NO:. 1 _ Commonwealth.of Massachusetts Executive Office of Environmental Affairs Department4of P Environmental �E�EOlf D , -. t , � 1Rllulem F. r F E B' 1995 Go error �,i t i 1 6-', Trudy Coxe uC A' Socretary,EOEA MMLTH�I �, ' David B. Struhs ! w.i. :7 DOWN OF.BAf NSTAUE Commissioner '�. 1`r t , •(ii 'p i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM" ' PART A CERTIFIt ATION l�L��vGG f3p1 Property Address: F,"Add ress I of Owner: Date of Inspection: /(l q�O (If different) 140 43 o F'V hn Name of Inspector: �� t,y' Company Name, Address and Telephone Number: o 41 f CAC 12r'— & S' Past C,N m°1-�'`1- CERTI TION STATEMENT 5-0,P-P?.P 14 S 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 inspection. The inspection was performed based on my training and experience in the proper function and, maintenance of on-site sewage disposal systems. The system: Passes ► i; , I e. Conditionally Passes NeeOs4 urther 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 within thirty (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 Department of Environmental Protection. '"• $' The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. -w. INSPECTION SUMMARY: P� ' Check A, B,C, O(R). AJ SYSTEM PASSES: if: ?ti' :I',r. i, . RI, !A e I have not found any information which indicates that the system violates any of the failure criteria as defined'in'310 CMR"15.303.' Any failure criteria not evaluated are indicated below. ' I i.fo I�., B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired.'The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. if"not determined",explain why note The 'septic tank Is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank.is replaced with a conforming septic tank as approved by the Board of Health. (revived 8/15/95) 1 One Winter Street . Boston,Massachusetts 02106 e ' FAX(617)556-1049 a Telephone(617)292-5500 Printed on Recycled Paper lt, it 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORW' ) ) �t PART A CERTIFICATION (continued) Property,AAddress: �Ii&13Q AT f2©r C� �6 `p tix� i Owns c Kl C.firt;►'-t�� �U�i.,9Y�°1 . .� .:', Date of Inspection. B) SYSTEMtiCOND1T_IONALLY PASSES (continued) 10 A.3r t i r,. Sewage.backup or breakout or high static water level observed in the distribution box is due to broken o ,obstructL ed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): 1 d t broken pipe(s) are replaced .t, obstruction is removed distribution box is levelled or replaced t The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if'(with apprd"val'of the Board of Health): broken pipe(s) are replaced ` ''obstra'ction is removed 1) .� 1{rT �'Y.-S1/•t' ✓R t_'_y�/i.(1 l' ' C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: —,Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 'I.rt, •t t 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING AN_ A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. :1 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) ®ETERMINES-THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well r+f ) l The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. — The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is i free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm• 10 D] SYSTEM FAIjS: " ' � ' I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. 'The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Alf Backup of sewage into facility or s stem com onent du t p e o an overloaded-or ciclogged SAS,or cesspool. ' t�,4c.K-Q iP l w S SP71 C 'AtvK, L6 4ct4 P j , �4AS I�'�w Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 %t f •. i; ; >r �, I it SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM,�i; PART A; ,( , , j CERTIFICATION (continued) Property Address: / d'i � L Owner: Date of InspectionUdd? DI SYSTEM FAILS b l Static liquid level in the distribution box above outlet,invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped i Y Any portion of the Soil Absorption System, cesspool or,privy is below the.high ,groundwater elevation. } Any portion of a cesspool or privy is within 100 feet of a surface water supply or.tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of.a public well. 0" 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 SO'feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. a t ii !,i7e.,7'i _ 1•,. � !. 'tit( �` - �. , .`) .. %1,"'3*1C fx' ,� 1. .�.. , Ej LARGE SYSTEM FAILS:. r ,t i i ;. l , 2,,, ' , e ,if "�.i-t �ir,,.,s ';. :. •;-.F,z,, The following criteria apply to large systems in addition to the criteria above: F ,, -,,,, Fri •,,�• p. .,. ,.. ;-' r:.Y ,..'•..�•' < ,, ;ii,.,. The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public. ublic health and'safety and the environment because one or more of the following conditions exist: 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) i The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department•for further information. (revised 8/15/95) 3 ••Fi I<.r. .;::awlY.�,)lfi748rtt}� iaim�+,bwx+caan.c:n.,_•, _,..... .�___.:s.... SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART B CHECKLIST 1 bk ,,.. Property Address:// �� ^^ ,ram r-) ��J 1 Owner: O C 6 7" /-If 12 IJ ig o r- r V � '.,,,•, { 1� Date of In3pe'4,on: Check if th�follow,.in,, have been done:Puump � information was requested of the owner, occupant, and Board of Health. 1 to None of the system components havebeen pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. L The facility or dwelling was inspected for signs of sewage back-up. 1 . I;, • .,I(1 ), r , (t" Ill, i '(, i r ,., I , 1)(11,1 ,1 .t„f•. _C The system does not receive non-sanitary or industrial waste flow hr,1 r' ,.t farad, 1 • t The site was inspected for sins of breakout. 's . ' ' ` ' I, �� r,, ik ; All I system components, e*eknft the Soil Absorption System, have been located on the site. L--fh'eseptic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition-of baffles or i tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. .I `1q1 , '.}' ui , .t r.o -; W.. iftf 1;.,1, .- r �Theize and location of the Soil Absorption System on the site has been determined based on-existing information or approxirnated by non-intrusive methods. ' ' vThe facility owner (and occupants, if different from owner) were provided'with information on the proper maintenance of Sub- Surface Disposal System. . ' r . ! . pia (f• t c h ' r (revised 8/15/95) •4 t r i;" . . „ � a t , f' ,"�t 4�,'.�6�', � ...' . .)... ,s- - 'vim I';f-:ir'�-ci;•""i _ '�"' 1 ' P SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:e. q W 6-60)ff J?P, � a 6'eU I L i' Owner: �� � a? u J I� Date of Inspec ion lJ fi F t , e. f FLOW CONDITIONS � 2w RESIDENTIAL- 3v Design flow: allons `l Number of bedrooms: Number of current residents:-3- Garbage grinder(yes or no): A-6 Laundry connected to system ( es or no): �' Seasonal use (yes or no): c-O /�� �} Water meter readings, if available: L 9 Q3, `7 j(/U�, l / y, 72�Z0, r 9'9 �r 60 Last date of occupancy;t��U C�-P—CbV 1, f ' ' COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: �allons/day ,r n Grease trap present: (yes or no)_. Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no) ` , Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION -;- PUMPING RECORDS andNrce informationIT System pumped as part off'inspection: (yes or no)45-0 If yes, volume pumped: eallons Reason for pumping: TYPE OF SYSTEM _ ;.�:.• , Septic tank/distribution box/soil absorption system Single cesspool - Overflow cesspool Privy Shared system (yes or o) (if yesc attach previous inspedi records, if y) er (explain) APPROXIMATE AGE of all components, date install (if known) and source of information: tl S E So 6^LT- `7 L T1 G 6PIA 1R. 9 9- Sewage odors detected when arriving at the site: (yes or no) (revised 8/15/95) 5 E �t �vi a,x' ��� �' I '��r {!'�f` E�t {r7 � }P *r LLY�1„� �., ��. v L�r c • �r<S y_.i, u� v3 ��; � 'd�i�'f �� IP i•.1,>'X l. ;J!- 1 r ij ' t, r,-y a ... 'JA./`.�1, P•,�}Clr2' lr! SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 9 PART C {� �1y SYSTEM INFORMATION (continued) ;.t c ij Property Address: k: At Owner ��c • ,rrys!rl 9c Date Ins-pec D 17 U �V r ih Iq SEPTIC TANK:— (locate on site plan) r• Depth below grader Material of construction: _ ncrete _metal FRP_other(explain) �„ "Y;1 • ' :t tnt];r ,f. Dimensions: © 0 ! Sludge depth: 9 1/ Distance from top of sludge to bottom of outlet tee or baffler Scum thickness:—.? ,- Distance from top of scutn to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: /O Comments: ..- - (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural,, integrity, evidence of leakage, etc.) 7 , G4--U IIA GREASE"TRAP:_ (locate on site plan) Depth below grade: __. (` ,,} f,a Material of construction: _concrete _metal _FRP—other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: ,, ..",,;�' , Ir ,� •m:, 1 ? +. ( " !., Distance from bottom of scum to bottom of outlet tee or baffle: •.lu,', 't•' ) f76y r t;- '.c'u ft rn qi? Comments: i, ^'r } (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) • .... •..- •r .. , x!; ' ,il}� ,, ia ,,�;, � + 'tit+',1`>" ,;`' -.0 (revised 8/15/95) 6 . r s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, 1t ' PART C 11 p BB �,, SYSTEM INFORMATION (continued) Property Address:l a W vj 6-i3m d�t d2D p c&N v I It t._ . , i. t• ;" Owner: C����✓� �Cy yvi Date of Inspection: ,1 ! i• r TIGHT OR HOLDING TANK:` (locate on site plan) Depth below grade: Material of construction: _concrete _metal —FRP—other(explain) Dimensions: Capacity: gallons Design flow: Rallons/day „ r Alarm level: f Comments: (condition of inlet tee, condition of alarm'and float switches;�etc.) i ;,1l,1 ,;I••' .-s'+t .,.1,?.`; ?{„;It •. ;� }„ ,; . 1 DISTRIBUTION BOX:_ (locate on site plan) ._ . .. ._.. _........�. �11,,. jr Depth of liquid level above outlet invert: - - --• 1' lci :I;., .. Comments: i (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) rt (revised 8/15/95) 7f; t ,,;� .1i7" Y1 .t'ff141�l ... ) f",M, V r .klM.. x'§�t"g�'t- . .. 1I'I'.r J !{'1I. 10i_ ,.1...,�.�4�.�,,;•�.�.�I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORAM je PART C,w SYSSTEE-M` INNF-O�RMMATIO,IN(i(continued) Property Address: Q Ld,���._.�O 6�Y �rL'1 Ul [ (� 1 ; f ;t Owner: LA Date of Inspection: P/ Y 1 ` SOIL ABSORPTION S ST (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) f If not determined to be present, explain: Type. _ _. ._. _ _ _ • leaching pits, number: e f 0V 6 614L leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, dumber, dimensions: overflow cesspool, number: " 'Comments: (note con` �•it�onof soil, signs of hydraulic failure, level of ponding, condition of vepetatio etc.) C 1 f-f— e 1 t ru C o (-,u Kj 2 6o► yt� LC)VFAe (TIC RAI eta CESSPOOLS: (locate on site plan) Number and configuration: �,.-., i Depth-top of liquid to inlet invert: 1 r Depth of solids layer: t ' Depth of scum layer: t Dimensions of cesspool: r Materials of construction: Indication-of groundwater. inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 1 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.) (revised 8/15/95) 8 t• 1 ..+.wuidFllsMwibe&iWIdMFl�1iWiFFYAu953i#illNidRtWrMp'YYFNIwwri.eex:FWWCHwM.xtc+wu:...n.r.wc..««wW+AMww,'w+••w....r. -........_ .�- .._.�. .- j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -d PART C SYSTEM INFORMATION (continued) Property Address: ! �L0 6-,go 1 ! 12 Owner: Ql C ,,h4 42 r Date of Inspection: , SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' DEPTH TO GROUNDWATER Depth to groundwater:/ � method of determination or approximation:_V (revised 8/15/95) .9 TOWN OF'BARNSTABLE LOCATION 1 L SEWAGE # VILLAGE' ' ��/�t�cry\(��.. ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. 1,14k() SY(?ti G SEPTIC;*TANK CAPACITY ��r t _ Q rV oolpoj LEACHING,FACILITY:(type) V%T (size) NO. OF.:BBbROOMS 3 PRIVATE WELL OR RURIC R BUILDEt.:bR OWNER tiYyYJy SQs1G`L-cZ DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE:.GRANTED: Yes No tom500c ;•t J Fas....sJ.�.. ea- ? THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T�c?�f�-�................ .N.' NA'4r. ........O F....BAQrr - ..................................................... ANNpliratiou for UWV0,9al Works TOMOtriirfion Permit r Repair an Individual Sewage Disposal l Application is hereby made for a Permit to Construct ( ) or P ( ) sySc at a I"..�J r.,.. ..�'e..r�Ter. ►..t1.�.. » a ..... �..............or....................................»..»...._..... I o Address ��,���Jrl�,y ......Lo.HS-�S'l4AT.........1?1�.1.0.. ................................ .....��. // Address Owner W Address Installer Size Lot...... }d0 ......Sq. feet Type of Building Expansion Attic ( ) Garbage Grinder ( ) •-•-••---_...p Dwelling—No. of Bedrooms..._...._ Cafeteria Other—Type of Building ............................ No. of ersons............................ showers ( ) — dOther fixtures ------•-----•--------------------- W Design Flow....... 3-t� 4-3-6-5-5............... per person per day. Total daily flow_........ 3..••----•-•••••--• gallons. a; Septic Tank—Liquid capacitylO.Qd...gallons Length.....-...._-- Width..... ....... Diameter................ a �•::: W Disposal Trench—No------•-------•-•---- Width....................Total Length...._.._..._..._._..Total leaching area........ sq. ft. x .........sq. ft. Seepage Pit No----- .............. Diameter Depth below inlet..........p.......Total leaching area........ . Other Distribution box ( ) Dosing tank ( // I to rt9 c,cC,t �utu`'�f P.Awx a Date---mil ... ...._. ............... Percolation Test Results Performed by............. ... NO Test Pit No. I...._.o.�-- minutes per inch Depth of Test Pit................:... Depth to ground water.11�P?r I �, Test Pit No. 2._.-•--•-•--•---mmutes per inch Depth of Test Pit.................... Depth to ground water........................ � ........................................................ ...---•.........................•----•--••......--•----....._......... D Description of Soil. A.t D....................... ............................ r . W ---------------------------•----•----------•----•--•---. - ................... x V Nature of Repairs or Alterations=Answer when applicable ...................: .--.. ,l Agreement: The undersigned d agrees to install the Sanitary Codelbed—Theutndersigned further agrees not vidual Sewage Disposal eto place the system ith n � ^T^_"' S of the State San y the provisions of L a- operation until a Certificate of Compliance has be i sued b the board of lth. Signed.._ 0 ._. . •Date i{ B N..._�""'" Date Application Approvedy. .".'..." a e Application Disapproved for the following reasons:--•--------•--••-•---•------•----•---------- •--•.......................••.----» ............................................ ............•---._........................._.._........... .Date..........^ .........................T......... Issued................ .•-•••.........---...............» Permit No......................................................... Date f a THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH OF..................................................................................... (9prtifiratV. of fffompliatta or Repaired ( ) THIS 1 TO CERTIFY, That t e 14w,' duaI -Sewage Disposal System constructed ( ) .- .............C..... •--•----........-----•--........---......................................... .................. by.............. ....: jp!taller at...hL� _. .1_ a Ql4T.._ 1'---.-.- . '�2 .1�. has been installed in accordrice with the provisions of TIT F j of I�he State Sanitary Code as described in the application for Disposal Works Construction Permit No----- _ 2_- L.3.3..--•---... dated----------------------------------••--•--------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. p \p�l� ................................... DATE................ S�_._� `S!_Q� Inspector-------------------------------�L-N-Z`� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH DD ................OF.............................................................•--..................... FEE.., ,,r. ..... �i��aott1 ork�-�on��rnr#ion pr i� ...................... .. .=......._ -----•-- -----.-- Permission is hereby granted........ - . .. . ••--•--•••----••••-•-....... to Construct ( ) or epair ( ) an Individual Sew a Disposal Syst at NO. _ \ Street •.................... ��'-�--I.Q.--- =-�-�-�' a�-r--- as shown on the application for Disposal Works Const•I\ction Permit No..................... Dated.......................................... -- --..-•......................................» •- F � rd of Health ' DATE------------------------------19. //`?-•.,V....-•-••.......... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ` ✓ J�4 k n lu 00 (car e Jv�/Q I__..y �ti � �,"`�-+,., •`� ,� ` Arr Ly c;pal y} A ro ev Or Ls Y 41 DISTANCE ASCERTIFIED t` 1 HERSISY"CERT•IFY THAT THE BUILDING SHOWN ON THIS PLAN IS LOCATED ON THE LOCUS: I..c?T .lQ t�l.a E GROUND AS SkOVO4 HEREON ItTHAT IT Gt��fP+�` .'{�i4�t✓iiC ' •. x CONFORM TO THE ZONING BY LAWS OF tHL P�ATJ.L�'AT'Sf.� Gi�IT@.�V t4.L�.> t1Y11��i Sr TOWN OF f WHEN.CONSTRUCTED.. DATE -- REF (.pT .►Ql � .•"G ( ' �Qw►�. C�A� en�I��eI/A8 PREPARED FOR:' 1�3.fiLld ,�3Y. i - CIVIL ENGINEERS LAND SURVEYORS — REG.LANO SURVEYOR i,+� .Z,l�� Ja"} � ' 2 , I ^,V, F.th� ;;L► ;-'+.ice Away u*.tS�+ T F'OQ. M p,�T•P•.sv t„S:`�' �O � 'GCI:Q„�i� � ,PaU• SECTION - SEWAGE �.; � � w�.� �.�, C+7-10`,15 c-' - - - "D"BOX - - LEACH SEPTIC TANK � ..2..OF119TOy=.. TOP OF FON WASHED STONE . . . !.5 - (MSL)M 4� - - IN• OUT IN- OUT IN SE PT I C 1n.r� 1'.L!cJ TANK 7b,[71 ELEV. I ELEV. ELEV. r«. ELEV { EL FL ELEV, II.Q� .r to"Lr OF)A"-ve �Pg WASHED STONE TEST HOLE LOG t �' Ao� cn Suv.ice u�T. 6"k 1 ) I ��. ►n��2e��__ ' BEDROOM HOUSE ` TEST BY DESIGN TEST DATE ---- T.H. � 2 - T.H. « 1 ELEV.I�i•� .E; LEV. 2a . N_-O—z— _ DISPOSER I Z" MIN/IN DISPOSER -N s ` PERC RATE __ �p(GAL./DAY FLOW RATE e� t n r3-s IL r SEPTIC TANK �o �T; REO'D SEPTIC TANK SIZE 7't TY +� LEACH FACILI z,�!(o,q5 G/D• k nni✓b. Rv ya►,o SIDE WALL i-Fc So.Lc. e _`=p-V-0 G/D A BOTTOM — ( I'O 1 rye TOTALZ��L�� �rrEZE.O bel►�iE Anwy ^TL /��gZr 6 ��0.*Aj!! ',d!J` LEAVi USE: T/ t YSry P r r st §F WATER ENCOUNTERED + � �+� r� ��•+�y.� „�� � ,, ��t' NOTES: (UNLESS OTHERWISE NOTED) ; 1YANNt S .......QUADRANGLE MAP 1• DATUM(MSL) TAKEN FROM -_-_._.._.__...._.- AVAILABLE 2.MUNICIPAL WATER.....-••_.. tt �..mot..-.•..._._...._....._. as ! J•PIPE PITCH: 1a"PER FOOT ____ — fA 4.DESIGN LOADING FOR ALL PRECAST UNITS: AASHO - a 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES Ill fT $r 5.PIPE JOINTS SHALL BE MADE WATER TIGHT t 1.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. + STATE ENVIRONMENTAL CODE TITLE. 5 tiNlttlW`'iiAL .�„ f TOWN OF BARNSTABLE LOCATION' 1 R L SEWAGE # ` o ��V:. <° VILLAC E____��Ivrevy\(�.e.. ASSESSOR'S MAP Q LOT INSTALIER'S NAME & PHONE NO. �tA�� l.lat�cn S`�QrtbG SEPTIC:TANK CAPACITY (ft<t ��r r _ 10-M 1 � LEACHING FACILITY:(type) -Qec-c4-v7 Vk T (size) NO. OF`BEDROOMS 3 PRIVATE WELL OR �cwR BUILDER OR OWNER G'ti rvo y DATE P�E,RMIT ISSUED: j -9 DATE <COMPLIANCE ISSUED: VARIANC.E GRANTED: Yes No w PVT- . . .. ...... s,Te AtION �d SEWAGE PERMIT . N4. L O C, . VILL#.. E INSt:A LLER'S`f. NAME . i ADDRESS j S U I:L:DE R OR OWNER - � F-5 DAT<E;::. PERMIT ISSUED DAT`:.E COMPLIANCE ISSUED o L .4::.CATION SEWA C E PER III IT>;: :M;:O v 1.-VL A O IN:'STA LLER'S . NAME i ADDRESS • L D E R OR OWN ER DA'TI PERMIT ISSUED CP9 DA>: . E COMPLIANCE ISSUED - � o NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:96.5 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL INSPECTION PORT OVER END UNIT T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE CHARCOAL EXISTING F.G. EL: 101.49(MAX.) VENT F.G. EL.=97.5t �F.G. EL: 100.0t MAINTAIN 2% GRADE (MIN.) OVER S.A.S. L = 19' L = 8'(MAX) INSPECTION S=1% (MIN.) @ S=1% (MIN.) PORT 4"SCH40 PVC 4"SCH40 PVC 6" LL 1 p„ 14" 6 11.3" TO EXISTING 48" LIQUID INVERT _ I ADD GAS BAFFLE INV.=96.35 PROPOSED INV.=96.18 4 ROWS W/4 UNITS AT 6.25'/UNIT = 25.0' INV.=96.45t D-BOX INV.=96.10 EXISTING SEPTIC TANK EXISTING 4 OUTLETS (MIN.) SOIL ABSORPTION SYSTEM (PROFILE) ESTABLISH VEGETATIVE COVER BACKFILL WTHmtiEAN NATIVE OR PERC SAND TO TOP OF CHAMBERS NOTES: BREAKOUT EL.=TOP EL. 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TOP ELEV.=96.49 4' INVERTS, PRIOR TO INSTALLATION. INV. ELEV.=96.10 r 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE BOTTOM ELEV.=95.16 ON A MECHANICALLY COMPACTED SIX INCH CRUSHED 2.83' STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. ABOVE BOTTOM OF - ' -. 3) INSTALL INLET & OUTLET TEES AS REQUIRED, T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=11.3' EXISTING SUITABLE 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE NO G.W., EL=88.1 = MATERIAL AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. 4 ROWS OF 16" (H-20) ADS BIODIFFUSER UNITS WITH NO SEPARATION BETWEEN EACH ROW & NO STONE SEPTIC SYSTEM PROFILE TYPICAL SECTION N.T.S N.T.S_ i SOIL LOG - 21" 6-4" POLYS*INLETS DATE: JANUARY 22, 2009 (REF#12,457) 2" 2" 1-4" POL SOIL EVALUATOR: PETER Mc ENTEE PE CSE _ WITNESS: � DONNA MIORANDI R.S. , _H HEALTH AGENT _. O--�=-r. - i2 ELEV. TP—1 DEPTH ELEV. TP DEPTH ` 6 o 99.3• A� 0.. 93.1 A 0.. SANDY LOAM SANDY LOAM 98 5 10YR 4/2 10YR 4/2 B . B "cv To View D-BOX 10" 98.3 10" P Section SANDY LOAM SANDY LOAM 1OYR 5/8 10YR 5/8 36" 95.6 42" C C PERC 54 75" FINE FINE LOAMY SAND LOAMY SAND 10YR 5/3 10YR 5/3 88.3 J 132" 88.1 132" 76" PERC RATE 3 MIN/IN. ("C" HORIZON) NO GROUNDWATER ENCOUNTERED PROFILE 16„ 11� 34" •-�. SECTION END CAP DESIGN CRITERIA 16"" HIGH CAPACITY (H-20) BIODIFFUSER UNIT NUMBER OF BEDROOMS: 3 BEDROOMS MODEL 16" HICAP SOIL TEXTURAL CLASS: CLASS I LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT DESIGN PERCOLATION RATE: <2 MIN/IN EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY DAILY FLOW: 330 G.P.D. DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. _ SIDE WALL HEIGHT 1 t 2" DESIGN FLOW: 330 G.P.D. OVERALL HEIGHT 16" GARBAGE GRINDER: NO OVERALL WIDTH 34" 4640 TRUEMAN BLVD LEACHING AREA REQUIRED: (330) = 445.9 S.F. 13.6 CF sms HILLIARD, OHIO 43026 .74 CAPACITY (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. EXISTING SEPTIC TANK: 1000 GALLON CAPACITY PROPOSED D-BOX:: 1 INLET, 4 OUTLET (MINIMUM), H-10 RATED PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 4 ROWS OF 4 — 16" (H-20) ADS BIODIFFUSER UNITS 19 LONGBOAT DRIVE, CENTERVILLE, MA Wf NO STONE FOR AN S.A.S. WITH DIMENSIONS 11.3' x 25.0' Prepared for: Viola Associates, Inc., P.O. Box 389, Centerville, MA 02632 (HIGH CAPACITY INFILTRATORS MAY BE SUBSTITUTED) SIDEWALL AREA: NOT APPLICABLE Engineering by: SCALE DRAWN JOB. 0 BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.7 SF/LF OF BIODIFFUSER) Engineering Worlb, Inc. NTS P.T.M. 104- 9 16 UNITS x 6.26 LF x 4.7 SF/LF = 470.0 SF 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 x 470.0 = 347.8 GPD (508) 477-5313 1/27/09 P.T.M. 2 Of 2 A5rLJ1 dokw ���t�g�ra • a � n 9 'a S 1 ` t Y 4 r e3 ——99--EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE N 100 PROPOSED CONTOUR aNY, ® Longb W EXISTING WATER SERVICE LOCUS —QH --OVERHEAD WIRES Copn Crosby Rd TEST PIT Pen Ln BENCHMARK a, �° H tc . CIO r LEGEND /�° t grC s Q'a �° Opt n 0 Grob r°F osr (n o Qa oµ°e hO^ �°, ooac cVe�Q �C� Q voy M°Sthepd In c Q�' VoQ P Q� LOCUS MAP x 102.18LONGBOAT DRIVE NOT TO SCALE ' . edge of road 108. 8 x — x 1` 3.60 PAVED f''ARKING " N 59`33'36' E R191.22' \_ L=5� 12' a tx 33.60' 702 1 2,,2 8 1�.4 106 ` ` 26', U� oo. p.R0Q0SE Ben chm ark Set 1 - ,- ,=S 1; o `• CORNER OF TOP STEP Z 100.60 �� 10, 1s � - x��,o3.63 EL.=100.00 (Assumed) o;' ��01' o VLN I EXISTING LEACH PITS "'ALL ONES ,O �_2 t '.� TO BE REMOVED-STRIPOUT (SEE NOTE 71) ---- - - N x 99.2 3 s EXISTING SEPTIC TANK 99.6 ` TOP OF TANK, EL.=97.78f LSSHED98.13 x 98.73 INV(OUT), EL.=96.45f ,N / EXISTING/1 HOUSE (#19) 1=;FET WALL /PTO==99.65fl o ALT UT BASEMENT FENCE DECK rri r mow';.,•., ._"5`-_ .._.: ,� .a....-..-.:---�.;;.-., -,�,;. :~�' ..- _. _., _.__....�.e---'--- —�-.o---'_".------"=-r- -'�.`'_„ `;.i-�,�"'�. - - ►�'-.a+�r-- "�-w�.-.�-- _�.a�.?.^,�-nor 10 15,004f S.F. i Mop' 193 fu Parcel 156 44.75, r, S 75_1=911 w 80.57' + S 712846" w GENERAL NOTES: 951's 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: 310 CMR 15.405(1)(b): 1) A 2' variance to the 3' maximum cover requirement, for no greater than 5' of cover. S.A.S. shall be vented and H-20 Rated. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. �a QF MgsS 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. o PETER T. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. o MCENTEE N CIVIL 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF o. 35109 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 9O �IG/St�RFO �c� 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. N 8. THERE ARE NO PRIVATE WELLS WITHIN 150' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 1 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE PROPOSED SEPTIC SYSTEM UPGRADE PLAN THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 19 LONGBOAT DRIVE, CENTERVILLE, MA _ 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE, AND Prepared for: Viola Associates, Inc., P.O. Box 389, Centerville, MA 02632 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). Engineering by: SCALE DRAWN JOB. NO. 12. ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC SYSTEM Engineering Works, Inc. "=20' P.T.M. 104-09 COMPONENTS NOT SHOWN ON THE PLAN. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. (508) 477-5313 1/27/09 P.T.M.. 1 of 2 . i i C 1 ,f '2-0r) 00 v ( 1 - I--- -- t- - -- - - - - - - - -- --- - - - - - - - - j 2 000 fl- N N� ' i N N 0 x N 00 2 to fl m fl O X ......_...._........._......... ' , 1 l .......................................................... UT 6 ....................._...:.._..__-.__................................... - - 1 i I c -1 N 0 0- N tt� to 1�0 X N " NAME: VIOLA RES. X H = o ADDRESS: 19 LONGBOAT DR. I ; c0o � o CITY: CENTERVILLE MA. zip: RES. PHONE: BUS. PHONE: 0 Q E ! N C - - I - --- - - - -- --_- - - --- - - - - - - - - - - x ...................... O O .. ._..._ ..... . ....... ...- ... _. ... ...... - i - J Op X CUSTOMER SIGNATURE: DATE �► VIOLA ASSOCIATES X N 110 ROSARY LANE, UNIT A, SCALE- I/4"- I HYANNIS, MA 02601 (508)771-3457 VIOLAASSOCIATES.COM DRN.BY: DATE: REV.NO.: DATE: SECTION - SEWAGE F"oR.• F- p��,.Ya.1v c_£.. car- �o �`. A>i..ca.ue.a.r� �j.rs`�.)� ���; n,-P.,,c� r�-T��A<.E w�TH <�.., :.�rx.st= fna•�. Y / I SEPTIC TANK - - "D" BOX - LEACH TOP OF FDN ' WASHED STONE J �N/ .l• f 7: IN OUT IN - OUT SEPTIC ELEV. i 1 Imo! TANK q0 ELEV. ELEV. ELEV. �� i_ I—, i _ -__--_-_- -- � 1Y�'I �\ t ELEV. ELEV. i, —� Cb` /.- l Q1` 7•~_�- S OF iN 11u.• WASHED STONE TEST HOLE LOG TEST BY ---- •1 ` WITNESS TEST DATE —� �_ -. BEDROOM HOUSE DESIGN _ T.H. * 1 T.H. 2 '� �4t--N - �4�` �.►o}'�� �. �53� ELEV.-1Vi oo_ 4.t = _ ELEV. FSI.nNO DISPOSER DISPOSER 1 e� \c'- - < 12.g gam. -> PERC RATE —_ MIN/IN. L-----� � ZA� � -+- 14c; FLOW RATE 30(GAL./DAY ) CA-120..y SEPTIC TANK _?v (I49= i o REO'D SEPTIC TANK SIZE �— _- __.-__- ,;, � �\ ,,1..- � G��� � ;'�'• LEACH FACILITY J / I SIDE WALL SS �f x .c��.^�j (�...� ) 3-1Ca. ._ G/D- e f '. _ r ` I.,c2 V1/,o--�t BOTTOM —�4i TT - �o.Z V ( \.o ) -gip' "- G/D. _'' EZEi7 TOTAL = i_� .Z.G qm(,"ac... 1Z �E I.+SE F lnaE� SAn,.� T> S't:Y: k'�C.riAK.'� !=�.�e.`�AvCe'.L. 1J w rre 4�L.cm $Z USE: .1,a 'A is -cr,;----LEACHING 7(T �$� A�' I\\ram --- --------- -------- ---- --- -- ' —WATEPENCOUNTERED NOTES: (UNLESS OTHERWISE NOTED) 1. DATUM (MSL) 'TAKEN F ROM i ti. "_ ) •_---.---.__A..-- __--�?--.--_- . QUADRANGLE MAP 2. MUNICIPAL WATER.__-______-!._2-----------_-__-._._-_-AVAILABLE 3. PIPE PITCH: ;%a"PER FOOT `i 10 4. DESIGN LOADING FOR ALL PRECAST UNITS: AASHO --_ �_—___..-44 5. MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. -- -¢-� - _ DISTANCE AS CERTIFIED 6. PIPE JOINTS SHALL BE MADE WATER TIGHT 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. I HEREBY CERTIFY THAT THE BUILDING SITE PLAN STATE ENVIRONMENTAL CODE TITLE 5 AM k SHOWN ON THIS PLAN IS LOCATED ON THE U )EER GROUND AS SHOWN HEREON&THAT IT—..-_ LOCUS:CONFORM TO THE ZONING BY LAWS OF THETOWN OF RE WHEN CONSTRUCTED. DATE . ___- c- REF: \•-•-4T 1 G�, l-.[..�.Sir Zi�l�O`i3 �«•1G(zT 1 d0Wn cape engineering PREPARED FOR: CNAe'1 cS �/. ''UcI1.4 S(vcY - CIVIL ENGINEERS BOARD OF HEALTH LAND SURVEYORS c J REG. LAND SURVEYOR CONTOURS (EXISTING) ----------- ■ Y,I.mourh&Orleans,MA SCALE (PROPOSED)-O-O-O-O- APPROVED -_-- ---- -DATE_.-----_---- ----.------- ---- MA 1 DATE SZ-^C>4' ..d