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HomeMy WebLinkAbout0241 NYE ROAD - Health 241 Nye.Rd. ..: Centerville .; A=147.017 i Health Department Drop-Off Hours: 8:00 AM -4:30 P.M v Town of Barnstable Received by Health o'SHE ,V Regulatory Services Department on o* Richard V.Scali,Director � Public Health Division �EDtiAAA Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ACCESSORY AFFORDABLE APARTMENT SEPTIC QUESTIONNAIRE Property Address: L/ - ul _ Assessor's Map/Parcel Number: A licant Name: �Y 1 �o h �, P�� Q �j C� '� • ��,. �� � PP Cs) Phone: �' - ��� .� 1 E-Mail: �r �` �Sa .N �5��`ci tttC' ( L. Size of Lot: 6 2a. How many bedrooms exist at your property now? 3 2b. How many bedroom are you planning to add as part of the Accessory Affordable Apartment Program application? 0 2c. How many bedrooms total are proposed at this property(including the Accessory unit)? 2e. Is the proposed Accessory Apartment contained within: . the main house; OR a detached,structure 2f. Submit floor plans for all buildings on the entire property. Show all existing rooms in the dwelling and the proposed accessory apartment. Label each room clearly. Label measured width of all open doorways. Use straight edge for hand drawn plans and be sure all labeling is legible. Signed: Date: Q) 1 ` ACCESSORY AFFORDABLE APARTMENT SEPTIC QUESTIONNAIRE FOR STAFF USE ONLY 1. Is the dwelling connected to Town sewer? ❑ Yes P-No 2. Dwelling located ❑ INSIDE I�OUTSIDE the Saltwater Estuary Protection Zone 3. Dwelling located ❑ INSIDE -q OUTSIDE public supply well Zone of Contribution 4. Dwelling is connected to ❑ ON-SITE WELL 1P PUBLIC WATER 5. Disposal works construction permit on file? 0-fes ❑ No 6. If yes, how many bedrooms were allowed by this permit: '-3 bedrooms 7. Were building permits obtained for additional bedrooms? ❑ Yes ❑ No 8. Engineered septic system plan: a. On file at the Health Division? ❑ Yes ❑ No b. If proposed accessory unit is detached from principal dwelling, is that plan on file? ❑ Yes ❑ No 9. Existing septic system capacity is bedrooms For the accessory unit to receive approval from the Health Department the following action must occur: ❑ Existing system accommodates proposed additional bedroom(s) ❑ Upgrade existing system to accommodate additional bedroom(s) El Must remove a bedroom from the main house ❑ Must connect detached structure to the existing septic system ❑ Must install septic system for the detached structure. C!(Other_ rarMer Signed— Date ,l� I 2 Bk 28465 P'o1O1 `W-48866 10-24-2014 & 10 2.06oL DEED RESTRICTION WHEREAS, GILSON O. MENDES and MARIA P. MENDES, are the owners of 241 Nye Road, Centerville, Massachusetts 02632 (hereinafter referred to as Lot 40, #241 Nye Road, Barnstable, Centerville, Barnstable County, Massachusetts 02632 and being shown on a plan entitled "Lumbert Mills", Scale 1" — 100' which said plan is recorded with the Barnstable County Registry of Deeds in Plan Book 252, Page 32 (Sheet 2 of 2 sheets). WHEREAS, GILSON O. MENDES and MARIA P. MENDES, as the owner(s) of said lot has agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in the present home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a permit for the installation of a new Title V septic system on the property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this instrument. HOWEVER, if the premises are ever connected to a town sewer system, this restriction will become null and void. NOW,THEREFORE, GILSON O. MENDES and MARIA P. MENDES do hereby place the following restriction on their above-referenced land in accordance with their agreement with the Town of Barnstable Board of Health, which restriction shall run with the land'and be binding upon all successors in title: 1. 241 Nye Road, Centerville, Massachusetts 02632 may have constructed upon the lot a house containing no more than THREE (3) bedrooms. Gilson O. Mendes and Maria P. Mendes agree that this shall be a permanent deed restriction affecting the house located on 241 Nye Road, Centerville, Massachusetts and being shown on the plan recorded with said Deeds in Plan Book 252, Page 32 (Sheet 2 of 2 sheets). For title, see Deed recorded with the Barnstable County Registry of Deeds in Book 19128, Page 212. Executed as a sealed instrument this day of October, 2014. 0 Gi n O. Mendes Maria P. Mendes COMMONWEALTH OF MASSACHUSETTS Barnstable County, ss; October 3, 2014 Then personally appeared the above-named Gilson O. Mendes and Maria P. Mendes, who proved to me through satisfactory evidence of identification, which were valid Driver's Licenses, to be the persons whose names are signed on the preceding or attached document, and'swore or affirmed to me that the contents of the document are truthful and accurate to the best of their knowledge and belief and acknowledged to me that they signed it voluntarily for its stated purpose. No k5(ic: . My commission expires: (o 2<5/1 `a\\\tinlntrii�f���. ON /n• �'_o,---'� a i_ I I i BARNSTABLE REGISTRY OF DEEDS i ,P11 JAL a 7 U.S. Postal S6rvice CEFITIFIED' M j A x ILR EC,E I PT, (Domestk Mail Only;No Insurance L;overage,:Provid6d).,,,:,, Yrl Ln tr ,n L E- U S Ln Postage $ 0 Ln Certified Fee -'-%Post rV'� Return Receipt Fee Here ITi (Endorsement Required) C3 C3 Restricted Delivery Fee Here r3 (Endorsement Required) C3 Total Postage&Fees $ ru - 02 M Sent To C3 .-I Street,Apt.No.; C3 or PO Box No. ----------------------------------------------------------------------- --------- C3 City,State. +4 r- � O2-S7?x 1 Zum= I � Certified Mail Provides: j e A mailing receipt © A unique identifier for your mailpiece o A signature upon delivery o 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. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece 'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt-is required. o 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". F+ © If a postmark on the Certified Mail receipt is desired,Please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry.- PS Form 3800,January 2001 (Reverse) 102595-01-M-1049 i� COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) ,B. Date of Delivery item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse C. C. Sig ture so that we can return the card to you. ,� , ■ Attach this card to the back of the mailpiece, X C� Agent or on the front if space permits. ❑Addressee D. Is delive ddress different from item 1? ❑Yes 1. Article Addressed to: w If YES,enter delivery address below: 3)"N%P— V-717n11 "J V O-eiz, an, Lab S�x6ftS Ir. VLW-C"I H AT C) 2 3�_ 3. Service Type Certified Mail ❑ Express Mail ❑ Registered e ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number(Copy from service label) — -.7001 0-320 0003 -6695- 9953 _ PS Form 3811;'July 1999 ' ' i 166mestic Return Receipt T 102595-99-M-1789 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid "c PY;No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • Public Health Division Town of Bamstable R0-$ex634 2e0 MA:^ Hyannis, Massachusetts 02601 I F , Town of Barnstable Regulatory Services o Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 September 20, 2002 Mr. Daniel Flynn 7 Wareham Lake Shores Drive Wareham,MA 02538 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00 STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at 241 B Nye Rd., Centerville, was inspected on September 19, 2002 by Sam White, Health Inspector, for the Town of Barnstable because of a complaint. The following violations of 105 CMR 410.00 State Sanitary Code II - Minimum Standards of Fitness for Human Habitation were observed: REGULATION 105 CMR 410.200 and 410.201: No functioning thermostat for adjusting the heat in the cellar apartment. REGULATION 105 CMR 410.481: Failure to post a notice outside the main entrance of the building bearing the name, address, and telephone number of the owner, manager, or agent of the owner. REGULATION 105 CMR 410.500: Ceiling in bathroom soft and damaged by water leakage from upstairs apartment. Leak in foundation by sliding glass door during heavy rain. Rotting door frames by main door and sliding glass door. Broken windowpane in bedroom REGULATION 105 CMR 410.504(b): Damaged wall in shower. REGULATION 105 CMR 410.551: No screens provided on 2 (two) small cellar windows and 1 (one) bedroom window. REGULATION 105 CMR 410.552: No screens provided at entrance doorway or sliding glass door. You are directed to correct these violations within 14 days of your receipt of this notice, by providing a functioning thermostat in the cellar apartment, by posting the Q:Health/WP/Flynn name, address and phone number of the owner on the premises, by fixing the damaged ceiling in the bathroom, wall in the shower, the leaking foundation, by replacing/fixing screens on all windows and doors described above, and by replacing the broken window in the bedroom. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF T B ARD OF HEALTH mas A. McKean, R.S. Director of Public Health Town of Barnstable r Q:Health/AT/Flynn rt.f ,. .,_�... ...w ...-..�.ti'r.--.•. J' -'\ �..�........y,,qy,•....,-r.•..J1,4,..--rJ' .-. __-.r� .. 'F-rr....4 w .`.^Y-J'�'r..s• „ry.7'-..•V._-_..,_^'._."lv�+.....�1a....—i. ., 14 ✓ IY / *FORM30 11 W HomsR WARREN'M THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN 4 W ' a DEPARTMENT f �� �`�'±_--! .i_irl..a`/R � - �i t✓/n F t 1!f'=f /-r� V f �V'' 'o�M ADDRESS f ��B � �+(� � �e✓� "7�J TELEPHONE Address � _ __� _ Vrr ___Occupant__ Wi �.,�,'t�L, ca-_ Floor Apartment No.__ _ _—_ No. of Occupants— No. of Habitable Rooms__- __No.Sleeping Rooms_ -]-___ No.dwelling or rooming units _____ No. Stories Name and address of owner Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage v Infestation Rats or other:, . STRUCTURE EXT. `N Steps,Stairs, Porches: t F Dual E ress:and Obst'n.: ❑ B ❑ F ❑ M Doors, 'Nindows. dcc .r c� . wr.. "c a_a .!! y1O -.506 O f s k,C ' ( J ✓ l.1 r f�1l � f a 44✓0 Gutters, Drains: Walls: oundation: � ,� -,.x:1 Chimney: 3 BASEMENT Gen.Sanitation: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor, eilin �� f n z , ;(,,�, ,. A-1/j) 500 Hall Lighting: Hall Windows: HEATIN Chimneys: / Central ❑ Y ❑ N � ,, . Rea 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 x. Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry - Den Living Room Bedroom(1) Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink _ Stove (Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin howe or Tub: "Infestation.'°�. � Rats;Mice, f3oac esor`Other:, . �. _. E gress Dual - General 19'1 i Pn osted .,rr. ' W, 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 INSPECT" REPORT t SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES O Y., / J INSPECTOR TITLES `1 /�S 'G'T�-r q A.M. DATE / Z TIME /� THE NEXT SCHEDULED REINSPECTION kVkA /S CeoplO'' " P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (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: k f kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven (1) Lac o a P Y 9 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. ? r FORM 30 HOBBS&WARREN THE COMMONWEALTH OF MASSACHUSETTS ' CI I&W inn BOARD OF HEALTH .y os fzli CITY/TOWN b DEPARTMENT )_ M ADDRESS115,o— d&Z - 1 6 Ll n / T LEPHONE Address 2 _ �1�._. lf���� _ Occupant—, VCJtrGc c2_ Floor Apar ment No. No. of Occupants__ No. of Habitable Rooms_ No.Sleeping Rooms_______ No.dwelling or rooming units ,_ _ No.Stories _ Name and address of owner _.______ Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: TRUCTURE EXT. N Steps,Stairs, Porches: Dual E ress:and Obst'n.: ❑ B ❑ F ❑ M Doors, indows. ' o(opr S c,c 2_o.anS' /0 SOd 00 e W nic- s or �co/S� drok2n 4/0 SS�SS 2 Gutters, Drains.- Walls: oundation: Chimney: J BASEMENT Gen.Sanitation: am ne Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor<aWeilin Ling_;) 6e__4.11 a; Hall Li htin Hall Windows: HEATIN Chimneys: Central ❑ Y ❑ N i . Rea �� u c n i �`�G�' ,, r,P iLt.,, e o . 1//0 2oa/2 o t TYPE: Stacks, Flues,Vents: , r PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: 11110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom(1) Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten., Gas, Oil, Elect..- Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove athing,Toilet Facil. Vent., Plumb.,S nit'n.: Wash Basi Showe or Tub: 5 e.✓ IIS „i �;'� ro,a�,`r 'I/D 57�Iffiz Infestation Rats, Mice, Roac es or Other: / Egress Dual and Obst'n: General <EMTd m 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 INSPECTI REPORT SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES P Y INSPECTO TITLE q A.M. DATE / 2 TIME '00 _ P•M• A.M. THE NEXT SCHEDULED REINSPECTION !N l.JOrk /s e0iftbl4e 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 impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required b 105 CMR 410.254. q Y (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, n electrical wiring standards or failure to maintain such facilties as are required b 105 CMR 410.351 and 410.352 gas fitting and e ect g q y , 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. I� COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTj.ON', � q 110 yr ap O�pS. V� TITLE 5 c"vV �� " S✓ , OFFICIAL INSPECTION FORM—NOT FOR VOLUN RY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM T` PART A CERTIFICATION Property Address: 241 NYE RD CENTERVILLE,MA 02632 Owner's Name: MICHAEL SWARTS,C/O OF WILCOX KING Owner's Address: . BOX 3464 WAREHAM MA.02571-3464 Date of Inspection: 10/29/01 Name of Inspector: (please print), JOHN GRACI Company Name: SEPTIC INSPECTIONS t Mailing Address: ]l'O!"BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340,of Title 5(310 CMR 15.000). The system: " X Passes _ Conditionally Pa es _ Needs Furth aluation by the Local Approving Authority Fails Inspector's Signature: Date: 10/29/O1 The system inspector shall submit copy'of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspec on. 1f the system is a shared system or has a design flow of 10,000 gpd or greater,the , inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be , a sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM NOW AND MAINTAINING EVERY ONE TO TWO YEARS.RECOMMEND NOT DRIVING OVER SEPTIC COMPONENTS-THEY ARE H10 ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 241 NYE RD CENTERVILLE,MA 02632 Owner: MICHAEL SWARTS C/O OF WILCOX KING Date of Inspection: 10/29/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: %;> X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 t CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM NOW AND MAINTAINING x EVERY ONE TO TWO YEARS.RECOMMEND NOT DRIVING OVER SEPTIC COMPONENTS-THEY ARE H10 B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, S' 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. Y. n/a The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replacedk'. with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating ` ;• that the tank is less than 20 years old is`available. ND explain: n/a k n/a Observation of sewage backup'oi break out or high static water level in the distribution box due to broken or obstructed , pipe(s)or due to a broken,settled'or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruc'tion is removed _ distribution box is leveled or replaced ND explain: n/a - n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced yf _obstruction is removed ND explain: n/a i.. Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 241 NYE RD CENTERVILLE,MA 02632 Owner: MICHAEL SWARTS C/O OF WILCOX KING Date of Inspection: 10/29/01 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and,SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia ` j , nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a t I Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 241 NYE RD CENTERVILLE,MA 02632 Owner: MICHAEL SWARTS C/O OF WILCOX KING Date of Inspection: 10/29/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No _ X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than 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 nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. to a surface water supply. _ X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary ., X Any portion of a cesspool or privy is within a Zone 1 of a public well. _ X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. IThis 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.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ 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 If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section L0 above the large Systelil hag railed.The owner or operator of any lame§ysteni considered a slgili scant threat. under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. n i Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 241 NYE RD CENTERVILLE,MA 02632 Owner: MICHAEL SWARTS C/O OF WILCOX KING Date.of Inspection: 10/29/01 ' Check if the following have been done`:You must indicate"yes" or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection ? r as built plans of the system obtained and examined? If the were not available note as N/A) X _ Were b y y ( Y X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank manholes,uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? X _ Was the facility owner(and.occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information.For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)J p S y Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 241 NYE RD CENTERVILLE,MA 02632 Owner: MICHAEL SWARTS C/O OF WILCOX KING Date of Inspection: 10/29/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents:4 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no):;NO Seasonal use: (yes or no): NO Water meter readings, if available(last2 years usage(gpd)): n/a Sump pump(ybs or no): NO Last date of occupancy: n/a P t COMMERCIALANDUSTRIAL '± ` Type of establishment: n/a `z Design flow(based on 310 CMR 15.203):;n/agpd Basis of design flow(seats/persons/sgft;etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Titl'er5 system(yes or no): NO Water meter readings,if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the.inspection(yes or no): NO If yes;volume pumped: n/agallons L How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool i _Privy _Shared system(yes or no)(if yes,attacli 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): n/a b Approximate age of all components,date installed(if known)and source of information: 1975 Were sewage odors detected when arriving at the site(yes or no): NO r ; Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 241 NYE RD CENTERVILLE,MA 02632 Owner: MICHAEL SWARTS C/O OF WILCOX KING . Date of Inspection: 10/29/01 BUILDING SEWER(locate on sitePlan) Depth below grade: 14" Materials of construction:_cast iron X40;,PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,'evidence of leakage,etc.): TOWN SEPTIC TANK: X(locate on site plan) Depth below grade: 8" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H 5' 7" W 4' 10"" Sludge depth:5" Distance from top of sludge to bottom of outlet tee or baffle: 29" Scum thickness:3" 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: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS APPEAR TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.RECOMMEND PUMPING NOW AND EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE GREASE TRAP:_(locate on site plan) Depth below grade: n/a ' `` I, Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a ` ',4"A, •e., t 7 i, Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 241 NYE RD CENTERVILLE,MA 02632 Owner: MICHAEL SWARTS C/O OF WILCOX KING Date of Inspection: 10/29/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity:n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level:N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a S.1 (? i DISTRIBUTION BOX:_(if presepn must be opened)(locate on site plan) Depth of liquid level above outlet invert:,n/a Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): NO DISTRIBUTION BOX-SNAKEDTHRU PUMP CHAMBER:_(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.): n/a Ul 1, 'v Q Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 241 NYE RD CENTERVILLE,MA 02632 Owner: MICHAEL SWARTS C/O OF WILCOX KING Date of Inspection: 10/29/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 2 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: nla n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a 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 NEW PIT HAS NOT HAD MORE THAN 2'OF WATER IN IT.-PIT HAS 2' OF STONE-BOTTOM AT 8' CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a :a n Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 241 NYE RD CENTERVILLE,MA 02632 Owner: MICHAEL SWARTS C/O OF WILCOX KING Date of Inspection: 10/29/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. I� d A g � �1 AC 33 AD �6 3s 3�6 C L/ rap 33 in Page 11 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 241 NYE RD CENTERVILLE,MA 02632 Owner: MICHAEL SWARTS C/O OF WILCOX KING Date of Inspection: 10/29/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: h NO Obtained from system design plans on record-if checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: GROUND WATER DETERMINED BY AUGER-NO WATER AT 12' „ i G o l :. VY) vi , A 3a 1 _ ' m l p,= ea r � VJ1 � a .s � Q V M ( .a0 HC9U G f� J -� �t —chi C(-tt � R 0 s � r Ra L i Mid-Cape Septic 20 Baxter avenue Hyannis, VA 02601 October 15, 1998 Subject property: 241 Nye Road Centerville, MA Joseph Cifizzari(owner) Barnstable Health Department Main Street Hyannis,MA -Dear-Sirs, 4n regards to subject property, 241 Nye Road,-Centervi-14%Mid-Cape Septic was called in early October by owner Joe CifFzzari to investigate a leak in his driveway. Mr Cifizzari was concerned that the-problem..may.involve a water.line break. -His water bill.-had i=.eased by five times.his normal usage over the last billing period. The driver had dug up septic lids and found water was continously running into the system. The water pressure was relieved. The problem stemmed from a running toilet for over five months. Another pit was Tocated'and found to be bone dry and disconnected from system. Mid Cape Septic will pump original completely dry and properly reconnect other pit. All said and done, system'witl be-in properworking-order. Please see attached letterto Bmk ng Department that dwelling will be single family October 30, 1998. Thank you for your consideration. Sincerely, Dated 10��4� Rodger E. Roberts October 18,. 1998 rf l Z 203 499 068 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse ' ✓� j& um / S IP C Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee N Return Receipt Showing to Whom&Date Delivered Return Receipt Showing to Whom, Date,&Addressee's Address 0 TOTAL Postage&Fees Is oA Postmark or Date ®�' LL a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the m Cc return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. a" 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. M 5. Enter fees for the services requested in the appropriate spaces on the front of this € A, receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. li 6. Save this receipt and present it if you make an inquiry. t o25s5-s7-B-ot 45 d r FINETp� Town of Barnstable O Department of Health, Safety, and Environmental Services MASS.t ��� Public Health Division pTEo 39. P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 D' ector of Public Health 1998 Mr.Joseph Cifizzari 11 Domenick Street Milford, MA 01757 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE AND 105 CMR 410.00 STATE SANITARY CODE H - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. On February 26, 1998 you were ordered to hire a licensed disposal works installer to repair your septic system located at 241 Nye Road, Centerville, within seven (7) days. However, you failed to comply with the order. The property owned by you located at 241 Nye Road, Centerville, listed as Parcel 017 on Assessor's Map 147 was inspected again on September 30, 1998 by Jerome Dunning, Health Inspector for the Town of Barnstable, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code U - Minimum Standards of Fitness for Human Habitation was observed: REGULATION 310 CMR 15.02 (207)AND 105 CMR 410.300: Evidence of overflowing sewage onto the ground. This violation is a serious public health hazard. You are again directed to contact and hire a licensed Disposal Works Installer within seven (7) days of receipt of this letter in order to repair this system or connect to town sewer. You may request a hearing before the Board of.Health if written petition requesting same is received within seven (7) days after the date the order is served. Non-compliance will result in a criminal complaint filing against you in court. PER ORDER OF THE BOARD OF HEALTH f.:. _X _ o s A. McKean Director of Public Health cc: Councillor Clark Is SENDER: v ■Complete items 1 and/or 2 for additional services. I also wish to receive the rn ■Complete items 3,4a,and 4b. following services(for an ■Print your name and address on the reverse.of this form so that we can return this extra fee): card to you. ai d ■Atttramo t this form to the front of the mailpiece,or on the back if space does not 1. El Addressee's Address d ■permit Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N ■The Return Receipt will show to whom the article was delivered and the date .. delivered. Consult postmaster for fee. ° o d v 3.Article Addressed to: 4a.Article Number d E 4b:Service Type ❑'Registered Certified IX LU� ❑ Express Mait' ❑ Insured S .0 Return Receipt for Merchandise ❑ COD o . 7:Date f,Delive 0 a p5.Received By:(Print Name) 8.Addressee's Address(Only if requested W and fee is paid) m t g 6.Signatur . ddressee or ent)^ ~ 0 PS Form 3811, December 1994 toz595-97+s-0179 Domestic Return Receipt UNITED STATES POSTAL SERVInEl First-Class Mail Postage&Fees Paid USPS Pec6t_NO.G-10 • Print your am? a dr s, and ZIP Code-in4bis,bowe-- -- P0iic Health Division Town of Barnstable PO Box 534 ' Hyannis,Massachusetts 02601 Fax(508)775-3344 Phone(508)790-6265 Health Complaints 30-Sep-98 Time: 11:00:00 AM Date: 9/28/98 Complaint Number: 1566 Referred To: JEROME DUNNING Taken By: K.S. Complaint Type: TITLE V SEWAGE Article X Detail: UNSANITARY CONDITIONS Business Name: Number: ??? 2W Street: Nye Rd. Village: CeNTERVILLE Assessors Map_Parcel: Complainant's Name: Anonymous Address: Telephone Number: �LI1 Complaint Description: The house, on the corner Nye Rd. and Duncan Ln., Centerville, has an overflow septic system more than one year. The smell is awful. This complainant is anonymous and she doesn't know the street numbe, but she gave me the owner's name. It is Joseph Cifizarri. Jerry, I was looking at the Assessor's book, but I didn't find anybody with the name Joseph Cifizarri. So, I couldn't figure out what is the right number, but I foun . house on the corner of Duncan Ln. It i #245 but the owner's name is different. Actions Taken/Results: Investigation Date: Investigation Time: 1 �AA4 Commonwealth Electric Company w 2421 Cranberry Highway COMflectric Wareham, Massachusetts 02571 Telephone (508) 291-0950 CERTIFIED MAIL May 13, 1992 Pierina Cifizzari 101 Lietrim Circle Centerville, MA 02632 RE: Account.#1463-6v9-0072 Service-at: 241 Nye Road, Centerville Dear Mr. Cifizzari: COM/Electric has received the enclosed violation of the Massachusetts Sanitary Code at the above address. The Sanitary Code states the following: The Owner shall provide and pay for the electricity and gas used in each dwelling unit unless: 1. Such gas or electric is metered through a meter which serves only the dwelling unit, and 2. The rental agreement provides for payment by the occupant. If the above two criteria are not met, the customer of record must be the owner, not the tenant, and the owner must pay for the service. According to this code and the Department of Public Utilities' practices, you are responsible for the bills from either the date the violation began, if it can be determined; the date your tenant(s) acquired service; the date you became the property owner; or for a period of time not to exceed six years (Statute of Limitations); whichever is shorter. In the near future, you will be issued a bill for the appropriate time period. The responsibility for service will remain yours until the situation has been corrected and reinspected. At such time, your tenant may call for service. Sincerely, COM/Electric Doreen CUSTOMER INQUIRY CENTER DMD:pvi cc: Tenants Wiring Inspector 5 s i i ;11 Dominick Street Milford, MA 01757 March 30, 1992 Richard R. Bearse, Building Inspector Town of Barnstable 367 Main Street Hyannis, Massachusetts 02601 Re: Joseph P. Cifizzari, Sr. 241 Nye Road, Centerville Dear Mr. Bearse: I received your letter, dated March 18, 1992, ,and as you know I have spoken to you concerning• the contents of-.your letter and the inspection conducted by the health inspector. You had asked me if the property at 241 Nye Road, Centerville had been sold to my son as a two-family dwelling. We checked with the attorney who handled the closing for him. The Purchase and Sale Agreement did not specify a two-family house, but the women who sold the property was occupying the downstairs area at the time my son purchased the house in October, 1982. It had been represented to him that the downstairs constituted separate living quarters, and that was one of the selling features at the time he purchased the property. Ply son was a building contractor at that time, and unfortunately, like so many others in his trade, the ongoing recession has taken its toll, and he basically lost everything he had worked for. My husband and I were able to purchase his Centerville properties from the FDIC. My husband is 67 years of age and I am 66 years of age and we were not aware, like our son before us, that we t were violating the by-laws of the Town of Barnstable. We have relied on the steady income from the downstairs unit to help pay for the mortgage. The resident has a lease with us through August, 1992. We are concerned about the potential liability should we have to ask the tenant to vacate before the end of the lease. i We, therefore, request that you provide us with a hearing on this matter. If the tenant must move out, we would ask that you allow us to let the tenant stay until August unless they find other quarters sooner. My husband and I have discussed placing this property for sale, but as you know, the real estate market is still very poor and there is an abundance of property for sale on the Cape. Since we only have a limited income, we ask that you not fine us or give us tickets as referred to by Thomas McKean's letter dated March 18, 1992. We did not know we were violating the Town By-Laws. We would appreciate any consideation you can give us. Very truly yours, 'i 14rs. Pierina Cifizzari i . The Town of Barnstable � Inspection Department eei 610. `�� 0k►1'' 367 Main Street, Hyannis, MA 02601 508-790-6227 Joseph D.DaLuz 1 P Building Commissioner May 5, 1992 1 Mr. & Mrs. Joseph, P. Cifizzari 11 Domenick Street i Milford, MA 01.757 RE: A=147-017 241 Nye Road, Centerville x Dear Mr. & Mrs. Cifizzari I have read your. letter concerningthe property formerly . owned by your son that you took over from F.D.I.C. In your -� -- letter you indicated that your son was represented by an 5 attorney who did the closing. I mention this only to suggest that you may need to have him clarify for you the legality of the downstairs living quarters relative to zoning. In terms of our Zoning Ordinance there is a violation. cannot extend a use that is not legal. I n situation, however, I must inform you that dthe downstarsour apartment must be removed and this office notified for inspection to assure compliance. I request notification of your course of action within fourteen ( 14 ) days of receipt of this letter. I trust this can be accomplished and the matter resolved k - without litigation. 'OSTAGE, i RVICES(see fm Peace, f the return add ,indpw or hand right of the ret o eph D. DaLu uilding Commissioner and address o.{ JDD/gr r ns of the gum g article RETU of the addres Certified mail: P 650 798 008 R.R.R. of this receipt i o.1990.270-1 C�ni7�e� Clitl� C� i This approval is granted because recent well test results indicate that the well water meets all the parameters of the Safe Water Drinking Act of 1974, revised 1986 and 1990. Yours Truly, s Joseph C. Snow, M.D. f Chairman BOARD OF HEALTH TOWN OF BARNSTABLE BOARD OF HEALTH JCS\bcs cc: Robert McDonough (// D) ®1 C / 105 CMR: DEPARTMENT OF PUBLIC HEALTH ��.. ) 410.354: Metering of Electricity and Gas /v I (A) The owner shall provide and pay for the electricity and gas used in each dwelling unit unless /J (1) Such gas or electricity is metered through a meter which serves only the AZ dwelling unit, except as allowed by 105 CMR 410.254(B); and ,rye (2) .The rental agreement provides for payment by the occupant. (B) If the owner is required, by this Chapter or by a rental agreement �l a consistent withathis Chapter,.to pay for.the electricity or:gas.used irr a dwelling unit, then such electricity or gas'may be metered through meters which serve more than one dwelling unit. I/ �1 / (C) If the owner is not required to pay for the electricty or gas used in a ®��1 dwelling unit, then the owner shall install and maintain wiring and piping so that any such electricity or gas used in the dwelling unit is metered through meters which serve only such dwelling unit.• -� 'SPACE AND USE ~� Section 410.400: Minimum Square Footage ����✓ I 410.401: Ceiling Height LP 4101402: Grade Level (410.403 through 420.429: Reserved) SPACE AND USE 410.400: Minimum Square Footage - --- —--`� (A) Every dwelling unit shall contain at least 150 square feet of floor space for its first occupant, and at least 100 square feet of floor space for each additional occupant, the floor space to be calculated on the basis of total habitable room area. (B) In a dwelling unit, every room occupied for sleeping purposes by one occupant shall contain at least 70 square feet of floor space; every room occupied for sleeping purposes by more than one occupant shall contain at least 50 square feet of floor space for each occupant. (C) In a rooming unit, every room occupied for sleeping purposes by one occupant shall contain at least 80 square feet of floor space; every room occupied for sleeping purposes by more than one occupant shall contain at least 60 square feet for each occupant. 410.401: Ceiling Height (A) No room shall be considered habitable if more than three-quarters of its floor area has a floor-to-ceiling height of less than 7 feet. (B) In computing total floor area for the purpose of determining maximum permissible occupancy, that part of the floor area where the ceiling height is less than 5 feet shall not be considered. 410.402: Grade Level No room or area in a dwelling may be used for habitation if more than one-half of its floor-to-ceiling height is below the average grade of the adjoining ground and is subject to chronic dampness. TEMPORARY HOUSING Section 410.430: Temporary Housing Allowed Only with Board of Health Permission 12/31/86 105 CMR - 3381 *INC ro` The Town of Barnstable i fAM : Inspection Department t 7 UA ., 367 Main Street, Hyannis, MA 02601 �0 YAY M' 508-790-6227 # Joseph D.DaLuz Building Commissioner March 18, 1992 Mr. Joseph P. Cifizzari 11 Domenick Street , Milford, MA 01757 RE: A=147-017 241 Nye Road, Centerville r Dear Mr. Cifizzari: At the request of Health Department Agent Donna Miorandi I accompanied her to inspect the dwelling owned by you located at 241 Nye Road, Centerville. This office has no record of a building permit to authorize an apartment in your single family dwelling. Your dwelling is located in a Residence C zoning District and only single family dwellings are permitted. Please contact this office immediately re the above matter. Very truly yours, ZcPhard Bearse Building Inspector RRB/gr cc: Health Department/ Certified mail: P 650 797 999 R.R.R. 'ss o s yTME Tp`` _ The Town of Barnstable per' Health Department E """r'M` rug 367 Main Street, Hyannis, MA 02601 Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health March 18, 1992 Mr. Joseph Cifizari 11 Domenick Street Milford, Ma. 01757 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE BOARD OF HEALTH'S NUISANCE CONTROL REGULATION NUMBER ONE The property owned by you located at 241 Nye Road, Centerville, was inspected on March 17, 1992, by Donna Miorandi, Health Inspector for the Town of Barnstable, because of a complaint. The following violations of Nuisance Control Regulation Number One Regulation and the Sanitary Code II were observed: 410.354 Metering of Electricity and Gas: Only one meter observed for two (2) dwelling units. If the owner is not required to pay for the electricity or gas used in a dwelling unit, then the owner shall install and maintain wiring and piping so that any such electricity or gas used in the dwelling unit is metered through meters which serve only such dwelling unit. You are directed to correct these violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of $40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health 1 6-7_ 0` No.... Fizz 3 Barnstable Conservation Ccr* ssi.oTHE COMMONWEALTH OF MASSACHUSETTS LA BOAR® OF HEALTH � ��-' OWN OF BARNSTABLE Signed Date Appliration for Uispotial Works Tonitrnr#ion ami# Application is hereby made for a Permit to Construct ( ) or Repair (xi' an Individual Sewage Disposal System at: .......... __ .-A........... .. a..... ...j•............................. Location-Address C. or Lot No. CS.. t............................... ------------------------------------- Owner Addr s Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.....................................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building No. of persons............................ Showers a —Type g ---------------------------- P ( ) — Cafeteria ( ) Otherfixtures -----------------------------------------------------------•--•---•-•••--••-•------•-•------.....--------•••-------........------•---•..........----• W Design Flow.....ce:S..............................gallons per person per day. Total daily flow....... ....................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.....J............. Diameter.,40._ ...... Depth below inlet..t............. 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........................ 9 -----------------------------------•------------••---------•---...------.........----•----•----•---.......................................................... 0 Description of Soil........................................................................................................................................................................ x UW -----•-•--•-----------------•-----------•-•--------••----•-•-•••--•-•---------------......•---••-------•-------•--------•-----....•---------•••••--••------•••••----•--•----•-------••--............... Nature of Repairs or Alterations—Answer when applicable.__. /i-SrA_& _....e-AL'-C . dam----_-_---....__- -JT -7-0Z'7`................................................................................................................. 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 issue the board of health. i ned ... ...-- �.�.... "�` ----------- — ------------ - Date Application Approved B � PP PP y ......�^............... � ..... ----------------------.......... Date Application Disapproved for the following reasons- -------------------- ------------------ ---------------------------- ........................-----.....---------..---- ---------------------------------------------------------- ------ ------------------------------------- ---- -------------------------------------------------------------------------------------- ----13�t'�................... No. 7........................ Issued ----...------ 1 � Date .. ................................ Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratmwu ��� ���«�� poiiaK� Works TonstrurtWmtt 1hrutit Application is hereby made for u Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: -_ - . -/ ��"���� - ___'-_~==Address . at No. - --__- Owner Address Installer Address ' Type of Building Size - feet Dwelling—No. of Bedrooms.....3---------------------------------Expansion Attic ( ) Garbage Grinder { ) Other—Type' of Building ............................ No. of persons............................ Showers ( ) -- Cafeteria ( ) ~� Other fixtures ueoggo .4�xUooaper person per du� Totalda�vflow.- Septic Tank—Liquid Length................ Width................ Diameter................ Depth................ Disposal Trench--No. .................... Width.................... TotalLength.................... Totaloc��---____�g �. Seepage Pit -.:.-' ��...-- Depth ��m� ��c� '............ Iotu urcu-----__ag b. Z Other Distribution box ( ) Dosing tank ( ) '- Percolation Test Results Performed by.......................................................................... Date........................................ � Test Pit No. ]�---.---minutes per�c6 Depth of Test u Pi --_------ c -- ----_ D�y�� togrouo� �utc . . . �� - Test Pit No. 2_------minutes per inch Depth of Test Pit.--------' Depth to ground water........................ *° ` .--'--------_-'-'-_-.-'-.----_-_-__-.---'-'---________'__.-___-___.- | ^' Description m6 Soil........................................................................................................................................................................ ---------------------------------------- --------- ---------------------------------------------------------------------------------------------------- ------------------------------- '--------------- ---------------------------------------------------------------------------------------------------------------------_.--'-__-_---'-'----'--_---'_---' U Nature of Repairs or Alterations—Answer when applicable-_ ------e.. -,) 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 board of health. Dtte Date I Dat -------------- THE COMMONWEALTH OF MASSACHUSET`rS BOARD OF HEALTH TOWN OF BARNSTABLE THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired (7<_� 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. _---------------- dated -------I,X THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE',,THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................../.O./­.-�............../..................--------------------------- Inspector .............................................................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH to Construct or Repair I an Individual Sewage Disposal System Street FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with o - ' TOWN OF BARNSTABLE LOCATION �� ��,�,� SEWAGE VILLAGE G-t&L ( N ASSESSOR'S MAP & LOT i" INSTALLER'S NAME & PHONE NO. 6APE_ SEPTIC TANK CAPACITY Cr-1 S4Z"t , c, 1, Ml \A LEACHING FACILITY:(type) i'R �Gt��"� Pc ( (size) NO. OF BEDROOMS PRIVATE WELL O LIC W�AT�R��./� BUILDER OR OWNER . DATE PERMIT ISSUED: O lq� DATE COMPLIANCE ISSUED: © / VARIANCE GRANTED: Yes No Ny W p a � 2fl3 499 114u US Postal Service Receipt for Certified ai No insurance Coverage Provided. Do not use for International Mail a re Sent to i St et, um P ce,S'40 IP e Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee rn Retum Receipt Slowing to Whom&Date Delivered Retum Receipt Showing to Whom, Q Date,&Addressee's Address CDTOTAL Postage&Fees is J. € Postmark or Date ck postage stamps to article to cover First-Class postage,certified mail fee,and rges for any selected optional services(See front). f you want this receipt postmarked,stick the gummed stub to the right of the return dress leaving the receipt attached, and present the article at a post office service ndow or hand it to your rural carrier(no extra charge). If you do not want this receipt postmarked,stick the gummed stub to the right of the turn address of the article,date,detach,and retain the receipt,and mail the article. LO If you want a retum receipt,write the certified mail number and your name and address rn n a retum receipt card,Form 3811,and attach it to the front of the article by means of the mmed URNends if spac e permits. Otherwise,affix to back of article. Endorse front of article f article ETIPT REQUESTED adjacent to the number. Q If you want delivery restricted to the addressee, or to an authorized agent of the O O idressee,endorse RESTRICTED DELIVERY on the front of the article. M Enter fees for the services requested in the appropriate spaces on the front of this E ,ceipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. `o Save this receipt and present it if you make an inquiry. 102595-97-I3-0145 Il r i EVE Town of Barnstable BARNMBL& Department of Health, Safety, and Environmental Services MASS. Public Health Division P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health February 26, 1998 Mr.Joseph Cifizzari l 1 Domenick Street Milford,MA 01757 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V• MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE, AND 105 CMR 410.00 STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at 241 Nye Road, Centerville, listed as Parcel 017 on Assessor's Map 147 was inspected on February 24, 1998 by Jerome Dunning, Health Inspector for the Town of Barnstable, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code II - Minimum Standards of Fitness for Human Habitation was observed: REGULATION 310 CMR 15.02 (207)AND 105 CMR 410 300• Overflowing sewage onto the ground. This violation is a serious public health hazard. 1) You are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four(24) hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. 3) You are further directed to contact and hire a licensed Disposal Works Installer within seven (7) days of receipt of this letter in order to repair this system or connect to town sewer. You may request a hearing before the Board of Health if written petition requesting same is received within seven(7)days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF HE BOARD OF HEALTH Thomas A.McKean Director of Public Health cc: Gloria Urenas PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel Id: 147 017- - Account No: 82528 Parent : Location: 241 NYE RD CENTERVILLE Neighborhood: 36BC Fire Dist : CO Devel Lot : 40 Lot Size : . 50 Acres Current Own: CIFIZZARI, JOSEPH P SR & State Class : 104 PIERINA A CIFIZZARI No. Bldgs : 1 Area: 1464 11 DOMENICK STREET Year Added: MILFORD MA 1757 Deed Date: 050191 Reference : 7516/230 January 1st : CIFIZZARI, JOSEPH P SR & Deed MMDD: 0591 Deed Ref : 7516/230 Comments : Values : Land: 30000 Buildings : 86400 Extra Features : 17000 Road System: 241 Index: 1110 (NYE ROAD ) Frntg: 211 Index: 457 (DUNCAN LANE ) Frntg: 132 Control Info: Last Auto Upd: 050695 Status : C Last TACS Update : 020692 Land Reviewed By: Date : 0000 Bldgs Reviewed By: Date : 0000 Tax Title : Account : Taken: Account Status : Hold Status : Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [147] [018] [ ] [ ] [ ] I d SENDER: V ■Complete items 1 and/or 2 for additional services. I also wish to.rife the — .N ■Complete items 3,4a,and 4b. O r'ST98 Ar an ai ■Print your name and address on the reve96. at we can return this card to you. �pp"" �s.�...,.. -- ,.�... .. > ■Attach this form to the front of the mail on l�e�aciyi pace does not ee'S Add permit. A Ali `S� $ ■Write'Retum Receipt Requested'on theni � 6w the article number �Cigd Delive�„ •The Return Receipt will show to whom th delivered and the dateo delivered. ,.; 6ec+sult postm fer for feer�M--�•:�" d 3.Article Addressed to: 4a.Article Number a 7 E 4b.Service Type «'+ ❑ Registered Certified ❑ Express Mail ❑ Insured LU w ❑ Return Receipt for Merchandise ❑ COD a 7.Date of Delivery z >I n 5.Rec ved By:(Print Name) + V Addressee's Address�v (Only if requested f fil��. :r d fee is paid) FW t g 6.,Sign !re: Addressee or Age t 4 Y X :r t + et r J — w PS 1=otm 3811, December t a S ozss5-s7-e-ons Domestic Return Receipt r r'�C�bl ERMirst-ass lidaiUNITED STATES POSTAL SERVICEMupstage.&-F-ees Paid = dP Print your nark Efei , and ZIP Code-irr public He �Ith Division Town bt Barnstable PO Box 534 Hyannis,Massach4u4setts 02601 Phone(508)790-6265 4. t i r TO OF BARNSTABLE L :�Tlor� SEWAGE # VILLAGE (, �1"� iLr ASSESSOR'S MAP & LOT - �� `1 LNSTAL.LEKS NAME&PHONE NO. SEPTIC TANK CAPACITY i LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 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) Edge of Wetland and Leaching Facility (If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet ----------------- SAP c I Li .A 1 AP ac LIT g® 3� i r TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. �sL. i� sdT - SEPTIC TANK CAPACITY LEACHING FACILITY:(type) -� ;a P� E (size) NO. OF BEDROOMS y PRIVAT'yE WELL O LIC WATER \.� BUILDER OR OWNER 0� a- DATE PERMIT ISSUED: i 1cf i I DATE COMPLIANCE ISSUED: DV f VARIANCE GRANTED: Yes No �y � << - t P` _ - I / 7 LOLt,TIOKI , 5EWo :�E PERMIITy-Qo. IMSTAL( LER S IJIE ADDRESS �J 5UILDEF12 5�.,Q &V AF- ADDRESS DtkTE PERNAIT 155UED DATE CONAPLI &MCE ISSUED : , i r , r , f: fr i � r � act 73 0 ,000:�� � i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... .... ��J.. _..........OF....�'�................�.... ................................................... ApV iraflon -for Uiiipoiial Workii Tomitrurtion Punift Application is hereby in d for a Permit to Construct ( '-)or Repair ( ) an Individual Sewage Disposal System at 5�D . 1.1. ' a' P�P�,d��...�*"��'�-,i/� �7���� /���;�� H---------------------------------------- Location.AddressGam. 041 r No. c ..3 k S� rt------------------------------------------------- ------ .....--- ...... -- -- 1-./---`�------------------------. Owner Address .......................................... ---..................................... Installer Address 2 Z S 0 U Type of Building Size Lot.... _....J----------------Sq. feet Dwelling—No. of Bedrooms.....--.�--------------•-------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ..__---------------------- No. of persons.......3------------------ Showers Cafeteria ( ) a' Other fiYtus U --------••---•-•----•-----------------•-•----------------------•------ W Design Flow-- -------- - ---- gallons per person per day. Total daily flow............-...--...................;__.._gallons. WSeptic Tank Liquid capacitv/MU allons Length______________ Width-------.-------- Diameter.....___...._... Dept h................ x Disposal Trench—No. ............... .... Width_--------..._..---- Total Length-------------------- Total leaching arca---L-U._Uv----sq. ft. Seepage Pit No..................... Diameter-------------------- Depth belo inlet_..... .........._ Total leaching area-..---- ----------sq. ft. z Other Distribution box ( ) Dosing tank ( ) ® ��-�'�t-- y Percolation Test Results Performed by-------- ----_- ........................................................ Date.....-..-----------------------•-.------ ,aa Test Pit No. 1----------------minutes per inch Depth of "lest Pit-------------------- Depth to ground water...._...........-------- f� Test Pit No. 2--_.._._....✓�pute ppr ' ch De th of Test P' ...............:_/. Prpth o ound wat r.....-.- O Description of Soil +9dr...1F-.:// . vet------------------------------------------------------------------------------------------------------ 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 the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in `_- operation until a Certificate of Compliance has been issued by the b�d-of ealth. Sign r " a3-c ___ -''Z �"'------ Date . Application Approved By----- ...... .".. .. Date Application Disapproved for the following reasons------------- -- - - -- •• •------•-••--•--------------.--.........----•----•-•---... ............................................................=-........................................................................•-----•------....-•-•-•-------------------------------------------- Date PermitNo......................................................... Issued........................................................ --.,. a.��__��,____.._._.__.�_.---�----�---------------------------------------------Date------------------------------- 410 No........!_L�-- FEE.. .. ..... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ 0 .._..._.......OF.....�;4.c......... 1: -- -........................., ppliratiun `fir Digpusa1 30orkii Tonstrurtion Vrrutft Application is hereby in hereby for a Permit to Construct ( �or Repair ( ) an Individual Sewage Disposal System at: r * G� ----`-j----_----?p rt�c b°----------------------- �O-- ---------/--- '-------....................... Location-A dress - or Iqt No. --- W Owner Address --------------------------------------------------------------------------------------- --------- Installer Address Type of Building Size Dwellin Lot_.Z? � r..:..Sq. feet g No. of Bedrooms-._---__-Z------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtues ----------------------- ---------------------------------------------------------------------------------- ----------- ............... Design . .. gallons per person per day. Total daily flow..............:............... g W - ------•-••--•----•- -•--....------gallons. We tic "'.Ink—Liquid capacityZAP__ allons Length................ Width------ ......... Diameter__-.--..-..-_--_ Depth._.._----.---- x D>posaI T•r ch—No_________ _ ___ Width.................... Total Length.................... Total leaching area--------------......sq. ft. eepa g.t'it�No.__/� �.-�I7iameter.................... Depth belo inlet_..... __..._____. Total I c ring area--:--.-.:--_--•.-_sq. ft. Z Other Distribution box ( ) Dosing tank Percolation.Test Results Performed bY.......................................................................... Date----------------------------------.. . a Test Pit No. --------minutes per inch Depth of 'Pest Pit.................... Depth to ground water........................ Test Pit No. 2--------.-------minute p;r h Depth o Pest P .___..__..t ...� pth moo[/. d wa r D Description of Soil........�`��'-•--•-••-- ••- �Gli, ----`-`--`----•_... _ ------------------------------------------------------ -------- ' U -------------------------------------------' ==..............-------------•-•-••-•••....--••••--•••--•••---•----•----••----••••••-••-----•-----•-••-•-•-•---•-••----•-• . --= _ W '< . . i - - U Nature of Repairs or Alterati ns=,Answer when applicable__., ._. ........... ''s K`ti •-------------- ---------- --- ------------------------------- Agreement The undersigned agreestlto,insiaf?the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the�State,-Sani ary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee Issued b the boaarddtof '91th. Sign // .........................----------- ------- - -- Application Approved BY----- ... .... ..a `.tic--••-- ---�-------------- ---- �. , . Date w4Date � Application Disapproved for the following reasons:.......................... -----•-••..............•----•--------•---•---._........•-•-------..........-•----•--- .....--•••---•---•--------------•----...--------------------••-----------•••----•••••--...--••------ ................................................. ............................................. ��•. Date Permmit No--------------------- Issued.-----.. _7- ----7-3 to THE COMMONWEALTH OF MASSACHUSETTS;. .'✓� l ..+ BOARD OF HEALTH OF.................... s' P Trrfifiratr of TOM'phaurr T IS S TO CR-J "rIFrAhat the Individual Sewage Disposal System constructed (#/,<Or Repaired ( ) by ------ ------------------------------------------------------------------------------••----......_....----- - 'Installer at----- ---- ----•- -•-•--••------••-•---- --------•-•••••--•-------•-----------•--•-......----••---•••-----•------ ---••--•----•.- has been installed in accordance with the provisions of Article, I of he State Sanitary Code as escrib d in the application for Disposal Works Construction Permit No.. Q ------ .�............. dated....L.�--� � K THE'fSSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. J DATE €.... Ins ector r �2/!% ez" THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ........ .... .......OF............ ..... _-........................................ No.. FEE../e!"!*'""°" --- V_ A_41 a yr T rurtion PrrmitPermission is hereby grante ...._.___to Construe� ) r Rea ( wage Disposal Sys at No"r_ o'� 11. .�..._ �njvidual ..."' 11• C'�'!.� '� "Q-`�`-r--rYs.l...'Q. ._.......= Street as shown on the application70r, Disposal Works Construction rmit - - Dated...I ._ _ "2_y --.-•- Ali - --�— - - --------- Board of H ,..,.. " DATE.........=...................................-................................... . FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 0 � Z t_ �► 1VYe t LOU.TION /'�// 5EWaC.4EP[/ERMIT -UO. VILLAGE IWSTDL.LER•S tJIE ADDRESS 15UILDIE S Q L MF- ADDRESS D/N►TE PERMIT D ATE COMPLI &I ACE ISSUED : 1 _� � * �� � �� � _ � �. F` � TO OF BARNSTABLE �Tr ��1 SEWAGE # SJ71021 9r'It`CAGE ASSESSOR'S MAP & L8T,— LNSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY 'LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by S�P AA +5 1� �c 3� RB s`