HomeMy WebLinkAbout0026 SOUND VIEW ROAD - Health 26 SOUND�IEW RD. CENTERVILLE
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT,OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON, MA 02108 617-292-5500
�y
WILLIAM F.WELD Robert Morris TRUDYCOXE
Governor a
Secretary
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner
PART A
CERTIFICATION
Property Address: 26 ,Soundview Rd., Centerville Address of Owner: 14' VFW Parkway
Date of Inspection: G —/—v `f MA (If different) Boston, MA 02,131
Name of Inspector: Wm E Robinson Sr
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: Wm E Robinson Septic Serv; .A
Mailing Address: PO Box 1 089 Pnt Rr yi 1 1 ar 02632
Telephone Numberv. 5 0 8 7 7 5_R 7 7 6
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience,init�e p oper function and
maintenance of on-:;Pa
wa a disposal systems. The system: 4$�
sses 1
— Conditionally Passes
E �VEO
— Needs Further Evaluation By the Local Approving Authority 1,
Fails4 Z` t' N 1 8 1999
Inspector's Signature: 4 b6 Date: 19 �—� TOWN OFBARNSTABLE
� HEALTH DEPT. ti,
The System Inspector shall submit a copy of this inspection report to the Approving Authority with`i-thirty (30) days of co i g this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspe hr/a�r`bidtthe sye shall submit
the report to the appropriate regional office of the Department of Environmental Protection. The origlna s o Id�b'ry e the system owner
and copies sent to the buyer, if applicable„and the approving authority.
INSPECTION SUMMARY: Check (1,f 8, C, or D:
A] SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
MENTS:
B] SY TEM 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.
Indicat yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not.
t _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(revised 04/25/97) Page 1 of 10
DEP on the World Wide Web: http:/hvww.magnet.state.ma.us/dep
'j Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
PropertyAddr 26 Sound.view Rd.. , Centerville , MA
Owner: bb� t Morris
Date of Inspection:
B] SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled-or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
_ The system required, pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
C] FURT ER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) JYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
RICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
te- 2) YSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
HE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
c.-,E VIRONMENT:
The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. .
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method used to determine distance (approximation not valid).
3 OTHER
(revised 04/25/97) Page 2 of 10 _
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued).
Property Address: 26 Sound.view Rd.. , Centerville , MA
Owner: Robert Morris
Date of Inspection: 7 9
D] SY M FAILS:
You must di Cate ei;!,er "Yes" or "No" as to each of the following:
I ave determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
fo this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Yes No
Backup of sewage into facility or system component due to an 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 112 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE YSTEM FAILS:
You must ndicate either "Yes" or "No" as to each of the following:
he following criteria apply to large systems in addition to the criteria above:
he system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
Yes No
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)
The o ner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requi ments of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/25/97) Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 26 Soundview Rd.. , Centerville , MA
Owner: Robert Morris
Date of Inspection: 6'_f g
Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following:
Yes No
Pumping information was provided by the owner, occupant, or Board of Health.
_ None of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or
t as part of this inspection.
V As built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
The site was inspected for signs of breakout.
_ All system components, excluding the Soil Absorption System, have been located on the site.
_ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
_ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System.
_ Existing information. Ex. Plan at B.O.H.
Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) (15.302(3)(b)]
(revised 04/25/97) Page 4 of 10
'SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 26 Sound.view Rd.. , Cemterville , MA
Owner: Robert Morris
Date of Inspection: o%Q c!
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 11�0 0 g.p.d./bedroom for S.A.S.
Number of bedrooms:
Number of current residents:Q
Garbage grinder (yes or no):, &,6
Laundry connected to system ( s or no):�rS
Seasonal use (yes or no): �9
Water meter readings, if a ilable past two (2) year usage (gpd): 1998 138 , 000 gal.
Sump Pump (yes or no):4 0 1997 161 , 000 gal.
Last date of occupancy:i(✓�
COMMERCIAL/INDUSTRIAL:
Type f establishment:
Design flow: gallons/day
Grease rap present: (yes or no)_
Industri I Waste Holding Tank present: (yes or no)_
Non-sa itary waste discharged to the Title 5 system: (yes or no)_
Water eter readings, if available:
Last da e of occupancy:
OTHE : (Describe)
Last da ccupancy:
GENERAL INFORMATION
PUMPING RECORDS and/source of information:
,/d
System pumped as part of inspection: (yes or no)VL-S
If yes, volume pumped: d-ff�21 allons
Reason for pumping: Vie R
TYPE.OF YSTEM
Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information: 6,
Sewage odors detected when arriving at the site: (yes or no)1-0 "
(revieed 04/25/97) Page 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 26 Sound.view Rd.. , Centerville , MA, .
Owner: Robert Morris
Date of Inspection:
BUIL NG SEWER:
(Locate n site plan)
Depth be w grade:
Material construction: cast iron _40 PVC_other (explain)
Distance rom private water supply well or suction line
Diameter
Comm ts: (condition of,joints, venting, evidence of leakage, etc.)
SEPTIC TANK: t/
(locate on site plan)
Depth below grader /
Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No)
Dimensions:
Sludge depth: )
Distance from top of sludge to bottom of outlet tee or baffler
Scum thickness:
Distance from top of scum to top of outlet tee or baffle: L ,
Distance from bottom of scum to bottom of outlet tee or baffler
How dimensions were determined: ��-ST II_'&l;
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level relation to outlet invert, struct ral
integrity, evidence of leakage, etc.) A/1��2tJ '+-
G O C! 'rrt a 0 5 5 L� ��- P Z-
GRE SE TRAP:
(locat on site plan)
Depth low grade:
Materia of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimen ions:
Scum t ickness
Distan a from top of scum to top of outlet tee or baffle:
Dista ce from bottom of scum to bottom of outlet tee or baffle:
Dat of last pumping:
Co ents:
(reco mendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integ ity, evidence of leakage, etc.)
(revised 04/25/97) Page 6.of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 26 Sound.view Rd.. , Centerville , MA •
Owner: Robert Morris
Date of Inspection: 2l
TI TOR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth low grader
Material f construction: _concrete _metal _Fiberglass _Polyethylene _other(explain)
Dimensio s:
Capacity: gallons
Design f ow: gallons/day
Alarm I vel: Alarm in working order_Yes; _ No
Date o previous pumping:
Corn ents:
(con i 'on of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
/�i L'JIB✓
PUM CHAMBER:
(locate on site plan)
Pumps n working order: (Yes or No)
Alarms in working order (Yes or No)
Comm nts:
(note ndition of pump chamber, condition of pumps and appurtenances, etc.)
491
(revised 04/25/97) Page 7 of 10 r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM,
PART C
SYSTEM INFORMATION (continued)
Property Address: 26 Sound.view Rd.. , Cemterville , MA
Owner: Robert Morris
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan, if possible;.excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number:
leaching chambers, number:
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number.
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hypulic failure, level of ponding, condition of vegetation, etc.)
CESSPOOLS: _
(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer.
Depth of scum layer: 7t
Dimensions of cesspool:
Materials of construction:
Indication of groundwater.
inflow (cesspool must be pumped as part of inspection)
Com ents:
(note ondition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY
(locate on site plan)
Materials of construction: Dimensions:
Dept of solids-
Co ments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 04/25/97) Page 8 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 26 SoLmd.view Rd.. , Cemtervill'e , MA`
Owner: Robert Morris
Date of Inspection: 4
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
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(revised 04/25/97) Page 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 4
PART C
SYSTEM INFORMATION (continued)
Property Address: 26 SoUndview Rd- , Centerville , MA �.
Owner: Robert Morris
Date of Inspection:
Depth to Groundwater I�l Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
t/Observation of Site (Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
r�
Describe in your own words how you established the High Groundwater Elevation. (Must be completed)
(revised 04/25/97) Page 10 of 10
TOWN OF BARNSTABLE
LOCATION 0 6-50 % SEWAGE # -3 1
VILLAGE�� - fZ�L t I C°' ASSESSOR'S MAP & LOT I �
INSTALLER'S NAME&PHONE NO. f, ^ . E' 90 -'-)511kJ iPLC, '7?S-S 77(.
SEPTIC TANK CAPACITY S n Q
LEACHING FACILITY: (type) DRY/(Q6 S (size) bast lOA a5�
NO.OF BEDROOMS - 3
BUILDER OR OWNER MO eg S
PERMTTDATE: COMPLIANCE DATE:11
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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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
/es
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
0[pplication for Mizpoar *p$tem Construction Permit
Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
o anon Address or Lot No. Owner's Name,Address and Tel.No.
Sound.view Rd. , Centerville , MA Robert Morris
Assessor's Map/ParcelZq 7 —O?q
Installer's Name,Address,and Tel.No. / Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service
P 0 Box 1089, Centerville , MA
Type of Building:
Dwelling No.of Bedrooms 3 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 gallons.
Plan Date Number of sheets Revision Date
-.........-_..Title'
Size of Septic Tank Type of S.A.S.
S and.
Description of Soil
. Nature of Repairs or Alterations(Answer when applicable) new Title-5 Septic System
Tank, B-hnx and 2 leach chambers
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this,BopW of flealt (J
Signed Y Date 7
Application Approved by P Date S-?�����
Application Disapproved for the following reasons
Permit No. Date Issued
No., / r /�`" Fee 0
THE COMMONWEALTH OF MASSACHUSETTS Entered,m computer:
h' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE�, MASSACHUSETTS es.
2pplication for Migpogaf *p.5tem Construction Permit
Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) El Complete System O Individual Components
i
r o ation Address or J of No� Owner's Name,Address and Tel.No.
Soundview Rd.. , Centerville , MA Robert Morris
' Assessor's Map/Parcel 7 Q 1 q
Installer's Name,Address,and Tel.No. / Designer's Name,Address and Tel.No.
Wm. E . Robinson Septic Service
P 0 Box 1089, Centerville, MA
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures s
.. DesigmFlow gallons per day. ,Calculated daily flow gallons.
,> Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Sand.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) F"n?w Title-5 Septic System
Tank D-box and 2 1Pan hhambPrs
Date last inspected:
�° A4
Agreement: -
The undersigned agrees to ensure the construction and maintenance ofthe afore described on-site sewage disposal system
in accordance with the provisions of Title 5'of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by thi 1Pd of Healt .
Signed j i Date S ap-
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
————————————————————————————————————
THE COMMONWEALTH OF MASSACHUSETTS
Morris BARNSTABLE, MASSACHUSETTS
(tertificate of (Eompliance
IS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(X )Upgraded( )
Aba ne 1b Wm. E . Robinson Septic Service
at erg urid.view, Rd- , Centerville, ivuh has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer Wm. E . Robinson S r,. Designer ,>< R J Cn
The issuance of this permit shall not be co, true as,a guarantee that the system,,�will function as desi�gned���irr i
Date l� I j t Inspector , �1 L��l 1 I/ �/fi
V
No. / . Fee $5 0
THE COMMONWEALTH OF MASSACHUSETTS
Morris _!p::BLIC-HEALTH-DIVISION—BARNSTABLE., MASSACHUSETTS
i. lwiopogaf *pztem Construction Permit
Permission is herebyzranted to Construct( )Repair(X )Upgrade( )Abandon( )
Systemlocatedat 20 Soundview Rd.. , Centerville , MA
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 com lleeted within three years of the date of'th' pe it.
Date: 2 a Y �/ Approved by
1/6/99
NOTICE. This Form Is To Be Used For the Repair Of Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I, Wm. E . R nh i n s'nn Sr , hereby certify that the application for disposal works
construction permit signed by me dated j / / , concerning the
property located at 26 Sound-view Rd.. , Centervi 11 e , MA meets all of the
following criteria:
• The failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
• There are no wetlands within 100 feet of the proposed septic system —
• There are no private wells within 150 feet of the proposed septic system
• There is no increase in flow and/or change in use proposed
There are no variances requested or needed.
The bottom of the proposed leaching facility will not be located less than five feet above the
ma;-dmum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor
method when applicable]
• If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed
leaching facility will not be located less than fourteen(14) feet above the maximum adjusted
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information) 6% -
tl
B) G.W. Elevation + the V1AX. High G.W. Adjustment
DIFFERENCE BETWEEN A and B —
SIGNED DATE:
[Sketch proposed plan of system on back].
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TOWN OF BARNSTABLE
LOCATION _ SEWAGE #
VILLAGE Ce— J 2y f, ^- ASSESSOR'S MAP & LOT
INSTALLERS NAME&PHONE NO. WIA F'
SEPTIC TANK CAPACITY 1 S 00
LEACHING FACILITY: (type) �R.l c�6 f S (size) QX 161c aC
NO.OF BEDROOMS Q- 3
BUILDER OR OWNER i" Q)EA CS
PERMTTDATE: V24 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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US Postal Service
Receipt for Certified Mail
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Do not use for International Mail See reverse
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Special Delivery Fee
Restricted Delivery Fee
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Whom&Date Delivered
n Return Receipt Showing to Whom,
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V) Postmark or Date
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charges for any selected optional services(See front).
1. If you want this receipt postmarked,stick the gummed stub to the right of the return
address leaving the receipt attached, and present the article at a post office service )
window or hand it to your rural carrier(no extra charge).
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3. If you want a return receipt,write the certified mail number and your name and address
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6. Save this receipt and present it if you make an inquiry. t o2595-97-B-ot 45 n.
FORM
HxW_ HOBBSs WARREN T" THE COMMONWEALTH OF MASSACHUSETTS
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Addres 1 U Occupar. l� Ooowi
Floor Apartment No. No.of Occup
No.of Habitable Rooms No.Sleeping Roo s
No. dwelling.or rooming units Flo. tories c ( /�
Name and address of owner
Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage
Infestation Hats or other:
STRUCTURE EXT. Steps,Stairs, Porches: INA
Dual E resS:and 0 st'n.: f
E B ❑ F El M Doors,.Windows: f' j
Fi,oaf _ ! N 1 �
Gutters, Drains: ,� .''"
Walls: ( SA � S ,(� d ,
Foundation:. r /� n -YIIVN
Chimney: ,, „ / p n °
BASEMENT Gen.Sanitation: (f ( Q /�'�`"
Dampness: N IQ
Stairs: / V C I ' Q f/
STRUCTURE INT. Hall,Stairway.- 1 K y •� Jf
Obst'n.: ./
Hall, Floor,Wall,Ceiling: f y
" Hall Windows: e
HEATING Chimneys: �/� / ED
Central ❑ Y .❑ N E ui Repair °
TYPE: Stacks, Flues,Vents:
PLUMBING: ;* Supply Line:
EJ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safet .and Verjf s
ELECTRICAL Panels,Meters,Cir.:
110 ❑ 220 Fusing,Grnd::
AMP: .. Gen. Cond. Distrib. Box: -�
Gen. Basement Wiring:
DWELLING UNIT ,
Ventii. L to . Outlets Walls Ceils. Wi d, Doors Flo% s Lock
Kitchen l
Bathroom �(/i�
Pantry (1 a7 , t� rP
Den
LivingRoom ,
Bedroom(1),
Bedroom 2
Bedroom 3.
Bedroom 4
Hot Water Facil Sup.Ten.,Gas, Oil, Elect.: "
Stacks, Flues;Vents,Safeties:
Kitchen facilities Sink ,
Bathing, Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin, Shower or.Tub: r _; / ,' ( may
Infestation Rats;Mice, Roaches or Other:
Egress Dual and'Obst'n: Q / A -rMAf ,/I t� ..�A f
General Buildin Posted ► � ' "
ocks on Doors: �L.J k�u7 U
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITIO 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 ,p °' .
INSPECTOR / TITLE
DATE _ /1 TIME P.M.:
THE NEXT SCHE ULED REINSPECTION ��1:o f P.M.
r ..
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
to remedy said condition within the time so ordered by the Board of Health.
PAP, ] Real Estate System - General Property Inquiry] Help [ ]
Parcel Id: 247 039- - Account No: 151873 Parent :
Location: 26 SOUND VIEW RD CENT Neighborhood: 55AC Fire Dist : CO
Devel Lot : Lot Size : . 22 Acres
Current Own: MORRIS, ROBERT H JR & State Class : 101
MORRIS, ELLEN HART No. Bldgs : 1 Area: 1224
PO BOX 2098 Year Added:
CENTERVILLE MA 2634
Deed Date : 030196 Reference : 10114034
January 1st : MORRIS, ROBERT H JR & Deed MMDD: 0396 Deed Ref : 10114034
Comments :
Values : 30500 Buildings : 68700 Extra Features : 500
Road Syste 21 , Index: 1502 (SOUND VIEW ROAD ) Frntg: 100
- Index: ( ) Frntg:
Control Info: Last Auto Upd: 020997 Status : C Last TAGS Update : 061996
Land Reviewed By: Date : 0000 Bldgs Reviewed By: Date: 0000
Tax Title : Account : Taken: Account Status : Hold Status :
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�ATES POSTAL SERVICE First-Class Mail
Postage&Fees Paid
USPS
Permit No.G-10
• Print your name,address,and ZIP Code in this box•
Public Health DIVISlon
Town of Bamstable
P0.Box 534
Hyannis, Massachusetts 02601
j I
CARA HARDING
ATTORNEY AT LAw
P.O. BOX 1236
BARNSTABLE, MA 02630
.TELEPHONE 508-771-2700
FACSIMILE 508-775-6029
June 8, 1998
Mr. and Mrs. Kevin Coughlin
26 Soundview Road
Centerville, MA 02632
Dear Mr. and Mrs. Coughlin:
Mr. and Mrs. Morris received the report from the Health Department on Saturday,
June 6, 1998. They have made arrangements for a carpenter/contractor to come to the
house to inspect the damage, make a material list and start the work.
As you are aware, Dan Catz came to the house early last week for the same
reason. He was advised by Nancy Coughlin that it was "her property" and he was
trespassing. Since he did not want to create any problems, he left without accomplishing
the objective of his visit.
In the event that you continue to deny workers and repair people access to the
property, Mr. and Mrs. Morris will be unable to make the repairs. Since you are seeking
the repairs, I would expect that we will receive cooperation in this regard.
Please contact me if you have any questions.
Very truly yours,
Cara Harding
cc: Bob and Ellen Morris
Donna Miorandic/