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HomeMy WebLinkAbout0620 CRAIGVILLE BEACH ROAD - Health (2) 558 Craigville Beach Rd Centerville P A = 246 030 0 IIII �Q �RECYCIFpc mea U IN UPC 12543 No.53LOR HASTINGS, MN a � - 035- oDA -- c o\ Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t V � 558 Craigville Beach RoadrD Property Address Y Craigville Court First Property Management r, Owner Owner's Name information is required for every Centerville ;/ MA 02632 12-11-17 per. Cilyfrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filing out forms A. General Information ,,/� / (� ��g1ullltuprr on the computer, l�7" /07 �-I ����``��1LSN OF MqS''�•,,� use only the tab 1, Inspector: .�`��� • sic key to move your cursor-do not JAMES use the return James D.Sears m; key. Name of Inspector =U; Capewide Enterprises Q Company Name , T I V 153 Commercial Street Company Address Mashpee MA 02649 L;nyt i own State Zip Code 508-477-8877 51623 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 12-12-17 specter's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform In the future under the same or different conditions of use. t5ins.000-rew.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Loel9s ts u i, a5ed xed dH 69?E L 60Z £6 Oa0 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is reequiredquired for every Centerville MA 02632 12-11-17 page. cityfrown State Zip Code Date of Inspedion B. Certification (cant.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal. Tank D Box and four teen 500 Gal. Chambers. Note: System is for all four units. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Hoard of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old`or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. •A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc-rev.6n6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pa6e 2 0117 Z a5ed xed dH 65:22 L OZ Cl, Oaa Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-11-17 page, Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass Inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 15ins.doc rev.6116 Title 5 Official Inspection Pam;Subsurface Sewage Disposal Systam-Page 3 of 17 £ a5ed xed dH 69ZZ L 60Z El, D-U Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-11-17 page, Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributaryto a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in INIM is less than 6" below invert or available volume is less than %day flow L,9A4u/A,( l5ins.0c-rev.We Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 tr a5ed xezI dH 69:2Z LI.OZ £6 Xl0 Commonwealth of Massachusetts Title 5 Official Inspection Form i�, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-11-17 page, Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. EJ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] r ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc-rev.V 6 Titre 5 Offuial Inspection Form.Subsurface Sewage Disposal System-Page 5 of 17 5 a5ed xed dH 65:22 L ME £6 380 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-11-17 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 10 Number of bedrooms(actual): 10 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 1100 t5ins.doc-rev.611E Tills 5 Omclal inspection Form:Subsurface Sewage Disposal System•Page 6 or 17 9 a5ed xed dH 69 ZZ L I.OZ El, -20 Commonwealth of Massachusetts Title 5 Official Inspection Form `i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-11-17 page. CityrTown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. Tank D Box and fourteen 500 Gal. Chambers. Number of current residents: NA Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2015-247,000Gal 9 ( y 9 (gP )) 2016-278,000Gal's Detail: Water usage is four all four units. Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6116 Title 5 Offldal Inspectlon Form:Subsurface Sewage INsposal System-Page 7 of 17 abed Xed dH 65ZZ Z 60Z £1, Oa(] Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-11-17 page. CityrTown State Zip Code Date of Inspection D. System Information (cost.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Yearly Pumping Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the 11A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Wns.doc-rev.6116 Title 5 Official Inspectior Form:Subsurface Sewage Disposal System-Page 8 of 17 g abed xed dH 00U L1,2 £l• M0 Commonwealth of Massachusetts Title 5 official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55B Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name requir required is Centerville MA 02632 12-11-17 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cant.) Approximate age of all components, date installed (if known) and source of information: Tank 1991 permit#91-B/D Box and 9 Chambers - 5 Chamber's Permit#2000-699 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 4 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc,): Pipeing is 4" PVC SCH 40. Septic Tank (locate on site plan): Depth below grade: 3'rest Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast H-10 Sludge depth: 2" I5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sawege Disposal System-Page 9 of 17 6 a6ed xed dH 0OU L60Z £1• -180 Commonwealth of Massachusetts Title 5 Official Inspection Form io Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-11-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cant.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 0 il Distance from top of scum to top of outlet tee or baffle e Distance from bottom of scum to bottom of outlet tee or baffle 18 How were dimensions determined? Asbuilt-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank at 3' below grade. Inlet cover at grade, outlet cover at 3". Three inlet tee's,outlet tee. No sign of leakage or over loading. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doe-rev.6116 1 Title 5 Official inspection Form:Subsurface Sewage Disposal System-gage 10 of 17 0 l, a5ed xed dH 60U Z 60Z £l, :20 Commonwealth of Massachusetts Title 5Officia Inspection Form �j�' Subsurface Ag p yForm -Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owners Name information is required for every Centerville MA 02632 12-11-17 page. Cityr town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): `Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Tine S Oficie1 Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 6 abed Xed dH LOU L1.02 £l, DaO Commonwealth of Massachusetts Title 5 Official Inspection Form l' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �Z_ 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-11-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 42" below grade. Box is clean and solid wrthree lines out. No sign of over loading or solid carry over. PumpChamber locate on site plan): ( P ) Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Z 6 abed xe j dH I.O:EZ Z 60Z E 6 M0 Commonwealth of Massachusetts Title 5 Official Inspection Form 1i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 558 Craigville Beach Road `J Property Address Craigville Court First Property Management Owner Owners Name information is required for every Centerville MA 02632 12-11-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont,) Type: ❑ leaching pits number: ® leaching chambers number: 14 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is fourteen 500 Gal. Dry well chambers. One set of nine and one set of five. Ck D Box and camera out to chambers. No sign of over loading or solid carry over. Steel cover on last set 8" water in last set of chambers. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction — Indication of groundwater inflow ❑ Yes ❑ No 15ins.doc•rev.6116 Title 5 Offal Inspection Form:Subsurface Sewage Disposal System-Pape 13 of 17 £ abed YU dH LOU L60Z £l• D80 C� Commonwealth of Massachusetts U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owners Name information is required for every Centerville MA 02632 12-11-17 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5ins.doc•rev.5116 Title 5 Official Inspection Form:Subsurface Sewage Olsposel System-Page 14 of 17 {�6 abed xed dH Z0U L 1,2 £6 XIG c Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;v 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner owner's Name information is Centerville MA 02632 12-11-17. required for every i page. Cityrrown State tip Code Date of Inspectlon D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately tSIns.doo-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Psge 115 of 17 5 abed xPJ dH ME LI.OZ E6 MO Dec. 18. 2014 i 1 : 11AM No. 6790 P. 4 ,dap Page t of 2 Town of Barnstable Geographic Information System P�rtel YteWet Custom Nap Abutters Mev Sze ■ zoom OUt,� I, i lln yr Rr 5 Q — rS e■ -1A 31 . ; r� i 17 7 ` D BOA r ~l U a ' 0 0 O i 3y p O 0. fi 0 20 Feet WR Set Scale 1" = 20 ( At:rWd Photos ( MAP DISCLATNER r,,,n�..*��nnc.oruw T,....�i asm.�ew• ue ou�..v....•.,,. %cnY7mmnrrtviT7=24603500A... 10/10/2008 9� abed xed dH ME L N E 6 Daa Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments c5� 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name i e is required for every Centerville MA 02632 12-11-17 o pege. Cityrrown State Zlp Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells M0 Estimated depth to�h ground water: 20'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting propertylobservation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Past report G.W. 20'+. Bottom of chambers at 6-6"below grade. Bottom of chamber's at 13'-6"+ above G.W. Depth. Before filing this Inspection Report,please see Report Completeness Checklist on next page. 15ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 L 6 abed xed dH £0:£2 L 60Z £1, 30 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owners Name information is Centerville MA 02632 12-11-17 required for every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information -Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.67'6 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System Page 17 of 17 g 95ed xed dH £0U L 60Z £6 Oa0 SENDER: COMPLETE THIS SECTION COMPLETE THIS SEC rlON ON DELIVERY ■ Complete items 1,2,and 3. A. Signature ■ Print your name and address on the reverse X ❑Agent so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, B. Rece' ed Nam) C. D c D iv or on the front if space permits. 1. Article Addressed to: D. Is deli dress differe m item 1? ❑Yes If YES,enter-delivery address below: ❑No C 3. Service Type ❑Priority Mail Express® IIIIIIIIII'llIIIIIIiIIllIIllllilil IllllIIIIIII 0 Adult Signature Adult tSi Maur il RestrictedDelivery 0R�nisteredMaRestricted O' 9590 9403 0922 5223 8275 95 ❑Certified Mail Restr ❑Collect on Delive nnercha raise etivery Signature.r._.._..�ton Der. gnature Con9 7 014- 12 0 0 0001 0358 4237 o Signature Confirmation i h -d Delivery Restricted Delivery JIPS Form 3811,July 2015 PSN 7530-02-000-9053 L� Domestic Return Receipt. USPS,.T.RAQK.. 1 First-Class Mail Postage&Fees Paid Permit No.G-10 9590 9403 09 2 5223 8275 95 United States •Sender:Please print your name,address,and ZIP+4®in this.,box* Postal See --- Town of Barnstable 6 Health Division 200 Main Street Hyannis,MA 02601 Certified Mail#7014 1200 0001 0358 4237 SF4E Tp�� Town of Barnstable IiA MASS.LE : Regulatory Services �Fo �A Richard Scali, Director Public Health Division Thomas McKean; Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 28, 2016 Kevin A Davis 268 Main Street Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at 558 Craigville Beachload, Centerville, MA was inspected on July 28, 2016 by Timothy O'Connell, R.S:, Health Inspectors for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violation(s) of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain.Structural Elements. Observed broken window within bedroom. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by replacing or repairing broken window You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the .date the order is served. Non-compliance will result in a fine of$100.00.per violation. Each day's.failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable QAOrder letters\Housing violations\Rental ordinance\558 craigvilee beach rd 7-28-16 ec 23 14 02:43p p.1 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigiville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-23-14 page. Cifyfrown State Zip Code Date of Inspection Inspection mutts must be submitted on this form.Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important rms A. General Information I �I `` ' on l the computer. ����� �CN`OF'Jy, ��ii t+i� use only the tab �� '•` C+'�% 1. Inspector. z. y key to move your o G s cursor-do not JamesD.SearS JAMES m= use the return Name of Inspector = key. CapewideEnterprises LLC Company Name �;�'��F�?�TTFt�C' x VQ 153 Commercial Street �i���a5i±N SIP,E,`�����` Company Address Mashpee MA 02649 Cityrrown State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 12-23-14 dK'spectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins'•3f 13 Title 5 al Ion Forth:S /urfe IDi sal System•Pale 7 Gf 17 • Dec 23 14 02:43p p.2 i t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owners Name information is Centerville MA 02632 12-23-14 required for every page. Cityfrown state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A B,C,D or E f always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal. Tank D Box and four teen 500 Gal. Chambers. Note: System is for all four units. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes","no"or"not determined"(Y, N, ND)for the following statements_ If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if 4 is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): 151ns-343 Title 5 Official Inspection Farm Subsurface Sewage Disposal System-Page 2 of 17 Dec 2314 02:43p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management _ Owner Owner's Name information is Centerville MA 02632 12-23-14 required for every page, CitylTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpslalarms not operational. System will pass with Board of Health approval if pumpstalarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed [] Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment 1_ System will pass unless Board of Health determines In accordance with 310 CMR 15.303(i)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 - 'nGe 5 OtWal Inspection Fonrc Subsurface Sewage Vispo3d"lem•Pape 3 of 17 Dec 2314 02:44p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owners Name information is Centerville MA 02632 92-23-14 required for every page. Citylrown state Zip Code Date of Inspection B. Certification (cunt.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered_A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in sompig is less than 6"below invert or available volume is less than day flow-4 F'/)'�/�j rid 15ins-3113 Tft 5 Official Enspection Farm:Subsurface Sewage Deposal System-Page 4 0l 17 Dec 23 14 02:44p p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craiaville Beach Road Property Address Craigville Court First Property Management Owner. Owner's Name information is required for very Centerville MA 02632 12-23-14 e page, Ckylrown state Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal colifonm bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Marge systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes'or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section O shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins.3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System.Pope 5 of 17 Dec 23 14 02:44p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is Centerville MA 02632 12-23-14 required for every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as NIA) ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 1 Number of bedrooms(actual): 0 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 1100 t5ins•M ll Title 5 Official Inspection Form:Subsurface Sewage Olaposel System•Pape 6 of 17 Dec 23 14 02:45p p.7 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road - Property Address Craigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-23-14 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal Tank D Box and Fourteen 500 Gal.. Chambers. NA Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 201244,0 OOOGa 9 ( y 9 (gP )T 2014-244,OOOGaI's Detail: Water usage is for all four units. Sump pump? ❑ Yes ® No Last date of occupancy: Present p cY� Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/personslsq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 Title 5Official Inspection Form Subsurface Sewage Disposal System•Page 7 of 17 Dec 23 14 02:45p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is Centerville MA 02632 12-23-14 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Yearly Pumping Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Uns•3113 TNe 5 OfBdEd Inspection Form Subsurface Sewage Disposal System•Page 8 or 17 Dec 23 14 02:45p p.9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information Is required for every Centerville MA 02632 12-23-14 page. cityrrown State ZIP Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Tank 1991 permit#91-8 f D BOX and 9 Chambers 98 Permit#98-189 2000 -5 Chambers Permit 9 2000-699. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 4'feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): 3' Depth below grade: feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast H-10. 1,. Sludge depth: Mns-3/13 Trtle 5 OflCdal Inspection Form:Subsur(eoe Sewage Disposal System•Page 9 of 17 Dec 23 14 02:46p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 556 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is Centerville MA 02632 12-23-14 required for every page Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" 0" Scum thickness Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-Tape Sludge Judge _ Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.). Tank at working level. Tank at 3' below grade. Inlet cover at grade, outlet cover at 3"Three inlet tee's outlet tee No sign of leakage or over loading Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 15ins•3n3 Tille 5 official inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 Dec 23 14 02:46p p.11 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address _Craigville Court First Property Management Owner Owner's Name information is Centerville MA 02632 12-23-14 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): `Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5im•3113 Tito 5 Oft el Inspection Fonm Subsurface Sewage Disposal System•Page it of 17 Dec 23 14 02:46p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments G 558 Craigville Beach Road Property Address Craigville Court First Properly Management Owner Owner's Name information is Centerville MA 02632 12-23-14 required for every page. cityrrovm State Zlp Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan); Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 42" Below Grade, Box is clean and solid wtthree lines out. No sign of over loading or solid carry over. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No' Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): •If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located,explain why: t51ns•3l13 TMte 5 Olfldal hmpowlon fomc SUmwfam Sewage olsposo System-Page 12 Dr 17 Dec 23 14 02:47p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 558 Crai ville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is Centerville MA 02632 12-23-14 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cons) Type: ❑ leaching pits number: ® leaching chambers number: 14 ❑ leaching galleries number. ❑ leaching trenches number, length: ,. ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is fourteen 500 GaI.Dry Well Chambers. One set of nine and One set of five.Ck D Box and camera out to chamber's.No sign of over loading or solid carryover. Steel Cover on last set. 6"water in last set of chambers. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.3113 Title 5 OfficW Inspection Fom Subswfaae Sewage Disposal System-Page 13 of 17 Dec 23 14 02:47p p.14 Commonwealth of Massachusetts tiTitle 5 Official Inspection Form p Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 558 Craigvilie Beach Road Property Address Craigville Court First Property Management Owner Owners Name require tlfo is Centerville MA 02632 12-23-14 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15in3-3113 Title 5 Official Inspactan Farm:Subswlaoe Sewage Disposal System•Page 14 of 17 Dec 23 14 02:47p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owners Name Wbrmatrequiredfn is Centerville MA 02632 12-23-14 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (corn.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3113 Title 501fioal bupeciion Form Subsurface Sewage Disposal System•Page 15 0 17 Dec 23 14 02:48p p.16 -Dec. 18. 2014 11 : 17AIA No. 6790 P. 4 Paget of 2 Map Town of Barnstable Geographic information System Parcel Vilevil Custprrl Mm�p Abutted Map Size Zoom Out.1 f I! I j I ln -3 % i a U TrC 2.r k 7 - i - lam Q °x ._ :' - � CD CJ O O 0 20 Feet - ' Set Scale 1" zo { Aerial Photos I MAP DISCLAIMER I•..n�..L.A/7nn�-7��T,ryw n/ DWO AAA 411.:nhri reee.v. . .. <,..... L1_ ..,., , r..«nc.r.a�9h�l�rnr�ar�h/f►1',1n nms?mmnrrtvTT)=24603500A,-. 10/1012008 Dec 23 14 02:48p p•17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owners Name information is required for every Centerville MA 02632 12-23-14 page Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N� Estimated depth to igh ground water, feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Past Report ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Past report G.W.20'+. Bottom of chambers at 6'-6" below grade. Bottom of chambers at 13'-6"+above G W Depth Before filing this Inspection Report,please see Report Completeness Checklist on next page. Mine•3113 TAIe 5 Official inspection Fomx Subsurface Sawage Disposal System.Page 16 of 17 Dec 23 14 02:49p p.18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments x 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name informations required for every Centerville MA 02632 12-23-14 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist -® Inspection Summary:A, B, C, D,or E checked ® Inspection Summary D (System Failure Criteria Applicable to Alt Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 15ins•3113 Title 5 Official Irmpection Form:Subsurface Sewage Disposal System Pegs 17 o117 I 4 y commonwealth of Massachusetts Title 5 Official Inspection Form ®�s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments EeCi wud Oe&k "t 558 Craigville Beach Road 1/1 z/I S- Property Address Craigville Court First Property Management Owner Owner's Name information Centerville MA 02632 12-23-14 required for every page. City1rown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Im :when filling out forms A. General Information on the computer, OF flygss use only the.tab 1. Inspector: key to move your cursor-do notes; JAMES •.m= use the return James D.Sears _ _ Name of Inspector ;y key. CapewideEnterprises,LLC '•.o o, Company Name 5.���RTTF 17•G�- '. 153 Commercial Street '��i�����sf iN SPtE"`��� Company Address Mashpee MA 02649 Cityrrown State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑. Fails ❑ Needs Further Evaluation by the Local Approving Authority 12-23-14 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-23-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal. Tank D Box and four teen 500 Gal. Chambers. Note: System is for all four units. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old'or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3113 Title 5 official Inspection Farm:Subsurface Sewage Disposal System•Page 2 of 17 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-23-14 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑' Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-23-14 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in awwpO is less than 6" below invert or available volume is less than%day flow-4 t4e111,.x:- t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 v Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �< 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is required or every Centerville MA 02632 12-23-14 f page. Cityfrown state Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303 therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No . ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-23-14 page. City/town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information.was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 10 Number of bedrooms(actual): 10 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 1100 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address C_raigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-23-14 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. Tank D Box and Fourteen 500 Gal.. Chambers. Number of current residents: NA Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2013-236,000Ga g ( y g (gpd))' 2014-244,000Gal's Detail Water usage is for all four units. Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No f Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner owner's Name information is required for every Centerville MA 02632 12-23-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Yearly Pumping Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owners Name information is Centerville MA 02632 12-23-14 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Tank 1991 permit#91-8/D BOX and 9 Chambers 98 Permit#98- 189 2000 -5 Chambers Permit#2000-699. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 4'feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4"PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: 3'feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast H-10. Sludge depth: 1" t5ins-3/13 TAIe 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts ffly-ffi Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road 'Property Address Craigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-23-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29' Scum thickness 0ir Distance from top of scum to top of outlet tee or baffle 811 181- Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Asbuilt-TapeSludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level.Tank at 3' below grade. Inlet cover at grade, outlet cover at 3"Three inlet tee's, outlet tee. No sign of leakage or over loading. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 558 Craigville Beach Road Property Address C_raigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-23-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): t Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-23-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 42" Below Grade. Box is clean and solid w/three lines out. No sign of over loading or solid carry over. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 TAIe 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-23-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 14 ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is fourteen 500 GaI.Dry Well Chambers. One set of nine and One set of five. Ck D Box and camera out to chamber's.No sign of over loading or solid carryover. Steel Cover on last set. 6"water in last set of chambers. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments rt 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is Centerville MA 02632 12-23-14 required for every, page. City/Town State . Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner owner's Name information is Centerville MA 02632 12-23-14 required for every , page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 or 17 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-23-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells /VD Estimated depth to, igh ground water: 20'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Past Report ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Past report G.W.20'+. Bottom of chambers at 6'-6"below grade. Bottom of chambers at 13'-6"+above G.W. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 558 Craigville Beach Road Property Address Craigville Court First Property Management Owner Owner's Name information is required for every Centerville MA 02632 12-23-14 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° M 558 Craigville Beach Rd Property Address First Property Mgmt Owner Owner's Name information is required for every Centerville Ma 02632 12/3/2011 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Informationfilling out forms I /p on the computer, /vIJ use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. Capewide Enterprises Company Name 153 Commercial St. Company Address Mashpee Ma. 02649 City/Town State Zip Code 508-477-8877 SI 4522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the "information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority C,h 12/3/2011 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. - ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title'5 Official Inspection Form:Subsurface.Sewage Disp al ystem•Pa 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 558 Craigville Beach Rd Property Address First Property Mgmt Owner Owner's Name information is required for Centerville Ma 02632 12/3/2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 558 Craigville Beach Rd Property Address First Property Mgmt Owner Owner's Name information is required for Centerville Ma 02632 12/3/2011 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N - ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•;11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 558 Craigville Beach Rd Property Address First Property Mgmt Owner Owner's Name information is required for Centerville Ma 02632 12/3/2011 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. El The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 558 Craigville Beach Rd Property Address First Property Mgmt Owner Owner's Name information is required for Centerville Ma 02632 12/3/2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: z ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 ,<L , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 558 Craigville Beach Rd Property Address First Property Mgmt Owner Owner's Name information is required for Centerville Ma 02632 12/3/2011 every page. CitylTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? �N ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 10 Number of bedrooms (actual): 10 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 1100 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 �. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 558 Craigville Beach Rd Property Address First Property Mgmt Owner Owner's Name information is required for Centerville Ma 02632 12/3/2011 every page. CitylTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: 2009 = 207,000 total = 567 gpd 2010 = 238,000 total = 652 gpd Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 558 Craigville Beach Rd Property Address First Property Mgmt Owner Owner's Name information is required for Centerville Ma 02632 12/3/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 558 Craigville Beach Rd Property Address First Property Mgmt Owner Owner's Name information is required for Centerville Ma 02632 12/3/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: ., Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 4 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints ok, no leakage, vented through roof Septic Tank (locate on site plan): Depth below grade: 3 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: 5" t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,..�'y 558 Craigville Beach Rd Property Address First Property Mgmt Owner Owner's Name information is required for Centerville Ma 02632 12/3/2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3.5' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers and took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank needs to be cleaned now and again every year for proper maintenance, septic tank is undersized for the size of the system. Inlet and outlet covers are on riser, outlet tee intact, water level was at bottom of outlet invert, tank was not leaking and was structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 �. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 558 Craigville Beach Rd Property Address First Property Mgmt Owner Owner's Name information is required.for Centerville Ma 02632 12/3/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 558 Craigville Beach Rd Property Address First Property Mgmt Owner Owner's Name information is required for Centerville Ma 02632 12/3/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is in good condition, water flow was even to both outlets, no sign of past hydraulic overloading. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: (Sins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 558 Craigville Beach Rd Property Address First Property Mgmt Owner Owner's Name information is required for Centerville Ma 02632 12/3/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 14 x 500 gallon ' ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No signs of past hydraulic overloading, no lush vegetation, soil and stone surrounding s.a.s. was found to be dry. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ec4M 558 Craigville Beach Rd Property Address First Property Mgmt Owner Owner's Name information is required for Centerville Ma 02632 12/3/2011 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privylocate on site plan): ( P ) Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form St Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5 CGM , 558 Craigville Beach Rd. 4 -- Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 10/10/2008 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 remm City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant totSection 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fail ' c:J.a ❑ Needs Further Evaluation by the Local Approving Authority o 10/10/2008 r? , Inspector's SirnaWe Date >� r The system inspector shall submit a copy of this inspection report to the Approvin 'Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. / 1 ? . ✓�' D 6 c� t5ins•09/08 Title 5 Official Inspection Form:Subsu ace Sewage Disposal System•Page 1 of 2 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 558 Craigville Beach Rd. Property Address First Property Mgmt. Owner Owner's Name information is Centerville Ma. 02632 10/10/2008 required for every page. City/Town State. Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. 6) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than,20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 558 Craigville Beach Rd. Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 10/10/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 3 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 558 Craigville Beach Rd. Property Address First Property Mgmt. Owner Owner's Name information is Centerville Ma. 02632 10/10/2008 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system. has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded'or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 4 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 558 Craigville Beach Rd. Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 10/10/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No El ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the-large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 5 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 558 Craigville Beach Rd. Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 10/10/2008 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently.or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 0 Number of bedrooms (actual): 10 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 1100 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 6 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 558 Craigville Beach Rd. Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 10/10/2008 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1500 gallon septic tank,distribution box and 14-500 gallon LC Number of current residents: unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d unavailable 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 10/10/2008 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 558 Craigville Beach Rd. Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 10/10/2008 every page. City/Town State Zip Code . Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Capewide Enterp rises,LLC. Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 8 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 558 Craigville Beach Rd. Property Address First Property Mgmt. Owner Owner's Name informationrequired for is Centerville Ma. 02632 10/10/2008 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 3' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 1 + fee et Comments (on condition of joints,venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): 3, Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gallon Sludge depth: 0 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 9 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 558 Craigville Beach Rd. Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 10/10/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle NA Scum thickness 0 Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? Tank pumped at time.of inspection. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every year.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. Grease Trap (locate on site plan): Depth below grader feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 10 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for..Voluntary Assessments 558 Craigville Beach Rd. Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 10/10/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 558 Craigville Beach Rd. Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 10/10/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is Ievel.Box has two outlet laterals with equal distribution.No evidence of solids carryover.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 12 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 558 Craigville Beach Rd. Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 10/10/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 14-500 gl. L.C. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.):_ Sandy dry soil,No signs of hydraulic failure.Leaching Chambers water level was 1' below invert at time of inspecton.No stain line observed above that point. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert , Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction t i Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 13 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 558 Craigville Beach Rd. Property Address First Property Mgmt. Owner Owner's Name information is Centerville Ma. 02632 10/10/2008 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 14 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ■ Zoom Out .34 PC, ti J �-- f --1 1 U O ti sill y -7t ® O O l li ti � - I�I' 3 0 o p O 20 Feet _ Set Scale 1" = 20 I Aerial Photos I MAP DISCLAIMER r'—...inhf 7(1(1F_7(1(1R Tn...n of Rornefohlc RAA All rinhfc rocenr. http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=24603500A... 10/10/2008 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 558 Craigville Beach Rd. Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 , 10/10/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of chambers 10' feet Please indicate all methods used to determine the high ground water elevation: r ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Da ta.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 558 Craigville Beach Rd. Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 10/10/2008 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ❑ System Information—Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 P so Le-� [ons S"T 1 0 �'X► 5T ►tJC-7 �cl �Z', S o►no-tv�o2 S �-� S ,� U -- IO I-p" Z x 8 jo 'o 0 dr 41s, �.: tea.V� �. s s s c►-�.;5�. � i� ��a.�I.� �d _ �R PLC 2-k10 t�A�L-�S i(.," p, L.. wit 1X10 RAFrgRS P+��N ou �E zx� +aEaes � >1' L�`� � � X� ST I N U D�✓G u_11J C� k>07S -r-� C., Fie zx8 �o�5rs 16 o•C. D>✓c.K 11JC, DOUBLE 2X8 ,t �• SB149 4,5- � 78 54 , 15� h -_ _ FND. 16 0. C� - 0--=-`- k (� --_--.) 4 0, Ig 9, I'v =_`a__ 20 9, ti 40, - - - - f 6,9, FAD bFADI � 2�9`=_ o 1,2r. g8. •� yy NB2 09,03„W E,4 C RD VOTE;• PRE--EXISTING N0NC0NP0RYlNG. ES. ZONE.' "RE Tnl3 MORTGAGE INSPECTION Plan i1 For FLOOD ZONE: JWN: �1'F<S-Z CRT — REGISTRY OWNER; H°nk u�� on, EED REF: �1 —BUYER: �E YYR�I' fT_GE�,ATE: 5/�¢ PLAN REF:��lf11= — — HEREBY CERTIFY TO SdtYD.�Z�f1_ — _ SCALE:1' �Q�.�.�FLTI.YF-86LYf� ___THAT THE BUILDING �x of YANKEE SURVEY TOWN ON THIS PLAN I3 LOCATED ON THE GROUND AS {OWN AND THAT ITS POSITION DOES CONFORM PAUL s CONSULTANTS THE ZONING LAW' SE1!T�BACK REQUIREMENTS OF THE 40B (SUITE 1) 'WN OF ----EA L TZcW.�iF______---_ MERiTHEW Z4 DOES_ VS_T _ LIE WITHIN, THE SPECIAL FLOOD NTHAT N o�� INDUSTRY ROAD EA AS SHOWN ON THE H. U.D. MAP DATED_ �F SfE o MnRSTONs MILLS, MA. 02648 250001 0008 D Z-```�� �441 LAx05 TEL• 428-0055 �- F,m Cq._-___--_ THIS FLAN NOT MADE FR06i, AN TRUMENT FAX: 420-5553 SURVEY NOT TO BE USED FOR FENCES ETC. 14630 A✓S COMMONWEALTH OF MASSACHUSE17S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . DEPARTMENT OF ENVIRONMENTAL;PROTECTION ►WAP 2 PARCEL, ,.® LOT TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 558 Craigville Beach .Road Centerville:, MA RECEIVED Owner's Name: Craigville Court Condominiums/van Johnson Owner's Address: Date of Inspection: Lj/ APR I.3 2004 TOWN OF BARNSTABLE Name of Inspector.(please print) Wi 1 I i am _ •Robinson Sr. HEALTH DEPT. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville. .MA Telephone Number: (508) 775-8776 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.lam a DEP approved system inspector pursuant to Se tioa 15.340 of Title 5(310 CNIR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the local Approving Authority Fails Inspector's Signature: tr Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heanh. vir DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall subtuit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies;sent to the.buyer,if applicable,and the approving authority. Notes and Comments `*This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page g 2of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_558 Craigville Beach Road _Centerville, MA Owner. . Craigville Court Condominiums Date of Inspection: Iaspectioo Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sy i m Passes: 1 have not found an information which indicates rcates that any of the failure criteria described in 310 CMR. 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. S,ystem Conditionally Passes: 1 One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND).in the for the following statements.If`not determined"please explain) The septic tank is metal and over 20 years old*.or the septic tank(whether metal or not)is structural) unsouk exhibits substantial infiltration or exfrltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. •A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old,is available. N explain: Observation of sewage backup or break out or high static water level in the distribution box due to*-brokcn or obs cted pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with jappval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced plain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will spection if(with approval of the Board of Health): broken pipe(s),are replaced obstructiom is nmovcd NO explain: I - Pa; e3of11 OFFICIAL INSPECTION FORM. NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 558 Craiqville Beach Road Centerville, MA Owner. Crai ville Court Condominiums Date of Inspection: . /^ C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failinglo protect public health,safety or the environment. 1. S;stem will pass unless Board of Health determines in accordance with.310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety_and the environment:- _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or.pnvy is within 50 feet of a bordering vegetated wetland or a salt marsh e 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system isl functioning in a manner that protects the-public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surf ce water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone.1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply.well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more frortl a. ivate water supply well** Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria 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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 � i Page 4 of l I i OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS _ SUBSURFACE`SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 558 Craigville Beach Ro ad Centerville, MA Owner: Crate' Condominiums Date of Inspection: D. System Failure Criteria applicable to all systems: Youust indicate"yes".or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool; i Discharge-be ponding of effluent to the surface'of the ground or surface waters due to an overloaded or g clogged SAS or cesspool 4 Static liquid level in the distribution box above.outlet invert due to an overloaded or clogged SAS or.' cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less:than 1/,day flow i Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Numbcr of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. f Any portion of cesspool or privy is within 100.feet of a surface water supply or tributary to a surface yIy water supply. I Any portion of.a cesspool or.privy is within a Zone 1 of a.public well. $ . .Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private w•at= supply well with no acceptable water quality analysis.(This system passes if the well water analysis, performed at a DEP certified laboratory.,for coliform bacteria and volatile organic compounds indicates that the well is free.from pollution from that facility and (lie presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria arc triggered.A copy of the analysis must be attached to this forma (Yes/No)The system fails. 1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. i� E: L`arge Systems To be considered a large system the system must serve a facility wilh a design now of 10,000 gpd to 15,000 gPd• You must indicate either'yes"or"no"to each of the following: ('flit following criteria apply to large systems in addition to the criteria above) 4 yes no - _ ) 1 the system is within 400 feet of a surface drinking water supply _ L14 the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If)ou ave answered"yes"to any question in Section E the system is considered a significant threat,or answered "ycs"in Section D above the large system has failed.The immer or operator of airy large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15 04.The system owner should contact the appropriate.regional office of the Department. 4 Page 5 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.B CHECKLIST Property Address: 558 Craigville Beach Road Centerville, MA Owner..Crai vi1le Court Condominiums Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No I _ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks?:.. _ Has the system received normal flows in'the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection?,. Were as built plans of the system obtained and examined?(If they were not available note as N/A) 1_ Was the facility or dwelling inspected for signs of sewage back up? _ Was the site inspected for signs of break out? _ Were all system components,excluding the SAS,located on site? _� _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ as the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location or the Soil Absorption System(SAS)on the site has been determined based on: . Yes . no Existing information.For example,a plan at the Board of Health. _✓_ Determined in the field(if any of the failure criteria related'to Part C is at issue approximation of distance is unacceptable)13 10 CMR 15.302(3)(b)) 5 Page 6 of I 1 OFFICIAL INSPECTION-FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C- SYSTEM INFORMATION Property Address: 558 Craigville Beach Road Centerville, MA OwnerCraigville Court Condominiums Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):/�2_ Number of bedrooms(actual): / DESIGN flow based on 310 CMR 5.203(for example: 110 gpd x#of bedrooms):,/ Number of current residents: X46 Does residence have a garbage der(yes orno):,-p 46 Is laundry on a separate sewage system(yes or no); e,o [if yes separate inspection required] Laundry system inspected(yes or no):,&,�.!d Seasonal use:(yes or no): Vk I Water meter readings,if available(last 2 years usage(gpd)): 2 0 03 - -21 T'i 000 Sump pump(yes or no): - 2bb,000 Last date of occupancy: . COMMI�RCIAIANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial trap, holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date 4 f occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: 1 el, ` ✓� -0 Was system pumped as part of the inspection(yes or no):/- If yes,volume pumped:_gallons How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool E�rhar ed system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval _Other(describe): C' �'' e A:,', Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):-") 6 ]'age 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART G SYSTEM INFORMATION(continued): Property Address: 558 Craiqville Beach..Road Centerville, MA Owner: Crai ville Court Condominiums Dale of lnspectlon: / /_EZ BUILDING S 1VER(locate on site plan) Depth below gr dc: Materials of co struction:_cast iron 40 PVC other(explain): Distance Gom rivate water supply well or suction line: Comments( condition of joints,venting,evidence of leakage,ctc.): SEPTIC TANK:Zocatc on site plan) Depth below grade: , s Material of construction:_zconcrete metal . - fiberglass_polyethylene If lank is metal list age:_ Is age confirmed-by a Certificate of Compliance(yes or no): certificate) (attach a copy of Dimensions: v j Sludge depth:_ S ' Distance from top of sludge to bottom of outlet tee or baffle: _ Scum thickness: Distance from top of scum to top of outlet tee or baffle: 3— Distance Gom bottom of scum to bonorry of outlet tee or baffle:[ 1�_ How were dimensions determined: 6 A' Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): , GREASE TRAP: (locate on site plan) Depth below lade:_ Material of construction:_concrete_metal fiberglass_polyethylene—other (explain): _ Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance frog bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments( n pumping recommendations,inlet and outlet ice or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM:-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 558 Craigville Beach Road Centervii1e, MA Owner: Craiaville Court Condominiums Date of lospection:_ 'j_ TIGHT or HOLDING TANK (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass Aolyethyle.ne other(explain): Dimensions: Capacity. Qallons Design Flow: Qallons/day Alarm present(yes or noj: Alarm level: Alarm in working order(yes or no): Date of last pumping:/ Comments(conditt n of alarm and float switches,.etc.): DISTRIBUTION BOX: resent ( p must be opened)(focate on site plan) Depth of liquid level above outlet invert: _ Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PU(NP CHAMBER: /(ol eate on site plan) Pumps in working order,(yes or no): Alarms in working ord r(yes or no): Comments(note con ttion of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5.58 Craigviile Beach Road Centerville, MA Owner: Craiqville Court Condominiums Date of Inspection: 4 /r c7 d SOIL ABSORPTION SYSTEM(SAS): locate on site plan,excavation not required) If SAS not located explain why: Type ` ._ leaching pits,number:_ 7/ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): _ CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet' vert: Depth of solids layer: Depth of scum layer: \ Dimensions of cesspool: \ Materials of construction: Indication of groundwater inflow\(yes or no): Comments(note condition of soil signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan Materials of construction: Dimensions: Depth of solids: Comments(note condition of s 1,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page l0 of 1 I OFFICIAL INSPECTION.FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:558 Craigville Beach Road Centerville, MA Owner: Craiaville Court Condominiums Date of Inspection: —! _ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference.landmarks or benchmarks.Locate all wells within 100 feet.Locate where public wat r supply enters the building. c� V . I _ . N 04 ,i 10 Page 11 of 11 f . OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 558 Craigville Beach Road Centerville, MA Owner. Craiqville Court Condominiums Date:of Inspection: c7�z SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) 'Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe hgwyou,gsta li hed the high ground water elevation: 11 SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS DELIVERY ■ Complete items 1,2,and 3.Also complete A. Received b �earl y(Please hty B. Date of De ivery item 4 f Restricted Delivery is desired. �� Print your name and address on the reverse so that we can return the card to you. C. gnatur 1 ■ Attach this card to the back of the mailpiece, ❑Agent or on the front if space permits. ❑Addressee &Uwde'livery addre different frofn item 1? ❑Yes 1. Article Addressed to: If YES,enter deli ry address below: ❑ No Ua,ei JolP1s.r Toti4saK C1 Co. P'o. 'gox 110a 3. Service Type / I / Certified Mail ❑Express Mail ❑ Registered Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. a0b 0 �0 3 JT 3 4• Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number(Copy from service label) PS Form 3811,Juiy 1999 1'' Domestic Return Receipt 102595-00-M-0952 UNITED STATES POSTAL SERVICE .First-Classlffit - *w Postage-&Fees=Paid USPS P 1A Permit No.6A0 • Sender: Please print yo name;address, and ZIP_t4_in this box_._•_ .._____ -' 'i I r�►5, "A I f °FIME r Town of Barnstable Regulatory Services • a ♦ " B" MASS. " Public Health Division •i639 �� iOrEo 39 ° 200 Main St.,Hyannis,MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health July 30, 2002 i Mr. Van Johnson C. Johnson & Co. P.O. Box 1100 Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF THE TOWN OF BARNSTABLE BOARD OF HEALTH'S NUISANCE CONTROL REGULATION NUMBER ONE The property owned by you located at 558 Craigville Beach Road, was inspected on July 25, 2002 by Sam White, Health Inspector for the Town of Barnstable, because of a complaint. The following violation of Nuisance Control Regulation Number One Regulation was observed: Ten (10) Feet Minimum Setback To Abutter's Property Line: Several refuse containers observed at 558 Craigville Beach Road were located within ten (10) feet of abutter's property line. According to Sam White, Health Inspector, there are other areas on the property to relocate the refuse containers greater than ten (10) feet away from any property lines. You are directed to correct this violation within thirty (30) days of receipt of this notice by relocating the refuse containers. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than$500. Each separate day's failure to comply with an order shall constitute a separate violation. PER BOAR ORDER OFT D OF HEALTH as A. cKean Director of Public Health CC u 1N\r. Pe A-e,,. y Health Complaints 06-Aug-02 Time: 9:30:00 AM Date: 7/24/02 Complaint Number: 3612 Referred To: SAM WHITE Taken By: Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: ILLEGAL OPERATIONS Business Name: Number: 55V56_0 Street: Craigville Beach Rd. Village: Assessors Map Parcel: Complaint Description: Actions Taken/Results: .,r Health Complaints 06-Aug-02 Johnson and Mr. Dunn on 8/6/2002. Trash containers on 558 Craigville Beach Rd. will be moved halfway from property line to condo building. Dumpster will be fenced and or shielded with greenery. Investigation Date: 7/24/02 Investigation Time: 11:00:00 AM 2 I 7l k�.Yt tF T� R jf ���s , fa.= wY :' Fes.• - ; , 4 / / /r � ° v� � �- �� �� .. � .� f� "tic, f��t' .;��.+ '�' js'��• _ ;�,.. + c `- '� / ��;j ss� C�'��'�c��� =��E � 5����- TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION i{ Date ��--� Owner " �" Tenant �� Addres§..5 Complionce Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 3. Bathroom FacilitiesIl 4. Water Supply h e- � 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation �p 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements IA. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing PART II 44, � I J�-�L 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition �—S/ J, Person(s)Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here HOBB.S$WARREN.INC. SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS DELIVERY ■ Complete items 1,2,and 3.Also complete A. Received by leas Pri t Clearly) B. Dat of Delivery item 4 if Restricted Delivery is desired. s d Cj ■ Print 3 our name and address on the reverse so that we can return the card to you. C. Si atur ■-Attach this card to the back of the mailpiece, X Agent or on the front if space permits. ❑Addressee elivery l dddress`differen from item 1. Yes 1. Article Addressed to: If YES,entered livery addr ss below: ❑ No u- 1n^n 3. Service Type [,D•Certified Mail ❑ Express Mail egistered ❑Return Receipt for Merchandise 02(s 3 2 ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number(Copy from service label) i 1L ft R PS Form 3811,July 1999 Domestic Return Receipt 102595-00-M-0952 It UNITED STATES POSTAL SER�ffiE First-Class Mail �p• r�4 T 'FosCage-&Fees�Paid �1 r MFPermit-No:G-10• • Sender: Please print Yourr"t' ,,jaddress,,and ZIP+4-in this box •.ea...---- Board of Heaffh s r . Town of Barnstable P.O.Box 534 Hyannis,Massachusetts 02601 �v COMPLETE •N 1! COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Received by(Please nt Clearly) B. D of Delivery item 4 if Restricted Delivery is desired. IA r/ ` ■ Print your name and address on the reverse C. signs ure so that we can return the card to you. �/� ❑.Age tl ■ Attach this card to the back of the mailpiece, or on the front if space permits. k ' ' je.e4EFAOdressee D. Is delivery ad different from item 1? ❑Yes 1. Article Addressed to: _ If YES,enter elivery address below: ❑ No fna Gn ne �r 11«S I l Oil►1] �C� 3. Service Type 1 ��lJ/t / r/�n3� ertified Mail ❑ Express Mail vtax registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number(Copy from service label ,i / 99 PS Form 3811,July 1999 a�r Domestic Return Receipt 102595-00-M-0952 I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • Board of HeaRh Town of BamsWe P.O.Box 634 Hyannis,Massachusetts 02601 ca till[if iitft 7fdifdiff7ff III fit 11111filfil Z a03 499 1.98 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sent to I. t Num r t i �Stat I e Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee u� Return Receipt Showing to Whom&Date Deliv c, Retum Receipt 6� Q Date,&Address ress j O TOTAL Po &Fees co EPostmark o Da ; Cl) U_� Stick postage stamps to article to cover First-Class postage,certified mail fee,and 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 y window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the m return address of the article,date,detach,and retain the receipt,and mail the article. ul 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article Q RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. M 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. �`8 6. Save this receipt and present it if you make an inquiry. 102595-97-B-0145 a I L Z 203 499 199 - US Postal Service Receipt for Certified Bail No Insurance Coverage Provided. Do not use for International Mail See reverse o l� StrEet& u l lP h P Stag, I ode Postage $ Certied Fee / CIL Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom&Date Delivered a & e S"to Whom, MQ Return e, Addressees Addresses A 0 TOTAL Postage&Fee $ 1 Postmark or Date 1 o ` LL t _. Stick postage stamps to article to cover First-Class postage,certified mail fee,and 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). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the rL return address of the article,date,detach,and retain the receipt,and mail the article. �- 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the O O addressee,endorse RESTRICTED DELIVERY on the front of the article. M 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. li 6. Save this receipt and present it if you make an inquiry. t o25s5-e7-B-oi45 a i 4 �oFTHEr ti Town ®f Barnst abk Department of Health, Safety, and Environmental Services BARNSTABM MASS. r i639• Public Health Division ♦0 AIED �a P.O. Box 534, Hyannis MA 02601 Office: 508-8624644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health March 6, 2001 Mark Levy P. O. Box 1100 Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE, ARTICLE 51 The property owned by you located at 558 Craigville Beach Rd., Centerville, was inspected on March 5, 2001 by Edward Barry, Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II, Minimum Standards of Fitness for Human Habitation were observed: 410.552 Holes in screen and screen door. 410.351 Handle to hot water faucet of kitchen sink therefore no hot water. 410.482 Smoke detector hanging from ceiling by wires. 410.280B Bathroom vent inoperative. 410.481 No twenty square inch sign stating the name, address and telephone of owner. You are directed to correct the violation of 410.351 and 410.482 within twenty-four(24) hours of receipt of this notice by removing the refuse from the property and repairing the smoke detector. You are also directed to correct the remaining violations within fourteen (14) days of receipt of this notice. Q:Ihealth/wpfiles/orderlet/ed/levy You,may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However,these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. 5A. ER®>F THE B ARD OP HEALTH V ean Director of Public Health Q:/heal th/wpfil es/ordeHe t/ed/levy l n The Town of Barnstable Health Department l ""'".n i 367 Main Street, llyannis, MA 02601 Office 508-790-6265 t Thomas A. McKean FAX 50b-iV 3344 (�� !� �' 1.1 4F4r'? Director of Public Health . r,� 3 G? NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CUDE_II�—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at,4'55—f was inspected on V ' - Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CHR 410.00, State Sanitary Code II, Minimum Standards of Fitness for Human Habitation were observed: You are directed to correct violations within twenty- four (24) hours of receipt of this notice. You are also directed to correct V41 � within days/hea&s- of receipt of this'� � notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health -7 F:aOM130 CIV J HOBBS&WARREN'" THE COMMONWEALTH OF MASSACHUSETTS • BOARD OF HEALTH L G CITY/TOW N o DEPARTMENT ADDRESS �jy�R /yyW /yq/y Z^�/►// Jjf� G,M Syey`• 1 � �l'f�.�� 9n'1M' �N' •+ i/ ��` O _f TELEPHONE Address !J'1f3 J �- (1,,� �� _ Occupantx e" r rSt Floor I Apartment No.__.` - _ No.of Occupants_ No. of Habitable Rooms2 ___No. Sleeping Rooms No.dwelling or rooming units No. tories ,[7 �Name and address of/oyw�ne.(K�^� 1 rye !!'f Fi ��f g5; .v Remarks Reg. Vio. YARD 'Out Bld s.: Fences.- Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: `ry ',� ,' /w, ? �,�f✓ 7' '/ ; -4 Dual Egress: and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Li htin : Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents.- PLUMBING: Sy I•aL-trw H1?l)`/ l i�; e7_ Alif ,r J r l� • f '' '`t A:6y s- ❑ MS ❑ ST ❑ P Waste Line: /`�',� 41 H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.j 10 ,�l , ry of r-.ev ❑ 110 ❑ 220 FU`sin + jr_f 4J IQI A✓ , AMP: .- 'i ._Gen'Cond.,Distrrib.,Box: 4 " E Gen. Basement Wirin •f A.DWELLING UNIT Ventil. Core 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., Plumy b--Sanit0n.` /;/ 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 INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTORS'+ r� L� �rf TITLE ^r �r` !'f✓' a ""T '? -7� .r �,Y�i' A.M. DATE -� TIME A.M. THE NEXT SCHEDULED REINSPECTION P.M. w 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 heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (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. • d t/ " 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) William E. Robins on,:Yxhereby certify that the application for disposal works construction permit signed by the dated concerning the property located at558 Craiqville Beach Rd. , HyannisPor`tmeets all of the following criteria: • The failed system is connpcted to a residential dwelling only. There are no commercial or business uses associ ted 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 Stistetu There ut:no private.wells within 150 feet of the proposed septic system - There is increase in flow and/or change in use proposed • There no variances requested or needed. • The bo m of the proposed leaching facility will not be located less than five feet above the ma.�i adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor meth 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 p9tt be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following; Q A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation _ 6 +the MAX High G.W. Adjustment. DIFFERENCE.BETWEEN A and B SIGNED : DATE: [Sketch proposed plan of system on back[. q.heaM folder cen Ih o ol 7 Lf 6 O 3 S�­w . s Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for 30igpogar 6pgtem congtruction Permit Application for a Permit to Construct( )Repair( g)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 2558 Ca gvtille Beach Rd. , Mark Levy ssessors ap ce gyannisport 1 Washington St. ,Wellsley, MA Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P O box 1089, Centerville Type of Building: Dwelling No.of Bedrooms T Lot Size sq.ft. Garbage Grinder( ) Other Type of Building T 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. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) Install 5 heavrduty leach ^hamhe�"a in parking area, with stone all around. 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 thi loao of Health. Signe L Date/G , Application Approved by Date 4 Z� Application Disapproved for the following reasons Permit No. 7400 G Date Issued /(—Zf , AAA �F �No"__C -Z Lf V� 0 S S w `� Fee�r:r i _ _ THE COMMONWEALTH OF MASSACHUSETTS EntereAn computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for Migogal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 58 C ajjgqv11' lle Beach Rd. , Mark Levy ssessor s ap7Pafcei Hyannisport 1 Washington St. ,1391teke MA Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P O box 1089, Centerville Type of Building: / Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building T� No.of Persons Showers( ) Cafeteria( ) Other Fixtures i 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. Description of Soil Sena t= Nature of Repairs or Alterations(Answer when applicable) TnGta 1 1 S hP.avv duty 1 aaeh nhamha4 in parking area, with stone all around. 'Date last inspected: S1 . 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 oa,0 of Health. % j/ Signe Date/ " `-O-C rI Application Approved by Date Z Application Disapproved for'the following reason 3 Permit No. 2 dbo-r: C q9 Date Issued l(-Zr- Z.ffo .. --------- f ————————— — ——————————————— ' �` ' THE COMMONWEALTH OF MASSACHUSETTS i Levy BARNSTABLE, MASSACHUSETTS � Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repatred(X )Upgraded( �)" Abandoned( )by Wm. E. Robinson Septic Service i at 558 Craigville Bea " h Rd. , Hyannisport has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No p dated-A . Installer Wm. E. Robinson Sr. Designer A The issuance of this permit shall of b construed as a guarantee tl'"a e 4 will f nc 'on design`e/-. QPr Date Inspector .� v t . -- ------ (o ----- -- 2 �- ?f:=(/ 0 —f------- No. 'Fee JJ /rAE 6OMMONWEALTHJOF MASSACHUSETTS Levy PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migogal � pgtem, 'Congtruction Permit Permission is herebyConstruct granted to ( )Repair( X)Upgrade( )Abandon( ) System located at 558 Crakoville Beach Rd. , Hyannisport 7 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:Construc 'on mus be completed within three years of the date of thi t. Date: �� Z � Approved b ' SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY r�;,CQmplete items 1,2,and 3.Also complete /A�. Received by(Pleas Print Clearly) B. Date of Delivery item 4 if Restricted Delivery is desired.:` VAA) t Z%s0z —�� il, Print your name and address on the reverse C,,so that;we'can,return the card;to you. C. Si to ❑Agent ■ Attach jhis card to the back of the mailpiece, X dressee or on the'front if space permits. D. ivery 4dress differe t from item 1? ❑Yes 1. Article Addressed to: If YES,enter livery add ss below: ❑ No IWO i 3. Se ce Type Certified Mail ❑ Express Mail i ❑ Registered El Return Receipt for Merchandise I, 2 ❑ Insured Mail ❑ C ti.O.D. 02 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number(Cop from service label) f/� et Q F?/ i ii i {ii ii{i i it i ii?s ii i ? _ �2-0 PS Form 3811,July 1999 Domestic Return Receipt 102595-99-M-1789 +-J UNITED STATES POSTAL SERVICE ail �0 Mq OSPS Po &Fees aid p°� ,; LISP ��. SID emit o. 0 0 .. ..a :_.. • Sender: Please print�k ur�. e, T' dress, and box' ,. Publlc heal Town of 8 P.o.Box 534,yannist MasusQtts 02601 er fill J1!{u l{ Z 203 499 191 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sent to Street& /yp�� Po (�, Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee LO rn Return Receipt Showing to Whom&Date Delivered a Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ 2-.90 ch Postmark or Date li y � " a Stick postage stamps to article to cover First-Class postage,certified mail fee,and 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). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the QQ) return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. CAD c") 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. �`6L 6. Save this receipt and present it if you make an inquiry. 102595-97-a-0145 a ,�.��. ��'� .` --� '°b� .� .� ' �i '• �. . .� i � � �a /�, f , i fs �w� - � 1,♦ _ 1 y Y !� `, � � , ,�� 1 � r ` ,�' `r �, . _ r,,_s_ iY ��� �-���� �,� ,t` �� Y��,g�" �� � '�� � ° ��121 A :,� '-�� � � � �. �w /!�'��, :�:�` �� :�•�; ,�� �,�- � � f� ,,: Mr; sto,m,q Ae ,� dA 00 t�lip, k, � _ _ __ _ _ _ _ _ - J � .. ,,% J � ��t � � �M -. �� � �.� .t r lrJ�1�..J� / � �� - � ^�' II -�� ICI �� Y � I _ �l ` •�= \�� 1�`` � � .�� , 1,` ,ate / �:'�';1ti. _ y _ . 1 Nj h A S �� � � � �I = �M�� � J .►�. - • � �► - � � r ■ � i � �`1 r .� tia !P — .. ^t ._. i', ,. , � � � .� + _ �—�. _ _ �:� p !{' !Y %e � i� � y �•....,�,. ��, �,r � � �" r� .V :• _ `�" ., /ti .�i � _ —•, /�' yy �r` ,'> �, is ^. y / �,� � y'1'N� f,. �'�.�Y �'.i� ':�'. T 41 10Y ;.r r a i•. �►�� r T _ �_ _ y r;.: ..�" ..,, `� :�... 1 � � 4r.�� p �' �` C ' r i M APP r f T�'+�. ^,. ��t r � •"�� a '�." �`; � �'.I =�, i� 76 r . o P� r' •' �y C - CN` is f� 4�'1�," tea. 41 - + _ \ fI r � �`; • J " 1 t � ' i , . e V� �``c � y may,.' P.' r �' •'�rl x t , � I Y 1. � N J r � I r �f J G .p I J i v OF THE Tp� RARNSrnBiE Town of Barnstable 9 MAss.' g, 1639. ,. Board of Health '°leo rn►t°i 367 Main Street,Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Ralph A.Murphy,M.D. Sumner Kaufman,MSPH Date: 6/15/00 Mark Lerry %C Johnson Co. P.O. Box 1100 Centerville, MA 02632 ORDER TO COMPLY WITH NUISANCE CONTROL REGULATION NO. 1 , SOURCES OF FILTH,REFUSE FROM COMMERCIAL BUILDINGS Attached is a copy of the Board of Health Regulation which requires screening of all commercial outdoor refuse areas from public view. Screening may be in the form of fencing, evergreen trees, or other plants capable of providing year-round screening. Your garbage container located at 558 Craigville Beach Rd., Centerville was inspected on June 13, 2000. The dumpster was not screened from public view at that time. You are ordered to correct this violation within thirty (30) days of your receipt of this order to comply with this Regulation by providing screening around the refuse storage area. You may request a hearing if written petition requesting same is received by the Board of Health within seven(7) days.of your receipt of this order letter. Failure to comply within an order of the Board of Health may result in a fine of forty (40) dollars. Each day's failure to comply with the order shall constitute a separate violation. Non-criminal ticket citations may be issued daily until the violation(s) are corrected. - PER ORDER OF THE BOARD OF HEALTH omas McKean, R. S., C.H.O. Health Agent �t '-TO° !'N OF FIA NSTABLE 17-4314* 177 1. � II. z Q S m z N Do \ TI m o � II I ........... Omwnby YM DESIGN,INC. EXISTING CONDITIONS 302 WINCHESTER STREET 558 CRAIGVILL MASg SKY NEWTON,MA 02461 BEACH RD.617-306-2898 7I2ano14 12 :47AM A-1 REMODELING Copyright YM DESIGN,INC 2010 AU dghL-tesemed Scale w m V-0• 0 � � m o z rn 2 3'-1 UX a o - � ,mTt �Y _ 2 z g S iK 03 o n r- n— 1 co N Rl N F— aj m Z A :0 AD C 2'•5114 m ° 2 m r _ < z m 0 O v le .O T T O O O 7C D � O � r Z 0 - Drawn by PROPOSED FIRST YM DESIGN. 302 W NCH STERNC.STREET 558 CRAIGVILLE ' '� r�nassnasror FLOOR PLAN NEWTON,MA 02"1 - 617-306-2898 BEACH RD. 714 REMODELING 1217.14AM A-2 CoWght YM dg DESIGN. 2010 -.. ._. _.. Scale 3W-r•0• 10 MRVP # Assessor's Office (1st Floor) Assessor's Map and Parcel # u Building Department (4th Flo ) 51 Zoning ' C� Z G' _ INSPE E 0.00 RE-INSPECTION FEE $15.00 Request For A Housing Inspection For Certification Under the MA Rental Voucher Program Your Name J10•�1(A)c� �/ \1`l' Q.6 S Affiliation (Circle One) Owner al Estate �Ae Tenant Your Address �SG� � �� �Y.(1n�.S Mt) Telephone Number (Day) ��4 j-[,(Night)moo Address of Property Where Inspection is Requested Unit/Apt.# �;Se3 Gr�.bd,��i�� ���.�.� ��. , 'vim►�- Cen�rer4�0� �, Name of Owner Address i) nI�C ` �* �' w a Mailing Address (if different) Telephone Number (Day) (Night) Will there be any children under the age of six (6) who will be occupying the rental unit? (circle one) Yes No Was the dwelling constructed prior to 1979 Yes No ------------------------------------------------------------ FOR OFFICE USE ONLY: Certification The dwelling, dwelling unit, or rooming u- it located at .,s`�' t'?,.5�i Pected on �it by �3G� 7��i2 � Health Inspector for the Town of Barnstable and was found to be in compliance with the provisions contained within 105 CMR 410.00, State Sanitary Code II: Minimum Standards of Fitness for Human Habitation. However, this certification does not include a determination as to whether this unit contains any lead paint because under 760 CMR 49.02 Massachusetts Rental Voucher Program, a separate lead paint inspection must be conducted. Inspector's Signature P 9 Date'' y 71 MRVP # Assessors office (1st Floor) Assessor's Map and Parcel # ��Y f Building Department (4th Fl oqt) Zoning INSPEC,7I E, $60..00 RE-INSPECTION FEE $15.00 Request For A Housing Inspection For Certification Under the KA 'R/e�ntal Voucher Program Your Name Rf,�J)A Affiliation (Circle One) Owner al Estate A e Tenant Your Address I(;& A-\ a \0. 'D e Rn, , (y)A 7 Telephone Number (Day) (Night) Address of Property Where Inspection is Requested Unit/Apt.# S5� Cr���u;11e �e��� R� , v���- `3 . ener��ll e, fy�f� Name of. Owner t, Address r-l� Mailing Address (if different) i Telephone Number (Day) (Night) Will there be any children under the age of six (6) who will be occupying the rental unit? (circle one) Yes No Was the dwelling constructed prior to 1979 Yes No ------------------------------------ ------------------------ FOR OFFICE USE ONLY: Certification The dwelling, dwelling unit, or rooming unit located at U �`�' 4 G'!?'�39 j/-.44."- '���C.� pected on by Health Inspector for the Town of Barnstaple and was found to be in compliance with the provisions contained within 105' CMR 410.00, State . Sanitary Code II: Minimum Standards of Fitness for Human Habitation. However, this certification does not include a detexmination, as to whether this unit contains any lead paint because under. 760 CMR 49:02 Massachusetts Rental Voucher Program, a separate lead paint inspection must be conducted. Inspector's Signature ✓�% r1G1.� Date"' ..--� _ TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE 11:MINIMUM STANDARDS FOR HUMAN HABITATION Date Owner Tenant" �7£� Address'*�'��$�f1�.c��'z" ��' 1� LL,� Address �r-67$ �✓ �9 �. Regulation# 1 r- Compliance Remarks or Yes No Recommendations 2. Kitchen Facilities .O <s✓'� 3. Bathroom Facilities 4. Water Supply v 5. Hot Water Facilities 1 6. Heating FacilitiesIF r F 7. Lighting and Electrical Facilities V 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service v, 11. Space and Use 12. Exits Y 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents eg 15. Garbage and Rubbish Storage and Disposal ;/ �o4�` " 16. Sewage Disposal 17. Temporary Housingq;4Z PART II 37. Placarding of Condemned Dwelling; IV IAI,r j OAV IF r fh pryw Removal of Occupants; Demolition Person(s) Interviewed Inspect o ' I d')"l aUr e,o;s If Public Building such as Store or Hotel/MoteApecify here HOBBS$WARREN,INC. l ( CO-1510NAT-ALTH OF MASSACHLSETTS _ MCt'TI« OFFICE OF EN-MO\'1M.N-TAL AFF.AdRS .. _ -DEPARTMENT OF ENVIRONMENTAL PBOTECTI.OT O\'E 1tZ\?ER STREET.DOSTO\I.A 0210i 161.1'292.SSIh, TRL'DT COL Seere:i-, ARGEO PALL CELLI:CCI DA1,7D g STF.-vc Governor a�a SUBSURFACE SEWAGE DISPOSAL SYSTEM NSpECTWN FORM Cotus:one- PART'A CERTIFICATION P►op,ei-yAd*ers:558 Craigville Beach Rd. NanteefOtrrts►„e .. v To�,�, Date of kwpeoeonxy a n n i s p o n t, MA Address of Ovntar: Nameof1ltspeeter:(PleasePrin0WM. E. Robinson Sr. Suite 300, Wellsley, MA 1 e►n a DEP approved s inspacto► 10 Sae6011 16—W of T1de 51310 CUR 15.000) Cempany Barrie: Wm• E . Robinson a tic Service MsZngAddress: PO Box 0 9. Centerville , M14 T400-M Number: 77 5-8?2(, CERTIFICATION STATEMENT 1 certify that 1 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 an my training and-experience in the proper function and maintenance of on-site sewage disposal systems. The system: asses Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: =� -41� The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty (30)days of completing this inspection. If the system is a Shared system or has a design flow of 10.000 gpd or greater.the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer.if applicable. and the approving authority. NOTES AND COMMENTS ® Poor)or I] SUBSURFACE SEWAGE DEPOSAL SYST113A NSPECTION FORM , PART A CERTIFICATION Ioarrinm4 NopirityAddress: 558 Craigville Beach Rd. , Hyannisport Jwnw: TT Date of 4npactit .vyI� INSPECTION SUMMARY: Chsck6 B, C, o/ D: A. SY PASSES: 1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMNIEPM; S. YSTEM CONDRIONALLY 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. Indicate y s_no. or not determined(Y.N.or NO). Describe basis of detemtination in all instances. If"not determined*.explain why not. The septic tank is metal,unless the owner or operstor has provided the system inspector with a copy of a Certificate of Compliance lattached)indicating that the tank was installed within twenty 120)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 complying septic tank as approved by the Board of health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipets) or due to a broken,settled or uneven distribution box. The system will pass inspection if Iwith approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more then four times a year due to broken or obstructed pipets). The system will pass inspection if Iwith approval of the Board of health): broken pipets)ere replaced obstruction is removed Pale 2 of 11 (; SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION IF F lined) Property Address: 558 Craigville Beach Rd. , Hyannisport Owner: Levy Dace of Inspection- C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine it the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CUR 15.303 11)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF.HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and 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 then 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for eoliform 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 lapproxim rtion not valid). 31 OTHER - - se . . -a Page Page3oril SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION 1conenosdl Property Address: 558 Craigville Beach Rd. , Hyannisport Owner: Date of hopw6 Levy_ D. SYSTEM FAILS: You st indicate either `Yes' or `No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure Yes o Backup of sewage into facility or system component due to an overloaded orebgged SAS or cesspool. Discharge or pondmg 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. LA GE SYSTEM FAILS: You mus indicate either "Yes or "No' to each of the following: The following criteria apply to large systems in addition to the criteria above: he system serves a facility with a design flow of 10.000 god or greater(Large System)and the system is a significant threat to public ealth and safety and the environment because one or more of the following conditions exist: Yes 0 the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA) or a mapped Zone 11 of a public water supply well) Tne wner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional 'office of the Department for further information. Pagr4of11 SUBSURFACE SEWAGE DISPOSAL SYSTM INSPECTION FORM PART B CHECKLIST Property Address: 558 Craigville Beach Rd. , Hyannisport Owner: Levy Date of hupection:��`�_ � Check if the following have been done: You must indicate either 'Yes" or 'No- as to each of the following: Yes No JL 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 sin&the system has been receivirtg nermst flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this 1 / inspection. v _ As built plans have been obtained and examined. Note if they are not available with NrA. _ The facility or dwelling was inspected for signs of sewage back-up. I,( _ 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: v _ Existing information. For example, Plan at B.O.N. _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 115.302(3)(b)1 _ The facility owner land occupants,if differera from owner) were Provided with information on the proper main mac „t p p tangy SubSurface Disposal Systems. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION boperty Address: 558 Craigville Beach Rd. , Hyannisport Owner: Levy Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:, G a g.o.d./bedroom. Number of bedrooms(design): IQ Number of bedrooms factual):)U Total DESIGN flow /G c>-v Number of current residents: Garbage grinder Ives or no):/-0 Laundry Iseparete system) (Yes or no)/�b: If yes.separate inspection required Laundry system inspected (yes or no; Seasonal use Ives or no):J— 0 Water meter readings,if available (last two year's usage Igpd): 1999 5 4 9 . 0 0 0 Qa l. Sump Pump(yes or no) A- 0 1998 390,000 gal. Last date of occupancy r 1 Z7 COMMERCIALIINDUSTRIAL: Type of establishment: Design flow: dpd ( Based on 15.203) Basis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: Ives or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings. if available: Last date of occupancy: OTHER:(Describe! Last date of occupancy GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no(�C) If yes. volume pumped: gallons Reason for pumping TYPEOF YSTEM Septic tank distribution boxisoil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes. attach previous inspection records,if any) VA Technology etc. Attach Copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known)and source of information: J •`-' —Q--6.0 Sewage odors detected when arriving at the site: Ives or no) 0 SUBSURFACE SEWAGE DISPOSAL SYSTBA INSPECTION FORM PART C SYSTEM INFORMATION Ica+sa+ed) 'rop"Add►ess: 558 -Craigville Beach Rd. , Hyannisport Owner: Levy Date of Inspecbon1;L, —S-6-c--, BUILDING SEWER: !locate on site plan! Depth b ow grade:_ Material f construction:_cast iron_40 PVC_other lexplain) Distance from private water supply well or suction line Diamete Comme ts: (condition of joints, venting, evidence of leakage.etc.) SEPTIC TANK:_ (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 baffle:S eJ Scum thickness: b I ) Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlets ee or baffle: /`/ How dimensions were determined: M j°L 1 d ti Zomments: (recommendation for pumping. condition of inlet and outlettees or baffles.depth of liquid level in relation to outlet invert. structural integrity. evidence of leakage. etc.) fi5-U 60 Z. / .z X- ,� j� - lZ0v25/7- ICA tz GR SE TRAP: (locate n site plan) Depth b low grade:_ Material f construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensio s: Scum thic Hess: Distance f Om top of scum to top of outlet tee or baffle: Distance om bottom of scum to bottom of outlet tee or baffle: Date of la t pumping: Commen s: Irecom endation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity. eviden of leakage. etc.) Palic7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Icandrandl 'rop"Address: 558 Craigville Beach Rd. , Hyannisport Owner: Levu Date of Inspection`. TI OR HOING TANK: (Tank must be pumped prior to, or at time of. inspection) lioea a on sitelf an! Depth below grade:_ Materi I of construction:_concrete_metal_Fiberglass_Polyethylene_otherlexplain) Dimens ons: Capacit gallons Design ow:_gallons day Alarm resent Alarm vel: Alarm in working order: Yes_ No Date o previous pumping. Com ents. (con ition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_v (locate on site plan; Depth of liquid level above outlet invert: 0 Comments: (note if level and distribution eqy . evidenpq of solids carryover,evidence of leakage into or out of box. etc.) PUMP C AMBER:_ llocate o site plan! Pumps i working order: (Yes or No Alarms i working order (Yes or No) Comme ts: Incite c ndition of pump chamber. condition of pumps and appurtenances. etc.) Page s or i l SUBSURFACE SEWAGE DISPOSAL SYSTEM NISPECTION FORM* PART C SYSTEM NtFORMATION lew" a") lrooerty Address: 558 Craigville Beach Rd. , Hyannisport Owner: 7 Date of / SOIL ABSORPTION SYSTEM(SAS)!/ (locate on site plan,if possible:excavation not required,location may be approximated by non-intrusive methods 1 If not located,explain: Type: leaching pits:number:/3 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 hydraulic f *lure.level of ponding. damp soil,cond%it�ion of vegetation, etc�.)) ) CESSPOOLS:_ llocaie on site plan! Number and configuration. Depth-tog) of liquid to inlet invert: 7epth of solids layer: Depth of scum layer: Dimensions of cesspool. Materials of construction_ Indication of grounowater. inflow Icesspool mus be pumped as part of inspection; Comments tnote condition of oil, signs of hydraulic failure.level of ponding, condition of vegetation, etc.) PRIVY:_ hocate on site plan) Materials of constr ction- Depth of solids: Dimensions: Comments: (note condition soil. signs of hydraulic failure.level of ponding, condition of vegetation, etc.) Papt 9 of I I SUBSURFACE SEWAGE DISPOSAL SYSTEM nSPECTION FORM PART C SYSTEM INFORMATION leonfinued) lropertyAdd►ess: 558 Craigville Beach Rd. , Hyannisport lwrW: Levy Jaw of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) d7Ei i j ` PaRr10of11 � �w SuBSuRFACE SEWAGE DISPOSAL SYSTEM NSPECTION FORM PART C SYSTEM NFORIMATION leoffft0dl roparllr Address: Owner: Dace of knapection:J �S 6---I- NRCS Report name Soil Type_ Typical depth to groundwater USGS Date wabsite visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check CeUer Shallow wells 1 Estimated Depth to Groundwater Ls Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record �bserved Site (Abutting property.observation hole.basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators.installers Used USGS Data Describe how you established the High Grounowater Elevation. (Must be completed) �� d Iq Ind 6 Yh � p3 lSCi cJ w 9/219E Pa¢c11or11 P 339 579 325 us Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail a reverse Sant St ber Po ZI ode Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee LO Return Receipt Showing to Whom&Date Delivered a Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ P OP Postmark or Date - l0 3®--as 0 U) a stick postage stamps to article to cover First-Class postage,certified mail fee,and 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 m window or hand it to your rural carrier(no extra charge). m 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the If return address of the article,date,detach,and retain the receipt,and mail the article. Q i LO i 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811.and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article Q RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. CO 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. to 6. Save this receipt and present it if you make an inquiry. CO Town of Barnstable Regulatory Services �T"E TO�ti Thomas F. Geiler, Director Hnxivsrnai.e, Public Health Division 9e� � Thomas McKean, Director �fDMA'�A 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 October 30, 2000 Mark Levy c/o C. Johnson & Co. P.O. Box 1100 Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE H, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE, ARTICLE 51 The property owned by you located at 558 Craigville Beach Road, Hyannis, was inspected on October 10, 2000 by Glen Harrington, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code H, Minimum Standards of Fitness for Human Habitation were observed: 410.351/750: The bathroom shower was observed to be backed up. The toilet was observed to drain slowly. Sewage odors were detected upon entrance to apartment. As this condition is typically caused by problems with the septic system, you are ordered to do the following: 1) You are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four (24) hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. 3) You are further directed to contact and hire a licensed Disposal Works Installer within seven (7) days of receipt of this letter in order to repair this system or connect to town sewer. You are directed to correct this violation within twenty-four(24) hours of receipt of this notice. levy/wp/q/ls You.may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with-an order could result in a fine of not more than $500 Each separate day's failure to comply with an order shall constitute a separate violation. Renting the above property with uncorrected violations is a violation of the State Sanitary Code and the Town of Barnstable Rental Ordinance, Article, section 6-2 PER ORDER OF THE BOARD OF HEALTH ��asK a� Director of Public Health enc- copy of gold inspection report levy/wp/q/Is rA 1 CF 1ME 1p� BARNSTABLE. = Town of Barnstable 9 MASS. 1639. ,' Board of Health tED MA'S A 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 Susan G.Rask,R.S. FAX: 508-790-6304 Ralph A.Murphy,M.D. Brian R.Grady,R.S. dc4gbLast.Zl -3nne-14r-2000 CIO C Sv".s 9 P Co . �• o .�ca>L 110 � pZG3Z NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00,STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 SYT Cr v i The property owned by you located at I was inspected on DG'f 1 0,2000 by Glen Harrington,R.S.Health Inspector for the Town of Barnstable,because of a complaint. The following violations of 105 CMR 410.00,State Sanitary Code 11,Minimum Standards of Fitness for Human Habitation were observed: a] cm f 4/0, '3S1 /7SV / ,,-.GO �,,M,,.✓I. 1 J l..A,..t..- (,..�., E,IO,�Lr�P� d� to dv ajoau.d 4_L- - U..'G e.vc Y �� i7 Gt.w.1 6, i��LG, `ft- 1-70 A.'e -Sy14 '"1 You are directed to correct this violation of 410.482 within twenty-four(24)hours of receipt of this notice. .rhis.�lic�— You may request a hearing if written petition requesting same is received by the Board of Health within seven(7)days after the date order is received. However,these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than$500. Each separate day's failure to comply with an order shall constitute a separate violation. Renting the above property with uncorrected violations is a violation of the State Sanitary Code and the Town of Barnstable Rental Ordinance,Article 51,section 6-2. PER ORDER OF THE BOARD OF HEALTH Thomas A.McKean Director of Public Health w Enclosure: of Inspection Report HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS FORM30 Caw BOARD OF HEALTH CITY/ OWN = W Art IV b DEPARTMENTLl ,/ ADDRESS 1M SVOy`oW f�V 2a U 6 U y TELEPHONE Address 3T? /C, 6_A; "Occupant Floor / Apartment No. G No.of Occupants 3 No. of Habitable Rooms 2- No.Sleeping Rooms _ No.dwelling or rooming units 2- No.Stories Name and address of owner �)CL 'V LA v7 Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches.- Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS LIST ❑ P Waste Line: S quo dAa,"- (�,} xJeL.,l y 410 YI7s`� H.W.Tanks Safetyand Vents .Ce 4 +-w kcp v r,,, WjfW ELECTRICAL Panels, Meters,Cir.: a�,I �dLo ❑ 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 INSPECTION REPORT IS SIGbIED AND CERTIFIED UNDER THE PAINS AND PENALTIES F PERJU Q INSPECTO �J ' TITLE � 3 DATE Id t 'soi TIME P.M. p I� �/ . C1 - A.M. THE NEXT SCHEDULED REINSPECTION w P.M. Irn.N;�;,�;r*'�: ', ..:m�sw�aw�+?e.�rdv�«.,�.�.� R: R><'�.s�% .. ��* �In�f+• � sAC; "�O.;r��: "'" s � 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 heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. C Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) ' (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities'in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (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 witb.in.th.e time so ordered by the Board of Health. Va A,I kn fiv 67 y �J 00is 00600 � -7 ?viAn ®'f i r ,Sol^ n Buildmg Department • ComplainV Inquiry Report Date: / G — GO Rec'd by: le Assessor's No.:.�`1G-a ✓� Complaint Name• /� Complaint Description: Inquiry 0 Description: 1 l For Office Use Only i Inspector's Action/Comments Date: 16,110T/zov Iaspeccor C Follow-up Action Additional Info.Attaclied Copy Disnib=on: White-Depamneat Fdc ' Yellow-Inspector Pink-Inspector(Rerun to Office:Manager) cy r Deuet�Lt rr , t 5i 0 t CENTERVILLE MA ~026321N �; 00-0000-000 e t)ats, 070192 //r Ft ter nce 7 8105 332 ` ianuary�lst LEVY MARK r p$ d� 0792 '� ec!Re 8105/332 � �1/at ��� 000000000 uit an s 000031500 � �� s. 0000000000 y��� �� � r � e i�'��"''�558 �CRAIGVILLE BEACH ROAD ��.. '��Frstist ; CO VW ��5; 8, to ex: 0000 ern g. OO r Yam{' €' �� � � 9 2\�✓ \\ r � � 6y ✓� l j i V SENDER: 1 •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1;2,and 3.Also complete A. Received by(Pleaso Print Clearly) B: Date of Delivery item 4 if Restrict4o Delivery is desired. ■ Print your name and address on the reverse C. Si n ure so that we can return the card to you. Agent ■'Attach this card to the back of the mailpiece, Ja or on the front if space permits. ❑Addressee s delivery a ress diffe nt from item 1? ❑Yes 1. Article Address! to: If YES,ente !livery a dress below: ❑ No C. 3. Service Type P Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. Z 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number(Copy from service iaberk PS,Form 3811,July 1999 Domestic Return Receipt 102595.00-M-0952. + fn.• MA UNITED STATES POSTAL SERVICE �00 O 1.��-F� P V. fiat ge s a I IIV , • Sender: Please print your name, address, and ZIP+4 in this box • Board of Health Town of BamstabIG P.O.Box 534 tiyannts,massachusetts 02601 =n- - 111 I 1 11 tl IfI` i ! I1 1 ii i f i 1i -:_...:.:%4 u!fr � ! t! ruftf �;!!: t rrr t� r: ra �! .!! rt ! t k 1 } C . johnson & co . commercial * residential ® property management P.O.Box 11.00 *Centerville,NIA 02632�(508) 790-1647 FAX 790-2322 Town of Barnstable Public Health Division 367 Main St. Hyannis, MA 02601 Attention: Thomas A McKean October 24, 2000 RE: 558 Craigville Beach Road Apt #6 Centerville, MA 02632 10/30/2000 Letter Dear Mr. McKean, I received your letter today concerning the septic system at the above address. Please be advised that the tenants have been instructed to call me if any problem should arise. I would a then call Robinson Septic to pump the system. We are aware that we are having a temporary problem with this system that Robinson Septic installed about two years ago. We are working u with Bill Robinson to correct this problem at this time and expect that repairs will be completed shortly. If you have any questions please do not hesitate to call. Sincerely, { Van B. Jo h on Agent for 558 Craigville Court cc Mark E Levy • . h ._.`ir ..'fir. ,:f'- r 7-1 - t4 SS8 Gr.w�v%lac le�.c4Rdv C e.�l�(, Tt"d 4ls60 fl..r�;•,3t�•••,�•t i 6/�o/t g SSa Grail�:ll� (Qs•ci.wi Vall /14 t d f t L Cv to o fo,rr;&15*t tl 2Q•S. _�- 1 Apr O M.e la eN Catf 4+a cl w.t�'wts•..t tr Der, hr4 . (o G�t� �a��ttiy�o.�, R• s• r. i ` dlI I 6_J0-!9 rs*SCrwi3vill� ire 444, F.W., Gv:!(i Mold Or, 0%;jkreew► Gvp&oA..sL. 1: i A44A a c'v:t4 Si o wt a G►+t�loJw� . '+f Health Complaints 29-Jun-99 Time: 2:30:00 PM Date: 6/29/99 Complaint Number: 1925 Referred To: gLEN HARRINGTON Taken By: k.s. Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: (3 l Number: 558 Street: CRAGVILLE BEACH RD. Village: CENTERVILLE Assessors Map-Parcel: Complaint Description: THERE IS EXCESSIVE MOLD IN THE BEDROOM AND LIVING ROOM. Actions Taken/Results: Investigation Date: Investigation Time: 1 "e �w TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE 11:MINIMUM STANDARDS FOR HUMAN HABITATION Date Owner ., 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 SC,reY-"^ 8. Ventilation w� Pd.a.a- �IT);i� S°cirtof ki-sj tk ck- N.I-grr ofwr4w•.rQ-1, ®Jd. l4 o-o C, r„ �7 crero i.�,dv t F 9. Installation and Maintenance of Facilities 0�—D( E• 5°tII is 10. Curtailment of Service b ), S t tL4e w e..ei cn e"�+3 'IV c e-at l P _f "e 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural S";//e"' fQVktA&VkU7^ IS w6 , -r,Spee*-' Elements m _T I 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal V00, 17. Temporary Housing PART 11 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Person(s) Interviewed S '' Inspectors�� �• If Public Buildingsuch as Store or Hotel/Motels specify here P Y HOBBS&WARREN.INC. ,J i -T- fir, ry ! Y[a G3S „ + t 7 S +k►a�cGtao f + ^ f ---------- --------__ f ._ + r ___ ------L' ------- ILI, V�1 U �- t 365 DAYS OF FLY FISHING CALENDAR • WORKMAN PUBLISHING - Flat,calm days on the : that time the fish will Bay Islands,Honduras, _ probably be spooked by TUESDAY are great for bonefishing, the boat. J A N UA RY•19 9 8 because you can spot the o fish farther away.'On o cloudy days,a bonefish could be 20 feet away before you see it,and by VY 7�� I)EXP OBSE WATION IIOLE LOG 11nte# Depth from Soil I lorizon Uliur Soil Texture Soil Color Soil Surfece(in.) (USDA) (Munsell) Mottling (Structure,Stones,Itouldercs. ------------ Ilnlc# DEE4 p OBSCItVATION HOLE LOG Soil other Soll Texture Soil Color Depth from Soll I lorizon Sur race(in.) (USDA) (Munsell) Mottling (Structure,Stories,bouldetes. 1. J Q. PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel Id: 246 035-OOJ- Account No: 335293 Parent : 149636 Location: 558 CRAIGVILLE BEACH RD Neighborhood: 0142 Fire Dist : CO Devel Lot : Lot Size : . 00 Acres Current Own: LEVY, MARK State Class : 102 °sC JOHNSON & CO No. Bldgs : 1 Area: 425 P 0 BOX 1100 Year Added: 86 CENTERVILLE MA 2632 Deed Date : 070192 Reference : 8105/332 January 1st : LEVY, MARK Deed MMDD: 0792 Deed Ref : 8105/332 Comments : Values : Land: Buildings : 22100 Extra Features : Road System: 558 Index: 369 (CRAIGVILLE BEACH ROAD ) Frntg: Index: ( ) Frntg: Control Info: Last Auto Upd: 050695 Status : C Last TACS Update : 020593 Land Reviewed By: Date : 0000 Bldgs Reviewed By: Date : 0000 Tax Title : Account : Taken: Account Status : Hold Status : Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [246] [036] [ ] [ ] [ ] 1 m � P 339 57.8 770 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mai Gee reverse t I�lymber l(/ Pry Me, ZIPICode Postage Certified Fee Special Delivery Fee Restricted Delivery Fee u� Retum Receipt Showing to Whom&Date Delivered Retum Receipt Showing to Whom, Date,&Addressee's Address 0 TOTAL Postage&Fees M Postmark or Date E 0 a Stick postage stamps to article to cover First-Class postage,certified mall fee,and 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 m window or hand it to your rural carrier(no extra charge). m 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the m return address of the article,date,detach,and retain the receipt,and mail the article. U) 3. If you want a return receipt,write the certified mail number and your name and address rn IF on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article 4 RETURN RECEIPT REQUESTED adjacent to the number. Q 4. N you want delivery restricted to The addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. CO 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. ti i 6. Save this receipt and present it if you make an inquiry. CO 4 PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel Id: 246 035-OOA- Account No: 335202 Parent : 149636 Location: 558 CRAIGVILLE BEACH RD Neighborhood: 0142 Fire Dist : CO Devel Lot : Lot Size : . 00 Acres Current Own: LEVY, MARK State Class : 102 %C JOHNSON & CO No. Bldgs : 1 Area: 426 P O BOX 1100 Year Added: 86 CENTERVILLE MA 2632 Deed Date : 070192 Reference : 8105/332 January 1st : LEVY, MARK Deed MMDD: 0792 Deed Ref : 8105/332 Comments : Values : Land: Buildings : 22200 Extra Features : Road System: 558 Index: 369 (CRAIGVILLE BEACH ROAD ) Frntg: Index: ( ) Frntg: Control Info: Last Auto Upd: 050695 Status : C Last TACS Update : 020593 Land Reviewed By: Date: 0000 Bldgs Reviewed By: Date : 0000 Tax Title : Account : Taken: Account Status : Hold Status : Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [246] [035] [OOB] [ ] [ ] 4 FORM3o HOBBS&WARREN,INC. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H A/tTH CITY OWN u W L3 T o r 69 � /� EP MEN PYANAI/,� ADDRESS 70/0—(f�� g ,per G ✓/cLE s Address 6 C416 V I C 9 a Occupan d�I N -�- �'OI.CN j � 1� floor Apartment No. No.of dccupants I LA-,(JA/Ir,,�_ 3 7/ MAX/� No. of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units N r�t rie �k,n, ) � ©� //00 CE��� Name and address of owner �/ /VJ A m c� vV Remarks Reg. Vlo. VLE YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Hall, Floor,Wall,Ceilina� —Hall_L-i htin1 )4 Hall Windows: Cr HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair ail TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: 10 ❑ 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 INSPECTION REPOR. IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALT TOF PERJURY. 0 0 AI INSPECT, TITLE G v M DATE TIME Ail. A.M. THE NEXT SCHEDULED REINSPECTION v� /V� � P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of these 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 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential to fall within this category in any given situation but may not do so in every case and therefore cannot be included in this listing. Failure to include shall in no way be construed as.a determination that other violations 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 the violation(s) pursuant to 410 CMR 410.830 through 410.833 nor shall it 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) Shut-off and/or failure to restore electricity or gas. (D). Failure to supply the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253(A), 410.253(B) and the lighting in common area required by 105 CMR 410.254. (2) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage system in operable .eaudition 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 an object, including garbage or trash, Which prevents egress in case of an emergency 105 CMR 410.450 and 410.451. (H) Failure to comply with the security requirements of 105 CMR 4110.480(D). 5 (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.602 ;vLich.rims ults in any accumulation of garbage, 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 lead-based paint on a dwelling or dwelling unit in :.violation of the Massachusetts Department of Public Health Regualtions for Lead Poisoning Prevention and Control 105 CMR 460.000. (K) � Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or *Alrbent to health or dafety. (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 facilities as are required by 105 CMR 4i0.351 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 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: ('t) 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 operable. (2) failure to provide a washbasin and a shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3) and 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,, gae-fitting, 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. (N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A) through (M) shall be deemed to be a condition which may endanger or-materially ispair 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. { 77 FORM HOBBS&WARREN,INC. THE COMMONWEALTH OF MASSACHUSETTS 1 BO RD OF HEALTH AAA�1/.�,� ITVROWN�—�, 5 W (� EPA TMENfr / 3� rVy -ki VA A) I �z ADDRESS v w / TELEPHONE (l� Address: �/Af�1��V .F- �2,/ cio r floor Apartment No. No.of •ccupants "ju Nt1 No.of Habitable Rooms No.Sleeping Rooms— No.dwelling-or rooming units No.Stori ` e4Us Name and address of owner l� � v Remarks Reg. Vio. YARD Out Bld s:: Fences: V Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: I Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof "N,.. Gutters, Drains: Walls: ' Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: ~' Lighting: 's STRUCTURE INT. Hall,Stairway: O.bst n: / Hall, Floor,Wall,Ceilin i Hall Lighting:---- r Hall Windows: f c/Qutc-1, �. HEATING Chimneys: I Central ❑ Y ❑ N Equip.Repair TYPE: Stacks,Flues,Vents: r PLUMBING: Supply Line: Q ❑ MS ❑ ST ❑ P Waste Line: �� 1 d ` r UD H.W.Tanks Safety and Vents 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 n 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 ` _ - BuildingPosted ,T ` 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 REP OFIT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY.: 0 4 . INSPECTO � JFl!%/�� TITLE. DATEjf TIME P.W. - T,HE NEXT SCHEDULED REINSPECTION01 S"' P.M. s+. 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 these items which are deemed to always have the potential to endanger 'or materially impair the health or safety, and well-being of the opcupants`oi the public. Because Chapter II, 105 CMR 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential to fall within this category in any given-situation but may not -do so in every case and therefore cannot be included in this listing. #allure to include 'shall in no way be construed as•a determination that other- violations may not be found to fall within ,this category. Nor shall failure to include affect the duty of the local health official to order iepair or correction of the violation(s) pursuant to 410 CMR 410.830 through 410.833 nor shall it affect the legal obligation'of the person to whom the order is -I issued'-to comply with-such order.. _ 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.- _ _ j (B) Failure to provide heat as required by 105 CMR 410.201 or improper veating'or use of-a space heater or water heater as prohibited .by 105 CMR -410.200(B) and 410.202. - - (C) Shut-off and/or failure to restore electricity or gas. _ ..,,(D). . Failure_to supply the electrical facilities required by 105 CMR 410.250(B), 410.251(4), 410.253(A), 410.253(B)- and the lighting in common 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 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 angobject, including garbage or trash, _ -which preven.t`s egress in case. of an emergency 105 CMR 410.450 and 410.451. (H) Failure'to comply with the security requirements of 105'CMR 4110.480(D). - - 410.6 0 xhrou h 410.6 2 I Failure to comply with an provisions of 105 CMR 0 g 0 ( ) P Y Y "' ' _ w6leh.results in any accumulation of garbage, rubbish, filth or-other causes - af 'sickness which may provide .a food source or harborage for-rodents, insects ; .-=ar other pests or otherwise contribute to accidents or to the creation or _ -:spread of disease. (J) The presence of lead-based paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health,Regualtions for Lead Poisoning Prevention.and Control 105 CMR 460.000. - f- (K) "Roof, foundation, or other'structural defects that may expose the 'occupant or anyone else to fire, burns', shock, accident or other dangers or - t --�f spatreent to health =or dafety. , - (0 Failure to install-electrical, plumbing, heating and gas-burning _ facilities in accordance with accepted plumbing, heating, gas-fitting and ti - electrical wiring standards or failure to maintain such facilities 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'` j `•to:health or safety.` - - - '� - (M) 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: _ lack of_a kitchen sink of sufficient size and capacity for _. -washing dishes and kitchen utensils or lack of a.stove and oven `- T or any defect that renders either operable. (2) _ failure to provide a washbasin and a shower or bathtub as required in 105 CMR 410.150(A)(2) and 410:150(A)(3) and 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. ginerally accepted plumbing heating,. gae-fitting, 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. (N) Amy other violation of Chapter II not enumerated in 105'CMR 410.750(A) , through (M) shall be deemed m be a condition 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.. P SENDER: m ■Complete items-,1-.emdiorI for'a3`ditional services. I also wish to receive the m ■Complete items 3,4a,and 4b: following services(for an N ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you._ 0 ■Attach this forth to the front of the mailpiece,or on the back if space does not Permit. , ❑ Addressee's Address � � d ■Write'Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery W ■The Return Receipt will show to whom the article was delivered and the date delivered. Consult postmaster for fee. o. '0 3.Article Addressed to: 4a.Article Number r� 71767 e E 4b.Service Type r° .� � �j � [3 Registered JP Certified � to ❑ °t / Express Mail ❑ Insured 5 a [3Retum Receipt for Merchandise ❑ COD a ' 7.Date of Delivery Z - 3 z 5.Received By:(Print Name) 8.Addressee's Addre s(Only if requested c W . and fee is paid) _ tr t- 6.Sig ur (Addre ee en!) 0 a� Ps AIrm5811, Dec 1994 102595-97-B-0179 Domestic Return Receipt t UNITED STPTES POSTAL SERVICE �Op-pMq o� RA • Print your name addre s:�'q d ZIP Code'n tWbox* N Pubile Health DIAlan Town of Bamstable P.O.Box 534 Hyannis'Massachusetts 02601 Illttt111tl flit oil IIIItt111ttt111 Z 203 500 2�7'4 US Postal Service 4 Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sent to Street&Num L'• CfU Post Office,Sate,&ZIP Code P O, Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee Ln Return Receipt Showing to Whom&Date Delivered n Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ V) Postmark or Date LL i 2.. a. / ��� Stick postage stamps to article to cover First-Class postage,certified mail fee,and 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). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q) return address of the article,date,detach,and retain the receipt,and mail the article. 5 f 7 3. If'you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article y a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. ILL 6. Save this receipt and present it if you make an inquiry. 102595-97-B-0145 rn n. C 4 '-PORM3o HOBBS&W_ARREN,INC. THE COMMONWEALTH OF MASSACHUSETTS _ �OA D OF HE ,LT 01 CITYGTOWN c / EPA TMENT VI)MIA //�AD RES / sV° s /7'7 C .0 ,,rrff Address' �t�' Gl.l:--Pa�TY i/cr- pan-/ZU/E NE —Al #1 —(/ Q +� Floor Apartment No. No.of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No.Stories �-f Name and address of owner � f' �? �7 �V ram_ (..� a� Vd Q�.0OARimarks Reg. Vim YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: �. Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: r Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink j ` Stove © ,/„ � Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: ' jpS �. A Wash Basin,Shower or Tub: u /' 12 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 INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." 0 G -47 4 , INSPECTOR // TITLE _ v r A.M. 1 DATE TIME P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 5 1 410.750: 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 these 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 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential to fall within this category in any given situation but may not do so in every case and therefore cannot be included in this listing. Failure to include shall in noway be construed as.a determination that other violations 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 the violation(s) pursuant to 410 CMR 410.830 through 410.833 nor shall it 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 ° ' a6d temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.490 for a period of `24 hours or longer. - - ` (B) -Failure to provide heat as required by 105 MR 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) Shut-off and/or failure to restore electricity or gas. (D) -. Failure -to-supply the electrical facilities required by 105 CMR 410.250(B), 1- 410.251(A), 410.-253(A), 410.253(B) and the lighting in common area required by-105 CMR 410.254. - (8) Failure to provide a safe supply of water. . ,(F)_ Failure to provide a toilet and maintain a sewage system in operable 1. condition as required by 105 CMR 410.150(A)(1) and 410.300. `(G) Failure to provideadequate exits, or the obstruction of any exit, . passageway -or common-area caused by an object, including garbage'or trash, which-prevents' egress in case of an emergency'105 CMR 410.450 and .410.451. (11) Failure to comply with the security requirements of 105 CMR--4110.480(D). Y (I)v Failure to comply with any provisions.of 105 CMR 410.600 through-410.602 �.,Alch_results in any accumulation of garbage, rubbish, filth or other causes 'of sickness which may provide a food source or harborage for rodents, insects -ior other pests or otherwise contribute to accidents or to the creation or - spread of disease. (J) The presence of lead-based paint on a dwelling or dwelling unit in .vi6lation-of the Massachusetts Department of Public Health Regualtions for Lead Poisoning Prevention and Control 105 CMR 460.000. - . -(U). 'Hoof'-foundation, or 'other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or nt to health -or dafety. r 0. Failure to install electrical, plumbing, -heating and gas-burning t facilities in accordance with accepted .plumbing, heating, gas-fitting and - electrical wiring standards or failure to maintain such facilities as fm --ore`requ.ired 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.- - -- _ _ ` ( .__Any of the-followinglcondicions .which:remain uncorrected for a period i _ of five or more days following- the notice to or knowledge of the owner_ _ of said condition or conditions: - . ('t)` 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 operable. (2) failure to provide a washbasin and a shower or bathtub as required _ - --in- 105-CMR 410.150(A)(2) and 410.150(A)(3) and any defect which renders them inoperable. - - s Q) any defect in the electrical, plumbing, or heating system which makes _. such system or any part thereof. in violation.of generally accepted plumbing heating,. gas-fitting, or electrical wiring standards that do not create an immediate hazard. ..,(4)_'tfaiiure 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. (N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A) -through (M) shall be deemed to be a condition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the.oi+ner to remedy said condition within the time so ordered by the board of health. ' PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel Id: 246 035-OOJ- Account No : 335293 Parent : 149636 Location: 558 CRAIGVILLE BEACH RD Neighborhood: 0142 Fire Dist : CO Devel Lot : Lot Size : . 00 Acres Current Own: LEVY, MARK State Class : 102 C! JOHNSON & CO No. Bldgs : 1 Area: 425 P O BOX 1100 Year Added: 86 CENTERVILLE MA 2632 Deed Date: 070192 Reference : 8105/332 January 1st : LEVY, MARK Deed MMDD: 0792 Deed Ref : 8105/332 Comments : Values : Land: Buildings : 22100 Extra Features : Road System: 558 Index: 369 (CRAIGVILLE BEACH ROAD ) Frntg: Index: ( ) Frntg: Control Info: Last Auto Upd: 050695 Status: C Last TACS Update : 020593 Land Reviewed By: Date : 0000 Bldgs Reviewed By: Date : 0000 Tax Title: Account : Taken: Account Status : Hold Status : Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] r Parcel Number [246] [036) [ ] [ ] [ ] � 1 No. Fee $5 0 . 0 0 THE COMMONWEALTH OF MASSACHUS TTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for 30ig;paal bpotem Construction 3permit Application for a Permit to Construct( )Repair(x)Upgrade( )Abandon( ) El Complete System El li dividual Components Location Address or Lot No. 558 Cr a i gv i l l e Court owner's Name,Address and Tel.No. (7 81 ) 2 3 7—8 8 8 0 558 Craigville Beach Rd, Centervi le Mark Levy -One Washington St Assessor's Map/Parcel Ste 300 , Wellesley, MA 02181 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. PO Box 1089, Centerville W E Robinson Septic Service Type of Building: 5 sm Cottages Dwelling No.of Bedrooms 8/1 0 Lot Size sq.ft. Garbage Grinder(nq 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. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) Title 5 Leaching to existing 2 5 0 0 g tank. Remove old galleys and install D-box & 9 H-20 stonepacked PEcast 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 B aard of He h. Signed Dates-fir' Application Approved / Date.2F— Application Disapproved for the following reasons Permit No. Date Issued ��� No. Fee $50.00 ') THE COMMONWEALTH OF MASSACHUS TTS Entered in computer: Yes PUBLIC HEALTH DIVISION =TOWN OF BARNSTABLE., MASSACHUSETTS - ZppYication for Mi*ga �potem Congtruction Vermit Application for a Permit to Construct( f)Repair(?C)Up de( )Abandon( ) El Complete System E 'Intiibtdualc,np nent� ! 1 >t -L'ocation#Address or Lot No. 5 5 8 Craiggville 0urt Owner's Name,Address and Tel.No. (7'81 )2 3 7—8 8 8 0 * 558 Craigville Beach Rd, ,Cettervi le Mark Levy -Qne Washington St ` Assessor's Map/Parcel • Ste 3004 We l l e s l ty, MA 02181 Installer's Name,Address,and Tel.No. 7 7 5—S7 7 6' Designer's Name,Address and Tel.No. PO Box 1089, Centerville --_ W E Robinson Septic Service Type of Building: 5 sm Cottages ., �,7,5 0t Dwelling No.of Bedrooms 8/1 0 Lot Size sq.ft. Garbage Grinder(ng Other Type of Building N of P rsons Showers( Cafeteria( ) # Other Fixtures w Design, low gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title t Size of Septic Tank Type of S.A.S. 't Description of Soil sand i1t l b e Nature of Repairs or Alterations(Answer when applicable) Title 5 Leaching to existing 2500g tank. Remove old gallys and install D-box & '9 H-20 stonepacked .' pecast leach chambers. Date last inspected: 1 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 B and of He r Signed ' Date '9-5-9 I Application Approved Date Application Disapproved for the following reasons Permit No. Date Issued ''' �! { ———————— -- —————— — t-------=L - - - - THE COMMONWEALTHOF MASSACHUSETTS Lev `° Y ARNSTABLE, MASSACHUSETTS `'1 , Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(XX)Upgraded( ) Abandoned( )by at 558 Craigville Beach Rd, Centerville has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer W E Robinson Septic Sry Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date - Inspector No. ���' `�� --------------------------Fee $50.00 THE,COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLE., MASSACHUSETTS Levy,,,, �- 'igpogat 6pgtem Congtruction Vermit ,j,Frmission is hereby granted to Construct( )Repair(XJ�Upgrade( )Abandon( ) System located at 558 Craigville Beach Rd Centerville Installer: W E RObtbnson Septic Service and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this porput. �, Date: �-' � 7 10 Approved 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 ENGINEERED PLANS) I, _William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated 3" concerning the property located at 558 Craigville Beach Road, Centerville, meets all of the following criteria- * There are no wetlands within 100 feet of the proposed leaching facility. * There are no private wells within 150 feet of the proposed septic system. ASSESSORS MAP NO Le-) * There is no increase in flow and/or change in use proposed. PARCEL NO. , �Z Ci 0-'0 A,- There There are no variances requested or needed. * If the proposed leaching facility will be located with 250 feet of any 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 Elevation(according to the Engineering Division G.I.S. map) B)Observed Groundwater Table Evaluation(according to Health Division well map) SIGNED: G, l t �. DATE LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). 3 _,__ � �� �� ---- A �d r �`` ., s ��� __� n TOWN OF BARNSTABLE LOCATION 4� je c/ SEWAGE S #C�c� _. VILLAGE C•y_w �Yr / ASSESSOR'S MAP & LOT '(,� '• t INSTALLER'S NAME&.PHONE NO. SEPTIC TANK CAPACITY 36 6-<-) ' LEACHING FACIL=: s a�ej w. L G • . (type) (size) NO.OF BEDROOMS ZQ BUILDER OR OWNER PERMTTDATE:_/Z -.-.'V—<.-c-•-a COMPLIANCE DATE:./.X-- Separation Distance Between the: - Maximum Adjusted Groundwater Table to the Botto of Leaching Facility Feet Private Water Supply.Well and Leaching Faci (If any wells exist on site or within 2W feet of leaching fa ty) Feet' Edge of Wetland and Leaching Facility.(If any wetlands exist within 3.00 feet of leaching facility) - Feet ' i Furnished b y .. . .. .. r---r I uh � �# o T � - °s Commonwealth of Massachusetts Executive Office of Environmental Affairs R` «�� :3 FEB Department of 996 Cb Environmental Protection WOF Wllllam F.Weld Gommor Trudy Coxe SseretW EOEA David B. Struhs CommiWoner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i3-,a-C_1t Aa PART A /)_-r CERTIFICATION Property Address: V Address of Owner: Date of Inspection: / ;-3--`J IC (if different) Name of Inspector: W.E. Robinson Sr. Company Name, Address and Telephone Number: W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT g-7 7�77--77 I certify that I have personally inspected the sewage dispbs l s�sCerh6at this address and that the information reported below is true, amrate and complete as of the time of inspection. The inspection was performed, based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: t✓Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: l t Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shalt submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: A]:711 M PASSES: 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. B] SYfST M COND ITIONALLY PASSES: O e or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, p s inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not] The septic tank is metal, 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 8/15/95) 1 One Winter Street a .Boston,Massachusetts 02108 a FAX(617)SW1049 a Telephone(617)292-UN 40 Printed on Recyded Paper S � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: �` iZ ell-IC h Iq 17 le/ ly�h�'►�cS /��J� f Owner: r ld A e v� Date of Inspection: p B] SYSTE 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): 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] FURTHER ALUATION IS REQUIRED BY THE BOARD OF HEALTH: „ Conditio s exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public he Ith, safety and the environment. 1) SYSTEM ILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH W LL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ C sspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE N ENVIRONMENT: _ The cvstem nas a septic tank and soil absorption system and is within 100 feet to a surface water supp:y or tributary to a surfa a water supply. The has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The s stem has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supple 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• D] SYSTEM FAILS: I have determined th t the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or dogged 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. (revised 8/15/95) 2 1 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) i'xa-c A RZ? Property Address: Owner: YY1 hr X °f -a Date of Inspection: l—;L 3—C D)SYSTEM ILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ny 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 SYSTEM AILS: The follow ng criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the en ironment because one or more of the following conditions exist: he system is within 400 feet of a surface drinking water supply the stem is within 200 feet of a tributary to a surface drinking water supply the sylIstem is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a p7bl"t water supply well) The owner or operaf any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 R 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of Inspection: / -3 ^� Check if the following have been done: _2"ping information was requested of the owner, occupant, and 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 as part of this inspection. k'/�As built plans have been obtained and examined. Note if they are not available with N/A. .,, he facility or dwelling was inspected for signs of sewage back-up. 4./rhe system does not receive non-sanitary or industrial waste flow _&�he site was inspected for signs of breakout. . Il system components, excluding the Soil Absorption System, have been located on the site. _ ( he 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. jz1he size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. J,'T/he facilit,t o�%ner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION s�-K cro,y�I'l%- 13���h A Property Address: 2 U� Owner: {')'1 R r K J� Date of Inspection: ).—,r�J a to FLOW CONDITIONS RESIDENTIAL: Design flow:(gallons Number of bedrooms:I Number of current residents:_ Garbage grinder(yes or no): Laundry connected to system (yes or no): y' Seasonal use (yes or no):_ Water meter readings, if available: 19 9'Lf -L//O UOd Last date of occupancy:_L=_?--3--� COMMERC NDUSTRIAL: Type of establish ent: Design flow:jreadi allons/day Grease trap yes or no)_ Industrial Wing Tank present: (yes or no)_ Non-sanitaryscharged to the Title 5 system: (yes or no)_ Water meter , if available: Last date of occup ncy: OTHER: (Describe Last date of occup ncy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no) r/ If yes, volume pumped. Qallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool nvy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: 3�y/k 16 J Sewage odors detected when arriving at the site: (yes or no) ifl (revised 8/15/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: L5-,5-� Gr��%'(// ��e. - 13��G� Iry av • ,�ys lrl/S �✓o/'.� Owner: m4rk ktv// Date of Inspection: SEPTIC TANK: 10 (locate on site plan) a � Depth below grade: f 3 Material of construction: ✓concrete metal _FRP—other(explain) Dimensions: G G -N 7 4, ) Sludge depth: "3 Distance from top of sludge to bottom of outlet tee or baffle: S'A Scum thickness:/' j Distance from top of scum to top of outlet tee or baffler ,/ Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet lees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) C Of 0`C- 4 � GREASE P:_ (locate on s(a plan) Depth below g de: Material of cons uction: _concrete _metal _FRP_other(explain) Dimensions: Scum thickness Distance from top o scum to top of outlet tee or baffle: Distance from botto. of scum t� hot-tom of outlet tee or baffie: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc., (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: M,r/" ),-e—v Date of Inspection: 6,V-3_4 61 TIGHT OR HOLDING TANK:_ (locat�on site plan) Depth bel. w grade: Material o construction: _concrete_metal _FRP—other(explain) Dimensions: Capacity: Rallons Design flow: allons/day Alarm level: Comments: (condition o7inlette ondition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: d Comments: (note if level and distribution is equal, e,,idence of solids carrlo•:er, evidence of leakage into or out of box, etc.) PUMP CHAMBER: (locate on site plan) Pumps in working order:(ye or no) Comments: (note condition of pump charftber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Ss'�- Owner: m 4rl< e-V Date of Inspection: / —X SOIL ABSORPTION SYSTEM (SAS): L (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: A i R TO n 10 Type: leaching pits, number:_ leaching chambers, number: leaching galleries, number: - G `1 dt Pac��.s I o leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) CESSPOOLS: (locate on site Ian) Number and co figuration: Depth-top of liqu d to inlet invert: Depth of solids la er: Depth of scum lay r: Dimensions of ces ool: Materials of constr lion: Indication of groun.watei: inflow (c Is spool must be pumped as part of inspection) Comments: (no condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of constructio Dimensions: Depth of solids: Comments: (note conditi n of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) kl (revised 8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) �' c/ C'�'ig/ylii l�C.. /fie�c,Gl /� D lc/. �y�hhiJ �i•�` Property Address: Owner: /n / Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM:' include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' �Ll �L v S°8 f r 5 / , , •1 e ( •w` ` y 3 ITe DEPTH TO GROUNDWATER Depth to groundwater: ! --A feet method of determination or approximation: l C`5 f 146 ki et (revised 8/15/95) 9 TOWN IOF BARNSTABLE BAR-W 556 Ordinance or Regulation WARNING NOTICE I Name of Offender/Manager a J-P L'1!j CO N��+ �'�h 4- t. 0 Address of Offender 80k- // Qj> MV/MB Reg.# Village/State/Zip ( J2�i+ �y// �1.. 141 A 6-16 3 2 Business Name ! !V am/ m on Z Business Address Signature of nforcing Officer Village/State/Zip n1 Location of Offense SSA ,I us ll� �C� /mod � Enforcing Dept/Division Offense !J w -a Facts �!/ e2 _ Akt'e ,. 11401d #- ale f 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 BAR-W 556 Ordinance or Regulation WARNING NOTICE 9 Name of Offender/Manager fwap Lp ✓!!f (1/6 V h. 4-- 62 Address of Offender �, (� • p D k' // Q j MV/MB Reg.# " Village/State/Zip � hy��(,! ! �• , � Business Name _V=amKmD on _19 Business Address w,a �,,,e 1411 ,,;,+_-4 , 41 S gnature of 9dforcing Officer Village/State/Zip I Location of Offense ct-a.r rut l/V sear' En orcing Dept/Division Of V01 ' . n C C aesw Facts c/ d !! - lac. ' ^,7"1 Cd 4- V. 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 BAR-W Ordinance or Regulation WARNING NOTICE Name of Offender/Manager ar& ,'t,/y C/ Address of Offender , o • E D r 11 ,06 MV/MB Reg.# Village/State/Zip e0h, - "4✓11 Business Name /" 0amgm-) on Z/// 19 Business Address �� Signature of Enforcing Officer Village/State/Zip Location of Offense 'yrrr�►rl!"B �✓ En orcing Dept/Division Offense A21A C`r r �'e!i 1,74.,,t-r U Facts , € i r �' i �1� , . " A..-- �� ttw'x ..r # 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.