HomeMy WebLinkAbout0786 SHOOTFLYING HILL RD - Health 786 Shootfl.ying Hill Rd
Centerville
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments +
786 Shootflying Hill Rd r ,
Property Address
Bank Owned (Contact David Holt c@ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is
required for every Centerville ✓ MA 02632 12-24-15
page. City/Town State Zip Code Date of Inspection
- C71
Inspection results must be submitted on this form. Inspection forms may not be alteredTn any
way. Please see completeness checklist at the end of the form.
A. General Information
1. Inspector:
Shawn Mcelroy
Name of Inspector
Upper Cape Septic Services
Company Name
P.O. Box 73
Company Address
E. Falmouth MA 02536
City/Town State Zip Code
1-508-495-0905 S13971
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. 1 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
12-24-15
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.
f�� f1
t5ins•3l13 Tiffe 5 Official Inspection Form:Subsurface Sewage Disposal Page 1 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 786 Shootflying Hill Rd
Property Address
I`° Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner I. Owner's Name
information required for e 6very i Centerville - MA 02632 12-24-15
page_ U City/Town State Zip Code Date of Inspection
E ` B. Certification (cont.).
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 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:
System is in good working order with no sign of failure.
B) System Conditionally Passes:
❑ .One or more system components as described in the "Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or 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.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•3l13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
4M . 786 Shootflying Hill Rd
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 12-24-15
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with,Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. System will
pass inspection if(with approval'of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ 'N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y , ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the,Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in.a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑` Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts -
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
s 786 Shootflying Hill Rd
Property Address
Bank Owned (Contact David Holt c@ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 12-24-15
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health(and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes"or"No"to each of the following for all inspection's:
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 1/2 day flow
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments.
786 Shootflying Hill Rd
Property Address
Bank Owned (Contact David Holt c@ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 12-24-15
page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No ,
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
El
® 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.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts '
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
786 Shootflying Hill Rd
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 12-24-15
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
❑ r® 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
t :
available note as NIA)
® ❑ ; Was the facility or dwelling inspected for signs of sewage back up?
® ❑' Was the site inspected for signs'of break out?
r%
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the P
septic tank manholes uncovered, opened, and the interior of the tank
P
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® El 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:
4
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form-
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
786 Shootflying Hill Rd
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 12-24-15
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No
information in this report.)
.Laundry system inspected? ❑ Yes ® No
Seasonal use? t ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: Unknown
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): canons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
4�M , 786 Shootflying Hill Rd '
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 12-24-15
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: Town--pumped 1-2012
Wass stem pumped as part of the inspection? El Yes Z 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):
t5ins-3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
" Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
a
786 Shootflying Hill Rd
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 12-24-15
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
2002
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 24"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.):
Good condition.
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: 1500 gal
Sludge depth:
12"
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 786 Shootflying Hill Rd
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 12-24-15.
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle
20"
Scum thickness -2"
Distance from top of scum to top of outlet tee or baffle
6„
Distance from bottom of scum to bottom of outlet tee or baffle 14"_
How were dimensions determined? Tape
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank is in good condition with baffles installed and no sign of leakage.
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
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
" Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 786 Shootflying Hill Rd
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 12-24-15 .
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
•• Dimensions:
Capacity:
gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
786 Shootflying Hill Rd
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800=966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 12-24-15
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
Comments (note If box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Good condition with water at working level and no sign of back-up from field.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ .Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
y Commonwealth of Massachusetts ,.
Title 5 Official Inspection- Form
Subsurface,Sewage Disposal System�Form.-Not for Voluntary Assessments
GqM , 786 Shootflying Hill Rd - -t
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 12-24-15
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 4-infiftrator3050's
❑ 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.):
Leach field in good working order and empty at inspection with no sign of back-up into d-box or
surrounding stone.
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
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form =Not for Voluntary Assessments
M s 786 Shootflying Hill Rd
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner
Owner's Name
information is required for every Centerville MA 02632 12-24-15
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
786 Shootflying Hill Rd
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 12-24-15
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
1 _
r 13 C-
r _
`
,A W
9
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 786 Shootflying Hill Rd
Property Address
Bank Owned (Contact David Holt c@ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 12-24-15
page. Cityfrown 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: 12'+
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:
Original design plans show no groundwater at 12'.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
786 Shootflying Hill Rd
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Centerville MA 02632 12-24-15
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary:A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
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Certified Mail#7012 1010 0000 2850 8319
AIM Tati Town of Barnstable
Regulatory Services
MRNbTABLF_
39. Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
February 10, 2014
Aleta Hogan
371 Quinaquisset Road
Mashpee, MA 02649
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION,
THE STATE ENVIRONMENTAL CODE, TITLE 5. .
` The property owned by you located at 786 Shootflying Hill Road was inspected on
February 10, 2014 by Timothy O'Connell, R.S., Health Inspector for the Town of
Barnstable. This inspection was conducted on the basis of a complaint. The following
violations of the State Sanitary Code were observed:
105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements:
Observed structural flaws (gaps, rotten wood, ect) where garage meets main part of the
house. These structural flaws do not exclude wind, rain, rodents and chronic dampness.
Nuisance Control Regulation No. 1, Part VII, Section 1.00: Construction debris
observed in back yard.
You are directed to correct the violations listed above within thirty (30) days
of your receipt of this notice by insuring that home is rodent proof and excludes
wind, rain, and chronic dampness; by removing construction debris.
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 se ate violation.
PER ORDER THE BOARD OF HEALTH _
as A. McKean, R.S., CHO
Director of Public Health
Town of Barnstable
Cc: Melissa Weston; Occupant
Q:\Order letters\Housing violations\Rental ordinance\786 shootfling hill 2-10-14
TOWN OF BARNSTABLE
�. BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date f s ( � Time: In Out
Owner Tenant
Address I Address -7
Compliance Remarks or
Regulation# Yes O Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal �.
16. Sewage Disposal
17.Temporary Housing
18. Driveway Width
19. Number of Tenants Observed
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Number of Bedrooms Number of Vehicles Allowed (max)
Number of Persons Allowed (max)
Person(s) Interviewed Inspector
/ - 0"----
If Public Building such as Store or Hotel/Motel specify here
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date _ Time: In Out
�Q .. I Owner Tenant
i
Address 3 Address F'
I
Compliance Remarks or
Regulation# Yes J,,INO Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
�( AID
7 �,
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
*8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
i
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
n
18. Driveway Width
E.
19. Number f�fienan ,Observed
�.,
n
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Number of Bedrooms 7 Number of Vehicles Allowed.(max)
Number of Persons Allowed (max) , '
Person(s) Interviewed Inspector
m
If Public Building such as Store o�Hotel/Motel specify here
Law Office of Richard J. Reilly Jr.
508420-1013 P.O. Box 33 email:mycaueattomeyp_gmail.com
Facsimile:617.300.8890 East Sandwich, MA 02537 website:www.rreillylaw.com
February 18, 2014
Ms. Melissa Weston
Mr. Gerry Stanley
786 Shootflying Hill Road
Centerville, MA 02632
RE: NOTICE OF ENTRY
Dear Ms. Weston and Mr. Stanley:
Please be advised that contrary to the information you provided on February 6, 2014, 1
have not been contacted by any attorney retained by you. In the event that you have in fact
retained counsel, kindly advise me of his or her contact information.
I have been told that Mr. Timothy B. O'Connell, Health Inspector for the Barnstable
Board of Health, has contacted my client regarding remediation work that is required on the
property you presently occupy. As you know, my client attempted to make precisely the same
repairs last month upon first learning of the problem, but you and/or Mr. Stanley refused to allow
my client to enter the premises; because you gave notice of termination, as a courtesy my client
obliged and planned to affect repairs upon your departure.
As you are aware, the 14 Day Notice to Quit provides that you vacate the premises no
later than this Friday, February 21. Accordingly, my client has arranged for a dumpster to be
delivered to the property on Friday, February 28. The dumpster will be located directly in front
of the garage, and my client will enter the property beginning Saturday March 1, starting in the
basement to remove drop ceilings and insulation in accordance with Fowler Pest Control's
request. Once the area is accessible, a licensed contractor will repair existing holes around the
base of the home and they will also start repairing boards that surround the garage.
In the event that you remain in the premises on that date, please clear the subject areas of
any personal belongings; my client shall not be responsible for any damage to items that have not
been removed. Note that the dumpster will be left directly in front of the garage for the duration
of the remediation, and at the present time there is no completion date due to the uncertainty of
the level of work needed to compete the repairs.
In the event that you have any questions or concerns, kindly contact me at your
convenience. Please note that in the event you have not vacated the premises in accordance with
previous correspondence, a Summary Process action will be timely filed in the Barnstable
District Court.
Sincerely,
Richard J. Reilly, Jr.
Page 1 of 1
O'Connell, Timothy
From: Richard Reilly [mycapeattorney@gmail.com]
Sent: Tuesday, February 18, 2014 5:43 PM
To: O'Connell, Timothy
Cc: gregg locke
Subject: Gregg Locke: 786 Shootflying Hill rd., Centerville
Dear Mr. O'Connell:
Please be advised that I represent Mr. Gregg Locke in his eviction of a non-paying tenant at the above
property. Attached is a copy of a letter I mailed to the occupants today informing them of Mr. Locke's
plan to repair the property.
After speaking with the occupant, I am reluctant to advise Mr. Locke to enter the property until they
have vacated, but I understand that he has only 30 days to complete the repairs.
I will keep you informed as to what transpires with regard to the attached letter- hopefully they will just
leave on their own accord and we will not have any further problems. Thank you, and please feel free to
call me at 508-566-1165 if you have any questions or concerns.
-Rich Reilly
Richard J. Reilly Jr., Esq.
PO Box 33
East Sandwich, MA 02537
508-420-1013
fax: 617-300-8890
Website: www.rreillylaw.com
Email: mycapeattorneyggmail.com
2/19/2014
� 0o2-- zsy 1
No. ��� Fee
`^y-THE-COMMONWEALTH OF MA$SACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppffcation for �Digooal 6pgtem Consgtruction Permit
CV T� Application for a Permit to Cons )Repair(Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. �, j - � t4i I Owner's Name,Address and Tel.No.
Assessor's Map/Parcel 'F�-►V �� Z IC.�
A�7 19 a- 03 Installer's Name,Address d Tel.N Desi 'N e, dressand Tel.No.
neeXr Cf �av
�l T� ICU� CUM
Imo Z3�d �
Type of Building: .�
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures '
Design Flow gallons per day. Calculated daily flow 7C;Kf gallons.
Plan Date 6 0, Number of sheets Revision Date
Title
Size of Septic Tank 11tW 156DOU Type of S.A.S.
Description of Soil V 40 La-111
Nature of Re airs or Alt rations(Answe when ap lic'00able
r
am Llr
I iN vek
Date last inspected: DESI
INSTALLATION AND S INSTALLEDCERTIFY
NN STRICT
WRITING
Agreement: THE SYSTEM WAS
l�GnnR ANC TO PLAN.
The undersigned agrees to ensure the construction and maintenance of tae�escn ed on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been is ed by this Bo Healt .
Signed Date
Application Approved by qv. Date
Application Disapproved for the following reasons
Permit No. 6 0 2 —.2.s-q Date Issued
No Fee
; COMMONWEALTH OF MA SA H�JSETTS' Entered in computer:
PUBLIC HEALTH DIVISION`—TOWN OF BARyNSTABLE., MASSACHUSETTS Yes
h 2pprication for Mizponl *p!6te-fn Congtruction Permit
Application for a Permit to Construct( )Repair(/Upgrade( )Abandon( � ) El Complete System El Individual Components
Location Address or Lot No.- r t% Owne'r's,Name,Address and Tel.No.
rvl 1 Icy....
Assessor'sMap/Pazcel
Installers Name,Address,and Tel.No. Desi er's Name, ddress and Tel.No.
GIG. 1 neGr i
r
1A 1— hbYO M r+02--(4co 4 31
Type of Building: S .�
No.of Bedrooms Lot Size sq.ft. Garbage Grinder Dwelling ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures , /
Design Flow C) gallons per day. Calcu ated daily flow qLlc�, Y gallons.
' Plan;Date ., 1 0 o1. Number of sheets `Revision Date
r Title
z Size of Septic Tank Type of S.A.S. ln6u_�
Description of Soil & L t
cti �
Nature of Repairs or Alterations(Answe when applicable) QGI Y
Date last inspected:
s. ..1. r
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
' Cate of Compliance has been iss ed by this Board of Healt
Signed Date
Application Approved by Date
Application Disapproved for th following reasons
Permit No. 0 n d 2 —.2 Date Issued
i THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CE TTY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded
Abandoned( by
l` ,Abandoned
/ / has been constructed in a cordance
with the pro ision of Title 5-an the or isposal System Construction Permit No. (lug- �_C V dated / 12
Installer d Designer
The issuance of this permit shall not be construed as a guarantee that the syst m illAnction as dtsi&ed
Date �� 10 Inspector GNt4d, 1
------------
No.— 0 (�
_ — Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Mizpossar *pztem C nel uction J)ermit
Permission is hereby granted to Con eruct( Repair( 'Upgrade Abando
System located at // / �!) (LI
� n r
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this it.
Date: /7 Approved by G �
/ c
r TOWN OF BARN TABLE �00. aS t
LOCATION S G . I �. ,j
(�� / fJ'"sI SEWAGE #
VII—LAGE C ,�d�i �`'`� rASSESS S MAP & LOT " c
INSTALLER'S NAME&PHONE N0. I sl L ��✓
SEPTIC TANK CAPACITY
LEACHING FACILITY: (ty
NO. OF BEDROOMS
BUILDER OR OWNER e;'• ,r l �r
PERMIT DATE: (ob;t 7 _o COMPLIANCE DATE: Z
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
f
TOWN OF BARN TABLE 4 ;200ar 2S�
LOCATION S GG`r r�. +j SEWAGE #
VII LACE �� i ASSESS S MAP&LOT
INSTALLER'S NAME&PHONE NO. 1 �
SEPTIC TANK CAPACITY
LEACHING FACILITY: (ty ) 345D gz!t- 4 Z.�<Ao Asize) "T `�/;;L
NO.OF BEDROOMS
BUILDER OR OWNER
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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NAME OF OFFENDER /l f} ) BAR
TOWN OF ADDRESS OF OFFENDER�,Lt� r
BARNSTABLE CITY,STATE,;
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-TIME AND DATE OF VIOLATION ,f" ` LO� �LAT10N �. 2E
NOTICE OF :G C3 (A.M./ P.M4 ON, I 20 I "e r�;7 61�rsr ;� f -�J
SIGNATURE-OF-ENFORCING PERSON �! �t,,1� F CING EP_.,,.. BADGE NO. W
VIOLATION IA 1:10,
OF TOWN I HEREBY ACK 0 LEDGE RECEIPT OF CITATION i a
IV
ORDINANCE 0 Unable to obtain signature of offender.
THE NONCRIMINAL FINE FOR THIS OFFENSE IS Z IJ
Date mailed LU
W
OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a
DISPOSITION WITH NO RESULTING CRIMINAL RECORD. w
REGULATION a
(1)You may elect to pay the above fine,either by appearing In person between 8:30 A.M.and 4:OO.P.M.,Monday through Friday,legal holidays excepted, W
before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430,
Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. d
��2 If you desire to contest this matter in a noncriminal proceedirr�Ig yyou mayy do so by Making written request to DISTRICT COURT DEPARTMENT,FIRST
RNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this
Fr citation for a hearing.
(3)If you fail to pay the above offense or to request a hearing within 21 days,or If you fail to appear for the hearing or to pay any fine determined at the
hearing to be due,criminal complaint may be issued against you.
I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of b
Signature
ti.
SENDER: COMPLETE THIS SECTION' COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3.Also complete A.`S1 n to
item 4 if Restricted Delivery is desired. G� ❑Agent
X
■ Print your name and address on the reverse ❑Addressee
so that we can return the card to you. c ',, eceived by rinted Na a C. Date of Delivery
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
D. Is delivery add different from item 1? ❑Yes
1. Article Addressed to:
H i If.YgS,enter defiyery address below: ❑ No
4
2
rl"'7'P� Aleta Hogan
786 Shootflying Hill Road
Centerville,MA 02632 3. Service Type
M Gertified Mail ❑Express Mail
I ❑Registered Ceturn Receipt for Merchandise
❑ Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number + 7 0 0 6 0 810 0000 3524 5 218
(transfer from service lateen
h PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540
r
UNITED STATES POSTA • E S LCE � ��t,Y. ,�•f it w a 1} ,.
S .�.�. Laid
°� •'"Permit No G 10"
Sender: Please print your name, address and ZIP+4 in this
I �� Town of Barustatile �
x Public Health Division I
200 Main Street
fI �� Hyannis,MA 02601
I i �
1"11„i, 1,1,11„11,,fill1i,i,;lil„�li,�,,,1,111„,fig„�1�1,1
Certified Mail#7006 0810 0000 3524 5218
Town of Barnstable
.� Regulatory Services
an�vsras[.E,
MAM $ Thomas F. Geiler, Director
tbg9. �0
f1659 Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
November 29, 2011
Aleta Hogan
786 Shootflying Hill 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 STATE ENVIRONMENTAL CODE, TITLE 5.
The property owned by you located at 786 Shootflying Hill Road was inspected on
November 28,.2011by Timothy O'Connell, R.S., Health Inspector for the Town of
Barnstable. This inspection was conducted on the basis of a complaint. The following
violations of the State Sanitary Code were observed:
410.450 Means of Egress: Observed two (2) rooms within basement being used as
bedrooms without proper second means of egress.
1� 70-4 — Certificate of Registration. Rental property (Main House) is not registered
with Town of Barnstable Health Department.
You are directed to correct the violations listed above within twenty four(24) hours
of your receipt of this notice by removing all beds from basement and ceasing and
desisting from using any part of basement as sleeping quarters. You must install an
egress window if you choose to use it for sleeping. You are directed to correct the
violations listed above within ten (10) days of your receipt of this notice by
registering the rental property with the Health Department
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. J
PER ORDER OF THE BOARD OF HEALTH
� . McKean, R.S., CHO
Director of Public Health \
Town of Barnstable
Cc: Linda Price; Tenant
QAOrder letters\Housing violations\Rental ordinance\786 shootfling hill 11-28-11
FORM30 Caw HOBBS&WARREN'" THE COMMONWEALTH OF MASSACHUSETTS
BOARD�OF H� H
�wvt
CITY/TOW ILI
W
DEPARTMENT
ADDRESS
GSM Syey`eW
• ��� LEPHONE e,
Address �'�""" ` lot Occupant—
Floor—
—
Apartment No. No. of Occupants
No. of Habitable Rooms No.Sleeping Rooms
No.dwelling or rooming units--No. t rie
Name and address of owner
Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney
BASEMENT Gen. Sanitation:
Dampness:
Stairs:
Lighting:
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents.-
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen. Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pantry
Den
Living Room
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4
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: —I sV
Infestation - Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Building Posted _:jV—
.3 ^/
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OF PE Y."
lINSPECTOR TITLE '
DATE ( TIME r f'a P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to-provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner I
to remedy said condition within the time so ordered by the Board of Health. _
�� f_ - � 5�
�i
a
Health Master Detail Page 1 of l
ro
M-,
Logged In As: TOWN\oconnelt Health Master Detail Monday, November 28 2011
Application Center Parcel Lookup Selection Items
Parcel Septic Perc Well Fuel Tank
Parcel: 192-038 Location: 786 SHOOTFLYING HILL RD, CENTERVILLE Owner: HOGAN, ALETA
Business name: Business phone:
Rental property: ❑ Deed restricted: C Number of bedrooms : 4
Contaminant released: rl Fuel storage tank permit: r
I-i—Save Parcel Changes I 'Return to Lookup
Parcel Info Parcel ID: 192-038 Developer lot:LOT 9B, 10 & 10A
Location:786 SHOOTFLYING HILL RD Primary frontage:
Secondary road: endary frontage:
Village:CENTERVILLE Fire district:C-O-MM
Sewer acct: Road index: 1484
Interactive mapEn-
Town zone of contribution:AP (Aquifer Protection Overlay Di trict) State zone of contribution:OUT
Owner Info Owner: HOGAN, ALETA Co-Owner:
Streets:786 SHOOTFLYING HILL RD Street2:
City:CENTERVILLE State:MA Zip: 02632 Country:
Deed date: 10/07/2003 Deed reference: 17760/227
Land Info Acres: 0.49 Use: Single Fam MDL-01 Zoning:RD-1 Neighborhood: 0105
Topography:Level Road:Paved
Utilities:Public Water,Gas,Septic Location: Rear Location
Construction Info Building No ear Buil Gross Area Living Area Bedrooms Bathrooms
1 1957 3144 1092 3 Bedroom 1 Full
Buildings value:1,(117,200.00 Extra features: 3x3,000.00 Land value: ol10,000.00
J
http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=192038 11/28/2011
DATE: November 29, 2011
TO: Building File
FROM: R. Anderson
RE: 786 Shootflying Hill Road, Centerville
OWNER: Aleta Hogan, Quinaquisset Ave, Mashpee
11/3/1970 -S39341766
Responded on 11/28/2011 to request for inspection by Mike Grossman of COMM Fire.
Jeff Lauzon and Tim O'Connell were also present. Jeff Lauzon photographed the site.
Informed that on 11/25/2011 Rescue responded to basement apartment and transported a
very ill man from one of the bedrooms. EMTS advised rooms were lacking egress and
scene is contaminated with blood pathogens.
Found a ranch style home with attached garage. The topography is such that the garage is
lower than the house which rises above it directly to the right side facing the front. Entry
to the lower level is directly to the left of the garage doors. This door was unlocked and
opened into a common area containing two interior doors, one on the left and another
straight ahead but off to the right. At this time a woman from the primary residence
came outside to inquire about us. She informed me her landlord is Mr. Davalos. I had
the office check the Registry of Deeds for a recent conveyance as our records indicated
an Aleta Hogan as the record owner. Sally called back to say there were no other deeds
and Ms Hogan is identified as the owner in all department records and the Registry of
Deeds.
Mr. Davlaos arrived. He identified himself as the father of Aleta. He made a point of
saying that his daughter's name is on the deed. He asked why we were here and who
complained. He was informed about the medical call. He started to complain about the
EMTs breaking in and damaging the door. Mike had to remind him that the tenant was
incapacitated and they only damaged the door in effort to save the life of the tenant.
Mike also explained that the tenant is seriously ill and it is unknown whether or not he
will even survive.
We entered the property with Mr. Davalos. The interior door to the left opens into a
narrow hall. A kitchen is set up immediately to the left. A door on the right side (inside
this hallway) opens into a bedroom. A woman came out and I advised her we would
have to see her room. In order to afford her more time, we agreed to inspect her room
last and continued down the hall.
Another door on the right was locked but later was found to be the interior staircase to the
primary dwelling unit above. Another door just past the stairway entry was a mechanical
room. The hall continued and bent around a corner,just at the bend was a closet on the
left used for storage. Continuing down the hall, we found another door on the left side.
This was the bedroom of the man in the hospital. The room contained a bathroom and a
closet. The kitchen area was at the end of the hall just outside of his door. An exit door to
outside was blocked with household items in storage and a small area to the left at the
end of the hall was also being used for storage.
According to information we received on this occasion,the tenant was sick for awhile.
His room had no window. The air was quite stale and heavy. A pan of water was on the
floor and some kind of sheen was visible on the surface. Clothes were strewn about.
Rags stained with blood were noted on the floor.
We doubled back to the first room. The female tenant admitted us. She had her own
bathroom and one typical basement window above her bed. There was a makeshift
kitchen area with counters, kitchen equipment and a bar sink but personal items covered
the area and it was difficult to see. I asked her if she had a housing voucher as I noticed a
note on the door to the storage area reminding her to call them. She stated she is
currently trying to get a voucher for the Plainville area.
Jeff issued an exit order. The female tenant was advised that she is unable to sleep in her
room and to discuss her options with her landlord. I suggested that perhaps having
received this exit order will expedite her ability to move up on the housing list. The
tenant signed the order and a copy was provided to Mr. Davalos. He said his daughter
lives in Mashpee but doesn't remember her address.
Mr. Davalos admitted that he performed all of the required work to create this living area.
He admitted he did secure the necessary permits. When questioned,he stated he resides
at 137 Main Street, Centerville. This property is very familiar to Regulatory staff. As we
investigated a complaint at that address involving 5 units (4 illegal units).
In fact,we made Mr. Davalos dismantle an illegal and dangerous apartment in the
basement of his home. He was unable to obtain a building permit at the time because he
owed back taxes. He assured us he was selling the house or it would soon be in
foreclosure. In 2006, Mr. Davalos was issued a permit to restore to a single family-
there was no recorded activity on this permit. In 2007, Mr. Davalos attempted to obtain
another permit to restore to a single family. It was not issued when tax arrearage was
identified. Subsequently, it appears that Mr. Davalos refinanced the property. The status
of the illegal units is in question again considering that Mr. Davalos admitted creating
this illegal unit two years ago.
On this date, Mr. Davalos declared that he is losing his home on Main Street because of
us and our"stupid regulations". I reminded him that he said he was "losing"his house a
number of years ago. Obviously, he still lives there and managed to hold on to it. I also
remember Mr. Davalos refused to identify an asking price for his home when it was
allegedly for sale.
As we were finishing up and reviewing the exit order, Jeff reminded him that the exit
order also applies to the male tenant who is now in the hospital. Should he be released
the tenant will not be able to convalesce in his room. Mr. Davalos responded that he has
been trying to evict that tenant anyway so the exit order will assist him with the eviction. .
TO
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,DUG-14;2007 10:58 P.01
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AN, Wi( on Associates Inc,
FAX NII3\/SI3FR
( S08 ) 420 - 9795
FACSIMILE TRANSMITTAL SHEET
TO: FROM:
'P..\ N[itriil+;R: TOTAL:NO. P PAGES INCLUDING COVER:
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A:C,;508)420-9792
'20 fiasr„lly Rabbit Road
Un+t ;'08 420.9792
lvl.mf Offs Wills, MA 0264E f AX 508 420 9795
.nU13-14-21J07 10:59 P.03
Town of Barnstable P# JG �S
Department of Regulatory Services
i Public Realth Division mNa Date
200 Main Street,Ftyrinnit MA 02601
F>ate "3 Scheduled /
Time , Fee Pd.`v
Soil SUitability Assessment for Sewage Disposal
f eAorirrnra By; �- �t9.•!1.r .
Witnessed BY: � �O/► �.f tM�'�`''�
LOCATION&GENEW INFORMATION
1«lian A6droa Qj(� S li dv�F I 1
LA,Owner's Name Z '
/ Address
Aa9easor's MaplgascsL• 2�� '� � l
f:agintxr'e Namc "J.�J�y��
Ng,wl 11NS PigIICROEd RBPAm /
Li!:Q Use
slopes(b) - Z
surface Stnncs_,
Dnt±nnaa-'Harr. Opre WalrrBody- i St_ft possible Wet Area
-1-5 i�
/ 'rt Drinking Water Well Zl g
! - Draiimgc Way 5 0' ,
i
-- _" Prepe" uoc t o rt omcr
i SDZETES(3tr r name,dlmenaiene of lot MCI lamdons of rest holes&pens tests,locale wetlands ill proximity to holes)
9 .
7,90
f �
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k t 1!�I1
; k�A,
Je�0
f f�tteod rrarteetat(3eo+ppe) tit Depth to Bedrock
7e(h to 13m,ndwater.Standing Water in Hole.a\O
Weeping 14otn Pit Fnco t ZO tt
{3stitnn4a'?*I;gmlHigtt3mundmier legj1 ���'
f
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'TERRUNATION FOR SEASONAL HIGH WATER TABLE
Method U;sd: � O
Depth O ed elanding in ohs,hale:
DWa rm a'eeplas fmm Lido of oCa,hots; In Depth to tall mottler:�'•P�_ In,
Indsrll'eilA_�_ RWIngDate; Inde, WeIllmvel In' OronndwaterAdjuslment
-..---w!_�h.
AtIJ.Factor Adj.aroundvakr4awl„.
FERCOLATION 1,ESI,
OaserrrllCn Dal
Ida kt d� t.
LI
75ma at 4" L 1� � _. o't
'tml p4o'i4 71,m®
'Rma(9"-6")
13ad
tI Sad Mitt rRacth
'• ,3tziy(hthiti�tyAsseasroent S" laassal'� 9irt•F?silWt
Additional Testing Newed(y/N)
4 fFriEinal:puFlla t9eahD Ditislan Observation Hote Dare 1'o BC Completed on Back-•••..--
Vetr"Olntlom test is to be conducted within loo'of wetland,you Must first notify the
73o!' Iia6Pe CO'0SOVation Division at least one(1)week prior to beginning.
1' t TOTAL ?.03
PUG--14•-2007� 10:59 F.02
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' DEE'1P.OBSERVATION BOLE LOG Hole#
Depth Flom Soil Horircn Soil Testura Sail Color Soil her
9wfnce(in,) (USDA) (Munsell) Moulins (Snuclum,Stones:Boulders.
�.eo51�
�G.•o �ro� •� S1. I Ot(� 3/Z, �ovQ )Jo S�!N� '
�?t 3?.crRl l.5 1oYIZ Alb
DEEP OBSERVATION HOLE LOG Hole# r�
repo h.nn Sall Flotimn Soil lwore Soil Color Solt er
Swim 110 (USDA) (Munsell) Moulins (Stnletum Sumes,Boulders.
`` 1_OoSt✓
—r30 1tii A S� \O`{R �✓/IL. 1�loNt�+ o V—
�$a •¢�A 641E
M4EV• a Y. �e66�rSS
__•� Z 1zatr e- t Sa z.el ` � tk
DM OBSERVATION HOLE LOG Dole#
Depaa ff yms Sail Horizon Soil Texture soil Cola Soil Olhr.
Sni{z,o I;ti,) (USDA) (Munsell) Modeling (SWeture,Slortes,Boulders,
anivell
DEEP OBSERVATION BOLE LOG Hole#
Depth Fraan Soil Horizon SoIl'M Wi
ule soil Color Drhs7
tling (Slruclum,Stottea:9aulders.
Surface(lo.) (USDA) (Munselq Ma
r
&'gonci 1tlstrrancEl-&Mal,-
ltrsou;500 year¢oW boundary No_ Yes.,.
vilydLlo 500 yew boundary No—V—/'Yes
A 4W a 100 ye'ar flood boundary No—�'/Yes
f aRGt j�&f,urally i ririne Pervious Mats&
Does at least four fast of naturally occurring pervious material exist in all areas observed throughout the '
an:a psoposed for the wil absorption system? Y 5 —
If nut,what:€5 the depth of'naturally occurring pervious material?.- -----
Cry tifieariotl
I CA' that on 3 (date)I have passed the soil evaluator examination approved by the
Depa.r Wit it of Environmental Protection and that the above analysis was perforrrted by me consistent with .
sha tF;!utt A training.expertise nd experience described in 310 CMR 15.017.
t Date O3-lq o�
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June 28, 2002
Outback Engineering
106 West Grove Street
Middleboro, MA 02346
(508) 946-9231
Town of Barnstable
Health Department
200 Main Street
Hyannis, MA 02601
Re: 776 Shootflying Hill Road
Septic System Inspection
To Whom It May Concern:
Outback Engineering has conducted the necessary inspections for the referenced property
and found the newly installed septic system to be in conformance with the approved plan.
Very truly yours, ^
Jy `
l ames A. Pavlik,P.E.
i
BENCH MARK: TOP OF FND. 0�
(SAS) SHALL BE
MANHOLE COVERS TO EXTEND TO 34.0' LONG . G� L Iq
WITHIN 6" OF FINISH GRADE 12.17 WIDE
2' DEEP 'Po
" 2X BAFFLE REQ'D
• Q
��• . 8� NEB f'x. EL=.(ns'0 . _ . (,oLU
65 1; Soo 6 •61 �5�1( D.B. "` __ ____ GENERAL NOTES:
2" PEASTONE TOPPING
o 6 A V,O IJ � -� �'4'Q 4 t_4•S Z` _ _ � CA, ENDS - ELEVATIONS SHOWN BASED ON U.S.G.S. DATUM.
SYSTEM PIPE SHALL BE EITHER C.I. OR
6• C�USFED TONE - - -- - SCHEDULE 40 P.V.C.
S� t = - -- - 3[4' DOUBLE WASHED
'••� i1 THE BOARO OF HEALTH SHALL BE NOTIFIED
Z 2� cv' fe" G RU$ffE� E1= -2•S 2- STONE ALL AROUND PRIOR TO BACKFILLING OF SEPTIC SYSTEM.
STONE DESIGNING ENGINEER MUST SUPERVISE - SEPTIC SYSTEM STRUCTURAL COMPONENTS
ITING
SHALL BE CAPABLE OF WITHSI NDING A
20' MIN. 2.0 30.0' o TALLATION ANDINSTTALLED IN STRICT _ sEFI cLOsTEM uN EAR DSPE IFIEAYS OTHERWISE
SHALL
srnL TEST � ' THE SYSTEM WAS COMPLY WITH A H-20 .LOADING.
IBC RATE-< 2 YIN/INCH PROPOSED SEPTIC SYSTEM USE FOUR (4) RE CNARGERs ACCORDANCETOPLAN•
-THE DESIGN AND COMPONENTS OF THE SEPTIC
MODEL NO. 3050 CHAMBER SYSTEM SHALL BE IN COMPLIANCE WITH THE
ELEV.— (pis NO SCALE WITH 4:0' OF STONE O. SIDES STATE OF MASSACHUSETTS SANITARY CODE
DEPT}10 A L~ sND to y f, do 2.0' OF STONE ® ENDS N O T-; TITLE V. AND SHALL BE IN COMPLIANCE WITH
!Z�� a LCAW sewn ,�v y A, (� NO STONE .AT BOTTOM w N'v J a &4' ATE_ THE LOCAL BOARD OF HEALTH RULES AND
REGULATIONS.
T14 A t� Z O THE CONTRACTOR SHALL BE RESPONSIBLE FOR
�-D LOCATION OF ALL UNDERGROUND UTILITIES AND
---r" -`/ Ell pr�,CA SHALL NOTIFY DIG - SAFE PRIOR TO
!O _ _ �- CONSTRUCTION.
130
CJ ,j _ —' — - - NO GARBAGE GRINDER
_SOILS ENCov�T.i�'e (o _ - ---- LE6ENp: DESIGN CRITERIA:
CtsS �� —_ \ PRopo5E0 v�ihT� SEx.� 'C —"V+s'—
�! µ •- S hn)D$. P \ DESIGN FLOW
1 EX S ���� O 4 BEDROOMS AT 110 G.P.B. / DAY 440 G.P.D.
C( �A rI/ N E+� Tl� K A E 1 TI Icy _ - - REQUIRED SEPTIC TANK:
/ 13 I ExtSrIN4 CoA4TO -- — 6$ _ Vu. T
O j SEPTIC TANK PROVIDED l� SA4 GAL-
SEPTIC
0 TF• WA DESIGN PERC RATE <2 MIN/INCH
SIZE OF REQ'D (SAS) AREA - 440/0.74 - 595 S.F.
I\ (�/LcI vr.�Q �J A-�C S G�4�CIf�M�
/ ! SIDEWALL (2)(2)(34)+(2)(2)(12.17)= 184.68 S.F.
!S tI vl BOTTOM (12.17)(34) = 413.78 S.F.
��� 20 ��� '!r _ C�XiST 1�4� i SIZE OF LEACHING FACILITY PROVIDED:
r O / OI_ a �jNOFlygs 413.78 S.F. + 184.68 S.F. = 598.46 S.F.
/-� {• p / o3 T.O (0 8. 84
�
4 �k• qy
I JAMES A. Go
?"tJ S i A Lt. S r �4 C. p c�N OcJ T / . ..:..
� PAVLIK -� EFFECTIVE DEPTH: 2'
70 Up CIVIL H EFFECTIVE LENGTN: 34'
IJo 1z KrOW ," 2O NO.36488 EFFECTIVE WIDTH: 12.17'
C�SSd� �4�►+� I3�ic�%w Is Po
wALt, 90� FG/ E�` OUTBACK ENGINEERING
ST, O t FSS/0 N 106 WEST GROVE STREET
VJ GLL O ' MIDDLEBORO, MA 02346
(508) 946-9231
Q TO BE
ow �� 5 �K- - 1 �- OZ
PROJECT: SEPTIC SYSTEM REPAIR
3 Jl 1� SN`�T��C. Fop
log ` Ai3a►.»aaD E� 77G t•foo.TF�% InIG t�lt � Rt). .
NeU W ATE 5 c 4vr<c-, �'
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1��5 GkrJ !S R.O �, RtTAl�ll�.Tl. � t I 20� R1(3!•t'(' D4 wAy OWNER: JOH�.1 �,�4pOLft
P �5 w A t I. / OOT F L I N(a N ILL. V) 7 7 to. S I�ooT 1=Ly t ti1 G I lu, FAQ
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