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0472 SOUTH MAIN STREET - Health
472 SOUTH MAIN ST. , CENTERVILLE a f No. 42101/3 ORA ESSELTE 10®,� 0 o a o �I Commonwealth of Massachusetts _ Title 5 Official Inspection For R Subsurface Sewage Disp:sal System Form -Not for Voluntary Assessments r >••''- 472 South iMain Street Property Address Centerville Village Apts Re;t ty Trust Ownt:r Owner's Name information is required for Centerville MA 0.'1632 January 21, 2013 every page. City/Town State Zip Code Date of Inspection Inspection results must b e submitted on this form. Inspection forms may not be altered in any way. Please see complete r ess checklist at the end of the f;)rm. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to mole your Patrick M. O'Connell cursof -do not Name of Inspector use the return key. Septic Inspection Servil_':s Co. Company Name V6:1 189 Cammett Road Company Address Marstons Mills _ MA 02648 City/Town State Zip Code 508-428-1779 S1 12555 Telephone Number License Number B. Certification I certify that I have personal) inspected the sewage disposal s�stem at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The i' spectjon was performed based on m�� training and experience in the pror.ier function and maintenance 5f2on MR sewage disposal systems. I i m a DEP approved system inspector pursuant to Section 15 40 ofE Title 5(310 CMR 16.000). 1'I ie system: cc ® Passes ❑ Conditionally Passes ❑ Fail ❑ Needs Further Eval j ation by the Local Approving Authority �' rn Co January 21, 2013 Job# 13-02 Ins ctor's Signature Date The system inspector sI li ill submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)withir W days of completing this inspection. If the system is a shared system or has a design flow of 10,))0 gpd or greater, the inspector and the system owner shall submit the report to the appropriate egional office of the DEP. The oritiinal should be sent to the system owner and copies sent to the b yer, if applicable, and the approving authority. ****This report only descri 3 as conditions at the time of inspection and under the conditions of use at that time. This inspf r ation does not address how the;:system will perform in the future under the same or different cc nditions of use. � � 2J t5ins- 1/10 Title 5 Official nspection For 8 surface Sewage Disposal System-Page 1 of 17�-� 3 3 Commonwealth of Uissachusetts - Title 5 Official Inspection Form Subsurface Sewage Dispo mf System Form -Not for Voluntary Assessments w, 472 South Main Street Property Address Centerville'Village Apts Rei II:y Trust Owne- Owner's Name information is Centerville requin;d for _ _ MA 0<::632 January 21, 2013 every page. Cityrrown - State ZiE,Code Date of Inspection B. Certification (co-t.) Inspection Summary: C.•eck A,B,C,D or E/always complote all of Section D A) System Passes: ® 1 have not found an/ information which indicates that any of the failure criteria described in 310 CMR 15.303 11r in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Recommend pumping t j ik, leaching system showed no sic ns of surcharge or saturation. B) System Conditionally '-asses: ❑ Ones or more syster i components as described in the"Gonditional Pass section need to be replaced or repaired, The system, upon completion of the replacement or repair, as approved by the Board of Health Nill pass. Check the box for"yes", 'no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please exf 1 ain. The septic tank is metal<ind over 20 years old*or the septic:;tank(whether metal or not) is structurally unsound, ex^ibits substantial infiltration or exfiltoation or tank failure is imminent. System will pass inspection if th;existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank wil )ass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating tl i;it the tank is less than 20 years olf l is available. ❑ Y ❑ N ❑ ND (Explain below): l5ins• .1/10 Title 5 Official nspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Dispi>aal System Form-Not for Voluntary Assessments i, 472 South Main Street nmh kl Property Address Centerville'Village Apts Re,i-l:y Trust Owne• Owner's Name inforn-ation is requirsd for Centerville _ MA 0.'632 January 21, 2013 every page. City/Town _ State Zir i Code Date of Inspection B. Certification (cost.) B) System Condition ally Passes(cont.): ❑ Observation of sew=_ge backup or breakout or high static water level in the distribution box due to broken or obstrui r ed pipe(s) or due to a broken, sett ed or uneven distribution box. System will pass inspection if th approval of Board of Health): ❑ broken pips rt s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction i;removed ❑ Y ❑ N ❑ ND (Explain below): I ❑ distribution It ox is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system require,i pumping more than 4 times.a year due to broken or obstructed pipe(s). The system will pass ins�,ection if(with approval of the Board of Health): ❑ broken pipe(5)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction isi removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist whi;i require further evaluation by the Board of Health in order to determine if the system is failing t)protect public health, safety or th a environment. 1. System will pas 3 unless Board of Health determLies in accordance with 310 CMR 15.303(1)(b)that th a system is not functioning.in a manner which will protect public health, safety and the envi r anment: ❑ Cesspool of privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a borderimJ vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official I lspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disp,>>al System Form- Not for Voluntary Assessments 472 South Main Street Property Address Centerville Village Apts Re;fl ty Trust Owner Owner's Name infom-ation is requirsd for Centerville , MA 0,!632 January 21, 2013 every page. Cityrrown _ State Zip Code Date of Inspection B. Certification (cc rt.) 2. System will fail finless the Board of Health (and Public Water Supplier, if any) determines that tP f,system is functioning in a man ier that protects the public health, safety and env!rol r nent: ❑ The systen I has a septic tank and soil absorpti Dn 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 they SAS is within a Zone 1 of a public water supply. ❑ The systen i has a septic tank and SAS and the: SAS is within 50 feet of a private water supply well ❑ The:system has a:e ptic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private •vater supply well**. Method used to det a rmine distance: **This system passes i' :he well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indical e s absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, p-ovided that no other failure criteria are triggered. A copy of the analysis must be attached to this form 3. Other: D) System Failure Criteria l Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ 1z B;lt:kup of sewage into facility or system component due to overloaded or clt .Iged SAS or cesspool ❑ IR Di s,harge or ponding of effluent to the: surface of the ground or surface waters dL E to an overloaded or clogged SAS or cesspool ❑ 12] Static liquid level in the distribution boK above outlet invert due to an overloaded or(logged SAS or cesspool ❑ 19 Lit I iid depth in cesspool is less than E:" below invert or available volume is less th;3 i_day flow t5ins•'1/10 Title 5 Official I ispection Form:Subsurface Sewage Disposal System•Page 4 of 17 i i Commonwealth of M a ssachusetts Title 5 Official Inspection Form Subsurface Sewage Disp,);al System Form -Not for Voluntary Assessments t 472 South Main Street Property Address Centerville Village Apts Re;r ty Trust Owner Owner's Name inform ation is requiusd for Centerville— _ MA 0.2632 January 21, 2013 every page. City/Town _ State Zit Code Date of Inspection B. Certification (cor t.) Yes No ❑ ® F t!quired pumping more than 4 time:., in the last year NOT due to clogged or c c strutted pipe(s). Number of times Jumped: ❑ ® A r y portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® A r y portion of cesspool or privy is wi•:hin 100 feet of a surface water supply or t►il lutary to a surface water supply. ❑ ® A r y portion of a cesspool or privyis within a Zone 1 of a public w p well. ❑ ® A y portion of a cesspool or privy is tivithin 50 feet of a private water supply At 11. ❑ ® A y portion of a cesspool or privy is Iris than 100 feet but greater than 50 feet fr.-m a private water supply well with no acceptable water quality analysis. [This s I stem passes if the well water an alysis, performed at a DEP certified Ii I ioratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is Equal to or less than 5 ppm, p r,)vided that no other failure trite•ia are triggered.A copy of the analysis a i d chain of custody must be attal:hed to this form.] ❑ ® T i B system is a cesspool serving a facility with a design flow of 2000gpd- 1 l 000gpd. ❑ ® T 1 e system fails. I have determined that one or more of the above failure ci i eria exist as described in 310 CMI2 15.303, therefore the system fails. The s, item owner should contact the Board of Health to determine what will be n;;essary to correct the failure. E) Large Systems: To bE, -onsidered a large system the system must serve a facility with a design flow,of 10,000 1 pd to 15,000 gpd. For large systems, you i ust indicate either"yes"or"no"to aach 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 ❑ ❑ th a system is within 200 feet of a tribt itary to a surface drinking water supply ❑ ❑ th a system is located in a nitrogen se isitive area (Interim Wellhead Protection A-(:a—IWPA) or a mapped Zone II of a public water supply well If you have answered"y a s"to any question in Section E the system is considered a significant threat, or answered"yes" in Se,.:ion D above the large system has failed. The owner or operator of any large system considered a sic r ificant threat under Section E or feiiled under Section D shall upgrade the system in accordance uv it h 310 CMR 15.304. The system owner should contact the appropriate regional office of the De^.artment. t5ins- 11/10 Title 5 Official nspection Form::iubsurface Sewage Disposal System•Page 5 of 17 Commonwealth of M e ssachusetts _ Title 5 Official Inspection F"orm Subsurface Sewage Disp)sal System Form -Not for Voluntary Assessments 472 South Main Street _ Property Address Centerville Village Apts Re 3 Trust Owne r Owner's Name information is required for Centerville_ MA 0:2632 January 21, 2013 every page. Cityrrown - State Zi)Code Date of Inspection C. Checklist Check if the following f a ve been done. You must indicate''yes"or"no"as to each of the following: Yes No ® ❑ PI,r 1ping information was provided by the owner, occupant, or Board of Health ❑ W:�e any of the system components pumped out in the previous two weeks? ® ❑ H,:;.the system received normal flows, in the previous two week period? ❑ Z H,,:1,e large volumes of water been into,oduced to the system recently or as part of this inspection? W;,e as built plans of the system obtz fined and examined?(if they were not av s ilable note as N/A) ® ❑ W 3 s the facility or dwelling inspected-lor signs of sewage back up? ® ❑ W 3>the site inspected for signs of bre ak out? ® ❑ W;-e all system components, excluding the SAS, located on site? ® ❑ W s�e the septic tank manholes uncov+:red, opened, and the interior of the tank in:pected for the condition of the bafflr;s or tees, material of construction, dir 1 ansions, depth of liquid, depth of nudge and depth of scum? ® ❑ W i>the facility owner(and occupants if different from owner) provided with inf D•mation on the proper maintenanct,;of subsurface sewage disposal systems? Th a size and location of the Soil Ab,s,orption System (SAS)on the site has be=n determined based on: ® ❑ Exi:+ting information. For example, a p an at the Board of Health. ® De t srmined in the field (if any of the failure criteria related to Part C is at issue ap,.roximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Informir:ion Residential! Flow Corn I tions: Number of bedrooms(Onsign): 7 Number of bedrooms(actual): 7 DESIG14 flow based on :;10 CMR 15.203 (for example: 11 C gpd x#of bedrooms): 770 15ins•11/10 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of MEssachusetts w Title 5 Official Inspection F0 Subsurface Sewage Disp�-sal System Form -Not for Voluntary Assessments t 472 South Main Street Property Address Centerville Village Apts Re a ty Trust Ownvr Owner's Name requi�ed for ration is Centerville MA 02632 January 21, 2013 requi _ even) page. City/Town State Zia Code Date of Inspection D. System Information Description: Number of current resi.i ants: 8 Does residence have a 3arbage grinder? ❑ Yes ® No Is laundry on a separai a sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspect:d? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, ii available(last 2 years usage(gpcl)): Detail: Sump pump? ❑ Yes ® No 2 units currently Last date of occupancy: Occupied. Commercial/Industrie I Flow Conditions: Type of Establishment: Design flow (based on 210 CMR 15.203): Gallons per day(gpd) Basis of design flow (s,s)ts/persons/sq.ft., etc.): Grease:trap present? ❑ Yes ❑ No Industrial waste holdirn 1 tank present? ❑ Yes ❑ No Non-sanitary waste dis-,narged to the Title 5 system? ❑ Yes ❑ No Water meter readings, i available: 15ins•11110 Title 5 Officiol inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fa Subsurface Sewage Disp 3 sal System Form -Not for Voluntary Assessments <? 472 South Main Street Property Address Centerville Village Apts Re 3 ty Trust Owmti r Owner's Name inforriation is Centerville MA 02632 January 21, 2013 requi•ed for - evenl page. Cityfrown - State Zia Code Date of Inspection D. System Information tion (cont.) Last date of occupancy/ise: Date Other(describe below General Information Pumping Records: Source:of information: None Was systern pumped e: part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pump ed determined? Reason for pumping: Type of System: ® Septic ank, distribution box, soil absorption system ❑ Single :esspool ❑ Overfl:w cesspool ❑ Privy ❑ Share., system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovrive/Alternative technology. Attach a copy of the current operation and mainti s Lance contract(to be obtained from system owner) and a copy of latest inspec.l on of the I/A system by system operator under contract ❑ Tight-E nk. Attach a copy of the DEP approval. ❑ Other(Describe): I t5in.:•11/10 Title 5 Offia it Inspection Porfr:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Mc-ssachusetts - E Title 5 Offic iial Inspection F"orm Subsurface Sewage Disp c sal System Form -Not for Voluntary Assessments i 472 South Main Street Property Address Centerville Villalge Apts Re Ity Trust Ownw Owner's Name requiredon is Centerville MA 02632 January 21 2013 required for _ rY ever) page. Cityrrown State Z!p Code Date of Inspection D. System Inform;ftion (cont.) Approximate age of all components, date installed (if known)and source of information: Installed: 2003 Were:sewage odors df ri ected when arriving at the site? ❑ Yes ® No Building Sewer(locat on site plan): 1 Depth below grade: feet Material of constructiol t ❑ cast iron C< 40 PVC ❑ other(explain): — Distance from private i v ater supply well or suction line: feet Comments (on conditit ii t of joints, venting, evidence of lea<age, etc.): Septic Tarok(locate of i site plan): ' Depth below grade: 1 feet Material of constructiol t ® concrete ] metal ❑fiberglass ❑ polyethylene ❑ other(explain) I If tank is metal, list age: years Is age confirmed by a ,'ertificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5' long x 5.8'wide- 1500 gal. -- 4-1Sludge!depth: l5ina•11110 Title 5 Official inspection Form:Subsurface Sewage Disposal system-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection F"orm Subsurface Sewage Disp sal System Form -Not for Voluntary Assessments 472 South Main Street _ Property Address Centerville Village Apts Re 3 ty Trust Ownt:r Owner's Name information is Centerville MA 0 2632 January 21, 2013 requi•ed for _ y every page. 51ty/Town State Zip Code Date of Inspection D. System Worm;ition (cont.) Septic Tank(cont.) Distance from top of sl a Jge to bottom of outlet tee or baffle: 29 Scum Thickness 3" Distance from top of sc:l Im to top of outlet tee or baffle 6"— Distance from bottom r r scum to bottom of outlet tee or baffle 10 ot How were dimensions c etermined? Measured Comments (on pumpir c recommendations, inlet and outle:tee or baffle condition, structural integrity, liquid bevels as related t)outlet invert, evidence of leakagE, etc.): Liquid level was found E t bottom of outlet invert and tees were intact. Grease Trap(locate o i site plan): Depth below grade: feet Material of constructiol I ❑ concrete [_ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: — Scum thickness — Distance from top of sc t im to top of outlet tee or baffle — Distance from bottom Ili scum to bottom of outlet tee or baffle — Date of last pumping: Date t5ins-11/10 Title 5 Officie;Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disp c sal System Form -Not for Voluntary Assessments 472 South Main Street Property Address Centerville Village Apts Re a ty Trust Owrntr Owner's Name information fn is Centerville MA _02632 January 21, 2013 requi•ed for _ ever} page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumpir c recommendations, inlet and outle:tee or baffle condition, structural integrity, liquid levels as related t)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 constructiol I ❑ concrete [_ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gaflors Design Flow: gallors per day Alarm present: ❑ 'Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition c f alarm and float switches, etc.): *Attach copy of Curren: pumping contract(required). Is coley attached? ❑ Yes ❑ No t5ins-11/10 Title 5 Orricia!Inspection Form:Subsurface Sewage Disposal System-Page 11 or 17 Commonwealth of Wssachusetts G ° Title 5 Official Inspection Form Subsurface Sewage Disptsal System Form - Not for Voluntary Assessments 472 South Main Street Property Address Centerville Village Apts Re 3 ty Trust Owm:r Owner's Name inforriation is Centerville MA 02632 January 21, 2013 requi,ed for - ever� page. City/Town - State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if pr a sent must be opened) (locate on site plan): Depth of liquid level at c ve outlet invert 0" Comments(note if boat s level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage in:()or out of box, etc.): Pump Chamber(loca-a on site plan): Pumps in working ordf,i: ❑ Yes ❑ No Alarms in working orde i s ❑ Yes ❑ No Comments (note cond t on of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption Syst?r (SAS) (locate on site plan, exca-cation not required): If SAS not located, exi lain why: t5im-11/10 Title 5 Officia Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Wissachusetts Title 5 Official Inspection F'morm Subsurface Sewage Disp c sal System Form -Not for Voluntary Assessments 472 South Main Street Property Address Centerville Villstge Apts Res Ity Trust Owni:r Owner's Name information is required for Centerville MA 02632 January 21, 2013 - every page. Cityrrown State Z p Code Date of Inspection D. System Inform.3tion (cont.) Type: ❑ leachin I pits number: ® leachin 3 chambers number: 8 Flowdifussors. ❑ leachin 3 galleries number: ❑ leachin 3 trenches number, length: ❑ leachin a fields number, dimensions: ❑ overflot v cesspool number: ❑ innoval ve/alternative system Type/n.i ne of technology: Comments (note cond t on of soil, signs of hydraulic failure, level of pending, damp soil, condition of vegetation, etc.): leaching chambers src.w no signs of surcharge or saturation. Cesspools (cesspool i iust be pumped as part of inspection) (locate on site plan): Number and configura:i)n Depth—top of liquid tc nlet invert Depth of solids layer Depth of scum layer Dimensions of cesspoo Materials of constructit►i t Indication of groundwe t.-r inflow ❑ Yes ❑ No t5in:!-11110 Title 5 Officia Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 N, Commonwealth of M i ssachusetts RE'= Title 5 Offic. ial Inspection Form Subsurface Sewage Disp c sal System Form -Not for Voluntary Assessments i a r 472 South Main Street Property Address Centerville Village Apts Re e Ity Trust Owner Owner's Name information is Centerville MA 02632 January 21, 2013 required for every-page. Cityfrown State Z p Code Date of Inspection D. System Inform-3tion (cont.) Comments (note cond t on of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site pl a n): Materials of constructil►is Dimensions Depth of solids Comments (note cond t on of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15ins•11110 Title 5 Officia Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of N;issachusefts Title 5 Official Inspection Form Subsurface Sewage Disr(1sal System Form Not for Voluniary Assessments 472 South Main Street Property Address Centerville_)Lillajge_?Apts RE E Ity Trust Owr er Owner's Name info,mation is required for Centerville MA C2632 January 21, 2013 ....................... eve;-�page Cityrrown State Zip Code Date of Inspection D. System Inform-::tion (cont.) Sketch Of Sewage DiE p osal System: Provide a view of the sewage disposal system, including ties to at least two permanen -eference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water sul iply enters the building. Check one )f the boxes below: Z hand-sketch in the area below ❑ drawing attached !;oparately Apts *1 & 2 F_" 10 Apts 3 & 49 3 519 C �Mil Commonwealth of Mec�ssachusetts E Title 5 Official Inspection F��orm Subsurface Sewage Disp c sal System Form -Not for Voluntary Assessments 472 South Main Street Property Address Centerville Village Apts Re 3 ity Trust Owner Owner's Name requi,ed fo is Centerville MA 02632 January 21, 2013 requi•edfor _ ry every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to hig i ground water: 12 feet Please indicate all met i ods used to determine the high grc.tund water elevation: ❑ Obtained ;r)m system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation dole within 150 feet of SAS) ❑ Checked r th local Board of Health-explain: ❑ Checked th local excavators, installers-(attach documentation) ❑ Accessed L ISGS database-explain: You must describe hay you established the high ground water elevation: Low area of marsh on »posite side of road is considerabPi lower than SAS. Before filing this Insr action Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of M.Issachusetts _ Title 5 Offic. ial Inspection F'=orm Subsurface Sewage Disr c sal System Form -Not for Voluntary Assessments > 472 South Main Street Property Address Centerville Village Apts Re e Ity Trust Owrn:r Owner's Narrte information is Centerville MA _02632 January 21 2013 required for _ _ ry , every page. Cityrrown State Z p Code Date of Inspection E. Report Completeness Checklist ® Inspection Summe r 1: A, B, C, D, or E checked ® Inspection SummE r 1 D (System Failure Criteria Applicable to All Systems) completed ® System Informatio i—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file y I t5ins 11110 Title 5 Officia;Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ' TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date I 1z 7.0 Time: In Out Owner 1G1 4�1> !L.l_p N�(� Tenant V oGpw 1 Address I 1 o 5 MA I N) Address q?2 ©s-ra 11Ll.-G, 11�1� cLI�7E(L�I�•(,t, VI/tl� Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities ;mmvea 4. Water Supply MD Ca 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 tJA PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms 3 Number of Vehicles Allowed i Number of Persons Allowed (max) Person(s) Interviewed C! Inspector _ If Public Building such as Store or Hotel/Motel specify here 1 TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date to — a 0 — I O Time: In Out Owner' Tenant MM � �Q 5 . rim--- cl Address �� 1"u^^� y` Address � �` Z' 6 0 A- &3rkr Compli ce Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 1 G. AA- 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 -7 6 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed ]�j L G 6 PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) i02,0� Person(s)Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here . i TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date ? 'I(A lo V1 Time: in Out Owner Li�� C(,0 L-L Pkk P J Tenant Uat4fo 1 Address ?o tj 5 1 Address t -�Z 5' AM'W S ( 3 06 1 exy i"Zt, , ILIA- G0 h.)TC-P-Ji L,-L,e�-, a4 j- Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities V 3. Bathroom Facilities WWI. 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 NA 18. Driveway Width 19. Number of Tenants Observed (� PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms 1 Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed inspector If Public Building such as Store or Hotel/Motel specify here ` I Date F ^ 2;- l/ To Whom It May Concern: vo-luntarily grant permission to the Town (Occupants name) of Barnstable Board of Health (Agent or Health Inspector) to inspect my dwelling unit located at 'Ifi ,, 3 '/7Z S OnAw ,1 t. C N%F/L v in accordance ' (House#, [AptlUnit#if applicable], street,-village) �— with the Town of Barnstable Code (Chapters 59 and 170) and the State Sanitary Code (105 CMR 410.000) on_ �� I hereby authorize and name (Date of.in ection) to be my tenant representative for the (Occupant representative) purpose of this inspection. /)q d R F S is an adult person (Occupant represe tative) designated and duly authorized to act on my be and will be accompanying the Town of Barnstable Board of Health for the inspection; granting access to any and all locations t (including bedrooms, bathrooms; closets,etc.,) allowing the use of photographs and answering questions. This authorization is only valid for the inspection date specified above, and must be renewed for any future inspection(s.) F Occupants.Signature 1 Date 1 0��u' se tative Signature 1 Date Q:�R=al Ord inancelinspcction ptrmisslon 2.doc TOWN OF BARNSTABLE BOARD OF HEALTH ' ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date Z'3I- 0 Time: In J,�Out Owner Tenant 9(114.j'� Address 7 Za Cg l) V\. ^ ; Address 1-1-7 )�` + e— 5* � 3 A Complian,pe Remarks or Regulation# Yes O Recommendations 2. Kitchen Facilities AXIMVek3 '11ati . . 3. Bathroom Facilities ; 4. Water Supply D �- 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 'p 18. Driveway Width N 19. Number of Tenants Observed `�7 f 1L PART II ` ,- 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms 01— Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector �' If Public Building such as Store or Hotel/Motel specify here i . i TOWN OF BARNSTABLE BOARD OF HEALTH li ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date i2 { I�'� 1( Time: In Out Owner Tenant Address �7® 1� M IR l rJ - k Address q 3 Z S I N Sr ©S T C--A-"/I L t.&. r4 PY M✓q Compliance Remarks or Regulation# Yes NO 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 1 Number of Vehicles Allowed (max) Number of Persons Allowed (max) Z—.. 6 Person(s) Interviewed 160AIO ` Inspector If Public Building such as Store or Hotel/Motel specify here i i , :� I TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date v— I Time: In Out Owner �'�"'` Tenant � � l Address -7-7 b Address Complia a Remarks or Regulation# Yes VNO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 2©—(0 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 i N I �� 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. If Public Building such as Store or Hotel/Motel specify here ` 0.N"-'3/?003 10:30 50@4288G37 MAFFEI LANDSCAPE PAGE 01/01 �"1�,✓.r�Y�� a�:as at���429-�.a7� H(3STo;'fTER RJ=kY'Y PAGE 02 D ate. To Wbonx It May Concern: I, °! I ►�- ... Volu-ttELridy merit pexmissf.0a to the To�rrn (00 cup ao, as;nc) of Barastable,Board of Health ( &ent or FTcaltia Taspectox) to inspect my dwelling unit Located at/�-P17.__P 44''? i /�,41�e J if c ,".., v_...__.rr? accordance ( ro�a4e#, j,�pdT.Jnit is appl.'"h1 strcot,VA age) w Vvitlt the Town of Bat 5tabjC Coeie(C.t?aptt;rs 39 and ( ?Q) and the State Sanitary Cvde � I hereby 3t�thnrtxe and name (Date cf lnspcc,:011) t� .:......_._,..__ to he my tenant reresentat+ve for the (C}CcupanC i'cps^cseritative Qpq /�fi�1 ��!!/�}� an adult person p k represens.:'�e) dPsignatcd and duly with+orizad t0 act on rray behalf ane will ne j.cODMp3,n.y1ng the Town o'Bar table ward of Health for t;-ke zr,�pcction,'.9ranting access to any and all locations ?nt:iiarlir, lledrGoms, bat' txooms;cirsGts, etc,,) a3lptVa.n Cjae txSc oFphategrBk,S and an w,Grai9 cli:c�ttc� s, This at.%thorj;�,etic:n l.s orOy valid fo'c the i:cspoctiora dAte spec:acd • S drnUs De renewcd For and u*iEre iris ct ones,) pxe e.ntfave 5� ;>xCze l oQate ;�Td<cntr,i V;.',u••b;rcti,,wF,n@,,^n nrrr.is:inn;i.00vt ' i TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date r J ' Time: In Out ��1 Owner Tenant Address LlJOA -�'' Address q Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities �1 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 4 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 (1j 17. Temporary Housing ® —fO 18. Driveway Width 19. Number of Tenants Observed a i 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 If Public Building such as Store or Hotel/Motel specify here r FORM30 Hlw HOBBS&WARREN'" THE COMMONWEALTH OF MASSACHUSETTS BO RD OF HEALTH vs)�Qdg CITY/T W W 1� o DEPARTMENT Caw� ADDRESS ` ?b�,— Iy� GSM yv9 y`0� l I (i TELEPHONE \ Address - QI _V lb Occupa�t�chtAl)-n�i�1(,V Floor _Apartme No.. No.of Occupants- No. of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming unit$ __ No.Stories - 1-4 Name and address of owner lG�Q 1 G�.�Q .1� �Il� _ �'�/���� / /r)r Remarks Reg. Vio. YARD Out Bld s.: Fences: 4 Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: 0bst'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.- Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS IN PECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENAL INSPECTOR TITLE 1 (� �-1 A.M. DATE v y`� TIME P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. t• 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 II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (I) 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. s as-f , ��� 1 l `AI z so Jvvl T C vl\ ST �C �1 � - - " \ Parcel Detail Pagel of 3 41 ow Logged in As: Parcel Detail Thursday, Marc Parcel Lookup Parcel Info Developer Parcel lD207-004 ! Lot: Location.472 SOUTH MAIN STREET Pri Frontage?285 Sec Road Sec Frontage village iCENTERVILLE Fire District'C-O-MM Sewer Acct I Road Index F1507 t `h 7„ Interactive Map Owner Info Owner CALLAHAN, RICHARD P & — Co-Owner j HOSTETTER, PRISCILLA M Streeti 345.SEASPRAY AVENUE w m� Street2 City PALM BEACH State FL zip 33480 Country?US Land Info - - _ -- Acres;1.29 use Multi Hses MDL-01 zoning RD1 Nghbd :0112 Topography ILevel Road Paved Utilities jPublic Water,Gas,Septic Location Construction Info - - - - - - _-_ wilding 1 of 2 Year' 11791 � Roof Gable/Hip Ex Wood Shingle Built Struct Walll Effect — ____ ____._._._... Roof;___ .._ _._._.___.____ AC Area 2332 Cover iAsph/F GIs/Cmp Type None Style jConventional Wall;Plastered Plastered Bed Rooms s"4 BedroomsmmNrv-_ -� Model Residential Floor Rooms Bath g i2 Full Rooms Grade!Average Plus Heat 1 Hot Water y __� Total Rooms Type Rooms r http://issgl/intranct/propdata/ParcelDetai1.aspx?ID=14486 3/29/2007 Parcel Detail Page 2 of 3 'TO(�_401 1 Heat ___ __.___ Found- m, r Stories 1 3/4 Stories FuelOII ation Typical ro Building 2 of 2 Year=1900 -. Roof'Gable/Hi� Exit `Ie Built I Struct p _ Wall Wood Shin g Effect1678 Roof As h/F GIsICm AC None Area Cover p p TYPe _ _. .. w Style Cape Cod allryWa Drywall____.-....- Rooms I- Bed(5 Bedrooms nt Wall I - ---- , •. Model �NResidential Int Bath 2 Full + 1 H Floor .. __ _r_..__ Rooms �---------- ---- -..-_._ Heat - __ --- ___.._.--{{ Total i Grade IAverage Plus Type Hot Alr 1 Rooms i9 Rooms s Heat�" __ ...... ..__.____ Found stories 1 1/2 Stories 1 Fuel Gas ation ITyplcal Permit History Issue Date Purpose IPermit# Amount Insp Date I Comments Visit History - - . .. ...... . ........... Date Who Purpose 9/26/2001 12:00:00 AM Paul Talbot Meas/Listed - Sales History Line Sale Date Owner Book/Page Sale P 1 1/15/1994 CALLAHAN, RICHARD P & 8989/340 2 6/15/1993 BBX REAL ESTATE CORP 8614/139 3 3/15/1989 SAURO, DAVID A&JANICE T 6682/018 4 11/15/1986 FRANCO, NICHOLAS D 5403/030 5 7/15/1985 RICH, JAMES M 4613/261 ; 6 10/15/1982 FITZPATRICK, DANIEL F ETA 3594/13 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parc( 1 2007 $365,700 $12,800 $700 $475,000 ; http://issql/Intranet/propdata/ParcelDetail.aspx?ID=14486 3/29/2007 Parcel Detail Page 3 of 3 2 2006 $322,100 $12,800 $700 $474,700 3, 2005 $280,400 $7,600 $800 $427,000 4 2004 $230,700 $7,600 $800 $759,100 5 2003 $204,500 $7,600 $800 $182,300 6 2002 $202,400 $0 $800 $182,300 7 2001 $202,400 $0 $800 $182,300 8 2000 $157,800 $0 $400 $101,700 9 1999 $157,800 $0 $400 $101,800 10 1998 $157,800 $0 $400 $101,800 11 1997 $160,200 $0 $0 $95,200 12 1996 $160,200 $0 $0 $95,200 13 1995 $160,200 $0 $0 $95,200 14 1994 $151,700 $0 $0 $95,200 15 1993 $151,700 $0 $0 $95,800 16 1992 $172,800 $0 $0 $105,800 17 1991 $188,000 $0 $0 $127,000 18 1990 $188,000 $0 $0 $127,000 19 1989 $188,000 $0 $0 $127,000 20 1988 $166,400 $0 $0 $63,500 21 1987 $166,400 $0 $0 $63,500 11 22 1986 $166,400 $0 $0 $63,500 Photos r http://issql/intranet/propdata/ParcelDetail.aspx?ID=14486 3/29/2007 I � TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date I (� �� Time: In Out Owner Ox Tenant Address o ,1' r IiftJ .51 Address Ag1q(0 5 I . Ma Mp Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities ✓ ^� z,�� "7�u1 4. Water Supply 5. Hot Water Facilities f 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 A* 18. Driveway Width 19. Number of Tenants Observed 2 PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition A Number of Bedrooms ( Number of Vehicles Allowed (max) IVA Number of Persons Allowed (max) 2— Person(s) Interviewed ��/�1�4 ( Inspector 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 16 - a °- 1 0 Time: In Out Owner Tenant Address 7 70 ��- ', ` Address 7 2-- Complia a Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation fioprAV VAX[1 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 5 R, I 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed PART II fig- 37. Placarding of Condemned Dwelling; �� , �jIL Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here f '' Y SECTION • • • DELIVERY COMPLETE ■ Complete?Aems;fl&and 3.Also complete A azure ent item 4 if Restricted Delivery is desired. dr ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. ecelved by(Printed Name) C. Date of Delivery ■ Attach this cans to the back of the mailpiece, 'I a �c or on the front if space permits. D, Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No P.i GI-tAP-XZ� (f4 LL A)-IAA 7?0 MAiN ST- t 3. Service Type ji$►Certifled Mail , ❑Egress Mail Registered 0 Return Receipt for Merchandise 0 Insured Mall ❑C.O.D. 4. Restricted Delivery?Oft Fee) ❑Yes 2. Article Number 7 0 0 6 2150 0002 1042 0132 pYansfer from service AftO PS Form 3811,February 2604 Domestic Return Receipt 102595-02-Wi54o V � UNITeo ST47-E,s pOsT r AL SERVICE Firs(Class Sender. Ple Posta Mail Please UsPS9e$:Fees Pgid Pont your name Permit No.G-10 address and ZIP+ _ -- n this bo _ x Town of Barnstable Public He 200 alth DivisionMain Street Hyannis,MA 02601 ��I1.''1�1F!!!�!ll�ltl}t!llFll�i� Certified Mail#70062150000210421009 ��j Tati Town of Barnstable o� Regulatory Services + BARNSfABLE. v� MASS.1639. g� Thomas F. Geiler,Director ArfDMAIA Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August, 13, 2008 Richard P. Callahan Priscilla M. Hostetter 345 Seaspray Ave Palm Beach FL 33480 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II— MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170 AND CHAPTER 59. The property owned by you located at, 472._South Main Street, -Centerville was inspected on 08/07/2008 by Jaime Cabot, Health Inspector for the Town of Barnstable. This inspection was conducted in response to a c�plaint. The following violations of the State Sanitary`Code were observed: 17 105 CMR 410.500—Structural Elements Front Porch is rotten, loose boards in ceiling, support columns tilted, hole in wall V 105 CMR 410.551 —Screens for windows l Screens missing from windows 105 CMR 410.482—Carbon Monoxide Detectors/Smoke Detectors No Carbon Monoxide Detectors,No Smoke Detector for bedroom, no battery in basement Smoke Detector 105 CMR 410.351(A)-Owner's Installation and Maintenance responsibilities. A leak was observed in the oil service line for an abandoned fuel storage tank . The trip lever in the bath tub is missing. 105 CMR 410.350-Plumbing Connections Sink was clogged QAOrder letterAHousing violationARental ordinance\Address.doc i Town of Barnstable Code Chapter, 59-3. Maximum Number of Occupants. Persons using porch for sleeping area. Two beds and sheets were on porch. Number of occupants of dwelling exceeds maximum number allowed. Town of Barnstable Code Chapter, 170-5. Posting Certificate of rental registration was not conspicuously posted. You are directed to correct the violations listed above within 24 Hours of your receipt of this notice by: fixing or repairing the Smoke Detectors and installing Carbon Monoxide Detectors. You are directed to correct the violations listed above within 30 days of your receipt of this notice by: removing the abandoned fuel storage tank and supply lines in accordance with the Fire Department Regulations.Replace trip lever in bathtub, clear clogged sink, repair and replace rotting materials on the front porch, repair columns, repair hole in wall and ceiling to front porch. Replace missing screens. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Health Inspector Q:\Order letters\Housing violationARental ordinance\Address.doc 08/07/08 Zoning Inspections Thursday Evening Bob McKechnie, Building Inspector Jaime Cabot, BOH Robin Giangregorio, ZE Officer Officer Brian Morrison 472 South Main St, Centerville Complaint relative to overcrowding and washing & storing commercial trucks. Property owners—Priscilla Hostetter& Richard Callahan Found two buildings that appear to be used as multi-families Confirmed later that both dwellings are on same lot. First house has historic plaque on front porch. Porch ceiling falling down, support columns-'are tilted. Advised that Jonas de Paula(not sure about spelling) owns business. Jonas does not live here but leaves trucks here. Jonas has an employee that lives here. Evident that trucks were parking over septic. Parking area exceeds,allowance. Inspected first floor of first dwelling. Invited in by first floor tenant of first dwelling— Claudio Barbalho. Total of 4 bedrooms on first floor including makeshift bedrooms in porches. Seven people present. Rooms lacking lighting provisions. One bedroom room lacked door knob—just something jutting out of the keyhole. First floor deficient of proper smoke & CO detectors. Second floor unit not accessible from first floor unit. Advised that second floor is a single unit with one male tenant in residence. That tenant left shortly after our arrival. Found abandoned oil tank leaking in basement. Jonas advised to contact me Monday. Directed Claudio to have commercial trucks removed. Officer Morrison agreed to check property the next night on midnight shift For commercial vehicles. Will ticket Jonas if trucks remain. BOH will contact owner regarding BOH violations noted during inspection. 1 I `. HOBBSSWARRENTM THE COMMONWEALTH OF MASSACHUSETTS FORM 30 C&W -BOARD OF HEALTH <-¢- CITY/TOWN LZN DEPARTMENT 2vo �4 ''GSM SVey`0: ADDRESS V 9� 06Z�' �� 4 50 � TELEPHONE Address el 7 2 M" l iJ S i Floor I Apartment No. Dd,.- Occupants�� No.of Habitable Rooms L 7 No.Sleeping Rooms Zo? /0Ott No.dwelling or rooming units *Z_ No.Stories Z L Name andaddress of owner _ ® -�i dS'( 'f Sys S/f/� S /L[�-7 1�VF 2.0,60 C,a L_(_A"A i SG f L L4 ►✓1. P1 pST vir ff.,?- �M emarkS Reg.VIo. YARD Out Bld s.: Fe ces: Garbage and Rubbish v Containers: Drainage Infestation Rats or other: W v STRUCTURE EXT. Steps,Stairs, Porches: S -C 1 t-41 (ooc-3 GVUw4 Dual Egress:and Obst'n.: < CLAc ,/4 LL ❑ B ❑ F ❑ M Doors,Windows: g_ ; /U7 p bd t / Roof v Gutters, Drains: G�M7 Walls: ej Foundation: now Chimney: BASEMENT I Gen.Sanitation: Dampness: Stairs: 9_Cf4-: V 01<17 Lighting: STRUCTURE INT. Hall,Stairway: U Zif V,-t& C Z Obst'n.: 2 Hall, Floor,Wall,Ceiling: Q ¢ /A/ G1 Hall Lighting: a-t 70 ff— Hall Windows: HEATING Chimneys: Central ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: e PLUMBING: Supply Line: aV GVZOL✓10I ❑ MS ❑ ST r P Waste Line: OtYL.SGw S SC.¢(Cpl N &AJ .S H.W.Tanks Safety and Vent(s)(jam-C,K ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: 0 o kA 10,%j Gen. Basement Wiring: Caa't£ DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom ► 1.L- #0 3 ro Pant Den L. .Q L o Living Room A 4--j-01, bl > Bedroom 1 Bedroom 2 Bedroom 3 1 Bedroom 4 Hot Water Facil. ec.. Stacks,Flues,Vents,Safetie Kitchen Facil i ' s Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted C) C) 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 PERJUR .INSPECTOR v TITLE k 6f-. ..T K DATE TIME 77 o �! P.M. A.M. THE NEXT SCHEDULED REINSPECTION 2A 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 II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead-Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: - - A (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. }- ' TM" THE COMMONWEALTH,OF MASSACHUSETTS ° a _ 10ORM_30 C&W' HOBRS&WARREN "�+.. +� BOARD OF HEALTH CITY/TOWN DEPARTMENT coo VAN I ,.` S ADDRESS GSM SVey`ow Z/r�� TELEPHONE Address 7? 4i tJ 5 i C4.'-T w4-�)Ccupan LA,,0i0 goAL 5044'No Floor Apartment No. 1)044,M 501% f`Vo�'of Occupants No. of Habitable Rooms 155 No.Sleeping Rooms__ A No. dwelling or rooming ws it 2. _No.Stories - 2a? /40� Name and address of owner Do, aS-r - &Z- 3 Wr 5if-A 5A0/14-1 AVf, �\Gl(A2�p C4LL, A"At4 Pai SGILL4 0'1. 1-1USTFT'ia(z_ ''Rem rks 4 Reg.4"o ZL YARD Out Bld s.: Fences: Garbage and Rubbish k Containers: ! Drainage Infestation Rats or other: 17 (w,(, P5 1.rC.A STRUCTURE EXT. Steps,Stairs, Porches: Locj<n r_ 156AR-a /A.r 60/4/ ,4 Dual Egress:and Obst'n.: /9 LG. ❑ B 'NO F ❑ M Doors,Windows: 0 61.1 4 1,04— AE C4bI e,i A 1417 l0 <0-0 t / Roof T6 ST1t1.-C7U Gutters, Drains: -7( Walls: 'c�2� _W�. tC.t1NL. Foundation: ve.� W W G4►t S ��i' Chimney: BASEMENT 1 Gen.Sanitation: Dampness: Stairs: 1.4 V l.�l ✓4 '�il(� 2 Lighting: ,- fSTRUCT.URE INT. Hall,Stairway: U fir' 0 r,� Obst'n.: 2 Yar4.o Hall, Floor,Wall,Ceilin :'"7 .g., 4r7 )Q v !w Ad_Sf#" .j 4D Z. 1 Hall Lighting: u ��► ,. '--. _ Hall Windows:, -- - _ HEATING. ~--` :._ .Chimne s. -` Central 4 ❑ N Equip. Repair x TYPE: , Stacks, Flues,Vents: PLUMBING: Su I 'Line: 0\1 Cty-G10140 r� ❑ MS ❑ ST / P Waste Line: Oki _ H.W.Tanks Safety and Vent(s)p��-Ckl p ELECTRICAL Panels, Meters,Cir.: ' ❑ 110 ❑ 220� Fusing, Grnd.: AMP: Gen. Cond. Distrib. Box: M 0 f_"-4—&L Gen. Basement Wiring: P11\C�."cJIL DWELLING UNIT » = �� Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks V Kitchen , Bathroom CAC,( 0 ► 7//b 3 5'o Pant .�. C. % tjI Vj A., ti _T J (LN � Den Lo Q k ► Q g t_ 1-1 fJ A I^ 0 Living Room 6z_t%,.,,Ou _r " Bedroom(1). r� Bedroom 2 —I Bedroom 3 (-7 Bedroom 4 Hot Water Facil. "'Stacks, Flues,Vents,Sa eties..°-_., 1 . Kitchen Facilities Sink k1— Stove -- ~"--w---`° Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: t Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted ._.._A(j its. , k-10S"C CNO Locks on Doors: k g 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 410.750'01` THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES'OFF�PERJURY." - - INSPECTOR t v TITLE r.;S c,.-r ' AA. DATE TIMEe - xY A.M. THE NEXT SCHEDULED REINSPECTION A '` P.M. r v 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 II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or.trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to.install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. I TOWN OF BARNSTABLE LOCTJ ATION. 7 7 2 t SEWAGE # V VII..LAGE n k,1/l`, CA liL•t.kCJZ) ASSESSOR'S MAP & LOT - INSTALLER'S NAME&PHONE NO. k-4 C" SEPTIC TANK CAPACITY IS 0—b r`n� LEACHING FACILITY: (type)ffl�(0 1 fK`11 4'44 (size) 92� NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: `- y 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 faci 'ty) Feet Furnished by f" 3 � � -�d55, -7- 70r3 &3-37,6 q-73,3 5-58 -q4'8d /D,q 0 No. j =,Kj ( ' € ~ 4�a; iz�,l Fee �0 THE COMMONWEAL'WO-F MASSACHUSE'rTS �`� 'mtzred in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Mig;posW *pg;tem Construction Permit Application for a Permit to Construct( . )Repair 4--f Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. 7�4� So ci 0,;�.S Owner's Name,Address and Tel.No. Cr�ic�v./le Ce,�7"e, y� c NsJ7 .0e.3,17 Tr11.7 Assessor's Map/Parcel r7126 A r/Ai ij S7• BfInstaller's Name Address,and Tel.No. Designer's Name,Address and1±Tel.No. Type of Building: 4/4-3= a— Dwelling) No.of Bedrooms Lot Size SS/yG 3 sq.ft. Garbage Grinder('ug Other' 'lope of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 7'O gallons per day. Calculated daily flow gallons. Plan Date 7et-,30 -.500 3 Number of sheets / Revision Date Title Size of Septic Tank /S'0064 FA % p Type of S.A.S. 'F/o L.)"As Description of Soil •-.1 Q� ZrJ' rY10 ae t h�%�. ?� r iTiw/ o�.G�6 0 EA/� _ - Nature of Repairs or Alterations nswer when applicable) A J%Say du ` e, s ry 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 S of the Environmental and not to pl e e system in operation until a Certifi- cate�of Compliance has b iss 's Bo of Heal 1 igned Date get^3 r o Application Approved Date lol-13/ a Application Disapproved for the following reasons M PeF6t No, PQ o�CO.3 M Date Issued 1°a 3/ d�3 ---- ———— ———————————— ------------------ No. .•" + t 4 "�` r Fee �. �T" � "'THECO � EA :T�OF MASSA nterehin oomputer:Q CHSETTS= � PUBLIC'HEALTHfDIVISION -"rOWN OF BARNSTABLES MASSACHUSETTS1 Yes -�-- - - ���rtcatior�.for �i��o�ar ��pgterri �or��tructiot� �errrtit F Applicat on-fora Permit to Construct f `)Repair Lipgrade( )Abandon( ) El Complete System El Individual Components w✓ii Location Address or Lot No. _ Pwner�.s jNa Ad7ss`an��Te�I j.)7 T i Assessor's Ma /Parcel �0G A H19/-i 17` Installer's Name,�ddress,a�d_e1.:No.- Q Designer's Name Address and-Tel.No. .1`� Q I; a-Awl*-I Type of Building: — Dwelling S No.of Bedrooms Lot Size sq eft. { Garbage Grinder( ) Other Type of Building No.of Persons Showers( �) Cafeteria( ) f , Other Fixtures ' Design Flow, . gallons per day.calculated daily flow gallons. Plan Date ° - a° Number of sheets Revision Date Title �Y " Septic Tank u t x Size of j Type of S.A.S. Description of Soilxel y , Natuse_of_RepP. 'rs�R r Aft ra✓hons.(Ans�r when applicable) J'/.1/l��� �/�%'' �k -' 'ar )c`e- o% P��t/ s j7�� t /r�' 7 i�d >iIT�/r I /�? X eG /-�rl� O✓�- `)I/ 7 ')r"V C' r,I.r sa.i- . - 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 EnvironmenteCe and not to pla elhe system in operation until a Certifi- cate of Compliance has beemisi o t Signed Date /`,? .0 3 Application Approved by- � ��-"� Date S�/U Application Disapproved for the following reasons r r - 1 Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ("r )Upgraded Abang2ned� )-by 5 t-vI ,c 1 k t c ,I r t at r " \ tc �' r`�\``" \' _ -has been constructed in accordance with the-provisions of T't1e,S stem Construction P Y and the for Disposal S uction Permit No. darted . Installer' C�Cep l \s Designer The issuance of this ermiLsh 11 n9t be co strued as a guarantee tha the s stem cti 6 n as�desi . Date P �l l J� Inspe or Y -- Fee �^ THE COMMONWEALTH OF MASSACHUSE17S PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS ie;pogar *pgtem Construction Permit Permission is here ' rat to Cons t y g p eti true( V Repair( )Upgrade( )Abandon( ) System located at 1_ ��` 1 � (C `A S i 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 cond'tions. Provided:Construction mu t be completed within three yearsof the date of this p t. Date: /3�� 3 Approved by � 9 j. d SENDER: I also wish to receive the. ■Complete items 1 an.a or 2 for additional services. a following)services(for an. as ■Complete items 3, d 4b. a► ■Pori name and a dress on the reve_rse'of this form so that we can return this extra fee): ca4io you f ❑ Addressee's Address d ■Attach this torn to the front of the mailpisoe,or dn•the bads if space does not - Z permit. m d ■Write Return Receipt Requested'on the inaiipieoe below th�article number. 2.❑ Restricted Delivery a, ■The Return Receipt will show to whom the article was delivered and the.date Consult postmaster for fee. z delivered. m 3.Article Address d to: 4a:Article Numb d cc 4b.Service Type m E° 0 ❑ Registered Certified Im cn /� ❑ Express Mail ❑ Insured N U) ❑ Return Receipt for Merchandise ❑ CODcc o C 7.Date of Delive Z 0 5.Received By: (Print Name) f3.Addressee's A dre (Only if requested W and fee is paid 6.Sign r : �orA� Nk X Domestic Return Receipt PS Form 1,December 1994 + I 9 � UNITFp STATES - ' PpSTAL SERVICE F!'st-ClaU Ma,, *Sender Pos FeegPlease US'h P" aldPerrrstNontYour name. G-10dress, and ZIP+4 in this boxTow . Y Public of Barnstable Health Division 200 Main Street HYannis,Mq 02601 l f�l!!filllli�ti TOWN OF BARNSTABLE BAR£-W 1424 . Ordinance or Regulation WARNING NOTICE Name of Offender Manager G 04//4AaPj Address of Offender 7 70 R A'm S cQ,f MV/MB Reg.# Village/State/Zip ��'- f/f/l�tB �h.� �}LDS' Business Name P.IiU t I l� �':,O a pm on 19 F6 CIF Business Address S gnature of Enforcing Officer Village/State/Zip Location of Offense BSc 'CrLt[� �l Enforcing Dept/Division N v t�do / /R..-f Offense 11 / Facts &t4- b0t 4s Q.u:�! f� « Va 4 O'(Jbt�Vj! This will serve only as a warning. At this time no legal .action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. TOWO 13pRW. . 24 E Y. . Ordinance or Regulation s, WARNING NOTICE Name of. Offender7Ma�nager Q / �. ; er ,�� p " [. h fYAddress of ,Offend ' MV/MB Regr # Village/State/Zip os V ////A ' Business Name ,�} f / f l ' FliUi! ( V t f fEd t, �, O_am pm� on ,�1 19 Business Address Signature of Enforcing Officer ,^. F Village/State/Zip Location of Offense _4 .) ,U�4 Nit, Enforcing Dept/Division Its viGt' j L1/If l Offense h d Facts tY 0` —h�j- L/44J &14,0 ahiu� duo,, vj . !2"Iw tte `' v 44 xd,4!/ to-1 f A Iv, This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. TOWN OF BARNSTABLE AR-W Ordinance or Regulation 4*1 -%` WARNING NOTICE Name of Offender/,� _.Manager t" c / ' 1 Address of Offender 770 )7 ern 'i� -� MV/MB Reg.# Village/State/Zip 05*1 0,1(jr Ilk€ �}S �•*�'" ,a°" 19 Business Name tdf# j, °f1/1 Mau pon Business Address 4t"14, t/i All Signature of Enforcing Officer Village/State/Zip / Location of Offense 4"f Enforcing Dept/Division Offense Facts �`l kou This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. Health Complaints 29-Jul-96 Time: 3:15:00 PM Date: 7/26/96 Complaint Number: 318 Referred To: CHRISTINA KUCHINSKI Taken By: LYNDA SARGENT Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name: Number `472 Street: SOUTH MAIN STREET Village CENTERVILLE Assessors Map-Parcel: ® � U Complainant's Name: ANONYMOUS Address: Telephone Number: Complaint Description: ALL KINDS OF TRASH AND DEBRIS ATTRACTING ANIMALS Actions Taken/Results: Investigation Date: Investigation Time: 60 pw _30 TOWN OF BARNSTABLE LOCATION �-� S Mom.► 51t SEWAGE # �,, C- VILLAGE ASSESSOR'S MAP & LOT U ,. O� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type)�7w 7*4z., NO.OF BEDROOMS BUILDER OR OWNER DKAJ PERMIT DATE: COMPLIANCE DATE: IS "94 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility `g � C 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 L f T3 40 TOWN nOFBARNSTABLE f. LOCATION o S T(,✓ � E# -TW J/ VILLAGE .�,✓/ ASS SO 'S MAP&PARCEL 'S NAME&-PHONE NO. !/te r GEC nn ed -/-n I ro t�s� NA SEPTIC TANK CAPACITY / O WS Q LEACHING FACILITY. (type) 74 Ud 1 U S S r S (size) b NO.OF BEQROOMS OWNER L PERMIT DATE: �C` 1QCE 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 Apts 41 & 2 ,. 10 `. au. Apts3 & 4 s 3 59 ' s No. "' - Fee �J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,L MASSACHUSETTS ZIppYicatfon for Mfgpogai *pgtem Congtruction Permit Application is hereby made for a Permit to Construct( )or Repair(`-}an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Installer's Name,Ad ess,apd Tel.No. .3 Z D Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder(�U Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow d —7 U gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 a of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this o d of Poh. �+ Signed `/ Lw- f� Date Application Approved by - Application Disapproved for the ollowing reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS :r:a Certific tea Compliance y. 1 THIS IS TO CERTIFY;that the On-site Se age Disposal System installed( ).or`re aired/r placed( `on bq t�,�+ � �2s�^�, �1 .��for 2Go;s... e4e4 as has een constructed in accordance with the provisions of Title 5 and the forDisposal System Construction Permit No. dated Use of this system is conditioned on compliance with the provisions set forth below: /42-� s No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi;pogar *pgtem Con5truction Vermit Permission is hereby granted to „T 1 C-02 t Xj It to c stru _( )repair( (-'),alc'On-site Sewage System located at .2 - 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. All construction must be completed within two years of the date below. Date: - �t1 `�� Approved by � d.... ,. .. 4 � � Y.. ,' • w'"'+•t}. .ti ••-, .;., — _ .__ . __ t�c��k � —; : -- � ..,s. Al No. k! �F:k , Fee, C_J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZippYicatiou for Migaal *p!tem Construction Permit `Application is hereby made for a Permit to Construct( )or Repr On-site Sewage Dis System at: Location Address or Lot No. Owner's Name,Address-and Tel.No. RY/11,e Installer's Name,AAd `'ess,apd Tel.No. 3 _ Q G Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder( lj Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design'Flow a gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil x Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: R The undersigned agrees to ensure the construction and maintenance of the afore described On-site sewage disposal system in accordance with the provisions of t`tle of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this o d of)'flea h. Signed Date (/. Application Approved by Application Disapproved for the ollowing reasons t r • Permit No. 9G- a-S Date Issued e " -�1iC, 2 + , G�J� c�, � 1V J8J '""'•lRA'°r'°art^.�r't7i�l�i"®° '.:e•• �t .aAA^,�s.a;y a �a J v j0 5 TEST N4 L.1~_ 1.d�S_CP�8 t�9� __ `•:• ,"��� � �} ;I ,�r�t'It�}� Ise � •�� DESICN DATA NOTES r .. I ..� , c r� Nc-rl►.;iPPr 1��Ior�as Mc�au�a� FE _ / �� �,f rYc Single Fa I 4 Bedroom I. Water Supply For This Lot is Municipal Water., - /�i {�11TNESS G+Es'�Y Tx1N►�INL— 9 Y Y P / With no Garbage Grinder 2.Location of Utilities Shown on This Plan Are Approx. ZZ-q3 Single Family-3 Bedroom I D d.TE 1- At Least 72 Hours Prior to.ny Excavation For This With no Garbage Grinder ' g Project The Contractor Shall Make The Required ,o� �� �� r e_1u. 2Art` ' Daily Flow=I10 x 7=770gpd Notification to DIG SAFE-1-888-344-7233. - ,��, ;�r� �'"a 4� } f Septic Tonkt770 gpd x 200%=1540gpd " J to Secure Required rac r 3.The Contractor is Re Appropriate � � �• Use Exist.IJ00 Gallon Septic Tank q Permits From Town Agencies For Construction 1-H'i ZO Z LEACHING AREA Defined by This Plan. I• � / 1 ���©S �( j �.Ts �, 4.Install Risers as Required tow 12 of Finished u Cj •« oe a�ev 770 d/C':74=1041 s.f,Re uire q 9P , q � Grade. Top Sidewall :G.96�(12 + 80 ) 0.96 =85s.f. g' S�I�S�IL 18•, Bottom Are i:12 x 80=960 s.f. 5.All Structures Buried Four Feet(4) or More or w 1045 s.f. Total Provided Subject to Vehicular to be H-2-0 Loading.MED SAND i7 z_ LEACHIVG CHAMBER DESIGN 6.Septic System to be Installed in Accordance With A!I Piping tc be Schedule 40.Use 9 310 CMR 15.00 Latest Revision And The Town of aRllslNAL Fi°ow tiffuscrs in a 12`z fi0'Washed Barnstable Board of Health Regulations. ° .- ' ' •' ��',;��,• L _ _IR Tar Storle Fielc, as,So awn. 7All Piping to be Sch.40 PVC. o !It -p�� - � �r;igvllle Bead i �;' �16 Sal l l t•7 - // Pgcv_ //-ADJVSTEp �:+ •` ' Public Beach,-," e ---- -- L•-G¢ouNDWATEE )� Landing r.o i'IHE ♦:LLV=13.E 3� IOA" SAID -6gWU.DWATE2. • LOCUS PLAN! 1 13Z" q.z 11'z• F C 24.0 F.G.22.0 Scale : I��= 20001 r1. �2 uses GrzovlJalJATti(Z QpJ�sTHENr � '1.13_ 19.66 Assessors Pa p el 47 m 1 \9� WELL MIW- 2-1 2or.l� A /1DJv5rr'1EFi1- Z.15 9, 20.83 G i t S500 2058 _ r Top El.20.37 Groundwater Overlay Tank P rr::+, —�• Bot.El. 18.7 District:AP 20.1I I9.86 •.�r:.: 5 Bedding as Adjusted Groundwater ` Per Title 5 El.13.7 u DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Not to Scale Finial Grade f Filler �—Com acted Fill \ \ -�-m Fnbric-�� V J ®r Pen Stone Lo'•r ARMA \ •32 I -- SS/4 t,3� S.P \ \ a Leaching i 0 Chamber Washed l 1/2'Double _ H-20 ;U.4�� CROSS SECTION OF CHAMBER \ NOT TO SCALE if OF A 7 N \ � At 0 N K To R °•^L_L 1 LLB� w eM AI H�\ `,�20 0 �Po ---� 2Z YI s�41.�/ a� c � e <br / e0\ �</ -,A�N. EXISTING CO MT•�ONtN Tb 01= LEAGHINfr �-i` Ccc)� ARCA To tsE REMOvsp Ir T2lHQU�REID. \ \ �LgA \ `` J� +126M oVE ALt_ UN 9LJITADLG MA•TET2IAL N FOR\O'AROUNO PROP03E1> t-6AGHING , A ` GJ� �Rt l.Np fiEPl ACEt� WITH GL_aAN c9 \ q4L \ /j e /0 y- PLAN VIEW �� ,� SITE PLAN SEPTIC SYSTEM UPGRADE Scale: 1 "= 30' MARSH _ 472 SOUTH MAIN STREET The purpose of this plan is to secure a Board of Health Permit for the repair of the CENTERVILLE _: DEC. 30,2003MASS. SCALE: AS C1?O.Ai v DATE FIELD (DATA L'SY DEMATZE9T— McLELI_AN ENGINCER\NG existing septic system an is only valid with an original stamp and signature. SULLIVAN ENGINEERING INC. OSTERVILLE , MASS.