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HomeMy WebLinkAbout0190 PLEASANT PINES AVE - Health (2) 190 Pleasant Pines Avenue Centerville . A= 234—071 SMEAD� No.H163OR UPC 10259 smead.com • Made in USA Commonwealth of Massachusetts L: k Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Pleasant Pines Property Address Sri 190 Pleasant Pines LLC Owner Owner's Name information isCenterville MA 02632 2-26-18 '' required for every page. CityfTown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:out forms when fillip outf A. General Information on the computer,- �H OFrIS��i,,�� use only the tab 1. Inspector: key to move your 7 ? �y cursor-do not James D.Sears '�� JAMES N G$ use the return = ro key, Name of Inspector :I Capewide Enterprises =*' Company Name � �RTI1F O �IL SI 153 Commercial Street '�y 5 INSP��' O`���` Company Address fill om Mas hpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection, The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority C210� 2-27-18 ,46'spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Hoard of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Title 5Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 LTO VS 61, a5ed YU dH 1,0:6Z 91,0E LZ 9aJ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 190 Pleasant Pines Property Address 190 Pleasant Pines LLC Owner Owner's Name information is required for every Centerville MA 02632 2-26-18 page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E 1 always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The System is a 1000 Gal.Tank D Box and two flow's B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or eAltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): Gns-3/13 Title 5 Offic al Inspection Form:Subsurface Sewage Disposal System•Pape 2 of 17 OF a6ed xed dH ZOU 9 XZ LZ 9ad Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Pleasant Pines Property Address 190 Pleasant Pines LLC Owner Owner's Name information is required for every Centerville MA 02632 2-26-18 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s), The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 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 15ins•3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal system.Page 3 of 17 i,Z al5ed xeJ dH M£Z 8 60Z LZ qaJ II Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Pleasant Pines Property Address 190 Pleasant Pines LLC Owner Owner's Name information is required for every Centerville MA 02632 2-26-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well'". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® Liquid depth in is less than 6" below invert or available volume is less than '/z day flow - i;(111As•,( 15ins•3113 Title 5 Officiel Inspection Form:Subsurface Sawage Disposal System-Page 4 of 17 ZZ 96ed xeJ dH Z0U 8 XE LZ qaJ Commonwealth of Massachusetts V d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 190 Pleasant Pines Property Address 190 Pleasant Pines LLC Owner Owner's Name information is required for every Centerville MA 02632 2-26-18 per. Cityfrown State Zip Code Date of Inspection B. Certification (cunt.) Yes No ❑ ® Required pumping more than 4 times In the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system falls. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system falls. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems, To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 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 system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 £Z a5ed xed dH £0U 91,0Z LE 9ad I� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 190 Pleasant Pines Property Address 190 Pleasant Pines LLC Owner Owner's Name information is required for every Centerville MA 02632 2-26-18 page. Cityllrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant. or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the Facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 thins•3113 Title 5 Ofridal Inspection Form:Subsurface Sewage Disposal System•Pepe 6 of 17 bZ a5ed xeJ dH M£Z 9 X2 LZ qaJ i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '( 190 Pleasant Pines Property Address 190 Pleasant Pines LLC Owner Owner's Name information is required for every Centerville MA 02632 2-26-18 page, City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank D Box and two flows. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 2016-203,000Gal g ( y 9 (gp )�' 2017-11,000Gal's Detail.- Sump pump? ❑ Yes ® No Last date of occupancy: NADate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats)persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins,V 3 Me 5 Official Inspection Fortin:Subsurface Sewage Disposal Syslem-Page 7 of 17 gZ a5ed xeJ dH b0U 9 60Z LE qad Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 190 Pleasant Pines Property Address 190 Pleasant Pines LLC Owner Owner's Name informawn is required for every Centerville MA 02632 2-26-1 B page. City/rown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Aitemative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3113 Title 5 Official Ins"don Form:subsurface Sewage Oisposal System-Page 8 of 17 92 a5ed xeJ dH IVOU 9 1,0E LE 9aJ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments = 190 Pleasant Pines Property Address 190 Pleasant Pines LLC Owner Owner's Name information is required for every Centerville MA 02632 2-26-1 S page. Cityrrcwn State Zip Code Date of Inspection D. System Information (cant.) Approximate age of all components,date installed (if known)and source of information: 19135 Pert#85-333 1 New D Box 11-2015. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 22" feet Material of construction: ❑ cast iron ®40 PVC ®other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pi in i 4" 4 H- pe g s PVC SCH 0 &SC 20. Septic Tank(locate on site plan): Depth below grade: 1' reef Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal.Precast H-10 Sludge depth: 1" t5ins•VIS Title 5 Official ktspecuon Form:Subsurface Sewage Disposal System-Page 9 or 17 LZ abed xed dH 50:£Z 91,OZ LZ qad f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 190 Pleasant Pines Property Address 190 Pleasant Pines LLC Canner Owner's Name information is required for every Centerville MA 02632 2-26-18 page. City/Town State Zip Code Date of Inspection D, System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of Outlet tee or baffle 29" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 12 Distance from bottom of scum to bottom of outlet tee or baffle 17 How were dimensions determined? Asbuilt-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level.Tank and cover at 1' below grade. Two inlet tees-out let baffle. No sign of leakage or over loading. Grease Trap(locate on site plan): Depth below grade. feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 15ins•3113 Thie 5 Official Inspection Form,Suhsudace Sewage Dis"gal System-Page,10 of 17 8Z abed xed dH 90:£2 9 602 LZ qad Commonwealth of Massachusetts Title 5 Official Inspection Form �) Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Pleasant Pines Property Address 190 Pleasant Pines LLC Owner Owner's Name information is required for every Centerville ILIA 02632 2-26-18 page. City/Town State Zip Code Date of Impaction D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: I ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches. etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins 3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 62 a6ed xed dH SOU 8 60Z LZ 9ad Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Pleasant Pines Property Address 190 Pleasant Pines LLC Owner Owner's Name information is required for every Centerville MA 02632 2-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cons.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-19"below grade w/one line out. Box is new 11-2015 w/cover at 6". Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ Now Alarms in working order: ❑ Yes ❑ No` Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): ' If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15M•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 OE abed xej dH 90:EZ 960Z LZ qad i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 190 Pleasant Pines Property Address 190 Pleasant Pines LLC Owner Owner's Name information is required for every Centerville MA 02632 2-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number. ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two flow's. Flow's are 40" below grade. Foow's are dry w/no sign of over loading or holding water. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5irts-3/13 Title 5 Offloial inspection Form:Subsurrace Sewage Disposal System Page 13 of 17 I,E a5ed xed dH 90:EZ 2 60Z LZ 9ad f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 190 Pleasant Pines Property Address 190 Pleasant Pines LLC Owner Owner's Name information is Centerville required for every MA 02632 2-26-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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): t5uis-3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 14 or 17 Z£ abed xed dH 90:£Z 960E LZ 9ad Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Pleasant Pines Property Address 190 Pleasant Pines LLC Owner Owner's Name information is required for every Centerville MA 02632 2-26-18 page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately R Eke 0 14 � r', PIRA 99 ! 3 r3- ,y D c i 1 W&N 3H s ` TAfa S oaldal hapat*n Corm;auaaaraa ago ojapaaal 8Y 1ta m.papa 1$ aI tt i EE abed xed dH 90:E2 9 60Z LZ 9ad Commonwealth of Massachusetts Title 5 Official Inspection Form p - Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 190 Pleasant Pines Property Address 190 Pleasant Pines LLC Owner Owner's Name information is required for every Centerville MA 02632 2-26-18 page. city/Town State Zip Code Date of Inspedion D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 0 Estimated depth to igh ground water: 9+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Auger T.H.9'no G.K. Bottom of flows at 5'below grade. Bottom of flows at 4'above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins-3113 TNIe 5 Official Inspection Form:Stmsurtace Sewage Disposal System-Pegs 16 of 17 bE abed xed dH LOU 9 602 LZ 9ad Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 190 Pleasant Pines Property Address 190 Pleasant Pines LLC Owner Owner's Name information is required for every Centerville MA 02632 2-26-18 page. Cilylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, 6, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins 3113 Title s official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 5£ abed wed dH LOU 8 X0 LZ qad No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Nplitation for MispoSal *pBtrm ConstCUttion permit Application for a Permit to Construct( ) Repair(A Upgrade( ) Abandon( ) ❑Complete System [Individual Components Location Address or Lot No. (CID KG-A&AA-T P1,06S AYE Owner's Name,Address,and Tel.No. �i Vrc c.G 1 Gi C C>c-�aS�4r.t tit _S Assessor's Map/Parcel 3 ® f 18 To 1 u> R D E—Q4AM ,M A Installer's Name,Address,and Tel.No.509—47 7—R 871 Designer's Name,Address,and Tel.No. dA06Lv1b?_= &FK7-reXP&1SV% (,L-C_ tQ )A /5-:3 ME P Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided A 14 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ���L h--$OK, 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 Boa of Signed Date Application Approved by Date f j Application Disapproved by Date for the following reasons Permit No. f Date Issued Q®t 57— No. i �Q Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS "Yes applitatlon for bispoBAY 6pstem Construction permit Application for a Permit to Construct( ) Repair(A Upgrade( ) Abandon( ) f Complete System Individual Components s Location Address or Lot No. 1410 PCGA-SA "r PIJUI:S AVC Owner's Name,Address,and Tel.No. C.�Vt 4&,c i ct O P t-r.-ASOW P 11J C S L-t-C. \ Assessor's Map/Parcel 03 O 1 J S GOILL PQ> D L, AM M A Installer's Name,Address,and Tel.No. 509-477 FS 8"T`1 Designer's Name,Address,and Tel.No. G40Ewro G G.1.C- N/A 153 C0WAt9W-J P69- Type of Building: /�/ Dwelling No.of Bedrooms ` ' Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of.Persons'" Showers( ) Cafeteria( ) Other Fixtures ----- Design Flow(min.required) ►y gpd Design flow provided A gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank ,Type of S.A.S. ti Description of Soil Nature of Repairs or Alterations(Answer when applicable) ��i+4�� 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 Bo of Signed Date it - 3 Application Approved by Date Application Disapproved by Date for the following reasons ,r n Permit No. �O Date Issued o2C) s 3� --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS CPrtif irate of Copt iattre t THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired upgraded( ) Abandoned( )by CAPE W 06 C—•N tom' p,Q� C/.,�C— at IcIO e cxAFo t r P&AZ kVe C'✓I LL C has been constructed in�jc xdance (, with the provisions of Title 5 and the for Disposal System Construction Permit No. 0) 'JUdated 3 Installer E�t� C Designer �" �#bedrooms I Approved design flow, i,/{ gpd The issuance this pe it shall not be construed as a guarantee that the system w',1 do as desigri d. Date I / Inspector n --------------------- ---------- - No. �G �v Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal *psttm Construction permit Permission is hereby granted to Construct( ) Repair(X) Upgrade( ) Abandon( ) System located at (CIO p LC 14 34 XJT 'P f,tJ&�S A UQ7 <;;a(fj t 2V/L(-AC 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 be completed within three years of the date of this perm' . Date I ( 15 Approved by I L Nov 19 2015 22:52 Jh The Inspector Man 5085349919 page 18 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 190 Pleasant Pines Property Address Lisa Falkon a" Owner Owner's Name — Information is N Centerville required for eve MA 02632 11-19.15 page. Cfty/Town State Zip Code Date or Inspection Inspection results must be submitted on this form. Inspection fortes may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out fouls A. General Information �/ 2�Z prrir, on the computer, `,�tttjrtrlllt /I�J 7 ����� SN OF use only the tab 1. Inspector �� ' key to move your ��a.: "••,[,y+ cursor-do not James D.Sears �: JAMES •=� use the return — :�► key. Name of Inspector Ca wide Enterprises, LLC � Company Name 153 Commercial Street I N$09 Company Address Mashpee MA 02649 j Cltylrown State -Z1p Code 508477-8877 81623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address.and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to$action 15.340 of Title 5(310 CMR 15,000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority cy--' 11-19-15 spectors signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heatth or DEP)within 30 days of completing this inspection. if the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DER The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. ""This report only describes conditions at the time of Inspection and under the conditions of use at that time.This Inspection does not address how the system will perform In the future under the same or different conditions of use. Wine U13 Title 5 QfRcled kapeeion Form Sirbsurlsm Scrape UislDmi Syslem•Papa 1 d 17 �0�r V r Nov 19 2015 22:53 Jim The Inspector Man 5085349919 page 19 Commonwealth of Massachusetts Tulle 5 Official Inspection Fort Subsurface Sewage Disposal System Form -Not.for Voluntary Assessments 190 Pleasant Pines _�..... �.. _ _.M.._.__ Property Address Lisa Falkon Owner Owner's Name .......�_.._.�.._ Information is required for every, Centerville _..__�.....--_-._... _ MA.....__... 02632 _._.,,. 11 19-15 Y page. Crt rrowri state Zip Code Qate.of Inspection. _ B. Certification (cone.) Inspection Summary: Check A,B,C,D or E i always complete all of Section D A) System Passes; ® l have not found anyinformiation which indicates that any of the failure criteria described in 310 C M R 15.303 or in 310 C MR.15.304 exist.Any failure criteria not ovaluated are indicated below. Comments: The System is a.1000 Gal. Tank D Box and two flows. _..._,._ .... i I B) System Conditionally Passes; E 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 orrepair,as approved by the Board of Health, will.pass. Check the box for"yes", "no"or"not determined"(Y,.N, ND)for the following statements. if"not determined;" please explain.. The septic tank is rnsEa1 and over;20 years old' or the septic tank(whether metal or oat) is slrucEuraiiy unsound, exhibits substantial infiltration or exiiltration or tank failure is imminent, System will pass inspection if the:existing,tank is replaced with a complying septic ta Health, nk:as.approved by the Board of _ A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. Y. ❑ N F ND(Explain below). --------------- ....._..._....... _ _ l T Me 5;}Rcial h9pead0n f"I;su sw(ace Sewage Msp$01 System y'PvjIe 2 WIT s Nov 19 2015 22:53 Jh The Inspector Man 5085349919 page 20 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form. Not for Voluntary Assessments 190 Pleasant Pines Property Address Lisa Falkon Owner Owners Name Informrequired tion is Centerville MA 02632 11-19-15 requlrcd for every page. cilylTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval If pumps/alarms are repaired. B) System Conditionally Passes(cunt.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 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 Wins•3113 YiW 6 Official kupeution Fa",Subsurtme Sawepe Dispa"I Sytdem•Pop 3 or 17 Nov 19 2015 22:54 Jim The Inspector Man 5085349919 page 21 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 190 Pleasant Pines Property Address l_Isa Falkon Owner Owners Name information is every Centerville required forgive MA 02632 11-18-15 page. Cityrrown State Zip Code Date of Inspedion B. Certification (cunt.) 2. System will fall 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 I of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet Out 50 feet or more from a private water supply welr`. Method used to determine distance: " This system passes if the well water analysis, performed at a DEP oertifled laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 pprn, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must Indicate"Yes"or"No"to each of the following for all inspections. Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in somped is less than 6" below invert or available volume is less than 'Y2 da flow Uelll vG sins•11f 3 Tide 5 of dol Impecoon Fam:subsur"m •DI SaKp rpwal SlrIoem•Ppo 4 of 17 f Nov 19 2015 22:55 Jim The Inspector Man 5085349919 page 22 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 190 Pleasant Pines Property Address Lisa Faikon Owner Owner's Name information is required for every Centerville MA 02632 11-19-15 page, city/Town State Zip Code Date of Inspection B. Certification (cunt.) Yes No ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy Is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal colitorm bacteria Indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than S ppm, provided-that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system f"i . I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone It of a public water supply well If you have answered"yes'to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Sectlon'D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 151r,e-3013 Time 5 011idal k+epaGtion Fomr Subauraca Sewage Disposal Syslam•Page 5 of 17 Nov 19 2015 22:55 Jim The Inspector Man 5085349919 page 23 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 190 Pleasant Pines Property Address Lisa Falkon Owner Owner's Name information is required for every Centervilis MA 02632 11-19-15 _page. Cityrrown Stale Zip Code Date of Inspection C. Checklist Check If the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(if they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? i ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(5)) D. System Information Residential Flow Conditions: Number of bedrooms(design): NA Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Mms-MS 11t1e 5 Ofhaal Inttpectbn Form:tiubsvfeoe Sewepe Dlerwsel System•Pape S of I i Nov 19 2015 22:56 Jim The Inspector Man 5085349919 page 24 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Pleasant Pines Property Address Lisa Falkon Owner Owner's Name iequiretion is required for every Centerville MA 02632 11-19-15 page. Cityrrown State Zip Code Date of Inspectlon D. System Information Description: The system is a 1000 Gal. Tank D Box and two flows. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(include laundry system inspection [l Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage 2013-107,000Gal 9 ( y g (gPd))' 201447,000Gal's iDetall: i Sump pump? ❑ Yea ® No Last date of occupancy: NA Date Commerclallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatslpersonsiscl.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: i Ons-3113 Us 5 Drum i+mpenton Fmm subeurreu Sawaga Dispoear syetsm.Pepe 7 of 17 Nov 19 2015 22:56 Jim The Inspector Man 5085349919 page 25 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 190 Pleasant Pines Property Address Lisa Falkon Owner Owners Name Information is required for every Centerville MA 02632 11-19-16 page. Cityffawn State Zip code Date of Inspection D. System information (cunt.) Last date of occupancy/use: Oats Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: — gallons i How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ other(describe): ' Wins•Wl 3 Title S ORicief V-vection Form:Srbm once Sewage Disposal SYslem•Peme 8 of 17 I Nov 19 2015 22:56 Jim The Inspector Man 5085349919 page 26 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 190 Pleasant Pines Property Address Lisa Falkon Owner Owner's Name Informatlon (equiredfo is Centerville MA 02632 11-19-15 reQulred for every page. Cftyrrown state Zip Code Date of Inspection D. System Information (cant.) Approximate age of all components, date installed (if known)and source of information: NA / New D Box 11-2016. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth Below grade: 22"lest Material of construction: ❑ cast iron ® 40 PVC ®other(explain): Distance from private water supply well or suction line'. fat Comments(on condition of joints, venting, evidence of leakage, etc.): _Pipeing is 4"PVC SCH 40&SCH-20. I Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ®concrete I: ❑ metal El fiberglass ❑ polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal.Precast H-10 Sludge depth: 3" 'ISino•3113 Tire S OW-W 6WWon Form:Sunrun®S w S wwaps Wapa yatwn•Page 9 a!17 i Nov 19 2015 22:56 Jlm The Inspector Man 5085349919 page 27 i Commonwealth of Massachusetts I Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i 190 Pleasant Pines Property Address Lisa Falkon Owner Owner's Name infonellrequired Centerville MA 02632 11-19.15 required for every page. Citylrown state Zip Code Dale of Inspection D. System Information (coat.) Septic Tank(cunt.) 27" Distance from top of sludge to bottom of outlet tee or baffle f 1„ Scum thickness Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tank at working level. Tank and cover at 1' below grade. Two inlet tee's-out let baffle. No sign of leaks a or over loading. Grease Trap(locate on site plant' 1 Depth below grade: feet Materiai of construction: ❑ concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Nns•3113 rAle 6 OMl W Ir»peWon Fam Subwrfam Sew pe Mworl System•Pape 10 of 17 7— I Nov 19 2015 22:57 Jim The Inspector Man 5085349919 page 28 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 190 Pleasant Pines Property Address Lisa Falkon Owner Owner's Name information for is Centerville MA 02632 11-19-15 required for every page. City/town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural Integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: -- Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per da 9 p y Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes. ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Mins-U13 Title 5 0Mriel Inspect on forte subsumed Serape Disposal system•Page 11 or I I Nov 19 2015 22:57 Jim The Inspector Man 5085349919 page 29 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 190 Pleasant Pines Property Address Lisa Falkon , Owner Owner's Name information is Centerville MA 02632 11-19-15 required for Every page. CRown state 2 p Code Date of Inspection � D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 I Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"A 9"below grade w/one line out. Box is new 11-2015 w/cover at 6". Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ Noe Alarms in working order. ❑ Yes ❑ No` Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): ' If pumps or alarms are not in working order,system is a conditional pass. Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located, explain why: l5ins•3113 Title 6 Of wW bupaa!an ram&hsurfam Serape Diepand Sydem•Pape 12417 l Nov 19 2015 22:58 .fim The Inspector Man 5085349919 page 30 Commonwealth of Massachusetts Title 5 Official Inspection Form 5 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 190 Pleasant Pines Property Addr*ss Lisa Falkon Owner Owner's Name equired on to every r Centerville MA 02632 11-19-15 required page. CityfTown state Zip Code Date of Inspection D. System information (oont.) Type: ❑ leaching pits number: --- ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,etc.): Leaching Is two flows, Flow's are 40"below grade. Flow's are dry w/no sign of over loading or holding water. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Win•3113 Title 5 Olbdnl lrupsdion Fvm.Subsudr Scrap.Di.pod Syalem•Pepe 19 or 17 i - Nov 19 2015 22:58 Jim The Inspector Man 5085349919 page 31 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 190 Pleasant Pines Property Address Lisa Falkon owner Owners Name information is required for every Centerville MA 02632 11-19-15 page. Cityrrown state Zip Code Date of Inspection D. System Information (corm.) Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): i I I Privy(locate on site plan): i i Materials of construction: Dimensions I Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, i 1 151r a•3h 3 Title S Dfielal lnspedon Form!SLbauface Savage Disposal Syatam•Page 14 of 17 I Nov 19 2015 22:58 Jim The Inspector Man 5085349919 page 32 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 190 Pleasant Pines Properly Address Lisa Falkon owner Owners Name informrequired tion is Centerville MA 02632 11-19-15 required for every page. CRylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �#-1= ►7 REAR 47 0 IL 16trw•3/1 3 i Tide 5 fJAldal Inspection Form:SuDeuMre Setups Oieposel System•Page 15 of 17 i Nov 19 2015 22:58 Jim The Inspector Man 5085349919 page 33 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 190 Pleasant Pines Property Address Lisa Falkon Owner owners Name Information is Centerville required for every MA 02632 11-19-15 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells a0 Estimated depth t high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: pate ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USOS database-explain: You must describe how you established the high ground water elevation: Auger T.H. 9' no G.K. Bottom of flows at 5' below grade. Bottom of flows at 4' above T.H. Depth. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t6int•3013 Tile 5 official hspaeflan Farm:Subsurface Sewage Okposel Slam-Papa 16 of f 7 I Nov 19 2015 22:59 Jrn The Inspector Man 5085349919 page 34 ..;a\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 190 Pleasant Pines Property Address Lisa Falkon 0wner Owner's Name Information is required for every Centerville MA 02632 11-19-15 page, City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i 1 ISins•Wt3 Tile 8 OfkW Insomwon Farm:Subsurfsas SVOW Disposal System•Pape 17 of 17 I I Page 1 of 1 i Room .Lliiing Lit ing ]io im' 2$`xtb` Kitchew is ti6' 6'x6' All measurements are approximate and not�ouarante6c! th s'illustr'ation is pr`ovjded:for` tarket nq and conven er ce only,Allainforrnation should.be ven i 'tndeb'endently.O PlanOmatic https:Hphotos.zillowstatic.com/p_f/ISivnic2ihs11h 1000000000.jpg 9/6/2017 Page 1 of I Dii& AC . patit s2Q�X 2' Bedroom Bedroom. x3'x8� 4v ZI Will' i Bedbom sus cam: F® er _ 13ii x.5 � tra A!Vmeasurements are 4pproXimate end not guarantee'd This dlustrationtis pfovided'f6e arketincrand'convenience nIv.',All information should be verifii d ridegenderitiv:.'C?PIa Omat c https://photos.zillowstatic.com/p_f/IS2fkowsrppdth1000000000.jpg 9/6/2017 Page 1 of 1 Ol �k r a � ' 1 ! a i 1 ' r, _:=.f,� me'µ �F• � � �; 1 https://photos.zillowstatic.com/p_f/ISmgy6wy2mx7lh1000000000.jpg 9/6/2017 Page 1 of 1 41 tt a�v m � o t let'; https:Hphotos.zillowstatic.com/p_f/ISgxgofc4ee5thI000000000.jpg 9/6/2017 Page 1 of 1 1 r..�: It- I ' rY all ,' ►: l https:Hphotos.zillowstatic.com/p f/ISgxgofc4ee5th1000000000.jpg 9/6/2017 • 1a •�.�v'•-� $LA �1J�''`1�ya AlYAffrt;i= �.M 1',vd�•�',A[1fi c-1i1�'r•' � { �r'^.�'�M�Rc "�_ aA•t•y 't•. :A� �� Pad'I�+�>a�"`? + '� r, is } � r n.��, Alt v�`yr�"'3..C'r r �c ,� �, tv ��IP�.r,•r•'�`a+�.. aft v wry`,j ,rFly; ''r _ •--•, �` � n',��•�f r F� `� JRI� ,r�`S��"Ye1 r � �v t �7� `; �3`-�'� j+�t.r% 'ors. 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Lot Size *if one parcel is withili.11jultiple zpnes,.use the more strict limitation for parcel (bolded below) State 1+1/3 1+2/3 Defined 'True Acres Acres 2 Acres Acre Acre 10,000 13,333 20,000 30,000 =33,334 =40,000 =43,560 50,000 58,080 60,000 =72,599 80,000. =87,120 S.F. S.Ft, S,2FO S.F. S.F. S.F. SY S.F. S.F. S.F. S.F. S.F. S.F. STATE Red Title V: 310 i� Dlag. CMR 15.214 110 11 330 330 ;'� 440 440 550 550 _ 660 170 880 880 Lines *applicant can apply for a variance. STATE Red With I/A Diag. Lines Technology 110 220 330 440 550 660 660 770 880 990 1100 1320 1430 [I/A with _ - 660/acre Credit] • (+not in town ordinance) r TOWN ORDINANCE Green Regulation of 330 330 330 330 330 330 330 330 440 440 550 550 660 +Red Wastewater Zones Discharge *can not apply for variance and doesn't allow I/A. BOH-Interim - Blue Saltwater Estuary . 330 330 330 330 330 440 440 550 550 660 770 880 880 Protection ' Regulation *call apply for variance, lit QAOFFICE FORMS\ChartTnUle ListingWWDISCHAROE MAXIMUMS3.doc ,^ >� Health Master Detail Page I of 1 `r ., e 4 4.'�w.F. j fiAJ�dlalGd „.3 ApplicationLogged In As: TOWN\miorandd Wednesday,September 6 2017 Health Master'Detail .• t Selection Items Parcel Parcel:234=071 Location: 190 PLEASANT PINES AVE,Centerville Owner: 190 PLEASANT PINES LLC _ ,•;r-,.. Business name: Business phone: Rental property: ❑ Deed restricted:❑ Number of bedrooms Contaminant released: El Fuel storage tank permit: ❑ Save Parcel Changes Return to Lookup Parcel Info Parcel ID: 234-071 - Developer lot:LOT 2 Location:190 PLEASANT PINES AVE" g Primary frontage:212 Secondary road: ,Secondary,frontage: Village:Centerville Fire district:C-O-MM Town sewer exists at this address: No Road Index:11281 234071_1 Asbullt Septic Scan: 234071_2 Interactive map.Ra 2340713 Town zone of contribution:GP(Groundwater Protection Overlay District) State zone of contribution:IN „N Owner Info Owner: 190 PLEASANT PINES LLC Co-Owner: Streets:18 GUILD ROAD Street2: City:DEDHAM State:MA Zip: 02026 Country: Deed date:6/19/2014 AlDeed reference:28212/127 Land Info Acres: 0.46 use: Single.Fam MDU01 Zoning:RD-1 Neighborhood:t7111 Topography:Level Road:Paved Utilities:Public Water,Gas,Septic Location:Excel View Construction Info uildin ,rygep wlk 'ass. a 'vin cool t' rnnnsc-�-+� i 11974 994 1682 4 B d s 2 Full 1 Half P. Buildings value:$122,200.00 Extra features: $17,800.00 Land`value: $364,600.00 d 1 http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=234071 9/6/2017 • r �' - �} i Legend Road Names Ira 234001002 , t _ '»234003T00 #•222 t Z w > -Y �}i� � � •, ;, III �' � 1t i • �i�` #16 ` 234070 IrkAl 234072 OV • � • � 7 .� 234 71 t _t #19 � a I µ i 233007 0 #6 j �1 x *� � ILA Map printed on: 9/6/2017 This—pis for illustration purposes only.Itis not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 026oi 0 42 83 non-tbe ground survey.It maybe gcnerali,,d,maynnt accurate relationships to physical objects on the map 5o8-862-4624 reflect current conditions,and may contain such as building locations. Approx.Scale:i inch= 42 feet O cartographic errors or omn;sious. gis@town.barnstable.ma.us PROPERTY • • • [ TOWN OF i • Legend , c + + • • C i 13 Zoning Districts 4 --` - w GP-Groundwater Protection 234 O T00 y 2340Q4T00 p Wp-Well Protection #152 C parcels W1111011 1r "Town Boundary ' - t Railroad Tracks C1 Buildings r t 2$40 00 t Painted Lines 2340010 2 #t60 Parking Lots # 22 {,MQ70 tf 1 f:Unpaved # 16 ti f7 Unpaved \ Driveways \\ \ t 0 Paved Unpaved \ Roads 3 0'''```''g 72� O Paved Road 12 Unpaved Road 0 Bridge N Paved Medan Streams Mars a"�. ..,L G WatehBodies f S . 234071 1�0r l &53 33007 #0 l 233062 a l I 179 l� ti i 233008 1 , 6 i I F ! 23307 0 .o 1 t p u#30 tl Map printed on: 9/6/2017 This map is for illustration purposes only.It is not parcel lines shown on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 026m O 83 '67 n on-the-ground survey.It maybe generalized,may not accurate relationships to physical objects on the map 5o8-862-4624 reflect current conditions,and may contain such as building locations. Approx.Scale:I inch= 83 feet © cartographie errors or omissions. gis@town.barnstable.ma.us Soto, Kathryn From: Michael Falkson [michael@focalzone.coml Sent: Friday, November 14, 2014 2:14 PM To: Barnstable Rental Registration Subject: N pleasant pines ave centervilfe ma I Kathryn, we did not rent this during 2014. If we do rent it during 2015 we will register it please confirm receipt. Thanks i TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date ( Time: In Out Owner Tenant 04 A Address I Address ✓�'�`-� Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating FacilitiesQ��S�' 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use _ 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 333 3 2 (`- 17. Temporary Housing 18. Driveway Width (�j N too 13 d 130 l A- 19. Number of Tenants Observed PART 11 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition f Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here r. AW HomsBW�RRENTM THE COMMONWEALTH OF MASSACHUSETTS FORM 30 C BOAR OF H H CITY/TOWN l ✓'�"W � DEPARTMENT r ADDRESS ��`/��� TELEP ON Address_ J(G/�,� Occupant_. Floor Apartment No. -No.of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No.S ries � Name and address of owner 5 ,mark Reg. Vio. YARD Out Bld s.: Fences: .� Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: 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.: 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 b Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: S s, Flues,Ve Safeties: Kitchen Facilities i k e 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 HECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPO IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJUR INSPECTOR �' TITLE DATE '+ TIME A.M. THE NEXT SCHEDULED REINSPECTION P.M. _ I M I 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to includewaffect 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 b 105 CMR 410.351 and 410.352 9a 9 9 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. To:Tim-Board of Health Barnstable Page 1 of 2 2007-05-08 10:03:44(GMT) From:Micheal falkson i e FAX COVER SHEET TO Tim - Board of Health Barnstable COMPANY FAX NUMBER 15087906304 FROM Micheal falkson DATE 2007-05-08 10 : 04 : 38 GMT RE COVER MESSAGE ti ICI\ www.efax.com To:Tim-Board of Health Barnstable Page 2 of 2 2007-05-08 10:03:44(GMT) From:Micheal falkson i` '-i ti Michael and Lisa Falkson 11 Bubbling Brook Road Walpole, MA 02081 12-1-06 Town of Barnstable Regulatory Services Board of Health Thomas McKean, Director 200 Main Street Hyannis, MA 02601 Phone: 508-362-8904 Fax 508-790-6304 RE: November 7, 2006 Notice to abate violations Dear Board of Health, We would like to have the home reviewed so that it can now be rented. Would you please contact me at 781 801 9006 in order to schedule a time to visit the property. Thank you, Michael Falkson Air- ��VA Certified Mail#7006 0810 0000 3524 7588 �IFtE r Town of Barnstable Regulatory Services • BARNSTABI.E. � 9� MAS& `�g� Thomas F. Geiler, Director A'E039. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 7, 2006 Michael and Lisa Falkson 11 Bubbling Brook Road Walpole, MA 02081 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 190 Pleasant Pines Ave, Centerville was inspected on November 7, 2006 by David W. Stanton R.S., and Timothy B. O'Connell, Health Inspectors for the Town of Barnstable, because of a complaint. The following violations of the State Sanitary Code were observed: 105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements. Mold and signs of water damage were observed on the archway ceiling on the 1st floor as well as on the utility room ceiling and baseboard. Bathroom on the 1" floor, NE side, has a loose threshold. Several screen windows observed with holes and tears. Wood ceiling planks observed loose and some were missing on the 1st floor,NE side. Sliding glass door to the sunroom was not properly closed and secured. Weather stripping on French door on SW side observed hanging down. Hole observed in wall below sink of bathroom on 1st floor, SE side. Crack observed in wall above window on 2nd floor, SE side. Water damage was observed on the ceiling above the skylight on the NE side. 105 CMR 410.481: Posting of Name of Owner. Owner's name, address and telephone number not posted.* The following violations of the Town of Barnstable Code were observed: § 170-4 of the Town of Barnstable Code: Owner's Responsibility to Register Rental Unit(s). The unit is not currently registered with the Town of Barnstable Health Division. § 170 -7 of the Town of Barnstable Code: Owner's/Property Manager's name, address and telephone number were not posted inside the dwelling.* I QAOrder letters\Housing violations\Rental ordinance\190 Pleasant Pines Ave.doc M *Note: Once all the other violations have been corrected, you will be issued a certificate of registration for the rental property. The certificate of registration will have all the necessary information to satisfy the requirements of § 170-7 of the Town of Barnstable Code and 105 CMR 410.481. It is also noted that no carbon monoxide detectors were present on the first or second floor of the dwelling which contains a wood burning fireplace. The COMM Fire Department has been notified of the lack of carbon monoxide detectors being present during the inspection and may be contacting you to comply if you are found in violation of the State Fire Code. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice, by stopping the source of water damage and chronic dampness; by removing the mold and water damage stains; by securing the bathroom threshold; by repairing or replacing the damaged screen windows and doors; by replacing the wood ceiling planks and making them secure; by properly closing and securing the fixed section of the sliding glass door; by repairing or replacing t he I oose w eather s tripping; b y f illing i n t he h ole i n t he b athroom; b y repairing the crack in the wall; by properly posting name of owner and by registering your rental unit. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Dr. Munir Ahmed, Tenant Attorney of tenant David Stanton, Health Inspector Q:\Order letters\Housing violations\Rental ordinance\190 Pleasant Pines Ave.doc Town of Barnstable • Regulatory Services 9� 1659n. Thomas F. Geiler,Director �Ep MAC a Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 DATE: NUMBER OF PAGES TO FOLLOW: �p _ 3 '�t�L\\ NNV% Co'4 e�c) TO: 'l`Mvr FROM: �U C ��� 1nSQeC,}p� l�oa1� S +� r�lZ•S. PHONE: PHONE: (508)862-4644 FAX PHONE: FAX PHONE: (508)790-6304 S o� • `11� ��191� cc: 1 ... k NOTES/COMMENTS: Sb Soar - W&S (1 esc- OAt c AA I s dam a. u QAFax Form.doc Certified Mail#7006 0810 0000 3524 7588 �s Tati Town of Barnstable Regulatory Services Y ! BARNS"CABLE, 9� 63& Thomas F. Geiler, Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 7, 2006 Michael and Lisa Falkson 11 Bubbling Brook Road Walpole, MA 02081 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 190 Pleasant Pines Ave, Centerville was inspected on November 7, 2006 by David W. Stanton R.S., and Timothy B. O'Connell, Health Inspectors for the Town of Barnstable,because of a complaint. The following violations of the State Sanitary Code were observed: 105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements. Mold and signs of water damage were observed on the archway ceiling on the lst floor as well as on the utility room ceiling and baseboard. Bathroom on the 1st floor, NE side, has a loose threshold. Several screen windows observed with holes and tears. Wood ceiling planks observed loose and some were missing on the 1st floor,NE side. Sliding glass door to the sunroom was not properly closed and secured. Weather stripping on French door on SW side observed hanging down. Hole observed in wall below sink of bathroom on 1st floor, SE side. Crack observed in wall above window on 2nd floor, SE side. Water damage was observed on the ceiling above the skylight on the NE side. 105 CMR 410.481: Posting of Name of Owner. Owner's name, address and telephone number not posted.* The following violations of the Town of Barnstable Code were observed: 170-4 of the Town of Barnstable Code: Owner's Responsibility to Register Rental Unit(s). The unit is not currently registered with the Town of Barnstable Health Division. 170 -7 of the Town of Barnstable Code: Owner's/Property Manager's name, address and telephone number were not posted inside the dwelling.* Q:\Orderletters\Housing violations\Rentalordinance\190 Pleasant Pines Ave.doc r t *Note: Once all the other violations have been corrected, you will be issued a certificate of registration for the rental property. The certificate of registration will have all the necessary information to satisfy the requirements of § 170-7 of the Town of Barnstable Code and 105 CMR 410.481. It is also noted that no carbon monoxide detectors were present on the first or second floor of the dwelling which contains a wood burning fireplace. The. COMM Fire Department has been notified of the lack of carbon monoxide detectors being present during the inspection and may be contacting you to comply if you are found in violation of the State Fire Code. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice, by stopping the source of water damage and chronic dampness; by removing the mold and water damage stains; by securing the bathroom threshold; by repairing or replacing the damaged screen windows and doors; by replacing the wood ceiling planks and making them secure; by properly closing and securing the fixed section of the sliding glass door; by repairing or replacing t he 1 oose w eather s tripping; b y f illing i n t he h ole i n t he b athroom; b y repairing the crack in the wall; by properly posting name of owner and by registering your rental unit. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Dr. Munir Ahmed, Tenant Attorney of tenant David Stanton, Health Inspector QAOrder letters\Housing violations\Rental ordinance\190 Pleasant Pines Ave.doc l - P. 1 ' COMMUNICATION RESULT REPORT ( NOV.21.2006 3:13PM ) TTI BARNSTABLE BOARD OF HEALTH FILE MODE OPTION ADDRESS (GROUP) RESULT PAGE ---------------------------------------------------------------------------------------------------- 660 MEMORY TX 915087788866 OK P. 3/3 ---------------------------------------------------------------------------------------------------- REASON FOR ERROR E-1) HANG UP OR LINE FAIL E-2) BUSY E-3) NO ANSWER E-4) NO FACSIMILE CONNECTION aop•uuo,3 way :b �www_w w i jwwwl •n���A� ss�7.T 1 ' L-L • �Q ?A4Y Y lTl7.T F7 ���) 779-- ���� �. . P. 1 COMMUNICATION RESULT REPORT ( NOV.21.2006 9:20AM ) TTI BARNSTABLE BOARD OF HEALTH FILE MODE OPTION ADDRESS (GROUP) RESULT PAGE ---------------------------------------------------------------------------------------------------- 652 MEMORY TX 915087902385 OK P. 2/2 ---------------------------------------------------------------------------------------------------- REASON FOR ERROR E-1) HANG UP OR LINE FAIL E-2) BUSY E-3) NO ANSWER E-4) NO FACSIMILE CONNECTION Town of Barnstable Regulatory Services ' ; M Tkomas F. Geller,Director Public Health Divisi0x Thomas Mckean,Director 200 Main Street, 'Hya=is,MA 02601 MEN= MATE: NUMBER OF PAGES TO FOLLOW: _ l TO: FRO Comm -t - PHONE., � . / a - ,�3 7 5r PHONE: (508)862.46" FAX PHONE o f FAX PRONE: (509)790-6304 cc: Town of Barnstable Regulatory Services a 13AMSTA$L£, Thomas F. Geiler, Director MAS& Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 21, 2006 Attn: COMM Fire On November 7, 2006 Health Inspectors David W. Stanton, RS and Timothy B. O'Connell conducted a housing complaint investigation. The State Department of Public Health has not promulgated regulations for CO detectors into 105 CMR 410.000 the State Housing Code to date. It is the policy of the Town of Barnstable Health Division to take similar actions for CO detector violations as is currently required for smoke detector violations (under 105 CMR 410.482), which is to notify the Fire Department if there is a violation, or possible violation observed. The following property had possible CO detector violations: 190 Pleasant Pines Ave, Centerville, Assessors Map-Parcel: (234-071): -No CO detectors present on first or second floor of house. Said house contained a wood burning fireplace. ***Note, at the time of the inspection, the tenant was planning on vacating the premises, so the unit may be unoccupied at this time*** Da id W. Stanton, RS-Health Inspector QAOrder letterMousing violations\Rental ordinance\\Fire Violations\]90 Pleasant Pines-Fire.doc r C2 BNAB> Town of Barnstable prfMASS 039. It Regulatory Services Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 I( (date)? 0 ' .14 Fa)kso�► ffi k(�"N (name) ns �� (Od z.1�(address) rep ;;K 4p_ _RP5z, r Wu, a D P v4'� �� �� 171 � P� Ple; r U OTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY DE II - MINI SS FOR HUMAN HABITATION AND ARTICLE 51 OF THE TOWN RENTAL ORD U r`'` The property owne you locate at 0 location tw y w ��� 4U e N p P Y Y (_( ) ,l � was inspected on 6 3 (date) by (name) , Health Inspecto3'or the own of Barnstable,because of a complain .. The following violations of the State Sanitary Code were observed: T'V V10 g, Ocoo d/, 105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements.. V?MAqffl C M 0 o Se r✓Q - n o /3/_A0 W Si`QDe� Jv�l F" — NlAkr clrn� t b rLIe - -k roa C W a 00 *�Z✓e ✓� a F+in woo 14 l iA la.1 ✓P 60 l '.A ' m /�^�C s lid. � i la Utl tl, WFe (� 9 i. e 's s o Str l E �",. s ��pp rent ooc it 3 01) Si` � au/ `R rl c . o ' a hvaman 14e 1J1,&2,W,&JS dM� � ✓' wa e ' ' a ''re i m a,v, r a,.MH bra vn a e.'l,� u S 0 M er atio nsects,Rodents and Sk ks. Q:Health/Order letters/Housing violations/32 Fresh holes.doc PI.P fHfQ C�aq�Q "b hQ (dx4"� 10cqhV0L r� e s i 1iC(A 105'C 00: Owner's Responsibility to Maintain Structural Elements. 4 yA w LA, ¢ r .l ce p f C�'I �yo 105 CM 410.500: ostin of Na caner: Owner's name address and tele hon number n t poste � C Uon are directed to correct the violations listed above within thirty 30) days of your receipt of this notice, by �f'� Sovrc� oFl,.ipr(Xay�c IV u• ! Bf i kj o ut o f-ep4otr L, rit r h C of4LhUf�Jy Pq .,,• !' o eZb Pill / t t 70,-I e �tptf t7�� �100� rP^�►( u^,'�. S J 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 r esult i n a fine o f$ 100.00 p er v iolation. E ach d ay's f ailure t o comply with an order shall constitute a separate violation. �\ 1y7 6,11w", )If �1 �4f PEf ORDER OF THE BOARD OF HEALTH J lr f ,,,'d I& Dom. �� car �► r ,f) P C rP.4P1 VIA.'�. CAP °l J Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable � �. 3 YY Q,,�.�er- C�, �r. M��lr �' �m�eC� i �ena�l ` 7' 1- 14 (1 �u �. Sa.,rXws'c A. M.4 ©, 5O7 ) � t (Q:Health/Order letters/Housing violations/32 Fresh holes.doc l ��A� Arr C f C, Cv7dgmk ,`nl^Y Ie �Ql ��IQ b CG�G,4 w mow► . (Q:Health/Order letters/Housing violations/32 Fresh holes.doi; P�Q � Cu(Yf C/ (IV c ' I Legal Remedies for Tenants of Residential Housing THE FOLLOWING IS A BRIEF SUMMARY OF SOME OF THE LEGAL REMEDIES TENANTS MAY USE IN ORDER TO GET HOUSING CODE VIOLATIONS CORRECTED. 1. Rent Withholding(General Laws Chapter 239 Section 8A) If Code Violations Are Not Being Corrected you may be entitled to hold back your rent payments. You can do this without being evicted if: A. You can prove that your dwelling unit or common areas contain code violations which are serious enough to endanger or materi- ally impair your health or safety and that your landlord knew about the violations before you were behind in your rent. B. You did not cause the violations and they can be repaired while you continue to live in the building. C. ' You are prepared to pay any portion of the rent into court if a judge orders you to pay it.(For this it is best to put the rent money aside in a safe place.) 2. Repair and Deduct(General Laws Chapter 111 Section 127L). The law sometimes allows you to use your rent money to make the repairs yourself.If your local code enforcement agency certifies that there are code violations which endanger or materially impair your health,safety or well-being and your landlord has received written notice of the violations,you may be able to use this remedy. If the owner fails to begin necessary repairs(or to enter into a written contract to have them made)within five days after notice or to complete repairs within 14 days after notice you can use up to four months'rent in any year to make the repairs. 3. Retaliatory Rent Increases or Evictions Prohibited(General Laws Chapter 186,Section 18 and Chapter 239 Section 2A). The owner may not increase your rent or evict you in retaliation for making a complaint to your local code enforcement agency about code violations. if the owner raises your rent or tries to evict within six months after you have made the complaint he or she will have to show a good reason for the increase or eviction which is unrelated to your complaint.You may be able to sue the landlord for damages if he or she tries this. 4. Rent Receivership(General Laws Chapter III Sections 127C-H). The occupants and/or the board of health may petition the District or Superior Court to allow rent to be paid into court rather than to the owner.The court may then appoint a"receiver"who may spend as much of the rent money as is needed to correct the violation.The re- ceiver is not subject to a spending limitation of four months'rent. 5. Breach of Warranty of Habitability. You may be entitled to sue your landlord to have all or some of your rent returned if your dwelling unit does not meet minimum stand- ards of habitability. 6. Unfair and Deceptive Practices(General Laws.Chapter 93A). Renting an apartment with code violations is a violation of the consumer protection act and regulations for which you may sue an owner. THE INFORMATION PRESENTED ABOVE IS ONLY A SUMMARY OF THE LAW, BEFORE YOU DECIDE TO WITHHOLD YOUR RENT OR TAKE ANY OTHER LEGAL ACTION,IT IS ADVISABLE THAT YOU CONSULT AN ATTORNEY.IF YOU CAN- NOT AFFORD TO CONSULT AN ATTORNEY,YOU SHOULD CONTACT THE NEAREST LEGAL SERVICES OFFICE WHICH IS: LEGAL SERVICES FOR CAPE COD & ISLANDS,•' INC. 775-7020 (NAME) (TELEPHONE NUMBER) 460 WEST MAIN STREET, HYANNIS, MA 02601 (ADDRESS) FORM 31 Hons&WARREN,INC. NOV.1979 Certified Mail#7006 0810 0000 3525 0281 �OFSHE ra Town of Barnstable Regulatory Services • IIARNSTABLE, 9� MASS. �A Thomas F. Geiler, Director 1639. �0 ""A Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 7, 2006 Michael and Lisa Falkson 11 Bubbling Brook Road Walpole, MA 02081 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARS OF FITNESS FOR HUMAN HABITATION AND TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 190 Pleasant Pines Ave, Centerville was inspected on November 7, 2006 by David W. Stanton R.S., Health Inspector, and Timothy B. O'Connell, Health Inspector for the Town of Barnstable, because of a complaint. The following violations of the Town Code were observed: 105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements. Mold and signs of water damage were observed on the archway ceiling on the 1't floor as well as on the utility room ceiling and baseboard. 105 CMR 410.481 & TOB CH. 170-5 Posting of Name of Owner. Owner's name, address and telephone number not posted. TOB CODE CH. 170-4: Owner's Responsibility to Register Rental Unit(s). The unit is not currently registered with the Town of Barnstable Health Division. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice, by stopping the source of water damage and chronic dampness by removing the mold and water damage stains; by securing the bathroom threshold; by repairing or replacing the damaged screen windows and doors; by replacing the wood ceiling planks and making them secure; by properly closing and securing the fixed section of the sliding glass door; by repairing or replacing the loose weather stripping; by filling in the hole in the bathroom; by repairing the crack in the wall; by properly posting name of owner and by registering your rental unit. 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. QAOrder letters\Housing violations\Rental ordinance\190 Pleasant Pines Ave.doc i� r Non-compliance could result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S. Director of Public Health Town of Barnstable Cc: Dr. Munir Ahmed, Tenant Cc: David Stanton, Health Inspector i Q:\Order letters\Housing violations\Rental ordinance\190 Pleasant Pines Ave.doc r v000 cw�o vduu OUuo uouu Certified Mail# O Town of Barnstable x Regulatory Services sa STAULL p$ MAK Thomas F. Geiler, Director •63q. ♦� Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 N vemb r 7, 2006 Michael and Lisa Falkson L,.,f Y s �D sr!e 11 Bubbling Brook Road — Walpole, MA 02081 NOTICE TO ABATE VIOLATION F 105 CMR 410.000 STATE SANITARY CODE II — MINIMUM STANDARS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 1 eas was inspected CDC ) on Nuov , by David W. Stanton R.S., Health Inspector, and Timothy B. O'Connell, Health Inspector for the Town of Barnstable, because of a complaint. The following violations of the State Sanitary Code were observed: 105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements. Mold and signs of water damage were observed on the archway ceiling on the 1st floor as well as on the utility room ceiling and baseboard. Bathroom on the 1st floor, NE side, has a loose threshold. Several screen windows observed with holes and tears. Wood ceiling planks observed loose and missing on the Is' floor, NE side. Sliding glass door to sunroom was not properly closed and secured. Weather stripping on French door on SW side observed hanging down. Hole observed in wall below sink of bathroom on Is floor, SE side. Crack observed in wall above window on 2nd floor, SE side. Water damage observed on the ceiling above the skylight on the NE side. 105 CMR 410.481: Posting of Name of Owner. Owner's name, address and telephone number not posted.* The following violations of the Town of Barnstable Code were observed: 4 170-4 of the Town of Barnstable Code: Owner's Responsibility to Register Rental Unit(s). The unit is not currently registered with the Town of Barnstable Health Division. § 170 -7 of the Town of Barnstable Code: Owner's/Property Manager's name, address and telephone number were not posted inside the dwelling.* �0 QAOrder letterMousing violations\Rental ordinance\l *Note: Once all the other violations have been corrected, you will be issued a certificate of registration for the rental property. The certificate of registration will have all the necessary information to satisfy the requirements of § 170-7 of the Town of Barnstable Code and 105 CMR 410.481. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice, by stopping the source of water damage and chronic dampness; by removing the mold and water damage stains; by securing the bathroom threshold; by repairing or replacing the damaged screen windows and doors; by replacing the wood ceiling planks and making them secure; by properly closing and securing the fixed section of the sliding glass door; by repairing or replacing t he 1 oose w eather s tripping; b y f illing i n t he h ole i n t he b athroom; b y repairing the crack in the wall; by properly posting name of owner and by registering your rental unit. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Af. � Cc: Bit Mnnir4AwAQd4enant Cc: , Health Inspector �NUA-,k Q:\Order letters\Housing violations\Rental ordinance\1 ve.doc f t Michael and Lisa Falkson 11 Bubbling Brook Road Walpole, MA 02081 12-1-06 Town of Barnstable Regulatory Services Thomas McKean, Director 200 Main Street Hyannis, MA 02601 Sent via certified mail 12-1-06 RE: November 7, 2006 Notice to abate violations Dear Mr. McKean, In regards to this notice please be advised that we have taken corrective action in regards to each violation listed in your letter and at this time each item has been repaired. Please contact me at 781 801 9006 if I can be of any assistance. Thank u, _ ichl Falkson C c� r N �' Certified Mail#7006 0810 0000 3524 7588 ,,ems lati Town of Barnstable o� Regulatory Services + IIARNMBLE. ` 9� 6 q Thomas F. Geiler,Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 7, 2006 Michael and Lisa Falkson 11 Bubbling Brook Road Walpole, MA 02081 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned,by you located at 1.90,Pleasant Pines Ave, Centerville was inspected on-November 7,-2006 by David W. Stanton R.S., and Timothy B. O Connell, Health. Inspectors for the'Town of Barnstable, because of a complaint. The following violations of the State Sanitary Code were observed',- $r 105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements. Mold and signs of water damage were observed on the archway ceiling on the 1st floor as well as on the utility room ceiling and baseboard. Bathroom on the 1st floor, NE side, has a loose threshold. Several screen windows observed with holes and tears. Wood ceiling planks observed loose and some were missing on the lst floor,NE side. Sliding glass door to the sunroom was not properly closed and secured. Weather stripping on French door on SW side observed hanging down. Hole observed in wall below sink of bathroom on 1st floor, SE side. Crack observed in wall above window on 2nd floor, SE side. Water damage was observed on the ceiling above the skylight on the NE side. 105 CMR 410.481: Posting of Name of Owner. Owner's name, address and telephone number not posted.* The following violations of the Town of Barnstable Code were observed: / V 4 170-4 of the Town of Barnstable Code: Owner's Responsibility to Register Rental Unit(s).'The unit is not currently registered with the Town of Barnstable Health Division. S 170 -7 of the,1Town.of.Barnstable Code: Owner's/Property Manager,'.s name,,address and telephone number were not posted inside the dwelling.* QAOrder letters\Housing violations\Rental ordinance\190 Pleasant Pines Ave.doc *Note: Once all the other violations have been corrected, you will be issued a certificate of registration for the rental property. The certificate of registration will have all the necessary information to satisfy the requirements of § 170-7 of the Town of Barnstable Code and 105 CMR 410.481. It is also noted that no carbon monoxide detectors were present on the first or second floor of the dwelling which contains a wood burning fireplace. The COMM Fire Department has been notified of the lack of carbon monoxide detectors being present during the inspection and may be contacting you to comply if you are found in violation of the State Fire Code. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice, by stopping the source of water damage and chronic dampness; by removing the mold and water damage stains; by securing the bathroom threshold; by repairing or replacing the damaged screen windows and doors; by replacing the wood ceiling planks and making them secure; by properly closing and securing the fixed section of the sliding glass door; by repairing or replacing t he I oose w eather s tripping; b y f illing i n t he h ole i n t he b athroom; b y repairing the crack in the wall; by properly posting name of owner and by registering your rental unit. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Dr. Munir Ahmed, Tenant Attorney of tenant David Stanton, Health Inspector QAOrder letters\Housing viol ati ons\Rental ordinance\190 Pleasant Pines Ave.doc I . � 1 U.SPf;POSTAGE WFGr02090Mu I UN11FDsTA— ` DEAMOUNTO6 'R rosmcssawcE .� 7006 0810 00_06 3288 1710 0000 ozsoi ozi:fsq=os! � 90 ��; 1, 947 J, 4AJ� 1 r 0 ll1 t � i " Mr. Michael Falkson i 1 I Bubbling Brook Rd. 1 I Walpole, MA 02081-3323 V �33 FEB.../ /. ..... 1 _ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ....0 F......... // O " fpC�c /�/r.tuzfroG� ...................................... AV43 irFatiun for Uiu�rus al arks Toustrnrtinn amit -��•..��Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systln:at: t - -....�. _...P..1. ._._.P�_ ►V-zp.....��tfe.... .... ..........•••-......._y_-..............._..• ................................................ ocation-Address or Lot No , ��A6. .61AM......N RtKef-------------•---••----------••-----.... --•.......---•............_----_-_- _____...-- ----•--'.==•-.---__•......_...-- Owner Address a A.. ---------------------------------------------------------------------------- -------------- -- . --.... . Installer Address Type of Building Size Lot .......................Sq. feet aDwelling—No. of Bedrooms...............................................................................Expansion Attic ( ") 1;.. Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ;;) Cafeteria ( ) P4Other fixtures ------------••--••-------------------------•-------•--••...-•-•-••••------•-----------•-----••••-•--._..... = W Design Flow............��.....................gallons per person per day. Total daily flow____._....'73.... WSeptic Tank—Liquid capacityl.O.rPO..gallons Length..:IQ......... Width..A........... Diameter................ De- th...4......... x Disposal Trench—No. ..__2._......_. Width......i............ Total Length..... ........... Total leaching area...A ----------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft: Z Other Distribution box ( x) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date------------------------------------... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--___-____--_-___-__-.- Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' ..........................................................-...........�... ............................................................................. O Description of Soil....f�e�^.!!k-NM 'Ti�wvc.......�r�'......."- -----a------.... ` : 6� x -----•---------------•----------------------------------------------•----------------------------------------------------------------- r .......... U Nature of Repairs or iterations—Ans er when applicable.....P,PRl -__ �_QY�G�%t__�r�.¢�t __ 1 _......_.. t_06rrc,t 'tom t1��.� _.<�_�ef . �-.2........................................................................................ Agreement: The undersigned agrees to install the aforedescribed-Individual Sewage Disposal System in accordance with the provisions of TITA IL- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of In lth. Signed - ,.��--� ....... --- .....�... ........... at ------------ ApplicationApproved By.... =- ........I........................................................................... ........................................ Date Application"Disapproved for the following reasons:................................................. ----•..................................... ......_.._..._ .........................................•-------•--•-------......---•----------•---.........--•-•------------•-•----•-•---•------------------•------•-----------•----•---------•-------•---•--._.--•--- Date PermitNoss.:.. .2.3................................ Issued---------------------------------•-•--•---------------- 4 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Applira#ion for Disposal Works Tontrur#ion rranif Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual'-Sewage Disposal System at: rz........... z -0.t. z,.. Location-Address or Lot N.o, -- ........................ ---- -•----••-•-•------...-----••-----•--...._......__..... .•._..._..•---..._.............._...-•---- Owner Address ----------------------------------------------------- Installer Address T;Tpe „f Building Size Lot____________________ q. feet ,U S Dwelling—No. of.Bedrooms.____._................................Expansion Attic ( " ) Garbage Grinder Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) � Other fixtures ---------------•----.--..-------"•"------•-•----•-••-•.-•-------•-----•---•---•-----------------...--•--------------------._._....----............---- w Design Flow__________.,%r______________________gallons per person per day. Total daily flow_.__._.___:_:. !......................gallons. WSeptic Tank—Liquid capacit3tSiDR...gallons Length.:lcA.......... Width_........... Diameter________________ Depth...!.......... x Disposal Trench—No. _,7............. Width.....I............ Total Length....>S............ Total leaching area...&__ ..........sq. ft. Seepage Pit No---------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft: Z Other Distribution box (,�O Dosing tank( ) aPercolation:Test Results Performed by...............................................................------•-•- Date......................................... Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ fZq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -•-•----------------------------------------------•--------.._......_� ii-----------.....•--•-•-----------_____..___---•--•-------_ •-----•- O Description of Soil--=(,ado►=� •-•"�1�1�1 ........T7EP&T --......- --•(0•"--�=........TD=- 'MO-LE'................ x c.> w Nature of Repairs or Alterations—Answer when a hcable_._j�pr,� r U P PP _T Jf 'r 1��sEL�-+kt�c�. ea.a..•-•------- s �i-o - �,r�tv ���• �.. ----=--•-=---------=------- '-------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the.State Sanitary Code—The undersigned further agrees not,to place the system in operation until a Certificate of Compliance has been issued by.the board of health., • Signed ---------= ==----------------- ------------------ ---- _---•- ................................ Date ApplicationApproved By... =A-----=------------'____---------................................................. .......................... --•----------- Date Application Disapproved for"the following reasons:...................................................................,:-------------•.........................:....--- _________________________________________________________________________________________________________._._______.____.._..__________________-___________________________---_____-____-__________._.... r� Date PermitNo._,,t_:_2_2-_.........................'-----.. Issued_....................................................... Date THE.-COMMONWEALTH OF-MASSACHUSETTS, BOARD OF HEALTH .n!%`zc OF. '`7�,°�ry Ar.<..�`.................... Trdif irFat a of TompliFaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.................. ...............-------•-------•--------........_..__...----------••---•----------._....................-----.._._. Installer at /� '= . • ----- ---------------------------- -----•-----------------•-------•------------..-.-----•-•------ ::....•---•-•-•-----•- has been installed in accordance with the provisions of TITLE, j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-.--- f°..r__� ............ dated.......:...____;!.= :S_f................. THE ISSUANC OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FU CTIO SATISFACTORY. DATE.:.. 7_ .�... 1..--�•-•--•-------•------------•••--- Inspector......................... - -- --------- _..... .............. {_ THE COMMONWEALTH .OF MASSACHUSETTS 0 f. >i" 0, BOARD OF HEALTH. �:�. - A � . OF.. ..� e--x.---.: }... .�3 FEE........................ .- Disposal Yorks 015onstrudialt pamit Permissionis hereby granted........-......=--------------.............••--•---------------------------------------•-...................................................... to Construct ( ) or Repair (,O an Individual Sewage Disposal System /' Street ✓ fw. as shown on the application for Disposal Works Construction Permit No____________ ______ Dated..__:�.'._:�__::_::__._____.._........ ..................................................................................................... a Board of Health .'SATE......... S ,j FORM 1255 A. M. SULKIN, INC., BOSTON 1 c(o LOCATION -----ter SEWAGE PERMIT NO. z( l )lam e� ��" VILLAGE P / 1-e Y I N S T A LLER'S NAME L ADDRESS /�-Yc Cyr e U I L D E R OR OWNER DATE - PERMIT ISSUED DATE COMPLIANCE ISSUED 411`;� i AsBuilt Page 1 of I LOCATION 'SEW. PERMIT NQ VILlACE INST A LLEll NAME AD0RES.S, I! U IL.D`E R OR. OWNER v l -( x DATE. PERMIT. 1511,I1ED DAT E COM'.PLIANCE (ti.VED f I 3' i http://issgl2/intranet/propdata/prebui lt.aspx?mappar=234071&seq=3 9/6/2017