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Home My WebLink About0265 PRINCE HINCKLEY ROAD - Health 2 ` Prince Hinckley Road 71-117 Centerville III -14 �7 -7 a o r U, _ - C� � a `e �'aa✓ A— �..d' twji `�:: �` RBI•j . P � � � ^y aka � db- t g - t" f •'I r. dam: Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments A -°� 265 Prince Hinkley RoadC1 M Property Address Countrywide Bank Owner Owner's Name i information is required for Centerville Mass 02632 6-5-08 �1 � every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Douglas L. Williams Sr. cursor-do not Name of Inspector use the return key. American Home & Environmental Company Name r� Box 1069 Company Address Centerville Mass 02632 re10 City/Town State Zip Code 508-775-1500 n/a Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported,below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ® Conditionally Passes ❑ Fails ® Needs Further Evaluation by the Local Approving Authority i, 6-8-08 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. '"This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: large trees beside leach pit need removal and probably are clogging system whaic has been handed once B) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ® obstruction is removed t5insp Prince Hinkley.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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 ❑ obstruction is removed ND Explain: roots in system pool, and needs pumping C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5insp Prince Hinkley.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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 cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® 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. t5insp Prince HinMey.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface w Se age Disposal System Form Not for Voluntary Assessments ;M 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City[Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. CityTrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ® ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ❑ ® Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ❑ Existing information. For example, a plan at the Board of Health. ❑ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection 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 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 213.9 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Date 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: 163,000 Last date of occupancy/use: n/a Date Other(describe): t5insp Prince Hinkley.doc-03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: town 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/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): Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No 15insp Prince Hinkley.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 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.): Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1,000 gal Sludge depth: 10" Distance from top of sludge to bottom of outlet tee or baffle 14" Scum thickness 15' Distance from top of scum to top of outlet tee or baffle 10" 811 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? MEASURED t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 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.): NEEDS PUMPING AND TREES REMOVED FROM LEACHING AREA 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 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): l5insp Prince Hinkley.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert .5" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): t5insp Prince Hinkley.doc-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M10 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 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.): t5insp Prince Hinkley.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M s 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 24.7 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: plans t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 11�7 Town of Barnstable 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 July 18, 2007 Ms Flavia Vignoli 265 Prince Hinckley Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIROMENTAL CODE, TITLE 5 The septic system located at 265 Prince Hinckley Road, Centerville, MA was last inspected on June 15th, 2007,by Robert J. Bortolotti, a certified inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: The D-box is rotted. There is evidence of leakage out of box. Cover is broken. You have 60 days from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABLE HEALT DEPARTMENT Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health 4 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 265 Prince Hinkley Road Property Address �J Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: When filling out A. General Information When forms on the computer,use 1. Inspector: only the tab key to move your Douglas L. Williams Sr. cursor-do not Name of Inspector use the return key. American Home & Environmental ?d "IC—V Company Name t� f� Box 1069 s C-> - Company Address eum Centerville Mass 7 d 02632.Zip 6— City/Town State •�..� p Co dP. 508-775-1500 n/ar Telephone Number License Number m , B. Certification — �- cn M C19 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 OQ was performed based on my training and experience in the proper function and maintenance of on site ` sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ® Conditionally Passes ❑ Fails ® Needs Further Evaluation by the Local Approving AuthorityPdo�P �,�IT pa4 6-8-08 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ***`This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: large trees beside leach pit need removal and probably are clogging system whaic has been expanded once 13 System Conditional) Passes: Y Y ® One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ® obstruction is removed t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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 ❑ obstruction is removed ND Explain: roots in system pool, and needs pumping C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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 cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® 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. t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �^M 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ❑ ® Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ❑ Existing information. For example, a plan at the Board of Health. 7 ❑ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue t approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c�M 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection 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 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 213.9 9 ( Y 9 (gpd)): Sump pump? 4tl ',,j jf,.y). Qpf f' ^pw�vaGP? ❑ Yes ® No i Last date of occupancy: ?Date 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: 163,000 Last date of occupancy/use: n/a Date Other(describe): t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 4 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M ,.•''V 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: town 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/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): Approximate age of all components, date installed (if known)and source of information: err", Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet 1 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.): Septic Tank (locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1,000 gal Sludge depth: 10" Distance from top of sludge to bottom of outlet tee or baffle 14" Scum thickness 15, Distance from top of scum to top of outlet tee or baffle 10" Distance from bottom of scum to bottom of outlet tee or baffle 8" How were dimensions determined? MEASURED t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 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.): NEEDS PUMPING AND TREES REMOVED FROM LEACHING AREA 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 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): t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 Distribution Box(if present must be opened),(locate on site plan): Depth of liquid level above outlet invert .5" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 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.): t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° M 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. t5insp Prince Hinkley.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 t F Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 265 Prince Hinkley Road Property Address Countrywide Bank Owner Owner's Name information is required for Centerville Mass 02632 6-5-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 24.7 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: plans t5insp Prince Hinkley.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 �SANDER:VOIWPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent X ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you, B. Received b _(Prtnte ame) C. Dat f De'very ■ Attach this card to the back of the mailpiece, v or on the front if space permits. iA D. Is delivery address different from Rem 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No ass ��-:�,�� .�►.� Rd. `\ A b2�� 3. Service Type o f R 19 Certified Mail ❑Express Mail ❑Registered ®Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. III 4. Restricted Delivery?Pam Fee) ❑Yes 2. Article Number 1 i i I i 7 0 0 6` 0 81 'O D 0 0' 3 5 2 4f 18'3 0 (Transferfrom.serWdefaW 1 C PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540,1 i UNITED STATE$`.PT1L 'T {•�d�k• w�.�v: i V. ' "�`°°+„� irs4=Mass ltileil I • Sender:Please print your'name,address,and ZIP+4 in this box-* I I ' Town of Barnstable ' O4 Health Division I z 200 Main Street Hyannis,MA 02601 I n�I V' . I P�°pSHE Town of Barnstable • BARNS,rABLE, 9� "A Regulatory Services Department ABED MA'1 A. Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO February 12, 2007 Flavia Vignoli 265 Prince Hinckley Road Centerville, MA 02632 Dear Flavia, The Town of Barnstable Public Health Division Office received a complaint regarding your property located at 265 Prince Hinckley Road, Centerville. The complaint included allegations regarding the overcrowding of vehicles and occupants, as well as there having been space cleared in the back yard to allow for more parking. Local ordinance limits the number of vehicles allowed at residential properties, depending on number of bedrooms. On January 24, 2007, Timothy O'Connell, Health Inspector for the Town of Barnstable knocked at the front door and spoke with two gentlemen, to whom a business card was given and the request to have owner contact him Please telephone me at (508) 862 4644 to schedule a date and time for an inspection of the interior of this dwelling. Sincerely, Thomas A. McKean Director of Public Health Certified Mail#7006 0810 0000 3524 8387 q:\boh complaint ltrs\265 prince hinckley road.doc SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY ■ Complete items 1,s2,and 3.Also complete A. Si A item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X L ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 11 ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No a��j l�rf �tictK► AGrr�o,��' i 1 02 ul Z 3. Service Type ILCertilied Mail ❑Express Mail ❑Registered K Retum Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2..Article Number 7006 081,0 0000 3524 8394 (Transfer from seMce?abeg 1 PS Form 3811;February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail. M Postag U e 8 Fees Paid. I SPS ' I Permi4 No.G-10 I • Sender, Please print.your name,address, and ZIP+4 in this box• I I � ° Town of Barnstable T4,Os Health Division 200 Main Street I Hyannis,MA 02601 I I Ail I I I Certified Mail#7006 0810 0000 3524 8394 �0, tVf TQw� Town of Barnstable Regulatory Services i s � t3AANSTAETLE, ' $ MASS. Thomas F. Geiler, Director O 039. pry°M Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 . Fax: 508-790-6304 February 14, 2007 Flavia Vignoli 265 Prince Hinckley Road Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 265 Prince Hinckley Road, Centerville was inspected on February 13, 2007 by Thomas McKean, Health Agent for the Town of Barnstable. This inspection was conducted on the basis of complaints received by the Town of Barnstable Health Division. The following violations of the State Sanitary Code were observed: 105 CMR 410.350 -Plumbing Connections—Two illegal bedrooms observed in basement. Septic stem i p y s designed for three bedrooms maximum. Five bedrooms observed. 105 CMR 410.401 - Ceiling Height—Two illegal bedrooms observed in basement. Floor to ceiling height is only 6.5 feet. 105 CMR 410.450 - Means of Egress—Two illegal bedrooms observed in basement. No second means of egress provided. 105 CMR 410.481 - Posting of Name of Owner—Rental property is not posted with owner's name, address and telephone number. QAOrder letters\Housing violations\Rental ordinance\265 Prince Hinckley Road.doc f i The following violation(s) of the Town of Barnstable Code were observed: V70-4- Certificate of Registration—Property is not registered with the Board of Health as a rental property. Occupants state rent is being paid. 170-10- Maintenance of Smoke Detectors and Carbon Monoxide Alarms—No carbon monoxide alarms provided within dwelling. You are directed to correct the violations listed above by March 1, 2007 by removing all bedding from basement; preventing anyone from sleeping or living in the basement; by installing carbon monoxide detectors on every habitable floor; and by.submitting enclosed application to register the rental property with the Health Division at 200 Main Street, Hyannis. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. E WcKean, BOARD OF HEALTH S., CHO Director of Public Health Town of Barnstable Cc: Reginaldo Sanchez, Tenant Cc: Timothy O'Connell, Health Inspector Building Department QAOrder letters\Housing violations\Rental ordinance\265 Prince Hinckley Road.doc ti Certified Mail#0000 0000 0000 0000 0000 4t T Town of Barnstable Regulatory Services p Thomas F. Geiler, , Director Public Health Division . Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 0.✓ date Arri Psceess , _ 44Ad 2, city,state,zip NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at ��615 P�):ice-An �d�I 1-5 �� (Address) was inspected On by- �`� � � ��'� , Health Lq&p4QWr for the Town (date) (Inspector's name).} of B arnstable, iz .4 came L. C L-1,01 ;Z7� er-c t J, _ (Reason for inspection) The following violation(s) of the State Sanitary Code were observed: State code violation number-violation description) 105 CMR 410.E- 0 61 /-s o(�5 Qs �,Q l �tJ— N o sjg,e,6-6 1:1V 1 cXt Sal 105 CMR 410.LfQ I - 'Twt) cA W roo•-s a C cr in v 105 CMR 410. �� _ �� r �roaKs r7 -� i ��,•�tl - C .�-� �. � .�. l r��rv�t,,ts �l,riy�"nM✓,ti, a�-- �S Q:\Order letters\Housing violations\Reatal ordinance\template.doc r 105 CM:R 410. 8P� The following violation(s) of the Town of Barnstable Code were observed: Town code violation number-violation description) . pp §170- Prol r 0 99 l WAV §170-_ z''� d{�� - .lo ►2 ,r� c1 v M114A You are directed to correct the violations listed above w f of your receipt of this notice by f'P—W,n att nLOA n , Cr. �G J. iC OLVI You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: P2 h a l ln 2&s (Name,tenant,owner,Fire Dept.,Building Dept....) Cc: (Health inspector's name) (Generic codes located at QAOrder letters\Housing violations\Rental Ordinance\GENERIC CODES.DOC) QAOrder letters\Housing violations\Rental ordinance\template.doc FORM 30'\H—�� HOBBS&WARREN'M THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . 7 \ CITY/TOWN W DE ARTMENT ADDRESS -6v 1� M ey`0 TELEPHONE L� Address tSz � iC.� in�_C1 Occupant-- Floor—Apartment No. N.A. of Occupants No.of Habitable Rooms— T No.Sleeping Rooms_�____ No.dwelling or rooming units_ _—_a No.Stories._ '�,_. c femme and address of owner_ i Aa_ -o Ot nG z a 3& p_7'1 Ci, n�i/� }"c�7 Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: fb j.17 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:., _2 sA S, D Dampness: t 1\ 6,,3 Stairs: „Xrj Li htin : ` P� r STRUCTURE INT. Hall,Stairway:__'_ , Obst'n.: Hall, Floor,Wall,Ceilin 5 ,-� C ,.d lib Hall Lighting: ci Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom —Pantry Den —Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Bding Posted NO f7d IV _ Locuilks on Doors: jQmz, Jed ONE OR MORE OF THE VIOL TIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." " -� ;; i INSPECTOF# TITLE k66A I � DATE TIME 1� .M.3�_ A.M. THE NEXT SCHEDULED REINSPECTION I I'A NI�- a-. 2►9[S�I P.M. 0 1 8(3Q0 ,. �. y..r v"av+'.f: J- yrus,�„d - �-v'1•r" - kY.. • °C L��r.'i•,^eye i,�'�w.--...,t,�. .� �.-•`�11�`�Hvv�r+.z V;;"� -�`R•'':.,. - ,.....,_y.f.,ta_--v,•.,.�i'•, •�.,.�...�:`1:.-"�.. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as .prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. rr for period of five or more days following the notice to or 0 An of the following conditions which remain uncorrected o a ( ) Y 9 P Y 9 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. Certified Mail#7006 0810 0000 3524 8394 P,o,*"(KE ti Town of Barnstable Regulatory Services • IIARNS"CAIILE, b%.39. `gym Thomas F. Geiler, Director ArFDM a Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 2 M�� February 14, 2007 Flavia Vignoli 265 Prince Hinckley Road Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 265 Prince Hinckley Road, Centerville was inspected on February 13, 2007 by Thomas McKean, Health Agent for the Town of Barnstable. This inspection was conducted on the basis of complaints received by the Town of Barnstable Health Division. The following violations of the State Sanitary Code were observed: 105 CMR 410.350 -Plumbing Connections—Two illegal bedrooms observed in Y `� basement. Septic system is designed for three bedrooms maximum. Five bedroom observed. 105 CMR 410.401 - Ceiling Height—Two illegal bedrooms observed in basement. ��CA7 Floor to ceiling height is only 6.5 feet. 1 105 CMR 410.450 - Means of Egress—Two illegal bedrooms observed in basement. No second means of egress provided. " 105 CMR 410.481 - Posting of Name of Owner—Rental property is not posted with owner's name, address and telephone number. QAOrder letters\Housing violations\Rental ordinance\265 Prince Hinckley Road.doc The following violation(s) of the Town of Barnstable Code were observed: 1 70-4- Certificate of Registration—Property is not registered with the Board of Health as a rental property. Occupants state rent is being paid. 170-10- Maintenance of Smoke Detectors and Carbon Monoxide Alarms- 44,11 , carbon monoxide alarms provided within dwelling. I ( You are directed to correct the violations listed above by March 1, 2007 by removing all bedding from basement; preventing anyone from sleeping or living in the basement; by installing carbon monoxide detectors on every habitable floor; and by submitting enclosed application to register the rental property with the Health Division at 200 Main Street, Hyannis. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Reginaldo Sanchez, Tenant Cc: Timothy O'Connell, Health Inspector Building Department QAOrder letters\Housing violations\Rental ordinance\265 Prince Hinckley Road.doc / 7/ 117 Town of Barnstable 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 July 18, 2007 Ms Flavia Vignoli 265 Prince Hinckley Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIROMENTAL CODE, TITLE 5 t The septic system located at 265 Prince Hinckley Road, Centerville, MA was last inspected on June 15'h, 2007,by Robert J. Bortolotti, a certified inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: The D-box is rotted. There is evidence of leakage out of box. Cover is broken. You have 60 days from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABLE HEALT DEPARTMENT Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Op 1HE T NWP• Town of Barnstable STAB� : Public Health DivisionILUM �pcP�r 200 Main Street o Hyannis, MA 02601PlTwEY a ®__7005 1160 DDDD 0191 3493 ; 02 1A $ 05.210 . 0004606238 JUL18 2007 MAILED FROM ZIP CODE 02601 Ms. Flavia Vignoli i 265 Prince Hinckley Road , Centerville, M A_f7i11 X 02% M lA -1 F-08M 02 071 2'1107 FORWARD 'TIME EXA RT N TO SEND VIGNOL.I "F-LAVXA RO DOX 214 RETURN TO SENDER t I' COMPLETE THIS SECTION ON DELIVERY i SENDER: COMPLETE THIS SECTION ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mail piece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No I Ms. Flavia Vi;noli 265 Prince Hinckley Road I 3. Service Type r Centerville,-MA 02632 ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise I �. ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes i + 2. Article Number 4 7005 1160 0000 0191 34913 i (Transfer from sendce label) i i }; 102$95-02-M-1540 PS Form 3811;February 2004 Domestic Return Receipt iJ Town of Barnstable 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 July 18, 2007 Ms Flavia Vignoli 265 Prince Hinckley Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIROMENTAL CODE, TITLE 5 The septic system located at 265 Prince Hinckley Road, Centerville, MA was last inspected on June 15th, 2007,by Robert J. Bortolotti, a certified inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passed" under the,guidelities`of 1995,TITLE 5 (310 CMR 15.00) due to the following: The D-box is rotted. There is evidence of leakage out of box. Cover is broken. You have 60 days from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABLE HEALT DEPARTMENT Thomas A.^McKean,R.S., C.H.O. Agent of the'Board;-of Health Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 265 Prince Hinckley Rd. Property Address Flavia Vignoli Owner Owner's Name information is required for Centerville Ma. 02632 6/15/2007 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. ImpoWhen filling A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini. cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC Company Name t� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 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 totSection 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Failse ❑ Needs Further Evaluation by the Local Approving Authority 6/15/2007 as Inspector's ignature Date N The system inspector shall submit a copy of this inspection report to the Approving uthority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 265 Prince Hinckley Rd. Property Address Flavia Vignoli Owner Owner's Name information is required for Centerville Ma. 02632 6/15/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: Y B) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound,'exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed t5insp•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 265 Prince Hinckley Rd. Property Address Flavia Vignoli Owner Owner's Name information is required for Centerville Ma. 02632 6/15/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ® distribution box is leveled or replaced ND Explain: Distribution box needs to be replaced.Concrete is soft and falling apart and cover is broken.Tank needs to be pumped.Heavy solids in tank. ❑ 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 ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 265 Prince Hinckley Rd. Property Address Flavia Vignoli Owner Owner's Name information is Centerville Ma. 02632 6/15/2007 required for every page. City[Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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 cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® 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. t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title , 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 265 Prince Hinckley Rd. Property Address Flavia Vignoli Owner Owner's Name information is required for Centerville. Ma. 02632 6/15/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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 J system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a rdesign 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 Elthe system is located in a nitrogen sensitive area (Interim Wellhead Protection El Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 265 Prince Hinckley Rd. Property Address Flavia Vignoli Owner Owner's Name information is required for Centerville Ma. 02632 6/15/2007 every page. City/Town 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? ® El available as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ ❑ Was,.the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information.For example, a plan at the Board.of Health. ® El approximation 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)] t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 265 Prince Hinckley Rd. Property Address Flavia Vignoli Owner Owner's Name information is required for Centerville Ma. 02632 6/15/2007 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 3 j DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate-inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 2005:145'000 2006:57,000 Sump pump? ❑ Yes ® No Last date of occupancy: Date 007 Date 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: Last date of occupancy/use: Date Other(describe): t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c�M 265 Prince Hinckley Rd. Property Address Flavia Vignoli Owner Owner's Name information is required for Centerville Ma. 02632 6/15/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: 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/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: system installed in 1980.New leaching pit installed in 1991. I Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 265 Prince Hinckley Rd. Property Address Flavia Vignoli Owner . Owner's Name information is required for Centerville Ma. 02632 6/15/2007 _ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ❑ cast iron 0.40 PVC ❑ other(explain): r Distance from private water supply well or suction line: 20'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of leaks e.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: 16"feet Material of construction: - ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 8'6"x4'10"x57' Sludge depth: 6-1 , Distance from top of sludge to bottom of outlet tee or baffle 2' Scum thickness 1'4" , 4, Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Measured t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 265 Prince Hinckley Rd. Property Address Flavia Vignoli Owner Owner's Name information is required for Centerville Ma. 02632 6/15/2007 _ 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.): Pump tank every 2-3years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound.Septic tank needs to be pumped.Heavy solids and scum in tank at time of inspection. 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 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): t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts 4 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 265 Prince Hinckley Rd. Property Address Flavia Vignoli Owner Owner's Name information is required for Centerville Ma. 02632 6/15/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No 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.): Box is rotted .Evidence of leakage out of box.Cover is broken. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts N W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 265 Prince Hinckley Rd. Property Address Flavia Vignoli Owner Owner's Name information is required for Centerville Ma. 02632 6/15/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: Z leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No signs of hydraulic failure.No signs of ponding.New leaching pit water to invert was 4' at time of inspection. t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 265 Prince Hinckley Rd. Property Address Flavia Vignoli Owner Owner's Name information is required for Centerville Ma. 02632 6/15/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 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.): i t5insp•06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 265 Prince Hinckley Rd. Property Address Flavia Vignoli Owner Owner's Name information is required for Centerville Ma. 02632 6/15/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. I q5 , i. t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 265 Prince Hinckley Rd. Property Address Flavia Vignoli Owner Owner's Name information is required for Centerville Ma. 02632 6/15/2007 every page. City/Town State Zip Code i Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground"water: 40' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record 1f 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: As-Built card ❑ Checked with local excavators,,installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you,established the high ground water elevation: Used:Gaherty& Miller model 12/16/94 ground water elevations.Used:Observation Well Data June 1992.Used:Technical Bulletin 92-000-01 Plate#2annual ranges of ground water elevations. r ' t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT DEPARTMENT OF FIRE-RESCUE&EMERGENCY SERVICES 1926 1875 Route 28•Centerville, MA 02632-3117 508-790-2380•FAX: 508-790-2385 John M.Farrington,Chief Martin O'L. MacNeely, Fire Prevention Officer Craig E.Whiteley,Deputy Chief Francis M. Pulsifer, Fire Prevention Officer August 3, 2005 Mr. Reginaldo Sanchez Ms. Flavia Vignoli 265 Prince Hinkley Road Centerville, MA 02632 NOTICE OF VIOLATION Dear Mr. Sanchez and Ms. Vignoli: Relative to our inspection of your property on August 2, 2005, it was determined consecutively by the Building, Health and Fire Departments that you have installed an illegal apartment in the basement of your home, located at 265 Prince Hinkley Road in Centerville. Additionally, compounding the issue is our concern with lack of adequate egress from the basement where two bedrooms are located. Pursuant to 527 CMR 1.06(1)(a), you are hereby ordered to immediately discontinue the use of the sleeping quarters in the basement. Due to inefficient egress, this would endanger occupants in the event of a fire emergency. The alternative solution we discussed as far as utilizing the approved bedrooms on the first floor living level is acceptable. Please feel free to call me at the Fire Prevention Office, Monday through Friday, between 8:00 a.m. and 4:00 p.m. at 508-790-2380 with any questions or concerns you may have. Thank you for your immediate attention to this matter to ensure adequate safety for all occupants of your home. Sincerely, d rancis M. Pulsifer Fire Prevention Officer "Commitment to Our Community" y �sr COMM Fire District 1875 Route 28 D CENTERVILLE, MA 02632 1926 INSPECTION REPORT Wednesday August 3, 2005 BANKS, AUSTIN 265 PRINCE HINCKLEY RD CENTERVILLE, MA 02632 Occupancy ID: 9159 Date Completed: 08/02/2005 Inspection Type: REFERRAL/COMPLAINT - Housing Safety Building Inspector J. Fitzgerald called re: this address and requested assistance. Questionable issue with smoke detection in the building and access issues with a basement apartment. Responded w/o incident to find Building Inspector Jack Fitzgerald and Health Inspector Donna Miorandi on location of a single story ranch residential structure. Assessors Department have this property recorded as a three bedroom, two bath, six total room residence. Building and Health agents state that upon arrival, the suspected home-owner closed the door as they pulled into the driveway. Attempted notification of occupant to request access to investigate. Occupant did not answer the door for approximately 20 minuites. Perimeter of the residence shows several childrens toys including 2 childrens bicycles, a razor scooter, childs tent, trampoline and childs pair of roller skates all within .10 feet of the bulkhead entrance. Steel bulkhead doors were in the open position and a steel 9 lite entry door was at the bottom of the bulkhead stairs. The appearance is that there is a kitchen and living room area immediately inside the entry door to the basement. Small basement windows with plastic covers on the exterior were found on the perimeter. Again knocked on the door and verbally requested the occupant answer the door. Vehicle parked in the driveway is a black Ford Explorer MA plate 91Y N06. The occupant opened the garage door. All inspectors identified themselves and requested entry to inspect the premises. Explained that we were concerned with the question of a basement apartment. Occupant willingly allowed entry. Occupant with slight language barrier but speaks some english and understands questions directed at her. Occupant showed inspectors the access to the basement from the interior stairs. Stairwell from the first floor to the basement has a makeshift light attached to the 08/03/2005 11:55 Page 1 .. A lest; COMM Fire District 1875 Route 28 CENTERVILLE, MA 02632 J926 INSPECTION REPORT handrail that is hazardous and creates a fire hazard. Approximately 1/2 of the basement is finished as an apartment with a fill kitchen including stove and refrigerator, living room, bathroom and two bedrooms. One of the bedrooms has childrens beds and various childrens toys/ articles. The occupant identified herself as: Flavia Vignoli- owner of the property DOB: 05-07-1982 508-420-5902 Ms. Vignoli stated that she lives at this address with her husband: Reginaldo Sanchez DOB: 02-26-1979 Ms. Vignoli stated that she bought the residence in February 2005 and her husband did the renovations after obtaining ownership. Checked the log, a 26F inspection was completed by our department on 01-14-05 at 13:00 hours with no adverse remarks noted. During our investigation, Mr. Sanchez returned home. Re-identified all inspectors to Mr. Sanchez and stated our concern with the basement apartment. Advised Mr. Sanchez that there are multiple code violations present relative to life safety including but not limited to : - restricted egress - single egress from bedrooms - disabling of smoke detection equipment - height requirements - septic restrictions Mr. Sanchez stated that the apartment was established without permits for a relative who lives at this address on a part-time basis with two children. Advised Mr. Sanchez that the living conditions were hazardous and occupants could not sleep in the basement area under the existing conditions due to life safety hazards. Inquired about the three bedrooms on the first floor and asked if the occupants could reside in those bedrooms until other living arrangments could be made. Mr. Sanchez advised that this would be possible. Requested Mr. Sanchez discontinue the living arrangments in the basement immediately and report to the Building Department at 200 Main Street Hyannis for a consultation with Building, Health and Fire departments to outline an acceptable solution. Advised Mr. Sanchez that if he continued to support living arrangments in the basement, that a call to the office of child services would be warranted for reckless 08/03/2005 11:55 Page 2 � y Mgr COMM Fire District 1875 Route 28 Wt CENTERVILLE, MA 02632 1926 - INSPECTION REPORT endangerment of a child for knowingly supporting living arrangments without proper egress. Mr. Sanchez and Ms. Vignoli undrestood and agreed to discontinue living arrangments. Mr. Sanchez understands and agrees to meet with officials on 08-03-05 at 200 Main Street Hyannis. Buisness cards for all agents were given on site. All agents cleared w/o incident. Photographs by Health and Building department. PULSIFER, FRANCIS /Fire Inspector Inspector 08/03/2005 11:51:05 fpulsifer 08/03/2005 11:55 Page 3 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. SignoEol item 4 if Restricted Delivery is desired. r ,Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. Received by(Printed Na e) C. Date of Deli ve ■ Attach this card to the back of the mailpiece, �p1✓f 'l. D 2 or on the front if space permits. ill (7 I 2S r k. 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑ No f S,P rLA4h V IGM00 Mi��C iN�il�O0. ►��d�� 1 �� f f !V / Z 3. Service Type CO. ❑Certified Mail ❑ Express Mail ) ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number -- - ---- --- ---- -- (Transfer from service label) I,., 'i7 0 01;,16 8 0, 0 0 0 4 ,5458 2285 PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-154] UNITED STATES POSTAL SERVICA6w, First-Class Mail Sender: Please print�bu 8dress, and ZI P+4 in this box • _T0 0� TIA 6Z,9 A06) m6loy AfAf/: Oo 3 8'0 Certified Mail#7003 1680 0004 5458 2285 Town of Barnstable s 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 August 11, 2005 Ms. Flavia Vignoli Mr. Reginaldo Sanchez 265 Prince Hinckley Road Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II-MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at 265 Prince Hinckley Road, Centerville, was inspected on August 2, 2005 by Donna Z. Miorandi, RS, Health Inspector for the Town of Barnstable, because of a complaint. Mr. Jack Fitzgerald of the Building Department and Francis Pulsifer, Fire Prevention Officer, of the Centerville-Osterville-Marstons Mills Fire Department were also present and conducted their inspections. The following violations of the State Sanitary Code were observed: 105 CMR 410.401: CEILING HEIGHT (A) No room shall be considered habitable if more than 3/4 of its floor area has a floor-to-ceiling height of less than seven feet. 105 CMR 410.450: MEANS OF EGRESS Every dwelling unit, and rooming unit shall have as many means of exit as will allow for the safe passage of all people in accordance with 780 CMR 104.0, 105.1, AND 805.0 of the Massachusetts State Building Code. You are directed to correct all of the above violations within seven (7) days of receipt of this notice. Q:Health/Order letters/Housing violations/265 Prince HinckleyRoad.doc V You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance could result in a fine of up to $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 0,& 1; ArZ.Thomas A. McKean, R.S. Director of Public Health Town of Barnstable Q:Health/Order letters/Housing violations/265 Prince HinckleyRoad.doc ,L U LA T-10N SEWAGE PERMIT NO. VI.LLAGE SENT€R V/1-1-- m� INSTA LLER'S NAME i ADDRESS `RvRr. �B. OUR 3 U I L D E R OR OWNER 'E. Sn).09v� DATE PERMIT ISSUED DATE C0MPl1ANCE ISSUED (,F- .151 TOWN OF BARNSTABLE i LOCATION ZUS Yi nck � � SEWAGE # VILLAGE IG, l t-C a ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. s . C d4�r l y4[�J) C��P SEPTIC TANK CAPACITY eKaSr a c�c I CL70 LEACHING FACILITY:(type) f)ke- C.:-s"C 'p1T— (size) -[.es NO. OF BEDROOMS PRIVATE WELL O BLIC WA E-R— ( �' BUILDER OR OWNER J'�'C� M �V�c vs DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ti ' d c� `� '�a 6 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiou for Uiiplasaal Works Towitrurtiun ranfit Application is hereby made for a Permit to Construct ( ) or Repair �an Individual Sewage Disposal System at: ..... �- - ----.. hC�.G-_�.A.K(f ......... .....•------...... E.i .L........................................................ Location- ddress or Lot No. ------------ ys .s ..------...r>r S-------------------- --------------------�.a. ......_...- Owner Add ess W C Y�`Q.G_L.St4f .t!?._�c�� jam- ��_Dk._ �5 �C�ltCe 1_ .�. V 1. Installer Address Type of Building Size Lot----------------------------Sq. feet V Dwelling—No. of Bedrooms..........�....................... _Expansion Attic ( ) Garbage Grinder ( ) t, '4 Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ----------_-- -------------------------------- - -- W Design Flow...... ..........................gallons per person per day. Total daily flow.......... LO....................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No._------•------.__. Width....`.............. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------I.............. Diameter----J_(-�-___--_- Depth below inlet..... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_______-_____-___.._-_-- G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----------_------------ ..................------------••-------------••-••--•-----------•-•-•---•--••---•--•---•-----------.---••-•••-----•----••----•---•-•---.....---•----------............._...... 0 Description of Soil........................................................................................................................................................................ x V ------ •------------------------------- •---•------.-------------------------------------------------•-------------------------------•---------------•-----------•------------•-----------------•---- W -----••••---•----•----------•••-•--••-•••-----------•--•------••-••-•-•-••••--...-•-••-•-•-------•------•--•-••---------•-------...•--••-•---•--•---•------•••••-••••----••..._......-•---------•--_.... UNature of Repairs or Alterations—Answer when applicable-----A-100.....(Q (o-_py.T------ ........................ -----•.........o...S..( 1 ,----=-T.-It.rLF.-...-)E.. ------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE S of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee iss and of ealth. Signe ..... ...........------- --.... ........... ........ Date Application Approved By ................... = �1.... Application ............. - lq Disapproved for the fol owing reasons- ------------------------ ---------------------------------- ----------- ------------------ ----------------------------------- ------ -- ------------------------------------------------------- --- ------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- Permit No. -- .....C�--- �/(�..... ..... Issued ..... Date Date C/ C THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Uhiposal Works Tnnitrnr#inn jJamit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: r CeT ......................................................... ............ - ►- ....... -Address or Lot No. Owner Adr ss w ..................... .:.Asa 1'y��_.. t- ------------------- - ..�4. - - -------I . j.1.� .......... Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...... .................................Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures .................................. W Design Flow........ .....................gallons per person per day. Total daily flow------�--_-_�-�.2.....................gallons. Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.___-1-------------- Diameter-__- ....... Depth below inlet....(P........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P41 -••--•-•--••-----------------•-••-•••-•-----•••-•--•----•--•------•-----._......•--------•--._.....•........................................................ 0 Description of Soil...............................................................................------------------------------------------------------------------------------------•--- (� ------------------------------------------------ -------------- W V Nature of Repairs or Alterations—Answer when applicable--__A-0_0_____ .....1Q -------------------------- . Agreement: 11 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system.in operation until a Certificate of Compliance. lliance.has beep. issued-by-the and of-health. Signed--=--.�--:----- ---�•-............--......... --------------- ------- --------------------------- - • Date Application Approved BY �� ty ,yL¢--- -� � /Jf Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------..................................--------..............---...............-----'-----.......--......----------................................ ---.............. Dare---------------- PermitNo. ----------?, ..........//6...................... Issued --------------------------------- ................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE . %Tertifiettte of C�omyXianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (L--)- ' by ............................ Q :....U--AP4. ----- ..................-- --.......---------.................................................................--------------- at � - \- Intstallefr , Q` ` � ..............................fi-f.... ----------i ... ------------- -- has been installed in accordance with the provisions of TITLE 5 pt The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..... •,/.r....;/.�Li�.-�/ dated ....-...--- �............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..........3`0?07..T--------------------------------------------- ---------- Inspector ................................... --- -------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Z � TOWN OF BARNSTABLE Disposal Vorkg Tons#rndion "pamit Permission is hereby granted........... b lA G`C � 'V a '-•-----------•....................•--...................-----.... to Construct ( ) or Repair (L_),an Individual Sewage Disposal System at No. fn.S `( _ r�:!�._.. 1� r �r. Q2 ZT(�-..I................................................... t Street as shown on the application for Disposal Works Construction Permit No; ,h..... Dated.......................................... .............................. 7 _9� Board of Health DATE.............;. . . /� FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS �• c �7 .f- No........... .......... Fps... ............ THE COMMONWEALTH OF MASSACHUSETTS BOARDO HEALT -----/.04. ...O F.. , Appliration for Dispoii al Workii Tomitrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System........... .. ...._......'"--•-•...� .._... .... . --- ........ 7 7? L tion-A ess or ......... .... ...... . ... •..............••" ._............._.......... er Address Installer Address Type of Building Size Lot... ...Sq. feet Dwelling—No. of Bedrooms......_�............................Expansion Attic (/C),6 Garbage Grinder (/10Z Other—T e of Building No. of persons............................ Showers a YP g ---------------------------- P ( ) — Cafeteria ( ) Otherture .. --------------------------------------•-••••---•-•-------•••••----•-••--•••-•••••-•-•--•••••-••••-•-•••••........-•••-.....------•••• Design Flow___ ._... _.. ..__ Ilons per person per day. Total daily flow................ Ions. W •gn n P P P Y y 3._ _� gal WSeptic Tank--'Liquid ca acityll�lons Length................ Width................ Diameter----- .......... Depth................ x Disposal Trench—No ...._._.. Width.4.................. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......... .......... iameter.........../S�`b epth below inlet.................... Total leaching area...R.j_.f....sq. ft. Z Other Distribution box ( ) Dosing y�nk ) c `-' Percolation Test Results Performed by.... __a... . _ -_ _-... Date.._. ._' sl aTest Pit No. I...�:;�e..minutes per inch Depth o Test Pit...............•.... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ...........................................................••••_.... ... ---- Description of Soil a .... '.; ...............__. . .......... V -----------------------------------' ...._......._..------------ -.------------ ....... ------------------------------ ••---------------------- •---------------------- --------- •------------------- ---------------------------------------W U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ------------------------------------------------------------------------------•-....---'..........----•------•----------------------------...-----------------•----...-----------------------.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of`LIT,M 5 of the State Sanitary Code— The undersign rther agrees not to place the sys m in operation until a Certificate of Compliance has been by th rd iealth. Sign ••• ..... -•--• ••• • �/ ... .................... Date Application Approved BY ,�- . •••.......... .... . tl Date Application Disapproved for the following reasons------------------------------=--- •••••-••-•'•••••••••...•••-•-••••....•••••....•--•--•--••••••-••-••--•-----••-•••••....--••-•••-•----••_.._......••--••••••••--•-••••------••---••-••......•..............................-............. Date Permit No......................................................... Issued-_._-2 S— Date 7 f ~~ No.......=•.........-....... FEs �.............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF -iEALT t:.....:..OF....... r .!:a ....��.....1 .. Appliration for BigVvq a1. Works Tnnitrnrtiun Vvrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System. , at• 6_4 .... .. .--- _..... •- --•--•••-•--_... ........ .....••-••--••-• ----•---•---....--•-----•- -•-••---- 'S yLooccation AJddiess �g or Lot No* a< f Owner ` f/ Address W 9 vwT"yF s `r 1 G.,,wn.�y Installer Address Q '. {fi ? .S Type of Building � Size Lot_____ b ..•_ q.,feet Dwelling.—No. of Bedrooms.__... __ __.._Expansion Attic (,, 4x—) Garbage Grinder Other—Type of Building _________ _______________ No. of'. ersons............................ Showers — �W YP g - P ( ) Cafeteria QOther fixtures,::- .. .................._ •----•--- ---..-.-•--•• •--•.............•-----•--•-- Design Flow___„ -.�..,;,;__. Ilons per person per day. Total daily flow-.______ '7 ga • -- --•--•------ lions. . W Septic Tank J Liquid capacity/;�. ' Ilons Length -• -•--- ,Width Diameter---------------- Depth................ Disposal Trench ,�o �,. _____ Width __.._ Total Length_________ _________ Total leaching area....................sq. ft. '� �� Seepage Pit No.... __ _t+'__' iameter .__..:_.� {..: Depth below inlet____________________ Total leaching area... `�_!�_1....sq. ft. Z Other Distribution box ( ) Dosing G '-' Percolation Test Results Performed by.... ' ..__._. -� Date.___,1, ..__/_ ..... _� W ,-a Test Pit No 1:_. ' r__minutesper inch Depth o -Test Pit____________________ Depth to ground water rxq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water____' _:._..__-_.___. Ri + O Description of Soil.........`�___� 2 �- 11 �lrkt .. x V --•--------•-•._._...-•---•••••-••-•---•-•-----_•--• ---•- ------•- •----••• --•- -•• -••-••-• ----•••. -•---•� ......_-- _ -- - •--•••.............. W UNature of Repairs or Alterations -Answer.when applicable_________ ______ --------------•-•••. ••••--• -.....- •-•- •••••. -------- r Agreement: R 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 iindersigiied fizrtl:er agrees not to place the.system in operation until a Certificate of Compliance has been issued1by the board of health. Sign ---__ r`- Gt - ^r � r bate _ Application Approved BY Date Application Disapproved for the following reasons---------------------------------------------------- ----------------=------------------------------------------ ---=-------------------------•---•--•-----•..-----------------------------•-------------------------•-•-•---------------------------------------------------------------------=------------------.._.._. Date PermitNo........................................................ Issued---•-•-•--------------- ' Date THE COMMONWEALTH OF MASSACHUSETTS BOARD, OF HEALTH;' ............. OF...... , .? . ...... Trr#if iratr of THIS I CE at the In dua wzge Disposal System constructed ( or Repaired y F % — y alley } has been installed in accordance with the provisions of ` of The State lni Code as described in the application for Disposal Works Construction Permit N .,ll` _____ r ?"' _________ dated_.__ ; ..... ._'.�' ----•---- THE ISSU'A'NCE OF THIS CERTIFICATE SHALL:::NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM. WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector -----•---....---••••.......................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No `�. �. FEE - ..... i �a1 nr rani Permission is 'eby granted ___._ led-2_ _ to Constr t,.( ) or Rep ' ) an. div •ual Searage%gIspvsal Syst / r Street as shown on the application for Disposal Works Construction-Per' al• Board df e t' DATE ---..11�'�.-- 1 ---•---- • •------------•--..._ . FORM 1255 HOBBS & WARREN. INC., PUBLISHERS .�. "'. .•: .! •'.. : :.- ... ..".: aN.q .1.x•6.. ..-6�,a�;L.4#�.+e.�.�c.a � `:"• <.dr.. ...... .,. .... . ..t"_..z_r, .. __ , Q''�-'�t�►mil _ rts.'1 /L _ �``� /O�•00 .r- .. ti:� A �'IT • r Uat��r V=L,D.v L tIo G.P•b. d •PLOP �� iA �� T��,�'K TOTAL -0ES16W = d25 G•aD. N ,O TbTo L TUaI L`f 1=t-.D W PCf/C0L&T%0U rZhTc W ?Ma N�C¢ 1. is. � rO vN D 13+ . I ' M•„s, 1 --,—� �571 0F140 Gliq�7r -'N G FPiCH Y ' BAXITE . }..'4 too i Wt V—L& TL"-ST I Z�I�1-79 �G �/9 Tor 1~vv �too.o 77* t.M 1 'TA#4tc t o��0 9�'O t•w. tw. ':'. i GAL. 9G Z 96 G LEAr-H 'A PT STowi� 0,0 LOGAT1o" u� va jYr9TS.e ' 1 CCtZTt4=`( T1-1AT TI-lG �c�V�.1DAT1Dl, S.N�� PLL�1J Ri=r�i=L�E.�.1C_E !� � t-1f.t:t_o�,l Grati�PL�IS W ITEi TN` �jl D� Lt�-1� I� A1JD SC7L�ACIG 'VG4UIQ-GAA&- JP; O T►•+G �C7T �, 'YowU ot= �AiZ.t,15T' I�� (�.. �!L. 3O(o �L• �Z PAILIt..1G- kcGtS lU_va,(o Ii = • T1415 PLAN I e, LJOT AN ttt ' artt �J4 �i�c:.fca�! ''Islt... ca� � s�. Sttcww A. 1� C ,sA II Atan�t� t.lT ,dl,