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Home My WebLink About0382 MAIN STREET (CENT.) - Health 3 82 Main Street Centerville A=208 —043 S M EAD No.H163OR UPC 10259 smead.com • Made in USA �'�ier r e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - 382 Main Street Property Address Daniel Hostetter Owner Owner's Name information i e required for every Centerville Ma 02632 5/1/2013 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:When filling out forms A. General Information ((�� on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection, �y Company Name 74 Beldan Ln. -��-- Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com S14522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection_The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails rya ❑ Needs Further Evaluation by the Local Approving Authority _ 5/1/2013 Inspector's Signature Date ^ .= The system inspector shall submit a copy of this inspection report to the Approing Authority(Bond of Health or DEP)within 30 days of completing this inspection. If the system Is a shared system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall subfrtlt the report to the appropriate regional office of the DER 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 Inspecti o ubsurface Sewage Disposal yste page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 382 Main Street Property Address Daniel Hostetter Owner Owner's Name requinform r on is Centerville Ma 02632 5/1/2013 requiredd for every page. CityrFown 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 dwelling located at 382 Main St Centerville lis served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 2 1000 gallon precast leaching chambers. The system was found to be in proper working condition at the time of inspection. 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-3/13 Title 5 Official Inspection Form: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 , 382 Main Street Property Address Daniel Hostetter Owner Owner's Name information is required for every Centerville Ma 02632 5/1/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): I ❑ 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 M 382 Main Street Property Address Daniel Hostetter Owner Owner's Name information is required for every Centerville Ma 02632 5/1/2013 page. Citylrown 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. I ❑ 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 cesspool is less than 6" below invert or available volume is less than Yz day flow t5ins•3/13 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 382 Main Street Property Address Daniel Hostetter Owner Owners Name information is required for every Centerville Ma 02632 5/1/2013 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. ❑ ® 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 M 382 Main Street Property Address Daniel Hostetter Owner Owner's Name information is required for every Centerville Ma 02632 5/1/2013 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? ❑ ® 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): 4+ Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 1097 gpd provided t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 382 Main Street Property Address Daniel Hostetter Owner Owner's Name information is required for every Centerville Ma 02632 5/1/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 9/2012 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•3/13 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 382 Main Street Property Address Daniel Hostetter Owner Owner's Name information is required for every Centerville Ma 02632 5/1/2013 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information I 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-3/13 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 382 Main Street Property Address Daniel Hostetter Owner Owner's Name information is required for every Centerville Ma 02632 5/1/2013 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: system installed 7/22/1987 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: i ❑ 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.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 1 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: 6" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 382 Main Street Property Address Daniel Hostetter Owner Owner's Name information is required for every Centerville Ma 02632 5/1/2013 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 3 Scum thickness 3" 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, 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 should be cleaned soon and again every 2 years for proper maintenance. Water level was even with outlet, tank was not leaking and was structurally sound. Outlet baffle was intact and in good condition. t 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•3/13 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 °r 382 Main Street Property Address Daniel Hostetter Owner Owner's Name information is required for every Centerville Ma 02632 5/1/2013 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �M 382 Main Street Property Address Daniel Hostetter Owner Owner's Name information is required for every Centerville Ma 02632 5/1/2013 page. Citylrown 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.): Distribution box was in good condition, no rot, water level was even with outlet invert. i Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 382 Main Street Property Address Daniel Hostetter Owner Owner's Name information is required for every Centerville Ma 02632 5/1/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: i ❑ 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. ):9 ) , System consists of 2 precast leaching pits. Leach pit#4 on attached as-built was found to be dry with a stain line T from the bottom indicating that it has never been more than 50%full. Leach pit#5 on attached as-built was located but not excavated. ' 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-3/13 Title 5 Official Inspection Form!Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 382 Main Street Property Address Daniel Hostetter Owner Owner's Name information is required for every Centerville Ma 02632 5/1/2013 page. City1rown 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 Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 382 Main Street Property Address Daniel Hostetter Owner Owner's Name information is required for every Centerville Ma ' 02632 5/1/2013 page. Cityrrown 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 Pr Z p A-2 G-Z D_9* o o A 3 1-11'(." N-3 3S ' L A u+ P S A-y Z /3- y6 -s -73'1." yy (Sins•3113 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 382 Main Street Property Address Daniel Hostetter Owner Owner's Name information is required for every Centerville Ma 02632 5/1/2013 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: 12'+feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date 87 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: t ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Design plan dated 7/1/1987 indicates that no groundwater was encountered at 12'. Bottom of deepest leach pit is 10' below grade. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 382 Main Street Property Address Daniel Hostetter Owner Owner's Name information is required for every Centerville Ma 02632 5/1/2013 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist E 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 ® P Y 9 E 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 TD REALTY TRUST 770B1 Main Street Osterville, MA 02655 Tel: (508)428-2828 Fax:-(508)428-1974 May 27, 2011 Jimmy Mendonca and all other occupants 382 Main Street Centerville, MA 02632 Re: Outdoor gatherings -Dear Mr. Mendonca-and-others: Please be advised that we have received complaints about excessive noise coming from your rental property after 10 PM on May 25, 2011. It is our understanding that the Barnstable-police were called in. We realize thatyou have every right to enjoy the outdoor area of the leased property but we do ask that you be sensitive to the neighbors right to quiet nights. Centerville is a lovely, old village and the long-term residents value the-peaceful style of the neighborhood. We hope that there will be no future complaints that may warrant further action. `Wishing you a-good Cape Cod Summer! Sincerely, Judy McAbee Agent, TD Realty Trust cc: Timothy O'Connell Town of Barnstable Dept. Of Public Health YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$160.00 for 4 v ars). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to Tperate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: <; /'7/'_/ Fill in please: APPLICANT'S YOUR NAME/S: A S S I L UA BUSINESS YOUR HOME ADDRESS �, Pti N S"T CEN i U i ULI` — Y-t A 06 ' TELEPHONE # Home Telephone Number NAME OF CORPORATION- NAME V NAME OF NEW BUSINESS P' S ' N k Sl✓2u�Cl~S . TYPE OF BUSINESS S�V �I 1 R1 Cr IS THIS A HOME OCCUPAT \. YES NO Q ADDRESS OF BUSINESS 1M TES- IvT W(-�E -Ml� 0�2b MAP/PARCEL NUMEiER O 0 ®q (Assessing) When.starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** I � COMMENTS: -- w 2. BOARD OF HEALTH This individual ha e n i tornWd gf the jWr it requirements that pertain to this type of business. a lyj E Yhorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) cyCM This individual has been informed of the licensing requirements that pertain to this type of business. - r- n Authorized Signature** COMMENTS: Certified Mail#7008 3230 0002 5177 9251 v�THE Tp� Town of Barnstable y t Regulatory Services tY 4 u RARNS"CAbLE,i+ +fd , is. f� Thomas F. Geiler, Director �! t639/1$ pp ArFb Aga, Public Health Division s U� Ci Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 t July 21, 2010 411 �e ,111 Adam Hostetter 770 (B) Main Street �. Osterville, MA 02655 1.0 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY, CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 382 Main Street, Centerville was inspected on July 21, 2010 by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received at the Town of Barnstable Health Division. the following violation(s) of the State Sanitary Code were observed: ,/105 CMR 410.500 - Owner's Responsibility to Maintain Structural Elements: Broken windows in many different locations throughout this dwelling. Windows within enclosed porch area are in the need of replacement due to excessive rot. Bedroom on first floor had windows that were to leaking. It was also observed that ceiling within living �oom area was damp to the touch. This is due to either a faulty pipe or a breached roof 105 CMR 410.480 — Locks: Windows within first floor bedroom are not capable of being locked. 105 CMR 410.100 — Kitchen Facilities: Stove not working properly. (Shuts off randomly). �105 CMR 410.750 - Conditions Deemed to Endanger or Impair Health or Safety: Observed human feces on floor of bathroom within garage. Also observed feces within toilet which was not functioning properly (will not flush)._ QAOrder letters\Housing violations\Rental ordinance\382 main street Street.doc You are directed to correct the violations listed above within Thirty (30) days of your receipt of this notice by repairing all the broken windows throughout property; by replacing windows within enclosed porch; by replacing or repairing windows within first floor bedroom so they no longer leak; by alleviating all sources of chronic dampness (i.e. roof, leaking plumbing); by repairing or replacing stove so that it works as intended to. You are directed to correct the violations listed above within twenty four (24) hours of your receipt of this notice by insuring all windows are capable of being locked; by removing all feces in garage bathroom and sanitizing said bathroom using best industries practices. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OFT BOARD OF HEALTH Thomas A. McKean,R.S., CHO Director of Public Health + Town of Barnstable F QAOrder letters\Housing violations\Rental ordinance\382 main street Street.doc FORM30 !\&W HOBBSB WARREN'M THE COMMONWEALTH OF MASSACHUSETTS BOAR F 4HjZLT-*i CITY/ N 4 W o P MENT � c6b ADDRESS ��M grey`0 TELEPHONE Address ✓ Occupant_ Floor Apartment No. No.of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming u64�� . to s Name and address of ow Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: C STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: 5 ` Dampness: -- / Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceilin : t � Hall Lighting: Hall Windows: t 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.: 11110 ❑ 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, afeti s: Kitchen Facilities Sj tov Bathing,Toilet Facil. t., Plumb.,Sanit' .: yu 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.(Se Over) "THIS INSPECTION REPO S SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTLS8,ff7ERJUt . PINSPECTOR TITLE A. DATE `+ 2- 16 TIME V M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises,shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other,violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. ` (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) .Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. e .,(H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. ...,.-.. ..�,.,..._i—w.�`.;,rrcrs`'"+..-.�,.�,fy..v:,r•.....fi.'Ylr'ti,.---".-..-..--••^v.._....- ......,"^,r..... .._ _. - - - < ... ^._a•4.C�,..•,x'"•�UL'•T"'ao..�\"...�::-..`�^`x.,.J`L..rt'+,-w.f.�...,T..{'1•if.dr.��•;r...+.-... M L}}() FORM30 H&W HOBBS&WARREN'" THE COMMONWEALTH OF MASSACHUSETTS C�. BOARD�OF HE�A/1LT-H .CITY/TOWN W a MENT d66 ->� FPARTgqx .- 9 ADDRESS P` 'G1M SVBy`ew 1 TELEPHONE i Address 3 Occupant_ Floor Apartment No. No. of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No toribs Name and address of owne /Jt 7� ,,� Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: E """ '..fix, '', C 4n STRUCTURE EXT., Steps,Stairs, Porches: Dual Egress:and Obst'n,',,*',, ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: r e. Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: ACf Li htin : q STRUCTURE INT. Hall,Stairway: , LA D%l Obst'n.: // Hall, Floor,Wall,Ceiling: wQ Hall Lighting: i X- c'�C""-' Hall Windows: Chimne s: p , ' �(J HEATING Central ❑ Y ❑ N Equip. Repair •�' TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS DST, ❑ 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: tl DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pant 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 sAlk tove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation , Rats, Mice, Roaches o'r 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 PENALTJ, ,FPO_PERJURY." INSPECTOR td� TITLE I' A.M. DATE TIME A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation,any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. 4 Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. I TOWN OF BARNSTABLE LOCATION ,,3�1,,� i'�/,c� rti �� SEWAGE # a ASSESSOR'S MAP & LOTA0F - `,�r INSTALLER'S NAME & PHONE NO.Z,ff SEPTIC TANK CAPACITY /S a 0 G. LEACHING FACILITY:(type) (size) to al�f. NO: OF BEDROOMS PRIVATE WELL OR UBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTEDr'r.`Yes No r � �/v' 4 � `� . Flu - �.. �, ,�F. .� � �� z -� �l� DESIGN DATA �\ STRUCTURE Simcaua F- e Dwt=l jr,4 / DESIGN FLOW 1% „ \ -4 X it c> In.P,. Ui. = 44iD G.P. D. ,r 2 �� -4-40 X 1 . Z -- k:.I� ✓� Ee_& F-LATt= SEPTIC TANK r LEACHING RATES : SIDE AREA GPD/SF 2r6. e.-r4 ' CFI BOTTOM AREA c) GGPD/SF flf } \ID5� ' LEACHING FACILITY LD j � 1 Al2P: � rX}T Xe, ' Z ✓' LY�� . AQUA C 1 t x t 2 1 •X = 1 7 S.F. i Ts r � 1 7 >C C� i DcD 7 !to t PLAN REFERENCE '�i,� ,� -' E3a�-rP.� •� �urv-xY �t�;Tr � c,� des ��A ��\j PCAtJ 1 co 11co, s H 17- 2 I (OF t ��' ' , `ram ASSESSORS LOT NO. HAP 20� / RA1�Ej_ 43 i /PLATS NOTE: - �.>,.�. nt , ,t % �6� S, 1. ALL MATERIALS AND CONSTRUCTION METHODS LjJ ` 'f 8•R.E. t PLATS TO CONFORM WITH COMM. F�� 0 MASS. TITLE 3E ENVIRONMENTAL CODE / ` a CvMPU'T�.L� LL7T AZE,.A 15. ram`?4 S. •4`J p /hCeES �1 I Yf �Xl�T1NC-�• C=C�I�1TC�1)!Z_ -2 3. I `AV, � CJX\ ' g.Q Q- ATE f It LP.a U146 � � < '0,C (G 1 I / \� �.C'G�•`L3t raOL^T'J i�.E AE.AN 1 .T1 ��', '• �'`V 1 F,s / � F a � ,\ \ �'?..( `� 9S 1�11 �i' `` � ,;\ lZ� : L,.�_>v�r�� A�f�� .r-,Q - >`�� 2r_� . FAQ?_. •4�, SL.)F�T`rZ..T` L.�T' a�'a:<_. v ', % % 1 � o Ali M A i n-A S'T i i�TE/Ly I LE , 1�4 A�S . , i / `�` ',,-�. <''1, \ Gj� S C; 'T i F`f TC: THEE t�i ice'`( Pd A L c AY 1 r�K`7 e Al��K At t D 1 Z'` T I T lF Rom )ZS w z s•�.�o.H. � r, Itv.�urL.In1c-i ('�`7MP,RrvY 4VH�T" 7(E T AFL SKE c H �Q< ; �j , P 1. THE►'E ARE t,1p Viaov.,N ��. E)► r 01*_1 )%.3E�� -V-c* T`r C NOT ,� s�t�) 7jr .� V151P4 E ENCWAC_s M1EirT=, INTE�LJ L_ u1DEt_!NE }�i�\�I �.sQt Y AEbt� P�!^L _ P>7 STAD A LCnCA T L: III S , Qom. JAN. 1929 CC1)u"T`( LAYc_-)U•T N Of JOHN tiG DAVID. 9, ► EKISTINC 1JWE : t ir> 1� 'l o L A7L� I N t�E=SAT 6 d.S 1 1 P Tc M c N V c. MEND SN�\+.irJ �cv i>tA►.1 1t�Dlilc' LTF_� `�!ir.sC7 f.;`f 1��1 \ i o L 7HULIN \ �=57.7E 98744 �o No. 2 Locus w iT>- m L_cr- t) zc*,iE C , /� Ncint HAZAfLD AoZE ; R - STI. Q o �r1MuN ►TY �r'ANL N� �SC>QG�1 C�20B , S �SE� = 1�- O1 - 8�. y� EGI GI E� "u"IS' l !NE _ SAN. 1�32t'3 ��.1 t\�11 fii 11 LAN�s� IFS COUNTY UNYCOr C1cN�KVli�L1_- \ HYDRANT MAPSTC*4.S M1t r� f��4� , , �� Y! w�Ti c�TF_ c 16� , sN. MO i>F ,® I _ - P LA N INN oAT� RDLE zs124 SCALE 1" 0-na a,r I-WQt7 Nv-so-0 TEST PIT NO. 1 TEST PIT NO. SOIL OBSERVATION PITS �+Li__ �_aJ � 'a•�''�."=;�� `�'1(1{�'T MJ�i AraS7 Ph'.�'05EL lam _ ELEV. , T7. ELEV. DATE OF TEST -�_ - ____ ENGINEER MOTs --- - INV - 9.n B.O.H. AGENT rj J A EXCAVATOR _ - PERC RATE P NO T -- , IN T. IN. �. .� A ` F �. � M / ` J c , n� , 1 • i ELLIS & TH ULIN INC. 4� 1a � 2�' ,2.s 2 2. � LAND SURVEYORS AND CIVIL ENGINEERS l EAST SANDWICH, MASS. SECTION THR U SEPTIC SYSTEM '' SCALE 1 = HORIZ. tS' VERT. r