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0385 SHOOTFLYING HILL RD - Health
385 Shootflying Hill Rd Centerville ( o A = 214 059 0 OPSndaftwer 1521/3 ORA 10% P2 Bk 32351 Ps 14 7 48529 14-03-2019 & S.k PO r„�I DEED RESTRICTION WHEREAS, VPl D1 Ne1 Q�qn/ 6eIQ of - (owner's. ame)-- Cox✓/( s-- MA �8 s�Qcr 1-L-yi� l�.%/ / (address) j is the owner of 3,�3 5,,4 61— 6yle/ 'S � JfJ located /1 (address) at �Ci�7 cc/r/fcs ZOZ MA (hereinafter referred to as �- and being shown on a plan entitled "Subdivision of Land in MA, Property of - et al, duly recorded in Barnstable County Registry of Deeds in Plan Book a Page ; Or on Land Court Plan Number WHEREAS,O� '�'''�� ^d �'`� as the owner of said lot has (owner's name) . agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compiance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of. a building permit for the construction of a single family home on this property, is requiring that the agreement for the restriction on.the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, JI deedr U g Cf ...e -"4 «. w'.Y;. :n,• :r Jar NOW, THEREFOR "' D 21t ^- oes hereby place the (owner's name) following restriction on his above-referenced land'in accordance with his agreement with the Town of oarnstable 0oard of nealu ., wi lice l restriction iction shall run with the land and be binding upon all successors in title: 3XS -S f � L�iN� l ' e�jl 1 Ili may have constructed (address) } cc upon th lot a house containing no more than (j- ) bedrooms. X ;r QV (� agrees that this shall be permanent deed � owner's name). restriction affecting located on MA, and being shown on the plan recorded in Plan Book `� _ , Paged 0 Or on Land Court Plan For title of see the following deed: Book �� , Page _ . Or Land Court Certificate of Title Number ecuted as a sealed instrument �(�+ `day of ���'"t 4019 C wner's signature er's signature � \j Owner's signature COMMONWEALTH OF MASSACHUSETTS - ss 20_L9 Then personally appeared th above-named known to me to be the peVson who executed the foregoing instrument and acknowledged the same to be M Or N2, free act and deed, befor SARNSTASLE REGISTRY OF DEEDS. John F. Meade, Register 4f4V Notary ` V Public ,,414,01\0IA My commies n e pires: x (date) CO' +>}r "; °,k,� FELICIA FASIKU deedr �®Wr POP'.®ii" 2 e Notary Public .s, ` i T Al ��� '. / commonweanh of Massachusetts � r- 202$ My Commiss'on Expires April 25. t No. Fee (�� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpplication for Bisposal 6pstrut Construction 3pertttit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. j�f m ��j(9 H1 V owner's Name,Address,and Tel.No. #pO ll fl V f4t Assessor's Map/Parcel �` 7 G -4 Q n A R e 13 ICG%f7 R. Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Buil g: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building bn)� � No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided , 3 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Db i7 Type of S.A.S. 02 S-va Description of Soil c Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance.with the provisions of Title 5 of the Environmental Code not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. a 0/ Date Issued No. PLO[Ll I�O 1� I " Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes �r PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Bisposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ',❑Complete System ❑Individual Components Location Address or Lot No. 3 (, t��!/J 1 V Owner's,Name;Address,and Tel.No., #po 1119 qf4df Assessor's Map/Parcel 9 —S O G -1 0 4 n a dL 713 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Buil g: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.No.of Persons . Showers( ) Cafeteria( ) Other Fixtures '. Design Flow(min.required) 33 D gpd Design flow pri$ed l N9, 3 3 gpd Plan Date Number of sheets Revision Date Title l, Size of Septic Tank 10670 Type of S.A.S. 0d -ypZ GLI- S Description of Soil '�4 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code a not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed—I Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No.2 a/L�` �' Date Issued L� -/' f / --------------------------------------------------------------------------------------------------------------------------------------- ,,` THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Urtifirate of Compliance THIS IS TO CERTIFY, ,t� w that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )b oc/16 7(,S�m at s �� has been constructed in accordance / with the provisions Ti)1 5 and the /for Disposal System Construction Permit No.aZ GIU-- dated '-f C7—� I Installer ballllpYel / �KQ Designer 0 c e_C #bedrooms Approved des' flow 3 33 gpd The issuance of t 's ptrmit s ll no be construed as a guarantee that the system n /•e ig ed. e Date Inspector i V a No.go/ `I— 1 L6 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 30lsposal 6pste onstructlon Permit, Permission is hereby granted to Construct( ) Repair( Upgrade,( ) Abandon System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 permit.-, C Date R Approved by I , Town of Barnstable Regulatory Services Thomas F.Geiler,Director Public Health Division #' Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Sewage Permit# Assessor's Map\Parcel�,� Designer: Y17 li Ssoe leS Installer: &et/ )t�;Xyk- Address: � //f Address: ItIP-L) On was issued a permit to install a (date) (' staller) septic system at / hUl based on a design drawn by (a ress aA�140hos dated '-l�'-1 (designer) l certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built b designer to follow. OF MASS�c� (Installe S ture) VON h01 E �1063 /ZQesigner's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. t Q:Health/Septic/Designer Certification Form 3-26-04.doc TOWN OF BARNSTABLE LOCATION O / SEWAGE#_O /�Z 'VILLAGE Cft4a l OR'S MAP.&PARCEL INSTALLER'S NAME&PHONE NO. )'ske4e, - SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ';'00 &&b [)awJuJJ (size) NO.OF.BEDROOMSII OWNER ..���1lA✓7/7 a,, PERMIT DATE: -�9-I Z{ COMPLIANCE DATE: q" BZj ' Y Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist ori` site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet _ FURNISHED BY B 4 3 q7 : � 83 -- THE Town of Rarnstable Barnstable T°may Regulatory Services Department ;eficaCRy I • BAEtNSTABLE, • public Health Division Y MASS. �G ffD MA1" 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Intrim Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 2620 April 15, 2014 Johanna Dacey - 385 Shootflying Hill Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. The septic system located at 385 Shootflying Hill Road, Centerville, MA, was last inspected on 3/28/2014 by Sean M. Jones, a certified septic inspector for the State of Massachusetts The inspection of the septic system showed that the system"Failed"under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER O OF T E BOARD OF HEALTH Thomas McKean,R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\385 Shootflying Hill,Cent 20.14.doc I i Parcel Detail Page 1 of 3 f � _ Logged In As: Parcel Detail Monday,April 14 2014 Parcel Lookup Parcel Info Parcel ID 214-059 Developer Lot LOT 1 • Location 385 SHOOTFLYING HILL RD I Pri Frontage 1125 - I Sec Sec Road i Frontage - Village CENTERVILLE Fire District rC-O-MM Town sewer exists at this address No I Road Index 1484 riy x - Asbuilt Septic Scan: Interactive 214059_1 Map Owner Info Owner DACEY, B JOHANNA Co-Owner. Streetl 913 CAPRICCIO LN Street2. city APOLLO BEACH State,FL zip 33572 Country Land Info Acres 0.47 use;Sin le Fam MDL-01 zonin SPLIT ID-1;RC Nghbd r0105 Topography Level Road paved utilities Public Water,Gas,Septic Location Construction Info Building 1 of 1 Year Roof Ext Built struct 1979 I Gable/Hip Wood Shingle ---_ Wall ---Living --- 2112 Roof AC Asph/F GIs/Cmp ,None Area Cover Type 3 WDK 1 Style Colonial I Int Drywall Bed 3 Bedrooms ta: Wall Rooms 3 1.4 Model Residential I Floor Int. or Rooms Carpet � Bath+2 Full+ 1 H easy cry . � 7 2 FUS,. ' Grade;Average I Type AS B Hot Water Rooms;7 Rooms BAS' 14 stories 2 Stories I Heat Oil Found-:Typical 3' Fuel ationJb Gross;3603 Area Permit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=15311 4/14/2014 f7 Cammanwealthf 1assacht`sotts a Q 'it# . _... N - sutisurfaee s'evuge Dlsp o a!S"s Ofn F'# Nof f or Volunt 11:ary Assessments 81,1 Shoat FI In HIiiRoad -Y — Property Address Owner _..Johanna l0acey.... Owners 1Vama irifor 1 I...'€s Centervi 1 Ma 02632 3l2$12014 required for every page ;Crty/Town ::; : Sfatei Zip Code ©afeaf Inspection inspection results must be s�lbmt.. on ihls form lnspectiar fcartn may not be Itered in any way;.Please'sde sampleteness 0000tst at th'e enc9 of Of,.farm Important:When Gen�rat Ilnfaarr'I�atllon filing out:forms o..n the computer. use onlythe tab 1 Inspector 7a�:::LL::��-���;�::����,�::::-:��i::�:.::;�—�:�::��:��..L�,:::.:��.i:��:::.:��.�:�:::.:��:�:,:::.:��:�:�::-:::��.:::.�-�:::��:::�,::::�� ��:�I::�I:���F:::I:-::�.:��:�,-:�.��7::::-.��-L��:�,:::.:���-.��:��]::.:�.':i:�:�:::�.�-:::�,:�:::�.-�L.�:��:�:-:.:::-���.I�:,I�::.:::=:_�,:.�-��:�.:: key to move your cursor do not Sean.M J.o_nesI ��:��:-.::::::�.8:�:::-'�L�,:,�..::-L::L�::::.::L��:.�L��:::�L:.�,:�::�:.:.:::.�.I��::.:':,��.�,::U::�i:::::,::!:L:::.;::::.�:;::�::.:::�:!�.:'�:'.::::i:.�_:�.�:::::'.I:::6 .i use the return Name of,lnspeator key ,Capewide Enter uses r�. Company Name �'I 153 Commercial:St Mash�pee Ma . 0. __ Cil*a wn;_;; W. _.. State Zip Code 548 477�-$877 SI 4522 Telephone.Number : -License Number ..:: I-:::.:: ......... :....... :....... ... .....:::: ...... .........:, Glficaf��r _: I .q*00y`tha#l Have personally inspected theaewage dispmsal system at this addiess an'd that,the information reported below is trYae; accurate and cornplefe as of the tine:of the:inspection 7 he:inspection 'uvas peiformec# 00.,'on my training and experience In the proper function and maintenance of on site _:sewage disposal systems I am a bEP approved ysterin on pec!r ,,pd�e UAnt.to Sectjon 95 340 of Tale 5(310 ClIR 15Od0} The system . c Passes ❑; Cohditlon'ally Passes : ® balls :` ❑ Needs Further Evaluation b the Local Approving:Authority :: . . 3f28/201'4 Inspegtor s Signature :: OaYe The system Inspector shall sub€rtit a copy of#his inspection report tothe Approving Authority(Boaftl O Heaith gr DEP}withih,, 0 days of completing this inspection If the;systern is a shares!system or has a design flow of.10;0:Ot}gpd.or gI.... . •the;mspeetor and';the system owner shall sutirr it the report to the appcopnafe regional office<;of the:bEP•. Tie original should be-sent to the system ciwrier and copies sent to the buyer If applicable and the approving authority ****This report oniy.iiesc b#s conditions at thymme of a►Ysg�ectron O under the e40044 csf uee atthat trriie This anspect,on tses,riot`addr+a'ss hoi the';systerr'wr61 }i'erorrn ir :the future under the sam ,or tlifferent'cont#Iticsns of use: a5€ns 3/13 JAW-twal Uisooc n Form;Subsurface sevragepivm i System Page 1:ef i? (� :��: ::L b�db _ _....- � I_ ... y U.S.POSTAGE>>PITNEV BOWES r '; Town of Barnstable r gyp'�,�G P Public Health Division- BARNSTARLE.e! 200 Main Street- ' ZIP.0260 �{�/�� MASS. 0 $ 006-48 Hyannis,IVllA 02601 0001383424 APR. 14. 2014 7012 1010 0000 2851 2620 Johanna Dacy Shootflying KIN:11R uad Centerville, MA 02632_ NOT DELIVERABLE AS ADDRESSED UNABLE TO FORWARD 2 i'E '* 'a 1�9�.il v le1�' 1�11�3 1i�'�1���i 91.i"I�'�lolll q4t{�9':liliae�l j (k ` � [ i �/ 1� � 11? )} )) ! l/ � � � j1 �/� '� � � � \ � � �� � � � �j � ,'� 1 ��,. ..---- ----- - � r r _ -„ r �" - -r -- f �`F �----� f _ �5 { �( ? �I Town of Barnstable Barnstable Regulatory. Services Department edeaC'1 f 9�M `E'r Public Health Division �6gq. ♦� ArfDMAtA 200 Main Street, Hyannis MA 02601 2007 Office: - 2-4 44 O 508 86 6 Richard Scali,Intrim Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 2620 April 15, 2014 Johanna Dacey 385 Shootflying Hill Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. The septic system located at 385 Shootflying Hill Road, Centerville, MA,was last inspected on 3/28/2014 by Sean M. Jones,a certified septic inspector for the State of Massachusetts The inspection of the septic system showed that the system"Failed" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within.the deadline period will result in future enforcement action. PER O OF T E BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\385 Shootflying Hill,Cent 2014.doc Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 385 Shoot Flying Hill Road Property Address Johanna Dacey Owner Owner's Name information is required for every Centerville Ma 02632 3/28/2014 page. Cityrrown 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: rP 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 01( Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 385 Shoot Flying Hill Road Property Address Johanna Dacey Owner Owner's Name information is required for every Centerville Ma 02632 3/28/2014 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 385 Shoot Flying Hill Road Property Address Johanna Dacey Owner Owner's Name information is required for every Centerville Ma 02632 3/28/2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all 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 1/day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official i I Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 385 Shoot Flying Hill Road Property Address Johanna Dacey Owner Owner's Name information is required for every Centerville Ma 02632 3/28/2014 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: ❑ ® 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 El ❑ 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 385 Shoot Flying Hill Road Property Address Johanna Dacey Owner Owner's Name information is required for every Centerville Ma 02632 3/28/2014 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? E ❑ 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): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd 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 M 385 Shoot Flying Hill Road Property Address Johanna Dacey Owner Owner's Name information is required for every Centerville Ma 02632 3/28/2014 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 0 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: 2013— 165,000G &2012— 189,000G Sump pump? ❑ Yes ® No Last date of occupancy: vacant/unknown 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 385 Shoot Flying Hill Road Property Address Johanna Dacey Owner Owner's Name information is required for every Centerville Ma 02632 3/28/2014 page. Cityrrown 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 es volume y o e 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 M 385 Shoot Flying Hill Road Property Address Johanna Dacey Owner Owner's Name information is required for every Centerville Ma 02632 3/28/2014 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: original system 12/18/90 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 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.): Joint were ok, no leaks, vented through the roof Septic Tank (locate on site plan): Depth below grade: 8"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: 1000 gallons Sludge depth: 6" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 r Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 385 Shoot Flying Hill Road Property Address Johanna Dacey Owner Owner's Name information is required for every Centerville Ma 02632 3/28/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Y Distance from top of sludge to bottom of outlet tee or baffle 0" Scum thickness 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.): Water level in tank was ok, outlet tee was intact but is located under the top of that tank and is not accessible. Scum buildup on top of concrete baffle and dark staining around rim of cover indicate that the tank has been overfull in the past. 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 u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 385 Shoot Flying Hill Road Property Address Johanna Dacey Owner Owner's Name information is required for every Centerville Ma 02632 3/28/2014 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 l5ins•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 , 385 Shoot Flying Hill Road Property Address Johanna Dacey Owner Owner's Name information is required for every Centerville Ma 02632 3/28/2014 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 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 located but not excavated 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 G M 385 Shoot Flying Hill Road Y 9 Property Address Johanna Dacey Owner Owner's Name information is required for every Centerville Ma 02632 3/28/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ • leaching chambers number: ❑ 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.): At the time of inspection the leach pit was empty. Cover to pit is on a riser, top of pit is approx. 4' below grade, inlet pipe enters through riser approx 1.5' below cover, 2' above top of pit. The inlet pipe was observed to have a heavy buildup of scum and a candy bar wrapper resting on top indicating that the water level has been above the inlet invert which is approx 3' above the highest effective leaching level. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 385 Shoot Flying Hill Road Property Address Johanna Dacey Owner Owner's Name information is required for every Centerville Ma 02632 3/28/2014 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 t 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 .. . - ;: Commonw�aIth of Ida sache� e .. n `• Subsurface sewage Dasposal System Form Not`foc Voluntary Assessments 385 Shoot Flying Hill Road �" - Property Address - --- Johanna Dace:,y Owner Owner`s Name. — rnfo matron is Centerville Ma:. 02632- 3128/2Q 14 requieed for every . page .. ... GrtylTown- State Zip Eode Date' h4pection D .stem lnformt� n (cons}• Sketch Of Sewage Disposal System Provide',view of-the sewage dEs PPP al,system, ncludrn.g ties;tb at least two.permanent reference'landmarks or benchmarks L96ate all weils,witFiin°100 feet::Locafe where pudic water supply enters the bu ld- •Check orie of the boxes below, ® hand sketch in the area below ❑ ;drawtrig attached separately.; _._ _.._..... ..._..... _..... . ......_ .. ... ... ... .._ ... .:.. (9 CJ '( v� 1 b+ .... i 3r ... :,Sins 3lY3 Ti1te;5 0 cial lnspec(ion Farm;$ubsurf4 t-Sewage P!sp osal Sys(em�'Paga,i5 0(77 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °�M •''y 385 Shoot Flying Hill Road Property Address Johanna Dacey Owner Owner's Name information is required for every Centerville Ma 02632 3/28/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high 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: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Groundwater elevation was not established 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 385 Shoot Flying Hill Road Property Address Johanna Dacey Owner Owner's Name information is required for every Centerville Ma 02632 3/28/2014 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $40.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) 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, 1st FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. Fill in please: Date: w APPLICANT'S NAME: '-T c - 0ry c fF YOUR HOME ADDRESS: w BUSINESS TELEPHONE # 50� 36,0 4?)4k HOME TELEPHONE #: NAME OF CORPORATION: FID # � , NAME OF NEW BUSINESS' Lc� Q. TYPE OF BUSINESS IS THIS A HOME.OCCUPATION? TM%3, ADDRESS OF BUSINESS.-- a MAP/PARCEL.NUMBER (Assessing) When .starting a new business there are several things you must do to be in compliance with the rules and regulations of the Town of Barnstable. This form is 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 town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual P=fq ed of he p rrait re a ents that pertain to this type of business. Authorized nature** COMMENTS: MUST�;QMPLYWIT All .S MATF,RIALS R17l=1 11 ATinnic 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature*" COMMENTS: * 4 Date:/ /�.D 12,0 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: _ QjcI BUSINESS LOCATION: INVENTORY MAILING ADDRESS: `�`� TOTAL AMOUNT: TELEPHONE NUMBER: O . CONTACT PERSON: J ' EMERGENCY CONTACT TELEPHONE NUMBER: 50?). ?%1 '14/16Y-) MSDS ON SITE? TYPE OF BUSINESS: C�e.Q(>i wey INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS - The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers / Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials To of BArnstable. P# 22 °t Department of Regtilatory Services 3 Public 8eal&h Division Date s 200 Main Street;H.. nis MA 02601 J. Date Scheduled r ' .� ® I Time �r� �/ Fee Foil Suitability Assessment for Se a Di at 44 1 Br.. Aneliekg Attiv V60 Witnessed Br. LOCATION&GM4ERkL INFORMATION^ L� 71�ac:afiomnddress'3K 54ofR/yf Owner'sName � .I©eRiQ�i'�i! Address `l Assessors Mapm#ccl: s2 0 �� Engineer's Name X ! NEW CONSTR!!tLON REPAQt _ Telephone# •�7'¢" i i Land use ' ��P slopes(%) 6 surface scoots Distances from: Open Water Body _R Possible Wet Aries_ Ig _Mft Drinking Water Weli Drainage way lA�ft. Pmpetty Line 40 ft Other $ SKETCH:(uft ect name,dimmsiods of lot,exact locations of 14t holes&pert tests.locate wetlands in proximity to holes) C7 .. -4 • tl`'r9 7. /� l G//vl r ' pd th to . y .E / Parent material(geglogic) Ot AU4 SN �/a>�r c' Bedrock ��&5 P Depth to Groundwater: tanding Water in Hole: ' Weeping Aem Pit Faea,. ; Estimated Seasonal oigb Groundwater '7 Dt TION FOR SEASOkAL HIGH WATER TADLE 14h .�r —Method Used Depth a� standingo obs.hole: p - in. Depth to soil lnottlee: In. eP I in. amundwnter Adjustment fr• Depth toiwfeeping train aide of abs.hole: , thetor...,.!_. Ad j.Owundwater Level.,.., Index Well#_.� Reading Datrt Index well levll,,,�.....� A41• PERCOLATION TEST . Date --4¢!/4 ObservationI Tune at 9" _._.,.,.�.,. ..�:_..3IN1 Hole# `i Time at 6" 6 qw/ Depth of Pere � ��.. , 9'✓n Start pro-soak Titus� 1J1.�K End Pro-soak =---- Rate MrnAnch i l Site Suitability Assepsment: Site Passed Site Failed; - Additional Testing Needed(Y/N).T_ OrigiaaL•;Public He�ith Division Observadot Hole Data To Be Completed oil Back----- ***If percola ion test is to be conducted within 100'of wetland,you must first notify the Barnstable C6I¢servation Division at least one(1)welt prior to beginning• r L DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil ' Other .surface(in.) (USDA) (Muaselq Mottling (Stiucw%Stones,1104w ts. Consistency,%Gravel) Ay. S, . fiU DEEPOBSERVATION HOLE LOG Hole# Depth from• Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mowing (Structure.Stones,Boulders. Consistency,%Gravel) ,4 3 y DEEP OBSERVATION HOLE LOG Hole# Depth from' Soil Horizon Soil Texture Soil Color Soil . Other Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones,Boulders. • DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soli Other Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones.Boulders. QMvell Flood Insurance hate May: Above 500 year flood boundary No— Yes c Within 500 year boundary No -� Yes Within 100 year flood boundary No Yes Depth of Naturally Occurrine Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? 145' -- If not,what is the depth of naturally occurring pervious material? ,_._. Certification I certify that on - /f 4(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by the consistent with ' the required training,e e and experiea a described in 3.10 CMR 15.017. Signature Date.-- — ' ty ' SON-WM0NWEAL Ob MASSACHUSETTS 1 EXECUnVE OFFICE OF ENVIRONMENTAL AFFAIRS ' DEPARTMENT OF ENVIRONMENTAL PROTECTION s 1� TITLE OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address = �s'f C i _�!fC— JZ Owner's Name: h Owner's Address: 2�� �( Date of Inspection: �r-/„ ' Name of Inspector:(please print) Company Name: ra�(�rlC t�nrlrbti.wr /�, eckows T"�' Mailing Address: D = C) �►� AW Telephone Number: cn j c�*7 r CERTIFICATION STATEMENT E, I certify that I have personally inspected the sewage disposal system at this address and that the infotimation reported-:t' below is true,accurate and complete as of the time of the inspection.The inspection was performed based on:Ty training and experience in the proper function and maintenance of on site sewage disposal systems. am a DEP CIOapproved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The syste -- Dt Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: d��:�t�t _ Date: _Z/.75 f� 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. 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/'L000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CCERTIFICATION(continued) Property Address: kc64 —�t A., V Owner. �b III 5��, y Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: 0 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 ced or repaired.The system,upon completion of the replacement or repair,as approved by the Board ealth,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following stateme .If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank ether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank fail imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approve y the Board of Health. *A metal septic tank will pass inspection if it is structurally so d,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available ND explain: Observation of sewage backup or or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settl uneven distribution box. System will pass inspection if(with. approval of Board of Health): b en pipe(s)arempaced bsh urn is.removed distribution bent is Ievnled or replaced ND explain: The system re ed pumping more than 4 times a year due to broken or obstructed pil*s).The system will pass inspection if( approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSINMN7S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFI�C�ATION(continued) Property Address: Owner: Sd rLsca r. 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 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 wit 310 CMR 15.3030)(b)that the system is not functioning in a manner which will protect public hea 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 etland or a salt marsh 2. System will fail unless the Board of Health(and blic Water Supplier,if any)determines that the system is functioning in a manner that protects the ubiic health,safety and environment: _ The system has aseptic tank and so'lab) rption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surfa water supply. _ The system has a septic tank and AS and the SAS is within a Zone t of a public water supply. _ The system has a septic tank d SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well** ethod used to determine distance "This system passes i e well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile panic compounds indicates that the well is free from pollution from that facility and the presence of onia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria triggered.A copy of the analysis must be attached to this form. 3. Other: 3 page 4 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE IUD SYSTEM INSPECTION FORM PART A- CERTMCATION(continued) Property Address: ,s o�f� � ��� Owner:—_jo R Sso h Date of Inspection:_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No be _ 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 T Cr Liquid depth in cesspool is less than 6"below invert or available volume is less than'/x 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 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.IThis system passes if the well water:analysis, performed at a DEP certified Laboratory;for aalifirrin bacteria and volatile organic,compass& 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.] (Yes/No)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 f th a design now of 10,000 gpd to 15,000 gpd• s You must indicate either"yes"or"no"to each of the fo g: (The following criteria apply to large systems in ad ' 'an to the criteria above) yes no _ the system is within 400 feet of urface drinking water supply _ the system is within 200 f t of a tributary to a surface drinking water supply the system is locate a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone H of a pub' water supply well If you have answered" es"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D ove the large system has failed.The owner or operator of any large system considered a, significant threat der Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The m owner should contact the appropriate regional office of the Department 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST . Property Address: S8S 604 F�tt; tt, Owner: Take, Date of Inspection: '����,�r Check if the following have been done.You must indicate`eyes"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? 4 _ 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: Yes no o _ Existing information.For example,a-plan at the Board of Health. _r _ Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance is unacceptable)[310 CMR 15302(3)(b)J 5 PaFe 6 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMtNTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: .4 fe Owner c�N��U. Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): .� DESIGN flow based on 310 CMR 15.203 (for example: I I0 gpd x#of bedrooms):3,16 Number of current residents: y Does residence have a garbage grinder(yes or no):NO Is laundry on a separate sewage system(yes or no):: l (if yes separate inspection required] Laundry system inspected(yes or no):ItJ-6 Seasonal use:(yes or no): Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy:_711(ky- . COMMERCIAL/1"USTRIAL Type of establishment: Design flow(based on 310 CMR 15 and Basis of design flow(seats/perso gft,etc.): Grease trap present(yes or no •_ Industrial waste holding to present(yes or no}: Non-sanitary waste disc ged to the Title 5 system(yes or no):— Water meter readings available: Last date of occup cy/use: OTHER(de 'be): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): t 0 If yes,volume pumped:^gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM 0X 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) _Tight tank u Attach a copy of the DEP approval —Other(describe): 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): I�0 6 Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ,s kpf l � Owner: a0 ns6est� Date of Inspection: 7 aiS BUILDING SEWER(locate on site plan) . Depth below grade: d6 N Materials of construction:_cast iron _§�_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:A( (locate on site plan) Depth below grade: /S"14 Material of construction: o�concrete_metal_fiberglass_polyethylene _other(expiain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: lOUO Sludge depth: __ a Distance from top of�udge to bottom of outlet tee or baffle: c36 Scum thickness: / _ Distance from top of scum to top of outlet tee or baffle: 6 Distance from bottom of scum to bottom of outlet tee or�a#fl How were dimensions determined: /yf 4/ yyrY Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of lei age,etc trzv- 7w GREASE TRAP:_(locate on site plan) Depth below grade:— Material of construction: concrete I_fiberglass polyethylene_other (explain): Dimensions' Scum thickness: Distance from top of scum top of outlet tee or baffle: Distance from bottom of um to bottom of outlet tee or baffle: Date of last pumping: Comments(on pu mg recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outI invert,evidence of leakage,etc.): 7 i A ' Page$of l I OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: - Cod Owner: -TO rx5S69n Date of Inspection: :2 TIGHT or HOLDING TANK: (tank must be pumped at time of' ction)(locate on site plan) Depth below grade: Material of construction: concrete metal erglass_polyethylene other(explain): Dimensions: Capacity: •gallon Design Flow: day Alarm present(yes or no).- Alarm level: Alarm ' working order(yes or no): Date of last pumping: Comments(condition o arm and float switches,etc.): DISTRIBUTION BOX: < (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: V-611 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.): boK tmr--s Levc t/ a, Y--ec f w6Kt K.v e- f� aL PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or Alarms in working order(y or no): Comments(note condit of pump chamber,condition of pumps and appurtenances,etc.): _ 8 Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSU"ACI SE*AOE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address- rt wfFlw��,,� Owner: — Date of Inspection: p 50IL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number Ieaching chambers,number. 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.): 4,01 6 X Z- v� A CESSPOOLS: (cesspool must be pumped art of inspection)(Iocate 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 groundwat inflow(yes or no): Comments(note cond' on of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site an) Materials of constructio . Dimensions: Depth of solids: Comments(note c dition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page l0 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address. Shwf FI 17i ll Owner: 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 water sup enters the building. a s Page I I of 1 l OFFICIAL, INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 385','S"f CP 1014 Owner: �o nsss Date of Inspection: 71�� SITE EN 1 Slope .�5 Surface water 00 Check cellar t4E5 Shallow wells VJO Estimated depth to ground water a-6 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 how you established th high ground water levatio J�( mot.` a IUcI o 11 Conuuonwealth of Massachusetts Executive Office of Enviroiunental Affairs Dept. of Environmental Protection One winter Street'Boston Ma. 02108 .John Septic D.E.P. Title V Septic Inspector P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD -�� X.�,� (508)564-6813 Governor ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM /1 PART A �L�C to CERTIFICATION Y ao NOV 3 199 Property Address: 358 SHOOT FLYING HILL RD.CENTERVILLE Address of Owner: Date of Inspection: 10/2198 (If different) TOWNOPi;gRNST Name of Inspector: JOHN GRACI JOHANNA POL;BOX 721 CENTERVILL ABLE I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) HTHD Company Name,Address and Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection Is based on criteria defined in Title V COnditl0 all Passes code 310 CMR 16.303.My findings are of how the system is performing atthe time of the inspection.My Inspection does _ Needs ur er Evaluation By the Local Approving Authority not lmpy any warranty or guarantee ofthelongevityofthe Fails septic system and any of Its components useful Iite. Inspector's Signature: Date: 1o16/98 The System Inspector shall lub!mit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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. INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of — Co7hpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection, or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration,,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04127197) One Winter Street is Boston,Massachusetts 02108 • FAX(617)556A049 a Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 359 SHOOT FLYING HILL RD.CENTERVILLE Owner: JOHANNA POL;BOX 721 CENTERVILLE Date of Inspection:1012199 _ Sew.aQe backup or.breakout or high.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled 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 Cl 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 the public health. safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES 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 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 ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system 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 the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: I have determined that 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. Yes No Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. SAS is in hydraulic failure. (revised 04117)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 358 SHOOT FLYING HILL RD.CENTERVILLE Owner: JOHANNA POL;BOX 721 CENTERVILLE Date of Inspection:1012198 D] SYSTEM FAILS(continued) Yes No 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). Numbers 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 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. 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 FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System):and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: ,Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 358 SHOOT FLYING HILL RD.CENTERVILLE Owner: JOHANNA POL;BOX 721 CENTERVILLE Date of Inspection:10r2r98 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _x_ — Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the 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. — x As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. —x— — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System,have been located on the site. x 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. x _ The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is — — unacceptable)[15.302(3)(b)] (revised 04127)97i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 358 SHOOT FLYING HILL RD.CENTERVILLE Owner: JOHANNA POL;BOX 721 CENTERVILLE Date of Inspection:1012198 FLOW CONDITIONS RESIDENTIAL: Design flow: = g•p•d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: 0 Garbage grinder(yes or no): No Laundry connected to system(yes or no): No Seasonal use(yes or no): No Water meter readings, if available:(last two(2)year usage(gpd): n1a Sump Pump(yes or no): No Last date of occupancy: VANMR1998 COMMERCIAL/INDUSTRIAL: Type of establishment: nia Design flow:0 gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings, if available: n1a Last date of occupancy: Na OTHER:(Describe) Na Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Na System pumped as part of inspection: (yes or no)Yes If yes,volume pumped: 1000 gallons Reason for pumping: MAINTENANCE TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other: APPROXIMATE AGE of all components,date Installed(If known)and source information: 1979 Sewage odors detected when arriving at the site: (yes or no) No (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 358 SHOOT FLYING HILL RD.CENTERVILLE Owner: JOHANNA POL;BOX 721 CENTERVILLE Date of Inspection:1012198 SEPTIC TANK: x (locate on site plan) Depth below grade: 8" Material of construction:x concreate_metal_FRP_Polyethylene_other(explain) If tank is metal, list age nla . Is age confirmed by Certificate of Compliance Nc (Yes/No) Dimensions: L8'e"H5'7"W5'8" Sludge depth:5" Distance from top of sludge to bottom of outlet tee or baffle: 8" Scum thickness:e" Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 10" How dimensions were determined: MEASURED 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.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS. GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: _concrete_metal_FRP_Polyethylene_other(explain) Dimensions: rva Scum thickness:No Distance from top of scum to top of outlet tee or baffle.rva Distance from bottom of scum to bottom of outlet tee or baffle: rda Date of last pumpin&. 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.) We BUILDING SEWER: (Locate on site plan) Depth below grade: 14' Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction line•TOWN Diameter: nla graimments: (conditions of joints,venting,evidence of leakage, etc.) (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 358 SHOOT FLYING HILL RD.CENTERVILLE Owner: JOHANNA POL;BOX 721 CENTERVILLE Date of Inspection:1012198 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: n1a Capacity: rda gallons Design flow: Na gallons/day Alarm level:_n1a Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Na DISTRIBUTION BOX: x (locate on site plan) Depth of liquid level above outlet invert: LIQUID LEVEL VM BOTTOM OF PIPE Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) DISTRIBUTION Box IS STRUCTURALLY SOUND. PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_Ye: Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) rda (revised 04 27W) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 358 SHOOT FLYING HILL RD.CENTERVILLE Owner: JOHANNA POL;BOX 721 CENTERVILLE Date of Inspection:10098 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: rda Type: leaching pits, number: 1000 GALLON LEACH PIT leaching chambers, number:nla leaching galleries, number: rda_ leaching trenches, number,length: nfa leaching fields, number, dimensions:nla overflow cesspool, number:nla Alternate system:-rda Name of Technology._nra Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.THE PIT WAS EMPTY AT THE TIME OF THE INSPECTION.PIT IS TO DEEP TO SEE HOW FULL IT HAS BEEN. CESSPOOLS:_ (locate on site plan) Number and configuration: rh Depth-top of liquid to inlet invert: nla Depth of solids layer: Na Depth of scum layer: nla 'Dimensions of cesspool: Na Materials of,construction: rda Indication of groundwater: rda inflow(cesspool must be pumped as part of inspection) nfa Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Na PRIVY:_ (locate on site plan) Materials of construction: rda Dimensions: rda Depth of solids: rda Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Na (revised 04127197) i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 358 SHOOT FLYING HILL RD.CENTERVILLE JOHANNA POL;BOX 721 CENTERVILLE 1012198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) 10 J Q OD II AA A� 35y >1 3 C �!? yr 96 14 (revlaedOMT19T) - page ! of 10 J 1 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 358 SHOOT FLYING HILL RD.CENTERVILLE JOHANNA POL;BOX 721 CENTERVILLE 1012199 Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS MAPS AND CHARTS (revised0dm197) page 10 of 10 s I OWN OF wNsTABLE I........... '10 3-c� L A # '�17-AGE 11�'l 1 ���t2— ASSESSOR'S MAP 8c LOT 1? I"AL.L.ER'S NAME&PHONE NO. SEPTIC TANK CAPACITY d I' LEACHING FACILITY: (type) Ok Iee�V1 (size) W NO.OF BEDROOMS BUILDER OR OWNER �ItihOA PERMITDATE: COMPLIANCE DATE: �> Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) _ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) �\^��� Feet Furnished by l L),ec� . . A4-731 y . _ + y.�.v.'rr.��.......:.�......+.i:.:..��...,•:.:.....�:..,..«.r_..:.�....d.nn...-rt'i..r..- S`.•,a �.r. .,��'{a` .p vX.u..� -3 - r - � it 4 - ` F HOMES 100 West Main Street,Hyannis,Massachusetts 02601•(508)771-4400 September 8, 1993 FAX(508)771-0039•MA Toll-Free 1-8007628-9100 Ms. Donna Miorandi Health Inspector, Board of Health Town of Barnstable 367 Main Street Hyannis, Mass. 02601 RE: BARBARA FERRIS 385 Shoot Flying Hill Rd., Centerville Dear Donna: In connection with the above-referenced Barbara Ferris and for your information and your files, enclosed herewith please find a copy of the emergency Motion that was filed on September 3, 1993 with the Barnstable Superior Court. Also enclosed is a copy, of a letter, dated August 25, 1993, which we received from the Centerville-Osterville-Marstons Mills Fire District regarding an inspection of the smoke detectors at 385 Shoot Flying Hill Road. Since receiving the letter, we have been trying to set up an appointment with Mrs. Ferris to replace the smoke detectors but, so far, we have not been successful. She is just not cooperating with us. Please call me if you have any questions. Sincerely yours, G. Johanna Dacey ,1 GJD/pr Enclosures Boston Business Journal's E7 1"0 Top Single Family Builder in Massachusetts Wylie, Lipman & Freeman Attorneys Stephen 1. Lipman* 31 Milk Street Cape Cod Office David A Wylie f Boston,Massachusetts 02109-5171 3180 Main Street Peter L.Freeman Telephone:617 423-1233;617 723-2900 P.O.Box 578 Cable: Counsellor Barnstable,Massachusetts 02630 Telex:9102500606,Lipman UQ Telephone:508 362-4700 FAX:508 362-8281 September 3, 1993 Ms. Phyllis A. Day, Clerk SUPERIOR COURT Barnstable, MA 02630 Re: G. Johanna Dacey Vs. Barbara Ferris Superior Court Case No. 93-635 Dear Ms. Day: Enclosed you will find Plaintiff ' s Emergency Motion for Dismissal of Appeal, together with Certificate of Service as pertains to the above-entitled matter. Very truly yours, PETER L. FREEMAN PLF:njm cc: Susan Nagl, Esquire Legal Services for Cape Cod and Islands Ms. G. Johanna Dacey AtDacey\Court1.1tr •Also admitted in New York I Also admitted in Disttict of Columbia COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. SUPERIOR COURT Case No. 93-635 **************************************** G. JOHANNA DACEY, Plaintiff * Vs. * BARBARA FERRIS Defendant **************************************** PLAINTIFF'S EMERGENCY MOTION FOR DISMISSAL OF APPEAL Now comes the Plaintiff in the above-entitled action and moves, under the provisions of Superior Court Rule 9A (e) ( 1) , that the appeal in this matter be dismissed forthwith. As grounds therefor, Plaintiff states: 1 . Plaintiff won Judgment for Possession and Judgment in her favor on Defendant ' s counterclaims in the Barnstable District Court Summary Process Action, Civil No. 9325-CV-3190. 2 . Defendant has appealed said Judgment. 3. Defendant' s Motion in District Court to waive the appeal bond was allowed, but the District Court issued an Order that the Defendant pay the sum of $840 to the Plaintiff for rent for August 1993 by August 13, 1993 and $840 per month for each month thereafter beginning September 1, 1993 and also ordered that the aforementioned funds are a specific condition 1 as to the Defendant' s right to maintain her appeal in the Superior Court, all subject to the order of the Superior Court. See copy of Order, Joseph J. Reardon, Presiding Justice attached. 4 . Plaintiff has not received the rent ordered by the District Court. 5 . Defendant has filed a "Request for Review of District Court Order Setting Use and Occupancy Fee" with this Court, but said Request has not yet been scheduled for hearing. 6. The Defendant has repeatedly refused to allow either the Plaintiff ' s contractors or the Town of Barnstable Health Department Inspectors into the premises to reinspect and to replace smoke detectors. See copy of letter from Town of Barnstable Health Inspector, Donna Z . Miorandi, dated August 27, 1993, and copy of Memo from John Pimental, electrician dated September 2, 1993, attached. 7 . Despite the Defendant ' s claims that she is a participant in the Massachusetts Rental Voucher Program she has not signed the Payment Voucher under the Program and has not filled out and executed the Recertification required under the Program this past spring of 1993. 8. Regardless of the merits of the Defendant' s claims or the merits of her Appeal, the Plaintiff has served notice on the Defendant that the tenancy under the aforesaid Massachusetts Rental Voucher Program, if any, expires in any 2 I event on October 31, 1993 and that she is to vacate the premises on or before that date. See copy of letter from I II Peter L. Freeman dated August 30, 1993 attached. 9. The Defendant has committed a fraud upon the Barnstable Housing Authority and the Massachusetts Rental Voucher Program by representing that her husband, Stanley J. iFerris, does not live at the premises when in fact he does and he even has a motor boat registered in his name with an address of 385 Shoot Flying Hill Road, Centerville, MA. See copies of Town of Barnstable Boat Excise Billing for 1991 and 1992 attached. 10. The Plaintiff is wrongfully being denied rental income on the premises as a result of the Defendant' s wrongful actions. Dated: September 3, 1993 Respectfully submitted, Plaintiff, By her Attorney, PETER L. FREEMAN BBO# 179140 3160 Main Street - Box 578 Barnstable, MA 02630 (508) 362-4700 CERTIFICATE OF SERVICE Barnstable, ss. September 3, 1993 I, Peter L. Freeman, do hereby certify that this day I have served a true copy of tabVetoMotion he at attorney mailing forsame, the first-class mail, postage prepaid, Defendant, Susan460 West Main StreZHal ervices nisorMA a0260 d and Islands, Inc. , PREEMAN A:Dacey\Di8mi138a1.BF 3 I COMMONWEALTH OF MASSACHUSETTS DISTRICT COURT DEPARTMENT BARNSTABLE, SS. BARNSTABLE DIVISION NO. 9325SU3190 G. JOHANNA DACEY ) ORDER V. ) ) BARBARA FERRIS ) The defendant is to pay the sum of $840 . 00 to the plaintiff on August 13 , 1993 for rent due for the month of August. The defendant is to pay the further sum of $840 .00 per month beginning September 1 , 1993 and on the first of each month thereafter . The aforementioned funds are a specific condition as to the defendant ' s right to maintain her appeal in the Superior Court, all subject to the order of the Superior Court . i ENTERED: August 3 , 1993 Justic Jo ep J:' R, don, PreSl 9 n � The Town of Barnstable Health Department .o+•J` 367 Nfain Str a, 11�annii, MA, 02601 Office 508-79U265 Thumas A. Mckear FAX 508-7'75-33" Director ,?) Public Health August 27, 1993 Johanna A. Ducey 100 West Main Strett Hyannis, MA 02601 To Whom This May Concern: This letter is to t;tate that nonna M-for.an(il , Health Inspector for the Towel of Barnstable, has made several attempts to reinspect the property occupted by Mrs, Barbara Ferris At WS chootf.ly.i-ng Hill Roach, CenterviAl.e an,1 owned by .Joly nna B, Dacgy, During the p53C rvo lceek5 of 7;1.i1;usr, 16' 27, 1993 1 s_l 'i. several. l)hori:! calls tC) �lL... Ferri ttl':i She w.r c it'ter !ti? �'•.':it:��.i ? f rti i '' s 3 s �l_. , out ;f to vr, pr had d;octl_r at)po'.nt1'1':11tu. Vor;cver .'he ho''!l .1r9 rt UiPie oi, AyjI:+i,rr 24 11 d11d t I i Mrs. Ferris D[l er6d 01 Pir-rie and -:•,1= IIQi;,? . On Algid ,t 1?r,r Son arid othtiry wire, at the T,'side[ice-h. c SOV thi- pii ..re . T. infor--TWf l Mug. F:er: :_r that it t;t!�.rld only -'.A' - iiie 1.5 r'itnutes t;I the chtit I ]list Wanted to `IC:,':Ify Char rht- Olil;h Mrs- Fic rris 5C.3.red 1"ad -icea dono . On loL-FuE;v 26rh T. Mr; . orris on th,' phoilf'. oxY .e ly when: L i.'.C)u d 7:Ei.nspF,c [�h o c:,rr. rhf' a �y cr,,i :It 'r ,I l t'V t 1 c'I,_1 [: an ; C:K ll:Er 31[l� 1�:- t Changing the. subjact , On Auguar 26th T cl.)nti,Ctel 'tr. Tlvmil-':. L;rir;:ft of rhr Auth-)city and h:ttu of my pr,,J [cam.'i ?: w r:h 'Mr'3. Mr . Lynch stated r,het he w+ v'Id tall t z q, E': r. r1.+ 1n for. -i conferertc� to see what vh" prohl.Li m is in Irak.ilig the house j�)rri.ia}, le 20f tht, MVP (Kass. Ren.r.al Vour_her Program) inspection. If yr.[.r have any fu'rth r c1,;e ?ri. n= c,i...fi r. f;�l. free t•:+ cal .,ue at 790-6265. Si •ere ly, / ,/-, a �/v 7;+ Donna 7.. Mlor.-(� i. Health In.-�pe.cror �l QUICK RESPONSE,.. DACEY HOMES Its(► West Maim Street _ P.I fFrlltl:u� GALEV �-----_—'1' HYalu"is, Massachusetts 02601 (508) 7]i-44M lllc.serrl U Please Hesporld by _ . !.1 No Reply Needed 1. DA W TO. 5U8ACT: it Pilo t,u i �-� l�w,c f'' 1 f , SIGNEo.. Z'C RFPIY; � DATE:: SIGNED. ARIA 4`13 THE auSs%L�.g BJOr;Q h►s.n 1�i ba+fix f 1.E 9.r �C RECIPIENT R(TURN""HIS COPY V) SENDER. • t} s I - Wylie, Lipman mare & Freeman - Attorneys Stephen 1. Lipman* 31 Milk Street Cape Cod Office 180 Main Street David A Wylie( Boston,Massech 3 useto 02109-5171 3 8 Box St 78 Peter L. Freeman Telephone:617 423-1233;617 723-2900 Barnstable,Massachusetts 02630 Cable: Counsellor Telephone: 508 362-4700 Telex:9102500606,Lipman UQ FAX: 508 362-8281 August 30, 1993 Ms. Barbara Ferris 385 Shoot Flying Hill Road Centerville, MA 02632 Re: 305 Shoot Flying Hill Road, Centerville Dear Ms. Ferris: This firm represents G. Johanna Dacey, the owner of the premises at the above-referenced address . As you know, Mrs . Dacey has already obtained JudgmentCase No�r 93�25eSU13190 ssssion Bands you have in Barnstable District Court appealed this Judgment to Barnstable Superior Court. Although my client has disputed whether you are anelii gble int tenant under the Massachusetts Rental Voucher Program, my hereby notifies you that even if you are an eligible tenant, the under the Massachusetts Rental voucher Voucher Payment Contract if any, at the above referenced premises Program and your tenancy, under said Program expire on October 31, 1993 . Therefore, without .. in any way waiving any of my client' s reserving alhts l le above rights referenced Judgment, and specifically and claims she may have in connection with said property, you are hereby notified that you must vacate the premises as of November 1, 1993 . This notice is necessitated by your staying in the premises and is in addition to, and not in lieu of , the Judgment for Possession already obtained by my client. Very truly yours, PETER L. FREEMAN PLF:njm cc: Susan Nagl, Esquire, 1,egal Services Thomas K. Lynch, Barnstable Housing AuL-hority G. Johanna Dacey A:\Dacey\Eviction •AI5a ndmltt,J In Ne-Y-A i ANt,nrin,111ni In""rl"n(tl"h.,.,l•1, 1 , t }sy I f T^turf cif ea. t}at c- Mia _zl !.ar:u I:� �'lg!1 R�3Cj .Gt pr tC SbinC prti4Y c;Yi_j _F Fji i jr�i't "�`TAT1_,_: Inlr�,fT9v' a f{ ! f _ at On. / r�i / �_7n f:frrran` `statla�. FERRIS, :"TANLEY wt :;9� SHOOT FLYING HILL Rr t r' r'ENTEF'V I LLB MA 026,_� 4t ,Yr/Tyne 1975 L"MAN Vs! -e i'ns Alt /Loh2th MSS940Hf: I ENOTH 1.124, O0 ACC Mr,•1 n��5.00 lot !qat A`5t 7r'ar,sac �or!5 C.ur•rtnt �r .. r ? ' at Late LZi 1 _ i Tr, [fgt=e tia' a, c �j 'i� =" �',' Oefm4hd Ch.; 91/05/22 71, 00 /F*0E• ,j n XMT for afar. .data .�., t' Streinf NTSTA r= . P. 1 -7 1 , • ' ', r, Mia�r113nti��_g R_[a. , �.t P� c.css9 no q fir- BOAT cXrIISE PILLING i_r r,a r,t t St r.,aBOAT f To' FERR I _TAMLEY � \; _ ytsv7 '? '?p-, '=HnnT F YIN!± 1.JT1 i f,P s [E!VT.Eh�1I' !E� MA il?L'•? — )(1�);1 i i y.. iTy:• i��7►rt LYMAM Va u3t i c n T 6C`n. 4�� y ' 34Ft /l.�n^.tfl M'�'1`7ur:•'il_ i E- ,I��•�H 024 00 Acc:Vint N,;t 4 omt� a ��-~�+ �4 } Tr' ansact f,::rtg r'Ur'r1Ynt ^, . ;:•,: ; Dat a N i 1 1 e d Il,t p31 1r�C gC Am. Di l e �. nr� �� tnEtr:tt 53 . . .. XMT for data � ;xt Scraan: RT' TA pCAT , , No—t P1I ! F�I�c1 nl�e;:t Yea- s TOTAL P.01 "�? ! ST. 3 CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT OFFICE OF THE FIRE DEPARTMENT 1aZtb 1875 Route 28-Centerville,MA 02632-3117 508-790-2380-FAX: 508-790-2385 John M. Farrington,Chief Glen S. Wilcox,Fire Prevention Officer G*E.Whiteley,Duty Chief Martin 01. MacNeely, Fire Proven*04r August 25, 1993 Johanna Dacey Dacey Homes 100 West Main Street Hyannis, MA 02601 Dear Ms. Dacey, This letter is regarding the operation of the smoke detectors at the property you own at 385 Shootflying Hill Road, Centerville, MA. At the request of the tenant Barbara Ferris, because of a concern about the operating capabilities of the smoke detectors, an inspection took place on Friday August 6, 1993. At the time of the inspection all detectors responded within the appropriate time table when subjected to a simulated smoke condition. However, the smoke detector located on the first floor does not operate when the test button is pushed. Massachusetts General Law Chapter 148.Section 26E requires all residential units to have properly operating smoke detectors at all times. Therefore, the defective detector on the first floor shall be replaced within 30 days from the date on this letter. Please contact me as soon as the detector has been replaced, so that it may be properly noted. If you have any questions, I can be reached at 790-2380. Sincerely, i � Mar tj MacNeely t , Fire Prevention Officer CFI/1 C-&MM Fire District S �� tr v SEA .. 2 homes tra&tion 100 WEST STREET•HVANIJIS,MA 02fi01'—+�-� �•= °M1i"r.a rrnn-:J�u r" '-" Zy,.',gy■ �.. w""�"•�`��e'rr, — 's^ear�:Bw�o».rsn:d�:3�L`�:F i' .v- i Ms. Donna Miorandi Health Inspector Barnstable Board of Health 367 Main Street Hyannis, Mass. 02601 t� a � � � ��... �' ,, ._�... ,. _„- i r� ...�..,�.... � s.� -.p � .�.n ,,,..... r, /� i �` i �� J i � 9 onn a� ` - A k,-, wj+tl -�6Ae fl n O_r un rDm %� OF BA BUILDING _�BLE DEPt uu � e � 1 v � �u� 1�1�-02-�r�� k � v r S1hf � � rtil r ra v r � Y ;r .y, _ .affix,•.ty..,. k' / k �'ziRs+c' 5 . jldiK�{ �l �7� _ � � <f {4S y��Pv� �":5 k �i "'t 451•w,.� � l} ^x5�4' y /�d u 1 w h r ` j 41�r�sr6 i I i I I 4y� °�y�yd'#.�i? �'"ri. + r -.-h;3d �rti��+tgpz t ..,,>; � ..,. •�iy c i A^• ` ear Spy. 4 i I f r.. ° y -u i 1 1 S+ h h�� � ` . ' y�r � `� �� � . �,., r . . ����. ,�.�, i �.� .f ` :� K. x ,,f M It �.���. �} Y lYN .q 1 „ `d e.N. F '� �� to , �`. Z (p S r ��f;� k c .r y-rf ,F ��,CCC �y t r�G"71 } fill at`y'�-r.✓�i��j � ` ,�` � a"K�i.. � � r �' .i � 6 �fJ'�' r' r�:{� �' t � �! � � .. �q ,r� '..,� .f ��}��4y,�r i� i JCS s t f` �t r l+•w' a � �. �+'�4y`+�.�` `i; r � ,' t � n'L�d�� �f r ,r St'�„�°`.l 1�}r �y Gt�''1= i,-.x � •' 1 �Q� T E1l � G � �..c c.y ! Sr,� .:4'; h`���.:L�'^li �'i y�l'�9 'i`x.i• •��,!'4 re.4 A ����'` �J::t�'';' � Yf... t .�,�Y .y,Y,aKfy `.„partf _ `'r,.- - �`,��,, aF� , � �� �� - r ors. � '.i 4��i� A � S ..,_ 1 �� .?: ,` � i. .4 ��. b .. •. _..._.._.._rr, �'� -- .. '� :"• . �. I I r:+J Wyr._..j+a�..4 wa+.s�N,.:.r3ya�trr v.r,�.rN•«w•-x e. ..... ... .. x a CERTIFIED MAIL- RETURN RECIEPT AUGUST 26, 1993 MRS. JOHANNA DACEY I have been informed by my personal _ injury attorney ' s to inform you of an injury I substained at your property at 385 Shoot Flying Hill Rd Centerville Mass. The incident occurred on August 19, 1993 at eleven-thirty inithe forenoon when the dining room window fell and guillotined my right hand and wrist, I was taken to the Cape Cod hospital by Centerville/ Osterville fire rescue ambulance. The window that fell was mentioned ina letter from the Barnstable Building Inspectors office dated Aug 6, 1993 when Mr. Bearse did an inspection at your request. I am' hearby requesting the name of your insurance carrier for the property, be sent to me at the earliest convenience to the address below. As surgery and a lengthy recovery is a result of this injury. Thank -you Barbara Ferris 385 Shoot Flying Hill Centerville Ma, 02632 4 TOWN OF BARNSTABLE BUILDING DEP n o SEP 8 .199� �r. U cc:barn. board of health attn.--T-om-Mc-kean barn building inspectors '`attn.Joe Daluz barn town manager Warren R� he�fd r, _ LEGAL SERVICES FOR CAPE COD AND ISLANDS, INC. 460 WEST MAIN STREET, HYANNIS, MASSACHUSETTS 02601 (508)775-7020-428-8161 1-800-742-4107 All Numbers Voice and TTY FAX(508)790.3955 September 10, 1993 Ms. Donna Miorandi Health Department Town of Barnstable 367 Main Street Hyannis, MA 02601 RE: Barbara Ferris Dear Ms. Miorandi: I received your FAX late on September 8th. Apparently, you did a reinspection on the morning of September 8th and found that the unit essentially was in compliance. I am concerned about the electrical problems which were noted by the Deputy Wire Inspector. Please inform me, in writing, whether or not you noted that the problems cited by the Wiring Inspector have been corrected. Based on a review of the inspection report, it appears as though you felt you were competent to assess these items and found that the electrical violations had been corrected. Were you also able to determine whether or not the window had been repaired? In the event you need to return to the premises with the Deputy Wire Inspector to determine whether or not the electrical violations have been corrected, please contact me. I would be more than happy to arrange a time when you could reinspect the premises for this reason. In the event you believe the electrical violations have been corrected, please call me to discuss this matter. I will look forward to hearing from you. Very truly yours, 5 G� Susan Nagl Attorney at Law SN:bk Plymouth Office 18 Main Street Extension, Plymouth, Massachusetts 02360 (508)746-2777 1-800-585.4933 FAX(508)746-4311 LEGAL SERVICES �`_- --._....«4 y« FOR CAPE COD AND ISLANDS, INC. 460 West Main Street U.�,•`1'01S AGL � u / a Hyannis, Massachusetts 026011 , e� Stp q 3 �« 0.,N�an.0.� P 1 o A'aI ����� � •� 9 .a h�.l_i Y Ms. Donna Miorandi Health Department Town of Barnstable 367 Main Street Hyannis, MA 02601 f IIII II III IIt'll 1.11.11 tf:tltljI"III �, ... -�-- _. - �w' C _ .�. -r �' r \ i v TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date45 Owner Tenant / foe° C?, Address Address 3�rJ + �/ '� Complionce Remarks or Regulation# Yes No Recommendations 2._ Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. ExitsOfU? 13. Installation and Maintenance of Structural In�A+S� a�}c�t�rS `06ai ed At Elements /1Qt . 14. Insects and Rodents TPosT LI M T P857- �lSC0v 1 U 15. Garbage and Rubbish Storage and Disposal E{iD v� sP0�' i z► alat(a►b(- :ofI0 cad over 44a cisa c, -�o l i kx� 16. Sewage Disposal � � 17. Temporary Housing J IS PART II iacz S� �' 37. Plocarding of Condemned Dwelling; Removal of Occupants; Demolition Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here HOB83 8C WARREN,INC. (� -J [�n 1' n,eel , `�(�,�J Il@, 1 C 0%us o^ � je• j--j2r I °7,1993. i 4 John V. Ne:�°on TELEPHONE:7754120 'Hire;n;Fector EXT. 163 TOWN OF BARNSTABLE INSPECTION DEPARTMENT TOWN OFFICE BUILDING HYANNIS, MASS.02601 TO: Donna Miorandi Health Department FROM: Eugene Pelkey, Deputy Wire Inspector PMP RE: 385 Shoot Flying Hill Road, Centerville DATE: July 26, 1993 At. the request of the tenant, Barbara Ferris, I inspect the dwelling located at 385 Shoot Flying Hill Road, Centerville. 4 Ito . � r The post light was broke An electrical fixture on e house near the front door was hanging and broken No cover �.. �' on electric heat baseboard unit in dining room and first 5 � floor appliance room. Second floor bathroom has electric heat baseboard that is rusty with wires showing. Wires �"� should be covered. Another second floor bathroom has a 5 Je, rusty baseboard heater that the tenant says sparks when turned on. ntze part z, fo ULD }' TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE I1:MINIMUM STANDARDS FOR HUMAN HABITATION Date ® OwnerPAC6V Tenant , 4-O I�U/S Address Address Complionce 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 0 8. Ventilation D 8 a /o 9. Installation and Maintenance of Facilities IVVjN 10. Curtailment of Service 11. Space and Use o o 12. Exits WLPC9 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing ,/�% �fpy,�. PART 11 S ®r 5 o ✓C:��0( J 37. Placarding of Condemned Dwelling; ��� " "�#1v ►,�� Removal of Occupants; Demolition �y j ICPerson(s) InterviewedAA1`-�y'I/V (6WS Inspector eo4z4_1 If Public Building such as Store or Hotel/Motel specify here HoBBs&WARREN.INC. F D TOWN OF BARNSTABLE BOARD OF HEALTH '! ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION . 1 Date ' q�3 1 1 Owner Tenant Address _ J Address�V5- ).f 109 1 4 ylo#(-' " NULL 1eofit) Z U E )u. Complionce 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 Nt 8. Ventilation VULU � �H t 13C Jj o 0 / 9. Installation and Maintenance of Facilities ' ( ' Lf VINC. on� ill �- 10. Curtailment of Service 11. Space and Use 12. Exits J 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing PART 11 �-1 ! of s ! 1 �i`-'' 'n 37. Placarding of Condemned Dwelling; "�D Removal of Occupants; Demolition Person(s) Interviewed L A�64 (W)S Inspector If Public Building such as Store or Hotel/Motel specify here HOBBS&WARREN,INC. Johfi-4. Ne,1.on Wiref"r ',sector TELEPHONE:775-1120 EXT. 163 TOWN OF BARNSTABLE INSPECTION DEPARTMENT TOWN OFFICE BUILDING HYANNIS, MASS. 02601 TO: Donna Miorandi Health Department FROM: Eugene Pelkey, Deputy Wire Inspector RE: 385 Shoot Flying Hill Road, Centerville DATE: July 26, 1993 At. the request of the tenant, Barbara Ferris, I inspected the dwelling located at 385 Shoot Flying Hill Road, Centerville. The post light was broken. An electrical fixture on the house near the front door was hanging and broken. No cover on electric heat baseboard unit in dining room and first floor appliance room. Second floor bathroom has electric heat baseboard that is rusty with wires showing. Wires should be covered. Another second floor bathroom has a rusty baseboard heater that the tenant says sparks when turned on. C' CIt J - � , o .14-.,... L-A-1`7 TOWN OF 6A81Vsr 9� BUI LUIN BCE . . - EPr FPCEI leg , G ---------- _ � .k �a��rs4 a i r. .x;' ,N'Y'• f �r r a•t r t ��li�`�:i•rxu ��' .�,a AT »eC+rr�grecr�•r' q r s ' < ' 10 :✓l1r'��t11 [< t }r''.S.tn r 5 vz 4 .t Si hyr SSS '+�5�ra�+�'r��''�+'+�f�h rn� K ,�A., ;,'`' ��rih t� ���� '� Y3iA'r�t`r Sslr�,r ti''' � .� <•, �x x'SYf s,�b Fyda�l��ji✓� a � �fawl�� ..yyetfi,�ita,.rs tc•rf s. ¢"`� } v it ttC��`}�Yrt �M�,. Ys!_,7 i N:, �5 1.,'. t`rt49 1 S{ M1 1� �;A !tU(i'1•�P t'1 k J.. .J ' � i r o Ck° 4 ��r•�CI�S b� �7: ^}s r iY'"�tri+�' `5. � 0 I ,, h�r1.r, F ���50-�4 � � y, vd'e'�'�'rc��g�5� �k���}S ���} y v i e.'�4�� yY'� ,• °�� � J ,�.�„' 1 )"w+fSryl �J�w�'P1"!•�{�J� ?����N� �tv"v v.+ v e a, �t• , t rt•�Ci r.Rf f �+> b d t �_ r 'f'•' �. <j d 4 t 1 , .e u i. t .,, S '.ice 1!. ' V. F , / •y.+.�.�'y,,",thy rt ria�St , �w s�Jl•l,J.� rx �Rw rRii ,• 1�z.R;.Sr t:J SIY ■ri'r fpii'!/Ngi: I I'T4 t rrit^+ Pf i r t jtb�4: �STYy Yl t1,{�V - c} � 4 } 6 S 1 I .figp '-Mn . a ` e rod, r ry 7;rirr 3�<r•t.�-0 "GL9r �aFl tr i:+.v4',rt ,y )�y�q• �„r,y aI 7 Yf^ CERTIFIED MAIL- RETURN IZECIEPT AUGUST 26, 1993 MRS• JOHANNA DACEY I have been informed by my personal - injury attorneys to inform you of an injury I substained at your property at 385 Shoot Flying Hill Rd Centerville Mass. The incident occurred on August 19 , 1993 at eleven-thirty inithe forenoon when the dining room window fell and guillotined my right hand and wrist, I was taken to the Cape Cod hospital by Centerville/ Osterville fire rescue ambulance . The window that fell was mentioned ina letter from the Barnstable Building Inspectors office dated Aug 6, 1993 wlien Mr. Bearse did an inspection at your request. I am hearUy requesting the name of your insurance carrier for the property, be sent to me at the earliest convenience to the address below. As surgery and a lengthy recovery is a result of this injury. Thank -you Barbara Ferris 385 Shoot Flying Hill Centerville Ma, 02632 TOWN OF BARNSTABLE -- - - ------ BUILDING DEPT. EP .+ " 99�' D s cc:barn. board of health attn.--Tom-MG--kean� barn building inspectors 'attn.Joe Daluz barn town manager Warren Ruiheiford - I i 40, ,7 J SEP - 7 - 93 TIDE 1 S : 3 1 P _ QZ' LEGAL SERVICES FOR CAPE COD AND ISLANDS, INC. 460 WEST MAIN STREET, HYANNIS, MASSACHUSETTS 02601 (508)775.7020.428.8161 1.800.742-4107 All Numbers Voice and TTY FAX(508)790-3955 September 7, 1993 Donna Miorandi Town of Barnstable Health Department 367 Main Street - KA Hyannis, MA 02601 RE: Barbara Ferris Dear Ms. Miorandi: It is my understanding you intend to inspect Ms.. Ferris' house on Wednesday, September 8, 1993, at 10:00 a.m. One purpose of you inspection is to determine whether or not problems previously cited have been corrected. As you know, the Town of Barnstable conducted three separate inspections. The Board of Health, the Wire Inspector and the Building Inspector all conducted separate inspections. The Wire Inspector conducted his inspection on July 26, 1993, and noted a couple of problems with the electric baseboards. My client reports that these problems with the wiring have not been addressed. Perhaps it would thake some sense to ask Mr. Pelkey, the Deputy Wire Inspector, to return with you for the inspection tomorrow. I have attached a copy of Mr. Pelkey's original report. To the best of m knowledge Mr. Pelkey has not returned to the premises. It is true that the Building Department inspected on August 6, 1993, but that report does not address the concerns raised by the Wire Inspector. Please let me know if you have questions. Very truly yours, SusaNagl 2K Attor ey at Law SN:bk Enclosure Plymouth Office SEP — 7 P ra = i TELEPHONE;77$.1120 I _ EXT. 1A2 TOWN OF BARNSTAOLE INSPECTION DEPARTINE�T f TOWN OFFICE BUILDING HYANNIS, MASS. 02601 1 TO: Donna Miorandi Health Department j FROM: Eugene Pelkey, Deputy Wire Inspector rl/:01 RE: 385 Shoot Flying Bill Road, Centerville DATE: July 26, 1993 j At the request of the tenant, Barbara Ferris, I inspected the dwelling located at 385 Shoot Flying Hill Road, Centerville. The post light was broken. An electrical fixture on the house near the front door was hanging �nd broken. No cover on electric heat baseboard unit in dining room and first floor appliance room. Second floor bathroom has electric heat baseboard that is rusty with wiree' showing. Wires should be covered. Another second floor bathroom has a rusty baseboard heater that the tenant ' says sparks when turned on. i j I j} i f l i • 5 . ly. W'Of TN[lp`O ,A. -z The Town of Barnstable ..a Inspection Department i619 367 Main Street, Hyannis, MA 02601 �0 Y►Y�' 508-790-6227 Joseph D. DaLuz Building Commissioner TO: Joseph D. DaLuz, Building Commissioner FROM: Richard R. Bearse, Building Inspector RE: A=214-059 Tenant: Barbara Ferris 385 Shoot Flying Hill Road, Centerville DATE: August 16, 1993 An inspection was made of the above referenced property on August 6, 1993. During my inspection I found no Building Code violations. The smoke detectors were checked by the electrician during the inspection. Records on file indicate that a Certificate .of Occupancy was issued on December 6, 1979. The Certificate was signed by all department inspectors indicating that all Code Requirements had been met for the dwelling authorized by Building Permit #21580. I did, however, observe several maintenance items such as a cracked thermopane window, rusty electric heat covers, a a that 1.7 ..� �.. ; n the inoperative Sink trap, a vdndow than. would not .:.,.,.r �.. open position, etc. . r w 4'y�FTX[t`.w The Town of Barnstable ...� Inspection Department 367 Main Street, Hyannis, MA 02601 508-790-6227 Joseph D. DaLuz Building Commissioner August 17, 1993 Mrs. Johanna B. Dacey 100 West Main Street Hyannis, MA 02601 RE: A=214 059 385 Shoot Flying Hill Road, Centerville Dear Mrs. Dacey: Enclosed please find a copy of Inspector Bearse's report re the dwelling owned by you and located at 385 Shoot Flying Hill Road, Centerville. Peace, Josetiph D. DaL z Building Commissioner JDD/gr enc. ---7-7 1_(YOP i ��FTHE raw TOWN OF BARNSTABLE OFFICE OF i 31AHa9TdDL i BOARD OF HEALTH NAB& A i639. � 367 MAIN STREET 0 MAY k' HYANNIS, MASS.02601 July 29, 1993 Johanna B. Dacey 100 West Main Street Hyannis, MA 02601 ORDER TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE 11, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at 385 Shootflying Hill Road, Ma, was inspected on July 26, 1993 by Eugene Pelkey, Deputy Wire Inspector for the Town of Barnstable, because of a complaint. The following violations of 405 CMR 410.00, State Sanitary Code 11, were observed: 410.351 and 410-200 (A): Second floor bathroom has electric heat baseboard that is rusty with wires showing. All wires shall be covered. Another second floor bathroom has a rusty baseboard heater that the tenant says sparks when turned on. 410.253 (A): Post light is broken. 410.351: An electrical fixture on the house adjacent to the front door was hanging and broken. 410.351: No cover provided on the electric heat baseboard unit in dining room and first floor appliance room. You are directed to correct these violations within 24 hours of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health at Town Hall, 367 Main Street, Hyannis, within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please find attached a copy of the memorandum from the Deputy Wire Inspector, Eugene Pelkey. 5- K 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 �a T s ea Director of Public Health TOWN OF BARNSTABLE TM/bcs Certified - P272947540 i The Town of Barnstable s Health Department 131MITA ' 1 367 Main Street, Hyannis, MA 02601 .63y. `F Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health August 27, 1993 Johanna B. Dacey 100 West Main Street Hyannis, MA 02601 To Whom This May Concern: This letter is to state that Donna Miorandi, Health Inspector for the Town of Barnstable, has made several attempts to reinspect the property ti occupied by Mrs. Barbara Ferris at 385 Shootflying Hill Road, Centerville and owned by Johanna B. Dacey. During the past two weeks of August 16-27, 1993 I made several phone calls to Mrs. Ferris and she was either unavailable, out of town, or had doctors' appointments. However, when phone calls were made on August 24th and 26th Mrs. Ferris answered the phone and was home. On August 25th her son and others were at the residence=her son answered the phone. I informed Mrs. Ferris that it would only take me 15 minutes to do the reinspection and that I just wanted to verify that the plumbing problems were corrected which Mrs. Ferris stated had been done. On August 26th I repeatedly asked Mrs. Ferris on the phone exactly when I could reinspect the property. She didn't answer me and kept changing the subject. On August 26th I contacted Mr. Thomas Lynch of the Barnstable Housing Authority and informed him of my predicament with Mrs. Ferris. Mr. Lynch stated that he would call Mrs. Ferris in for a conference to see what the problem is in making -the house available for the MRVP (Mass. Rental Voucher Program) inspection. If you have any further questions please feel free to call me at 790-6265. onna Z. Mior�udi Health Inspector 68066 0 ,6 be 's 61,16, 11 6`6 � 8 iis' Gi '7D2 - - 1 f D � i � i � i � i� � � � . � i � � l �� � � � � i� _ _— -- - - a. - — - ----. - ---- - - - -- - �_ � � �� I �-- — . T— — - i , t r - - f E - -. _ _ -- _ _ _ _ _ _ __ ___- - T- - - --- - - - - - - - - -- E � k � � I i I I WHILE YOU WERE AWAY FOR ` DATE TIME M T' HQNEt} OF- PHONE 7 7ZZ YtEiRCA[L NUMBER EXTENSION • AREA CODE ry f{�+nAt�1 MESSAGE ` 1L1.. . U11�1{�.. TC' E YC1U 11, SIGNED TOPS FORM 4002 NOTES � ti ��� �• � � � ��� �o� �� �� i L� P 411 221 247 RECEIPT fOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) N N p Sent to v n e N m Street d No. P.O., tate and ZIP Czode au QarP�� Postage 5 Certified Fee 17 920 Special Delivery Fee Restricted Delivery Fee Return Receipt showing to whom and Date Delivered 1� rn Return Receipt showing to whom, Date,and Address of Delivery d j TOTAL Postage and Fees QPostmark or Date (n E Ply �6 /�9� 0 LL N IL 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 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 on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space per- mits..Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 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. i 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. Irreturn receipt is requested,check the applicable blocks in item 1 of Form 3811. 6. Save this receipt and present it if you make inquiry. . ,a U.S.G.ao.1989-z34-555 y�THE Tp�f The Town of Barnstable Health Department AINSTAIM 1 ' AM 367 Main Street, Hyannis, MA 02601 %659 y �0■ i" V Office 508-790-6265 q q + Thomas A. McKean FAX 508-775-3344 Director of Public Health July 21, 1993 Johanna B. Dacey 100 West Main Street Hyannis, MA 02601 ORDER TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE 11, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE BOARD OF HEALTH'S NUISANCE CONTROL REGULATION NUMBER ONE The property owned by you located at 385 Shootflying Hill Road, Ma, was inspected on July 21, 1993 by Donna Miorandi, Health Inspector for the Town of Barnstable, because of a complaint. The following violations of the 105 CMR 410.00, State Sanitary Code II, Minimum Standards of Fitness for Human Habitation were observed: 410.500: Cracked front window. Leaking living room ceiling, due to leaking upstairs bathroom. 410.750 A: No hot water due to failed hot water heater. 410.351: Leaking faucets in showers. You are directed to correct violations of 410.750A within twenty-four (24) hours of receipt of this notice. The remaining violations must be corrected within 5 (five) days of receipt of this letter. You may request a hearing if written petition requesting same is received by the Board of Health at Town Hall, 367 Main Street, Hyannis, 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 Dale Saad, PhD Acting Director of Public Health TOWN OF BARNSTABLE DS/bcs Certified - P411221247 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, .�" ' CITY/TQW N I� Q DEPART VENTA)lAi / ADDRESS J� TELEPHONE y Address J�i t � 1//n _ ilC.l. Occupant ) Floor. —_ Apartment Y.@. NN O cupants No. of Habitable Rooms __7_ No. Sleeping Rooms No. dwelling or rooming units rNo. S.tori ° Name and address of owner X� tt l� U f � � 0300/ 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: fi I ,"I)AL ,MP /(f )(,U Roof Gutters, Drains: \� Walls: Foundation: ) Chimney: i ) BASEMENT Gen. Sanitation: Dampn6ss: 1 )7177P 4r0 �_ ), !k YIN)f Stairs: _ Lighting: STRUCTURE INT. Hall, Stairway: Obst'n.: 4 1 C, le Hall, Floor,Wall, Ceiling: ��f ( p' �jq. N W Vr Hall Lighting: Hall Windows: ✓ ` zz HEATING Chimneys: z Central ❑ Y ❑ N Equip. Repair _ I } z TYPE: Stacks, Flues;Vents: Q PLUMBING: Supply Line: /V�_. ±1(,Ft UJM ❑ MS ❑ ST ❑ P Waste Line:1� m H.W.Tank(s) Safety and Vent(s) _ ELECTRICAL Panels, Meters, Cir.: _ 0 ❑ 110 ❑ 220 Fusing, Grnd.: AMP: Gen. Cond. Distrib. Box: 0 Gen. Basement Wiring: DWELLING UNIT Ventil. Lgtng. 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.: ,^<r J � �')�,'(.!� # SIW, OIC 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." �.1�.- T INSPECTOR _ TITLE __� ; A.M. DATE �- __-1__ TIME _'P' '� 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 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. (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 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 410.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.602 which results 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 impairment to health or dafety. _ (L) Failure to install electrical, plumbing, heating and gas-burning f 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 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 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 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 violationof generally accepted Numbing heating, gas-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 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. �c Q T To,, The Town of Barnstable Health Department 1 NAUWAU ! 367 Main Street, Hyannis, MA 02601 .639. �F Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health August 31, 1993 Susan Nagl, Esquire Legal Services For Cape Cod and Islands, Inc. 460 West Main Street Hyannis, MA 02601 Dear Ms. Nagl: I am in receipt of your letter dated August 30, 1993. on or about July 28, 1993, Health Inspector Jerome Dunning received a telephone call from Peter Freeman who stated that Ms. Ferris refused to allow the repair-workers into her dwelling to make repairs. on August 12, 1993 Health Inspector Donna Miorandi reached Ms. Ferris by telephone; Ms. Ferris stated she needs 24 hour notice. During the week of August 16 through August 20, 1993, Health Inspector Donna Miorandi made several attempts to reach Ms. Ferris by telephone and was finally told no re-inspections could be arranged during the weeks of August 16 through August 27, 1993 due to appointments and because she was not available. However, on August 24th, Ms. Ferris answered the telephone and told Ms. Miorandi that she hurt her hand due to glass fragments which fell from a cracked window. on August 25th, Ms. Ferris, child answered the telephone. Ms. Miorandi did not "interrogate" the child. she only asked if his mother.was at home. on August 26th, Ms. Ferris was at home. Donna Miorandi repeatedly asked Ms. Ferris when the dwelling could be reinspected. Ms. Ferris didn,.t answer Ms. Miorandi; Ms. Ferris quickly changed the subject each time. I think you can understand the difficulty we've had in trying to arrange a reinspection of the dwelling. Please be advised that it is the owners responsibility to make arrangements for repairs. I suggest you also advise Ms. Dacey of Me. Ferris, availability to arrange for the repair work this week during the mornings. sincerely Yours, Thomas A. McKean, RS, CHO Director of Public Health Barnstable Health Department The Town of Barnstable Health Department 367 Main Street, Hyannis, MA 02601 Office 508=790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health August 27, 1993 Johanna B. Dacey 100 West Main Street Hyannis, MA 02601 To Whom This May Concern: This letter is to state that Donna Miorandi, Health Inspector for the Town of Barnstable, has made several attempts to reinspect the property occupied by Mrs. Barbara Ferris at 385 Shootflying Hill Road, Centerville and owned by Johanna B. Dacey. During the past two weeks of August 16-27, 1993 I made several phone calls to Mrs. Ferris and she was either unavailable, out of town, or had doctors' appointments. However, when phone calls were made on August 24th and 26th Mrs. Ferris answered .the phone and was home. On August 25th her son and others were at the residence=her son answered the phone. I informed Mrs. Ferris that it would only take me 15 minutes to do the reinspection and that I just wanted to verify that the plumbing problems were corrected which Mrs. Ferris stated had been done. On August 26th I repeatedly asked Mrs. Ferris on the phone exactly when I could reinspect the property. She didn't answer me and kept changing the subject. On August 26th I contacted Mr. Thomas Lynch of the Barnstable Housing Authority and informed him of my predicament with Mrs. Ferris. Mr. Lynch stated that he would call Mrs. Ferris in for a conference to see what the problem is in making the house available for the MRVP (Mass. Rental Voucher Program) inspection. If you have any further questions please feel free to call me at 790-6265. Sipxerely, Donna Z. Mior i Health Inspector LEGAL SERVICES FOR CAPE COD AND ISLANDS, INC. � 1 ,�r 460 WEST MAIN STREET, HYANNIS, MASS ACHUSETTS 02601 - e4hohu (508)775.7020.428-8161 1.800.742-4107 All Numbers voice and TTY FAX(508)790.3955_ August 30, 1993 Thomas McKean Barnstable Health Department 367 Main Street Hyannis, MA 02601 RE: Barbara Ferris 385 Shoot Flying Hill Road Centerville, MA 02632 Dear Mr. McKean: I spoke with my client on August 39, 1993. She teports she is available any morning this week for workers to do repairs and/or to receive an inspector from your office. Simply telephone Ms. Ferris to make arrangements. As I told you, last week was a difficult week for (ny client due to the death of a relative. Although this was reported to Ms. Miorandi, a0parently Ms. Miorandi chose not to believe Ms. Ferris. Apparently, Ms. Miorandi thought it: appropriate to interrogate Ms. Ferris' son about whether or not his mother really was at.a funeral this past Wednesday. We would appreciate it if your attempts to make appointment§ with Ms. Ferris would be handled more respectfully. Also, please keep in mind that you do not have permission to interrogate Ms. Ferris's children about any of these matters. Please let me know if I can be of additional assistance. Very truly yours, Susan Nagl Attorney at Law SN:bk Plymouth Office TOWN OF BARNSTABLE 0 1 ro OFFICE OF ea �T�gtr. ! BOARD OF HEALTH Nee. 307 MAIN STREET CAI�Ya. HYANNIS, MASS. 02601 FAX # 508-775-3344 PLEASE FORWARD THE FOLL OW1NG PAGE(s ) TO THE FOLLOWING PERSON(s) T ,17r79--21 RECEIVE,? S FAX 0 : 3A� �® j'M} f DATE: PAGE( s ) : E:ccluding cover sheet 'M TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date _qi 1511�3 eb Owner PAC6 Tenant e Address Address 3R57 A1X6r,r',Q`1A&. 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 o 8. Ventilation o 0 9. Installation and Maintenance of Facilities ! USN 10. Curtailment of Service 11. Space and UseWay o 12. Exits 13. Installation and Maintenance of Structural o Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing PART II SynD� � 96 SM OW �V 37. Plocarding of Condemned Dwelling; Removal of Occupants; Demolition m a4ZAA�q� Person(s)Interviewedl-J� 0 7N �l s Inspector If Public Building such as Store or Hotel/Motel specify here HOODS Q WARREN,INC. i *r 105 CMR: DEPARTMENT OF PUBLIC HEALTH 3�9 410.501: continued stripping, the space between the door and the prime door frame is no larger than 1/16 inch at any point on the sides of the door or 1/8 inch at s any point on the top or bottom of the door. Y (C) A wall, floor, ceiling or other structural element shall be considered weathertight only if all cracks and spaces not part of heating, ventilating or air x � conditioning systems are caulked or filled in as to prevent infiltration of sexterior air,or moisture. ^ / 410.502: Use of Lead Paint Prohibited ' No paint that contains lead shall be used in painting any surface of any dwelling. (See 105 CMR 460.000.) 410 503• Protective Railings and Walls 1 (A) The owner shall provide a safe handrail for every stairway that is used or intended for use by the occupants. (B) The owner shall provide a wall or protective railing at least 36 inches high ;x enclosing every porch, balcony, roof or other similar place which is more than 30 inches above the ground and is used or intended for use by the occupants. t' All stairways used or intended for use by the occupants must be enclosed on t both sides by a wall or protective railing at least 36 inches high. (C) All protective railings required by 105 CMR 410.503(B) shall have balusters placed at intervals of no more than six inches, or any other ornamental pattern r or stair su ch that re six inches in diameter between the railing and floor P bet g cannot pass through. 410.504: Non-absorbent Surfaces (A) The floor surfaces of every room containing a toilet, shower or bathtub and every kitchen and pantry shall be covered by a smooth, noncorrosive, nonabsorbent and waterproof material. This shall not prohibit the use of { carpeting in kitchens and bathrooms, nor the use of wood in the kitchen provided they meet the following qualifications: (1) Carpeting must-contain a solid, nonabsorbent backing which will prevent the passage of moisture through it to the floor below; and (2) Wood flooring must have a water resistant finish and have no cracks to h allow the accumulation of dirt and food, or the harborage of insects. l_ (B) The walls up to a height of 48 inches(1.2 meters)of every room containing a toilet or bathtub shall be covered by a smooth, noncorrosive, nonabsorbent and waterproof material, provided with installed shower head or a shower compartment shall be of such material to a height of not less than six feel (1.8 meters). Such walls shall form a watertight joint with each other and with either the tub, receptor of shower floor. (C) The wall areas above built-in bathtubs having installed shower heads, and in shower compartments, shall be covered by a smooth, noncorrosive, '.). nonabsorbent waterproof material to a height of not less than six feet (1.8 meters) above the floor level. Such walls shall form a watertight joint with .. each other and with either the tub, receptor, or shower floor. }/ 410 505• Occupant's Responsibility Respecting Structural Elements 6 The occupant shall exercise reasonable care in the use of the floors, walls. doors, windows, ceilings, roof, staircases, porches, chimneys, and other r4. structural elements of the dwelling. ,��• tt�F�'• <.a teY,rl;31�x,rS4+fr,+-.`.1111C+Y-M1 r s' :4 t.,_: .... ... ..._. ... ...... ..... .. - ;� 12/31/88 `� 105 CMR - 3385 r, TOWN OF BARNSTABLE LOCATION X1,1 1ZW SEWAGE #lU "52 l VILLAGE_E4,t1 S*rl4 `.:� ASSESSOR'S MAP 6z LOT INSTALLER'S NAME & PHONE NO.9 C2'a � C�3.2 • C� 5"�l3 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) P, T (size) o!� NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No if b7 ;t ASSESSORS MAP N0: _ 14 '�' � �-013b PARCEL NO: 52 No...... _0. 5..�1 Fss.., �>................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Uiopooal Workii Tomitrnrtion 1hrmit Application is hereby made for a Permit to Construct @Vg') or Repair (`X) an Individual Sewage Disposal System at: Location Address or Lot No. OU ..:F�a.i..... b' _�:.-'gyzc 7... i'tl._.a r�........................... Owner ICL Address vV � Installer Address f U Type of Building Size Lot-__aa,. ...Sq."feet Dwelling—No. of Bedrooms.__1_h fr:.........................Expansion Attic Wc') Garbage Grinder (�") pa, Other—Type of Building ............................ No. of persons___.._.__-__•____-__-_______ Showers ( ) — Cafeteria ( ) P4 Other fixtures ------------------•------------- . W Design Flow...................................9:2..gallons per person per day. Total daily flow........................... .......gallons. -W Septic Tank—Liquid capacityLv0jC:).gallons Length.l9_`_-.1L"... Width-4�_-l-C?".._ Diameter----__7 .... Depth_5.�L6.1" x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....d!toc---------- Diameter...../Gf-___--_• Depth below inlet---A............. Total leaching area---A.5-Z....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1.4 Percolation Test Results Performed by._E.l&r&;- Date...7,%#l7l................... Test Pit No. I......Zi______minutes per inch Depth of Test Pit------1.2-1....... Depth to ground water________________•__-_--. (� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ •----------------------------------------------------------•---.....----------------•---•----_--_---.........................................................p 1t i 1 1 Description of Soil--.---A==_ro.-�"?^a--}--(o-----z.-T- cola _c�:t.. ._. _-7_.�_.» �4.��1ra_sr�ncQ-f--7-=�;;•----4Q4---$. land, x w U Nature of Repairs or Alterations—Answer when applicable...t�c_�_lc�c __.. x�i_t .._._� �Ala... i► ....c IR,........... -----------------------------------------------------•-.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation.until a Certificate of Compliance has beeni ued b the board of health. Signed -- ...... Date Application Approved B .... .. -- ------------------------------------------------------------------ ---------------------- --- '1 . PP PP Y Date Application Disapproved for the following reasons- -- ---------------------------------------------------------------------------------------------------------------------------- ----------- -------------- -------- --- -------------------------------------------------------------------------- -------- Permit No. ........ ( 12�/ O �� Date ® ! Issued ..... -- --- _ G Date .......... ..............._---.... ..��.1. 7� s9 l Fss. G No.... .. .... ............... r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE r ApplirFatiun for Disposal f urks Tomitrnrfiun Permit Application is hereby made for a Permit to Construct (,go or Repair (V an Individual Sewage Disposal System at: Location-Address or Lot No. ........xa- Awn42k...lab...Y-o61............................................... 385._Sl±oc�t ��af .�ffill. ol�q�._................--- Owner Address w Cif ._, , /�i02Gvl cc�/ ._ Lc ,frcvcl ..... Installer Address d Type of Building Size Lot___ ,�. _Z�#_._Sq. feet aDwelling—No. of Bedrooms-__1_.1Ar gAt........................Expansion Attic (iYO) Garbage Grinder (Al.) a Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other,fixtures . - •------------------------- W Design Flow....................................5_-S-_gallons per person per day. Total daily flow___..._..___............_�aQ.......gallons. WSeptic Tank—Liquid capacity.izoogallons Length..QIne... Width_4.'--la.`.._ Diameter---- Depth_,S�C.=('-- x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area_______•---_------sq. ft. Seepage Pit No.....ona.-------- Diameter.....1.4........ Depth below inlet.._G...•••...... Total leaching area......Z..S?...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by._ lAet,%e... ,3r_CoZn�; P._-RoAAcis, Date.... 17.?............... Test Pit No. I.......Z.,�.....minutes per'inch Depth of Test Pit------1.21....... Depth to ground water________________________ fTq ti, ' Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_____.._________-__-. �w _ Description of Soil-------Q_-b�T_1.a_rri-- -_!a°-Z2,._s.s�las r�il�.--��-7�7--t►aedl_wm-sc ►�-j---Z��I-L�_-�axSAL—C j, V .�. W" �. U - •. Nature of Repairs or Alterations—Answer when applicable...__9c ptac z____�i�e.---___1res c.k__,4!_...WJ-+-.......... ------4AUa...."c1i...Pik------- ....................=-----------------------•--------------•---------------------------------------................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE"5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ed-by the board of health. -;' f- r-- F - .. ---------.. f - aw /f Application Approved By ..--- - ------- ---- -- --------------------------- --------------- ..-�.. ...... r Date Application Disapproved for the following reasons: ... '------------------------------------------------------------------------------------------- -- ------------------------- �- Dace Permit No. -----------------------------!` Issued --1-�--^'�-�-^-- ...................... r ,„.Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Trr#ifictt#e of CZum li�xncE. THIS IS TO CE�R-T , That the Individual-Sew_age Disposal System const�cted ( ) or Repaired ( ) by ...................................... ---....( ............. ........ --------------------------------------- .................-.......................................... lnnsca er / ! at � ..-�'S.........e.."l'�o"�...... / -� 1.-y[=L/-----/ ---------..........................------------------------------------------------ has _ been installed in accordance with th�rovisions of TITLE 5 of The State Environmental Code as/described in the application for Disposal Works Construction Permit No. ...-Gil , --- ---/dated ---1/._2Z...--'1. ...- .�-.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A'S.A'GUARA�NTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY: ✓� t;l/yt �' ' DATE.............l.r�` 0=------- ---:')--------------------------------- Inspector .............................J`----J- ,.�..__\�... ---------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE -No....r. ..... ?� FEE.3 a....... i �rusttl urks Tun trnrtiun fermi# Permission is hereby granted--. ..... to Construct ( ) or Repair (�7- at n Individual Sewa a is asal System No.--------,_3_Frs ....-.51!w ._"�__� i''V � ...._. a ..r...............................................................' �. Street �J' as shown on the application for Disposal Works Construction Permit No.__`_(� 517 DDated....._�2� Board of Health -� DATE......;. f ----------------------------------- FORM 38308 HOBBS Q WARREN.INC..PUBLISHERS f 1 13rc.�.rc a�> q� 1L �r2 fO (.J -r N 95 EXISTING FAILED u ' LEACH PIT 100 I LOT 2 x LOT 5 �O 1 I v, ., ► , 5 10 ' LdT .� ,5�\ 2 ,462 s.�f. ', '� ,I I 1 00 Col. G \�\ \5 �\\91 1 8 p c O' e p D (� K 95 100 1190 95 95, 90 �O 12/5/90 INITIAL ISSUE CF THIS PLAN IS NEITHER INTENDED NO. DATE DESCRIPTION By FOR, NOR SHALL IT BE USED FOR SEPTIC LOCATION PLAN-LOT 1 MORTGAGE LOAN PURPOSES. SHOOT FLYING HILL ROAD BARNSTABLE, MASSACHUSETTS FOR BARNSTABLE HOLDING CO. I CERTIFY THAT THE STRUCTURES SCALE: 1'=40' JOB N0. 1546 SHOWN ON. THIS PLAN ARE LOCATED 0 40 80 ON THE GROUND AS INDICATED. LEVY, ELDREDGE & WAGNER ASSOCIATES INC. DATE REGISTERED LAND SURVEYOR ENcINEF& WNW ACE AKHMM PLANM LAND SURVEYORS 889 WEST MAIN STREET CENTERVILLE, MA 02632 P6 y DATE: ^L4'- 104 �� ASSESSOR'S MAP & PARCEL: COMPLAINT LOCATION: `� '� 4l1 1?ce-j- e �- 't COMPLAINT DESCRIPTION: LC�� ^ Cyr`''f` ��` �' ri" ► '�"� & ► PHONE: DATE: INSPECTOR: .J INSPECTOR'S ACTIONS/COMMEN S: ft No........................ to 4 O 5 Fx$..`......................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® F !-IEA T h ApplirFation for Disposal Works Tonstrurtion .ernt t � f Application is hereby made for a Permit to Cons rust r Repair ( ) an Individual Sewage Disposal T S :7 at: r �► ' --..... _.. ;,-. ... ►.��--: •°•..-•--•--••-----••--- ..........................................1...................................................... at on-Add ss 4 qr Lot :.�.. .......N�- Address� ..... .._ . Installer Address Type of Building Size Lot .-y. L_Sq. feet Dwelling—No. of Bedrooms_______________.............................Expansion Attic (� Garbage Grinder �j b Pk Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures. ------------------------------------------------------------------------------------------------------ .................................. W Design Flow._-•••.•••-••� ....................gallons per person per day. Total daily flow___- — .....................gallons. WSeptic Tank—Liquid capacityf07�gallons Length________________ Width................ Diameter---------------- Depth................ x Disposal Trench—No_ .................... Width.................... Total Length.................... Total leaching area_.(?........sq. ft. Seepage Pit No--------------------- Diameter......._............ Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box 4�) Dosing tank ( ) aPercolation Test Results Performed bY.......................................................................... Date-------------------•--• --• --------4 Test Pit No. 1.�__ _minutes per inch Depth of Test Pit_.__._R�.___ Depth to ground water_KO. 7 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....._.................. 0 Description of Soil... a °1 ' C U --- ----------- -...•-- x ...............-................................= 4-------- ------ . A_ -...------------------------------------------------------------------------------------......................... UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until jai Certificate of Comp�li nce has been i ed by the bou d o health. Date Application Approved By............ Date ........................................ Date Application Disapproved for the following reasons:--•-------•------------------------------------•---•---..--•-------------------------------•----•--••....._..•-- -----------------------------------------------------------------•--...._..••••••••-...•-•••-••_._........__...._....•--..-----------•--•-•-••-.-•---•--.-----•---------•--...--•-----•-.-•••------------ Date Permit No........................................... Issued_ 2,6--- 79 ............. ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD F' HE TH tr+�. ... OF..... r; Applirtttion for Disposal Works Tonstrnrtiun Prrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal Syst at , .I.LP4........................ ......................................... ....... at on-Add s qr Lot _.... ... •-••-• .... . ...w Address WA..:.: _.... . .-- t... .��. � ..... r � Installer Address �}} == ll Type of Building Size Lott P ?.j�K7 _Sq feet aDwelling—No. of Bedrooms_____ ____________________________________Expansion Attic ( Garbage Grinder 4:10,. aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtur _________________•- -- W Design Flow.............. _.gallons per person per day. Total daily flow___ .............gallons. WSeptic Tank—Liquid*capacity gallons Length................ Width................. Diameter............... Depth................ x Disposal Trench—No..................... Width..................... Total Length.................... Total leaching are A.4.(........sq. ft. Seepage Pit No-----------------_-- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box Dosing tank ( ) 0-4 Percolation Test Results Performed by.................................... ______ Date........................___ a Test Pit No. 1.' __minutes per inch Depth of Test Pit..... ___ Depth to ground water ............... ' (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------- 0 Description of Soil._ T .... ° y .....................� :� -- 7� _ W --••----------- -----------------------�-- f °��_. A:.-----------.----------------------------------•------•----•------------------------------------.............._ V Nature of Repairs or Alterations—Answer when applicable................................................................................................ --------------------••----.-.---•---..._._...-•---•---------------------------------..............--•-•-•-•-••-•----------------•--------------......--------•----------------------------------•-_..._. Agreement: "_':The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of l I.Lip 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Com 1,. nc has been - ed by the bo �ohealth. Al Date ApplicationApproved By................................................................................................... ........................-............... Date, Application Disapproved for the following reasons---------------••----••-----••--•-----------------------•-----------------------•---------------••---....._•-••-- Date •---------- ---•-•--------••---------------------------------------------------------------------------•--- PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHU;SETTS ;[ r.. 4 BOARD OF""HEALTH ............. .4 /` '�..........OF....../ .... ................................ (9rrtif ratr of Runt It anrr Y T S T; C TIFY, That the. Individual Sewage Disposal System constructed (Y or Repaired``�-�(,; ) by----- p :� -----•----•--•---•--•-•----•---••------------------------------ ----- -stall �.- at...... -7- 4C has been installed in accordance with the provisions of T 5 o The State Sanitary Code, as described in the application for Disposal Works Construction Permit iVo. ___ _-_ _________________________ dated------- application ISSUANCE OF THIS CERTIFICATE SHALL NOTE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION:SATISFACTORY. � DATE , Inspector _.. __ _ .!, r r s,.:.', ✓t z; �.�E ��r a � _ t Ste. a,,na`-„ u�," :�rn kJ a of iw*m.. 4 t z w s �^� s�, m .�,!�w a t k �. �� .�'� •:� .�k.i .K4 �-r�ey"�i sa, ., -'3 .,.`v i k' C a t t THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALT 6 N '/.......... FEE........................ �a r T #r oan rrmit Permission ereby ranted `� ' to Constr t ) or air ) d'vidual Se , g f Street... as shown on the application for Disposal Works Construction P 't No ._.}____= � Dattedd:___/�` � •� ���_-_-- •• ........ -•-••- /� `f Board of Heatth DATE... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS fY x.� t V r 5 r�-?'r ., S• �7 y / .:.� -'7�� "( t � -. , , t,A,° � 'fin �1? ��.�Kn. 7��. Al'. r. 4 4,.Ft ;}yf)Y r i+3', -}IF . L :"`�!' '1 •S'' :Srdi p�.� rkvz �'F�'`,�i�f5rp r dl'dk(r� s,a i i a :-4 Q f:ly�g�,t x r,�t,#✓�.'1 a ty,F��,.' : ' a y t ;t.� � r �' v'S::,� '�d�^ < ss� t �3r""i )t! �, 3 r V �^'j`-.' 4 •I 4 t. r .i` � , {; + 4T„ Z Sir r3 %SSf cc,.�a�I iwn t ' ,." /q ij 4 d 1i°�./ i ' .. s 4 W ➢ F, IF- No.� +Y- �` x� 9r Vt �,�_ ( t�p`�� �`�r� xiµ}i�ab� +� 'S �`+ �•�...� - -�� '� � �6 V � V \ A � it �, c�.�...A5 3y �"45 t' 1 ry ,lt No 9y3,ah�rrY� � �rW il t C g .n, y;a S ; �•i�. }fit Ali! f r 36 U_h q .. '` m ,;Vy r..•� iart.VPaVE ,{s r �' •N „csj b 1N sg �yt' �n.1'�F�trGi+r.F. ice! I - •$ �� S z-t 'iI �.j yy'N>S.qt dAs6 .E. '. Y 'r,•{��s �. i - \L/� _ \ u''K iP"y 1J pw ra: 1 ik :. _. , , a .. a• k r✓�'U-a '�u�j > i. r � ,, VF 'v t -- t i tad 3._�d .: U. (� J J4 X j' §', 1 ) J C •'/� �S�,�../ Y ! �,it!y'ti'`�"°t7 r�..� �'tr � r rare � D 0 A.M gk`� , � )t¢4 � = t, , a _ r ,i _ 1�V `S"�)� ,rs S � r�• . r t _aR air g. s' No:22152�9. Ifi q t ' '', •�v'� t r ryd7x,>f€ �),,' R.t�., 6 N xisI'M 0�'� A E�. IATION 4 ® ,lkR CERTIFIED PLOT » It " INISHED"; 5.��`P a.ELEVAYO®N G o� I s�►,�ur !, 4 �e�e.I �t+� -a.-;: ,3�,V�• � _ a Y ��W,v ®® . �+ gg{�/j �p q� ---.•--�.�,.�7 •.� r � � .. �_� ` r,._�+�'d�,��.r�j ,,pp�� J. 5• A e L'' ?Y'(t�y 1yA•,* ` .. °x: t i $ N L SENT SGALE:: '� 11 ,'� 0 ®ATE ORE6 . L eYi��Y1/�L fYI�C7 le�..�� --- CLIENT �� cry I CERT6FY T � RoPos���`� H "SHE =.� Wd�Bta �ii917i�" �� �ESi�e7TEgi® r —7Z0..�S k r x ��P JOB No. _ ®uc�®i�® SHOWN , ON ��6�� ��A ,,� r t 1 1 u J` � R.A�9�2 ®R:® 9.' ®NF®RP�S T®' THE p ®NONQ ` Al y �� . { URVEYOR ®F '®ARNS ®L' � 'FS11f09• 7 a. MAIN ST CN. By o '{ ,k 14, ,,.rr - SHEET ®F OWN ®�4�E-tRI:� i„ _. r+i �'' ,P.. ,l y1-. .. . �e� •?tt' - -Fe------- -- • . L E�Csd�//VCs ..P'/T, � � I°�/4'1P� :.7'�d./9 E!'V ��,� ��d.®b6/ - - : ,�® �: /►s///al. `� _ .. - ._ _____" - ..''s1�A„®��.r� �4",BOA�I E��•�,,CQ��'R�'�� _C'®C✓,g�6' Co/NCRETE lyE.4vy CAS? /oa"o GOdiE/P.5 �J /9 ®F,Q7FT. .' -•1F//v OR/vEl�a/.41� e: C®n/CR-7-E• - CbR.4®E Co tiEFd CLEAN .SAND Al = / OAC.le /LL e z 2tlLAYER y .�" CAS? OF IRON P/PE CAL. m ' o� o m Al) . P/TCN ® O ® ® ® ® e o n ®per ly/ASHL�D S72'JNE'` rq"PEm P r.. S�PT N/C/C TA U/sT. BOX v 0 0 ® m mom , c C• Q. ID �;� a p EFFECT/VE o D ; ° WASYED STONE 1 0 0 OI'PTl`/ 0 0 0 c' c ,^ 1 O: , @'. ,:• q:a.,,,:s . .:.p ...>y D., O 0 G 0 O O m A o 0 0 v, o�o g 4 ° o o a O ® m m m o ► ' PRECAST,SEEPAGE I o po o0e m O o ® co a ® o P/7OR EQU/V ! , 97 p %n/e%ERT AT SU/LD/NG — - J=T -- C(5EE TABULAT)ON> I 1 ML E T SEPY/C 7A' /1//C --- � OUTLET SEPTIC 7-AIV H .2k_, FT. - /NLET D/ST/�/dUT/ON BOX `��' U PT. SECT/ON aF rsROuNo btrflTER TA® E OUTLETD/STRf,8[/T/UN BOX `� FT. t E LE�i/NLT CH/NG / T D/� ` .- T.F aS� ®®.�P®s�t��. e�'�•��'�./� `TAJ1L.AT/DAI I-EACH11 6 P/T 3 FT. SCALE %4 _ /�- �'" UJMENS/_0A! A--�— D.ES/GN CRITERIA OoN FT. NUMBER OF SEDR00AIS GAR45AGED/5P0SAL UN/T - SOIL_ Z.®G 7E5 rorAL.ESTtmATEL> F -oAAV o_' G.41-.1DAY SOIL TEST */ SO/L 7ES7_*2 e A/UMBER U�" -Zr4CN6NG: p/TS_. . / �f^ELEv 7 p �ELEI/ ,DPI T� O� .�®/L. TES� S/OE LE.4CMOA/G PEs�d P/T �/FS1s' SQ, FY s „ RE'SUL'r�' bd/TMESSE® BY P d�un�/iG/S 7�` PE1�C04A r10" 1�A,TE */ L�s S - O®TTO/K 91CH/A/G PESa' /�/T ,SGj. F� p<F stir l:L-,VCoLAIrlON RA'7,E A& ��OTi9L LEACH/NG AREA Zb I. SQ FY .., G „_ 2 _ REsERVELE,4CN/ EA_z..66 SQ. FT. Su9sdl[ z v o �0 ROBERT, 6 -7' B NKI r U I ,No.22162 - S _ � t. :y � - ONALE�® - EL ,j ��`p - <� 712 A"1AI/Y SF: :33 /d0 /+'7s9//tlS Al .5 _ �/3/1 S3 /COG.rN r4�'E M/ Z/0 T r. Ka j �. GF�OtJ/4/O 1/b�#T•�I�'te�`��L.EI,�'* ,� ,.. - �." �#- i7. 0 S �Q _ 9 .M1 7 t'A,T ION A C E PERMIT N0. LACE q �}%�l e - 1 l I N S T A L L E 'S NAME i ADDRESS BUILDER OR OWNER (,J nit `DACP DATE PER��MIT ISSV E D 7 ;2-3 -7el, DAT E COMPLIANCE ISSUED 9--2S-_79, 09C d� � AP'R 25'16 m 7:4 4 y e 385 Shootflying Hill Rd ; CentervilleCleo 8'6"ft 6'0"ft 4'5"ft " Oil tank Walls: 40.00 it 2x4 studs Bathroom N R13 insulation 1/2" drywall Ceiling: 10.41 T01,ft drop ceiling 2'x4' panels Storage at 7' Boiler Floring: ceramic tile Stairs: width 36" 603.10 headroom 6'8" 152.22 " riser at 7 3/4" tread depth at 10" Bar Pool table Room N o O rn -0 (D v n =3 I+ (D n. n� 30'11"ft 3'S"ft I Route 6 _ —� GENERAL NOTES: ervlce oa LOCUS N 40e 3430 E #'�oti + 7 i �,��� 1. VERTICAL DATUM: Assumed ay o 125.00' ti� �� °> / 2. MUNICIPAL WATER I_AVAILABLE. a� Cd a ev(ew, r. / �j y 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT SYSTEM N ` Lot 1 + / / '�� UNLESS OTHERWISE NOTED. 20,414#S.F, 29' I/ / o A 4. ALL PRECAST& PLASTIC UNITS TO CONFORM TO 1 �ti� 0.47t AC: / �6 AASHTO: H-10 1r� + /' i �j i 5. PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. Ma 214 p� 6. ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE WITH MA Parcel59 4-}- i ENVIR. CODE (TITLE 5)AND LOCAL REGULATIONS. 10 7• CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO LOCUS MAP N.T.S. / �+ 6 02 CONSTRUCTION. RtSERVE AREA t; S ASSESSOR'S MAP: 214 116 k ti� // / •°S / / � LEGEND: PARCEL: 59 36 / / 108 4 4 Re grade for �- 99—f PROPOSED CONTOUR / / g ❑ REFERENCE: PL. BK. 275 PG. 66 j6f10 // 16IN-E]4 T -2 ( + 14 10 Breakout 99 PROPOSED SPOT GRADE ti / (N O> FLOOD ZONE. C Town of Barnstable '1 �a�� 6- T �0 S -- 4O EXISTING CONTOUR #2500010005 C (8/19/85) 3'4' — 30.23— EXISTING SPOT GRADE Aso "8 & TEST PIT 110 I1 + ° ,�p, � (n ® EXISTING WATER SERVICE 43' jI l OS X (0) P. ,� ©X WORK LIMIT LINE Z // /� TH-1 / 49' :. 10 361 / 1� 10 o rorb �1 / S 99 ,?1� I 100 rn 1 1 Q S m Q� JIc C? o / °8 O O 1 10 C' �� I 1Q 14- o / z�-/ q I ����� i761 / / —�� O I o� AMY L. ti� o TERRY 1 10> / 11' i0> L lr k0� m I o VON HONE y ANN Q / > + WARNER „ I No. 1068 No. 38721 � J°Q �F�I ST fR�4, FGI + I � ,� oti 109 \'70 S 10 111( L/ ° I, NOTE: This plan is to be used for septic + system purposes only and is not to be 1> considered a property line survey. Benchmark set: 10> �� I �9 0t CD Left corner wood bulkhead / 0 104 0� AD EL.= 109.44 (Assumed) / y 10 385 SHOOTFLYING HILL ROAD ° 6V H CENTERVI LLE, MA 10 J' A1011 sr6 %..Oj�. yCij ��� associates V� �J / �/ j�s i Q� SEPTIC SYSTEM DESIGNS PREPARED FOR: rr \ d A $'7. 12 c / , \ 320 Cotuit Road G. Johanna Pol 6 �88 \ +_ =19,15.'51' _ — — — sandwich,MA 02563 c , „ (0)508.833.0041 913 Capriccio Lane ��v r �— (C)508.274.0074 NOTE: Pump and Backfal.lailed 1p /-- 9 512 ��- ___ _ — �� _ — 9� A ollo Beach, FL 33572 Leach Pit. Re-use existing 1000 1o2' 9 O 9 p gallon Septic Tank. For Tank 100— �'S — S h 99. 9� Surveying by: condition,see Inspection Report Edge of Pavement 9� �'{ `�S rr Terry A. Warner. P.L.S. 22 oad by Sean Jones dated 03/28/14. 9� 6 SHOOTFL�I NG HILL R' AD Harwich, MADATE REVISED SCALE SHEET N0. o (508) 432-8309 04/11/14 1° = 20' 1 of 2 3 ` i Provide Riser over D-box NOTE:All components to be marked with NOTE:To prevent breakout,final grade T.O.F.(Full) to within 6"of final grade magnetic tape or similar prior to final cover. of EL. 104.0 to be carried out a EL. 109.29 minimum 15 beyond edge of leach (Cover to be watertight) j facility.Re grade as needed. F.G. EL: 104.0107.9t F.G. EL: 107.7t F.G. EL:106.Ot j. Maintain Min.2%slope over leach facility to prevent pondin g Existing f- p g F.G. EL: 105.0-107.0t -------------- Install risers w/covers over inlet and i Min.2"of 1/8"-3/4"Washed Stone or Geotextile Fabric Inspection Port within 6"to grade Existing Main Line a outlet to within 6"of final grade " L=12' (Access Covers min.20"diam.per Code) 'j 3/4 1 1/2 Double Washed Stone EL. 105.96 _ L=35' r 4 SCH 40 PVC L=10' SCH 40 PVC y 4"SCH 40 PVC Top of Peastone or Geotextile Fabric EL 104.0 @S=2%(2%MIN @S=3.6%(1%MIN) e® as 1 6' I; @S=10%(0.5%MIN) a eSSammama, 24 Eff. Depth EL. 105.46 allommma Bottom EL. 101.0 EL. 105.71 Install Gas Baffle 7,' ,. 04.17 EL. 104.0 PROPOSED DB-3 ` EL.103.0 _W • •••• • •• • •• '•• H-10 DISTRIBUTION BOX �; Use 2-500 Gallon Precast Chambers 4.07' (H-10)with Double Washed Stone EXISTING 1000 GALLON Watertest for levelness if 4'Ends,4'Sides H-10 PRECAST CONCRETE SEPTIC TANK more than one outlet - SEPTIC SYSTEM PROFILE (25'x 12.83'x 2') EL.96.93 Level and Shorten Line for Inlet Tee Lengthen Line for Outlet Tee to Access Cover ! N.T.S. SOIL LOG Bottom of TH-2 ADDITIONAL NOTES`: DESIGN CRITERIA � 1. Contractor to confim soil suitability prior to installation. Contact BOH and Design Number of Bedrooms: Existing 3 Bedrooms SOIL EVALUATOR: AMY VON HONE, R.S. S.E.#2517 Sanitarian in the event of varying soils from original soil test. INSPECTOR: DONNA MIORANDI, R.S., BOH Soil Type: Class DATE: APRIL 11,201411:00 AM 2. Failed leachpit to be abandoned per Title 5 specifications. PERCOLATION RATE: <4 MIN/INCH IN B Design Percolation Rate: <4 min/Inch in B Horizon PERMIT#: 14338 3. Water line to be sleeved at any sewerline crossings and within 10'of any septic Daily Flow: 110 G.P.D./ Bedroom x 3=330 G.P.D. components, as needed, per Water Department requirements. Design Flow: 330 G.P.D. (Min. Required) TH - 1 TH - 2 4. Distribution box to be placed on 6" crushed stone or compacted, level base. EL.108.42 EL. 107.1 Garbage Grinder: Not Allowed A Sandy Loam Fill 10YR3/2 FLOOR PLAN. Leaching Area Required: (330)/0.74 = 445.95 S.F. 10" 107.17 12" 106.1 B A Septic Tank Required: 330 G.P.D.x 200% = 660 G.P.D Loamy Sand Sandy Loam N.T.S. Minimum 1000 Gallon (Existing) 26 10YR5/6 105.83 13" 10YR3/2 106.02 Use 2 -500 Gallon H-10 Precast Chambers with Stone: B 4' on Ends, 4'on Sides : 25'x 12.83'x 2.0' C1 Perc Loamy Sand Medium Sand @ 10YR5/6 Bath Kitchen Entry/ Garage Sidewall Area: 4(25' + 12.83)= 151.32 S.F. 2 33 Sunroom .5Y6/4 (Bottom 103.35 Living Bottom Area: 25'x 12.83' = 320.75 S.F. 45" Room Total Area: 472.07 S.F. C1 Medium Sand Dining 2.5Y6 4 Design Flow Provided: 0.74(472.07 S.F.) =349.33 G.P.D. ' 385 SHOOTFLYING HILL ROAD 1st Floor � +1 4a I° V H CENTERVILLE, MA Clos is m m Bedroom associates - co 98.0 122" 96.93 2 SEPTIC SYSTEM DESIGNS PREPARED FOR: No Groundwater Observed No Groundwater Observed RI 320 Cotuit Road G. Johanna Pol Bed room om Sandwich,MA 02563 913 Capriccio Lane PERC RATE:<4 MIN/IN.(B Horizon) ) (0)508.833.0041 12"-9"@ 5:43 minutes Bedroom ,: (C)508.274.0074 9"-6"@ 10:09 minutes 3 Apollo Beach, FL 33572 I,Amy L.-von Hone,R.S.,hereby certify that I am currently approved by the DEP pursuant to surveying by: 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been Terry 2 LWarRoodP.L.S. performed by me consistent with the requirements of 310 CMR 15.017. 1 further certify that 2nd Floor Norwich, INA o2645 DATE REVISED SCALE SHEET N0. I have successfully passed the Soil Evaluator's Exam on November,1994. I (508) 432-8aos 04/11/14 111 - 20' 2 Of 2