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HomeMy WebLinkAbout0050 BETH LANE - Health 50 Beth Lane Hyannis A = 272 151 � I I .. � Commonwealth of Massachusetts. rn Title 5 Official Inspection Form ; '�� g-� " Subsurface Sewage Disposal Y osal System Form ry,-- Not for Volunta ^� ssessmenrs �7 0— Property Address /, //r-e&710 - As-se 6 s Owner Owner' Name information is 0a CO/ �a a --- reeuired for a✓��� /•✓/7 O?� every page. Cityfr State Zip Code Date of'nspeci•_r. Inspection results must be submitted,on this form. Inspection forms may not be altered in any way. lmportant: A. General Information When filling out forms or,the computer,use 1. lnsp C or: only the tab Ivey to move your cursor-do not Name of rIn/spector c / use the return L l O_ 1 4 G�T -- key: Cc m any Name Id 05 cogs f��s� Cityfrown State Zip Code phon umber License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The is�s eotion was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 15.000). The system: r 10 Passes ❑ Conditionally Passes U Fails � . ❑ Needs Further Evaluation by the Local Approving Authority ° - 6 /� a/ o = �' Inspect is Signature Date The system inspector shall submit a copy of this inspection report to the App Vlne Af il, a, of Health or DEP)within 30 days of completing this inspection. li the system�; is a shared system c, has a design flow of 10,000 gpd or greater, the inspector and the system owner shall su`_-rMI..; t ;e report to the appropriate regional office of the DEP. The original should be sera to s.ste and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the f;jture under the same or different conditions of use. DOC I I b q 15inso•03;08 - Title 5 Offide:.Inspec'ior,Form:Su_•z�­z c \ Commonwealth of Massachusetts r Title 5 Official Inspection Form yJ� Subsurface Sewage Disposal System Form-Not for Volunta; Assessments Jr0 �e � h-e— ---- — Property A ress l�01i-elm Owner Owner' Name inforrraiion is �j� ©d 60� /p�, eZ,/ recuired for AhV7 if -- — every pace. City/T Sate Zip Code Date cf! sp=cucn B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/ always complete all of Section D A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) S m Conditionally Basses: nne orts as described in the"Conditional Pass" section need to be re more system components or repaired.The system, upon completion.of the replacement or repair, as aoaro ed by the Board of Health, will pass. Answer yes; no or not determined (Y, N, ND) in the ❑ for the following statements. If"clot 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 imm nenT. System will pass inspection if the existing tank is replaced with a complying septic tan{ as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally Sound: not leaking a c' a tee, fica`e of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distrib tcn ox d!i to broken or obstructed pipe(s) or due to a broken, settled or uneven distrbuti : bcx. pass inspection if(with approval of Board of Health): ❑ broken,pipe(s) are replaced ❑ obstruction is removed t5inso•03%08 Title 5 Official Irsoe_tion=cnm:Sab>_raC=_SS::=-'_____ Commonwealth of Massachusetts Title 5 Official Inspection Form ___ W Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property dress Owner Owner Name Lion is required for /� (- e')h� � _ /•,�7 _ every age. city/-r State Zip Code Date c,4 Ins_ec io.: B. Certification cost. B) System Conditionally Passes (cont.): distribution box is leveled or replaced xplain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). T ,e system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: urther Evaluation is Required by the Board of Health: onditions exist which require further evaluation by the Board of Health in order to determine it 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 o- G 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) a,;e t e SAS 100 feet of a surface water supply or tributary to a surface weer supiv. ❑ The system has a septic tank and SAS and the SAS is a Zcne - supply. ❑ The system has aseptic tank and SAS and the SAS is within 50 feet = ^:-ivp--e .. . supply well. 5in.;p.03.-08 Title 5 0fficia!insDec ia.• Commonwealth of Massachusetts .DUI r Title 5 Official Inspection Form _= 1= Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Mdress 1/ Owner Ow—� / Name informationre o is Gj✓!{�llf //,� 0�6�/ required for every page. Cityfr State Zip Code Ga;= cf':^s ecticr Bo Certification (cont.) C) r her Evaluation is Required by the Board of Health (cone.): /� he system has a septic tank and SAS and the SAS is less than 100 feet but 5C 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 cel for;l bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, providad 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 ove c?ded or / clogged SAS or cesspool ❑ �/ Discharge or ponding of effluent to the surface of the orcund of s�.:�wce`•'.`e'er= u due to an overloaded or clogged SAS or cesspool ElStatic liquid level in the distribution box above out'.et 2/1 or clogged SAS cr cesspool Liquid depth in cesspool is less than o" below invu-fr, or eva;.... -El VY, !ess than 1/2day flow El IV,, Required pumping more than 4 times in the iast year NOT cladel�t " obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below higi-1 gr0u--. ❑ Any portion of cesspool or privy is within 100 feet of a s1j7-E;_e •..ia =r s,,�� ,o',:' tributary to a surface water.supply. iS�s�-03/08 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Prope y Address kite✓ Owner Owner's Name information is h f /��` �dt OZ 1 Q O required for � f every page. City&wn State Zip Code Date cf! ecti.,n B. Certification .(cont.) D) System Failure Criteria Applicable to All Systems (coat.): Yes No ❑. [ , Any portion of a cesspool or privy is within a Zone 1 of a public v,,ell. I Any portion of a cesspool or privy is within 50 feet of a private ;pater sucpl , ': . ❑ Any portion of a cesspool or privy is less than 100 feet but greater than. JO ree: from a private water supply well with no acceptable water quality analysts. [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.] FFI ,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 abo e failure criteria exist as described in 310 CMR 15.303, thereror e the system rails. The system owner should contact the Board of Health to determine what will lbe necessary to correct the failure. E� arge Systems: To be considered a large system the system must serve a facility with a O�/ 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 questions in Section D; Yes No ❑ ❑ the system is within 400 feet of a surface drinking water su^c:)'v ❑ ❑ the system is within 200 feet of a tributary to a surface dr i-;;i,�c _. -'P, the system is located in a nitrogen sensitiv,. Greg `I,;t., ,m, Area — IWPA) or a mapped Zone 11 of a public water su^pr: If you have answered "yes"to any question in Section E the system is co ,sicl;2, 4 or answered "yes" in Section D above the large system-has failed. The ,.wry=r or cce.`atc -�f =r ='p= system considered a significant threat under Section E or failed under Section sh.ali �cra:'_ .= system in accordance with 310 CMR 15.304. The system owner should cont�c. t :e regional office of the Department. t5insp•03108 T-Ne 50ific2I Commonwealth of Massachusetts Title 5 Official Inspection Form 181 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ccCCn';e('i C \J C= �o Property Address �J 411-etIl t Owner Owner's Name information is a N� -f Oa 6 0/ y�� required for — — every page. City n State Zip Code Date oz iKsperzf.;n C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of.the folio,;,,n c-: Yes No ❑ Pumping information was provided by the owner, occupant, or Beard of Hea:'t^ ❑ 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 file system recently or as cart of ❑ this inspection? El available 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 to .k 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) prcvided vith; information on the proper maintenance of subsurface sewage dispcsai syst i a? The size and location of the Soil Absorption System (SAS) on the site been determined based on: ❑ Existing information. For example, a plan at the Board of =eal :1i. �❑ Determined in the field (if any of the failure criteria re'aed to ?ai C i= at_ iss e approximation of distance is unacceptable) (3 0 Ci✓R i 5:3102,;511 !?inso•p3/GS Tine 5 Of5,ml.Insperior F_.....,____._-c cam.;-_-i-_ -=-• _ _ Commonwealth of Massachusetts =i= = Title 5 Official Inspection Form _t !, — ) Subsurface Sewage Disposal System Form - Not for Voluntary Assessments — Property�dressT vtl Owner owner' Name information is required for N 4rf — every page. Cityf State Zip Code Oa te or!r:so_o,on D. System Information ov, Residential Flow Conditions (` Number of bedrooms (design): Number of bedrooms (actual): 7— DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x of be`drooms): Number of current residents: Does residence have a garbage grinder? Yes i io— Is laundry on a separate sewage system? [if yes separate inspection requiredl 1 Yes N Laundry system inspected? Yes !�o i lI Yes Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Sump pump? t date of occupancy: Dat merciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per d2v (cpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? l yes tic Industrial waste holding tank present? t = Non-sanitary waste discharged to the Title 5 system? Y__ No Water meter readings, if available: — — — Last date of occupancy/use: Dae - Other (describe): Sins?•C3,'08 Tile 50 Ada'In-._,."Po,. S_os_ _-_ Commonwealth of Massachusetts 1 Title 5 Official Inspection Form =_iC Subsurface Sewage-Disposal System Form - Not for Voluntary Assessment-1- Property . Ad ess eoi,c --- Owner Owner's Name information is reeuired for every page. city/Town State Zip Code Da*� of i, sceaion D. System information (cont.) General Information Pumping Records: 17 Source of information: Was system pumped as part of the inspection? ❑ Yes I No If yes, volume pumped: gallons How was quantity pumped determined? -- - -- -- Reason for pumping: -- Type of stem: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection reco;.^Is, iF ❑ innovative/Alternative technology. Attach a copy of the cur rent operation and maintenance contract(to be obtained from system owner) and a copy 0i latest inspection of the !/A system by system operator under contract El Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Approximate age of all components, date installed (if known)and source Were sewage odors detected when arriving at the site? `es i5inso•03108 - Title 50-laal ins.Declion Form: `-= Commonwealth of Massachusetts JIB-r Title 5 Official Inspection Form lol Subsurface Sewage Disposal System Form -Not for Voluntary Assessme^ts Property Addr, s Owner Owner's'NJt2me /� )/ �� Q infcrmaifon is L,� .n�� _ILO�V O / Id—/X reGUired for �Yr—L--- - --�— o� City�ow State Zip Code Date or!nse=_ Jo:- ery oa.,. ystem Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet — Materia f construction: r 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.): Septic Tank (locate on site plan): l/ Depth below grader feet Material onstruction: concrete ` ❑ metal ❑ fiberglass ( II polyethylene ❑i other (exo!ain) If tank is metal, list age: years .Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑! Yes ❑ do ----------------------------------------------------------------------------------------------- Dimensions: i Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? !sir o•03;09 T;il 5 O (dal lnspe..,,',. . . Commonwealth of Massachusetts Title 5 Official Inspection Form '- � �i^, Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1-41 _ Property ddress ////_' Owner Owner' Name information is G✓l dl/S /"� ' r' Qo�b �� 02 recuired 11or — eve e. CitylTo State Zip Code Cate of ins e, :o-, ry pag D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition; structural intecrity. liqui vels as related to outlet invert, evidence of leakage, etc.): d �N l✓ _ es o� oo c/ Co11�J1 111oh rease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal El fiberglass i polyethylene (❑ other (exo'an): 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: Da --Comments (on pumping recommendations, inlet and outlet tee or baf le condi-_ion. str ctur l i.-. e ri_y. liquid levels as related 'to outlet invert, evidence of leakage, etc.): K-ight or Holding Tank (tank must be pumped at time of inspection) (locate on site 'a Depth below grade: — - Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ poiyeth,'le e ❑! 0a f8insp•D�08 �illo c C?i�i2i las_=ruon`-7r-;:S_r_c °-`-_"=___----_ �;'_ -___ Commonwealth of Massachusetts i r% 'itle Official Inspec#i®n Firm ,liV �I-! Subsurface Sewage Disposal System Form - Not for Voluntary?ssessmen`s Property dress Owner Owner's Name information is Q✓1 i?!� %'L ©p�6Dl l� C2 " required for — — - State Zip Code .,.. I ..���.on it /T wn P Da��or n. every page. � ) o D. System Information (cont.) ight or Holding Tank (cont.) Dimensions: Capacity: gallons —_— ------ Design Flow: gallons per day Alarm present: ❑ Yes ❑ No. Alarm level: Alarm in working order: j❑ Yes ❑! No Date of last pumping: pate — Comments (condition of alarm and float switches, etc.): i ch copy of current pumping contract (required). Is copy attached? 1-1 `'es Nc Distribution Box (if present must be opened) (locate on site /pllaaan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of sc'i: s carryo,,;er. arty eviden e of leakage into or out of box, etc.): / 40 P mp Chamber(locate on site plan): v "o Pumps in working order: Alarms in working order. i "es ❑ ;o 5insp•0_/OS . TiL'=_ fficz!L�sp-c;ia-,Fa^: Commonwealth of Massachusetts Title 5 Official Inspection Form ' _ 01 Subsurface Sewage Disposal System Form - Not for Voluntary Assess,mzants Property A7lZml ' Owner Owner's lame information is required for N—il -- — every page. CityTI o State Zip Code Date of inspe.lion ®,'Systern Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching"pits number: --- ❑ 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 pond g. da-: soil. c n i-_:c•^ of vegetation, etc.): D 2,,,,/, v7 40 Ste,� �t✓��, C ;5inso•Q3!OS T le S Official Insp=_dion F; t Commonwealth of Massachusetts ,F� : Title 5 ®fificial Inspection Fora h' " Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments Property Address Owner Owner's Name ,y^ information is ///� © 6 / Jag required for e-4Hhlf State Zip Code Daft of 1nsi ction every page. City/Tow D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site pian): 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of ecea°ic ; etc.): Privy (locate on site plan): / V Materials of construction: Dimensions Depth of solids - Comments (note condition of soil, signs of hydraulic failure, level of poncir tg, co-:`oc-.. cf Vece etc.): Sirs?•O iC8 I Itle 5 OM-121 insoed.iee=_^:a:bs•_`ac 8 -2_e:s_==.._ Commonwealth of Massachusetts Title 5 Official Inspection Form ^� =� Subsurface Sewage Disposal System Form - Not for Voluntary Assess,re:�:a so Property A r ess , ,itO — Owner Owners,Name information is required for ove,o �P Ciiv/To State Zip Code Date of!nspeca:an , pa . .®. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposa! sysiem including :ize's to at least two permanent reference landmarks or benchmarks. Locate all v,,elis within i 00 feat. Locate where public water supply enters the building. ise t-- 9a - �� t5insp-0�1/08 Title 5 official hspeciio:^ Commonwealth of Massachusetts == w Title 5 Official Inspection Form i i Subsurface Sewage Disposal System Form -Not for Voluntary Assessm,en s so Property Ad ss Owner Owner's Name information is required for every page. City/Tow State Zip Code Dale Of inspegtlon Q. System Information (cone:) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: ;get Please i ate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: pate ❑ Observed site (abutting property/observation hole within 150 feet of SAS) Checked with I Bo rd of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must d cribe how you established the high ground water elevat;o; !G rn Gtv► Cj T�s� NO/e /071�lvll4 �rOh oh (.�,7� �®f7`• �jo i�/'o ter ✓1 C' l�-ti � c, s4Pf7 �G //ey t5insp•03/08 Title 5 Otiiciel Inspection Fc: r P Certified Mail#7006 0810 0000 3524 9179 �pFSFIE rpw� Town of Barnstable Regulatory Services + IIARYSTABLE..' 9 MASS. Thomas F. Geiler, Director �p r63q. �m OM Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 29, 2007 John Portilla 50 Beth Lane Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II— MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 50 Beth Lane Hyannis, was inspected on March 28, 2007 by Meredith Morgan, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the Town of Barnstable Code were observed: 1§ 70-10—Smoke Detectors and Carbon Monoxide Alarms. Inoperable smoke detectors throughout house; no CO detectors within home. *Please note the Hyannis Fire Department has been notified that there were no CO detectors and inoperable smoke detectors observed at inspection. You are directed to correct the violations listed above within twenty-four (24) hours of your receipt of this notice by repairing or replacing smoke detectors; by installing CO detectors in accordance with MA State Fire Codes. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Q 1Order letters\Housing violations\Rental ordinance\50 Beth Lane.doc Non-complia&e will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection.. PER ORDER OF THE OARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Meredith.Morgan,Health Inspector QAOrder letters\Housing violations\Rental ordinance\50 Beth Lane.doc FORM 30 CH AW HOBBSB WARREN'"' THE COMMONWEALTH OF MASSACHUSETTS BO D OF EA TH TY/TOWN v f V oof b 1 D PARTMENT 1 VADSS 5 -&Ll ,M TELEPHONE Address 5—rD __iA_).---- -I'1A Occupa nt ' ' Floor _.Apartment No. ���J._No. of Occ nts — p U — No.of Habitable Rooms No.Sleeping Rooms__. No.dwelling or rooming unit No. tons Name and address of owne k it ��� Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows.- Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hull Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: —✓ -4,f PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent s / ELECTRICAL Panels, Meters,Cir.: r0 ❑ 110 ❑ 220 Fusing,Grnd.: Oi Ir 4-, OW AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room 1 -7 Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink c Stove h �. Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: , 5 Wash Basin, Shower or Tub: Infestation Ruts, 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 PENALTI INSPECTOR TITLE A. DATE TIME A.M. THE NEXT SCHEDULED REINSPECTION P.M. �'' 410.750: Conditions Deemed to Endanger or Impair Health or Safety .r The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to e-idanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such viola.ticn(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410-180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 41C.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstructor of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain urccrrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or ele;trical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protectivE railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0) shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. �r � ' � -, TOWN OF BARNSTABLE LOCATION U �r� ^� SEWAGE #o,0 p3 -3 7s VILLAGE l�y��d✓'� ASSESSOR'S MAP & LOT 27Z- 5I INSTALLER'S NAME&PHONE NO.64-- q b� 7 '71 1-3 4" SEPTIC TANK CAPACITY l e 0 0 L x 1 S T 1�^'S LEACHING FACILITY: ( peQ—) �''''s �"cv � deZS (size):33.,5 X t':3 X Q— NO. OF BEDROOMS .,BUILDER OR OWNER rs144-S PERMITDATE: 1,Aa- COMPLIANCE DATE: ?< 3 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 n \ \ ON W �n 0 T. 1 i' S. No. a U0 3 7s, ^f ° , Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pprication for Mi5po5ar bpotem Con5truction Permit Application for a Permit to Construct( . )Repair( �Upde( ' )Abandon( ) O Complete System O Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. S o 13 C •�T ,,i 2 cij� ,,✓ Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �D8 77s- /36a 7r/ -5-grs- aQLc5� 3 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow y-c,_ gallons per day. Calculated daily flow S ° gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank %o �d ��,r s T i t Type of S.A.S. 3 roe " .4 n, r"•2J` Description of Soil Nature of Repairs or Alterations(Answer when applicable( 30 Soo r/jJ d 4 f ?' ' e Ir S^r G <✓ = NZ'ors © ae>k Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this B ,ard of th. Signed Date Application Approved by Date W#76 Application Disapproved for the following reasons Permit No. 20n T— 7.S- Date Issued / U No. -f)fla Fee r 57 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - n.,.. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS i Ztppli.cation for Miopogaf *p,$tem (Construction Permit Application for a Permit to Construct( )Repair( grade( )Abandon( ) ❑Complete System ❑Individual Components µ. Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel ` Installer's Name,Address,.and Tel.No. Designer's Name,Address and Tel.No. .A6Le ,/ A vST �a ��2/� E�✓ /�jLcY 2 sob 7:> 1— i36.2 7 3 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) �_ Other Fixtures s , Design Flow - d Y �7 `3 gallons per day. Calculated daily flow . gallons. Plan Date ` ti Number of sheets Revision Date Title Size of Septic Tank /o -va C A' s i.%—t Type of S.A.S. �r 2r Description of Soil Nature of Repairs or Alterations(Answer when applicable(3� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of H lth. Signed n Date Application Approved by Date / r Application Disapproved fo rthe following reasons j Permit No.'2oa - 2 ;7-1— Date Issued ? // /) THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compt Wire THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( Upgraded( ) Abandoned( )by ct N � s 'r eo at S' 1.3c , 1 a ti F A/Y ja 1.-/v r'S has been constructed in accordance with the provisions of Title 5 and the.for Disposal System Construction Permit No. :2✓03-37S- dated S-11,11t, 3 Installer /I-l 14 Designer 1'H/1 A i,41 r 2 The issuance of this permit shall not be construed as a guarantee that the system wiYhfun'cIi. � sip Date ` Zd` Q 3 Inspector �75 --------------------------- --No. Dt73 Fee s THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Migozal by.5tem Construction Permit Permission is hereby granted to Construct( )Repair( 4-)<pgrade( Abandon( ) System located at S o l?E 7 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of thi .ermit. Date: /A Approved by i 1y TOWN OF BARNSTABLE LOCATION 5-0 �L� ZA SEWAGE #p_o o3 -3 7s VILLAGE Z�2-/— go `� ASSESSOR'S MAP & LOT 27Z' 5, INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /®d D x>S 7- �^'S LEACHING FACILITY: (typey /'''� � S d tzs (size), 3,YX t.3 X Q---- NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE:T 1,10 3 COMPLIANCE DATE: — 3 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 ` G ),c i 3 ;L1 HYANNIS FIRE DEPARTMENT APR g 2003 95 HIGH SCHOOL ROAD EXTENSION HYANNIS, MASS. 02601 Harold S. Brunelle BUSINESS: 775-1300 5ma a Oeteetoza Save odkea EMERGENCY: 911 FAX: 778-6448 To Town of Barnstable, Board of Health - T. kcKean Town of Barnstable, Conservation Commission - From ; Fire Prevention Bureau, Hyannis Fire Department Subject ; The installation of above ground storage tanks. Date �a2 Persuant to the applicable sections of 527 CMR - Fire Prevention Regulations, this Department has inspected the following location for above ground storage. ADDRESS OWNER/OCCUPANT PHONE :_ - SIZE OF TANK(S) o? - COMMODITY STORED , - PURPOSE FOR STORAGE THIS INSTALLATION IS : PR XIST NG A REPLACEMENT NEW This installation complies _� does not comply with the required installation regulation listed below. FIRE PREVENTION OFFICE For: HAROLD S.BRUNELLE, CHIEF HYANNIS FIRE DEPARTMENT Health Complaints 02-Apr-02 Time: 9:05:00 AM Date: 3/25/2002 Complaint Number: 3331 Referred To: Taken By: DANIELLE ST.PETER Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name: Number: 50 Street: BETH LANE Village: HYANNIS Assessors Map_Parcel: Complaint Description: NEIGHBOR HAS HAD A DUMPSTER IN THEIR YARD FOR ABOUT THREE MONTHS NOW. IT IS SUPPOSED TO BE FOR CONSTRUCTION DEBRIS BUT THEY ARE PUTTING HOUSEHOLD RUBBISH INTO IT. THE DUMPSTER DOES NOT HAVE A LID AND HAS NOT BEEN DUMPED FOR QUITE SOME TIME. THERE IS RUBBISH THAT BLOWS ONTO THEIR YARD AND THEY JUST FOUND A DEAD RAT IIN THEIR YARD. Actions Taken/Results: THERE IS HOUSEHOLD WASTE IN THE DUMPSTER, I TOLD THEM THEY CANNOT PUT HOUSEHOLD TRASH IN THAT DUMPSTER,AND THAT IT IS FOR DEMOLITION DEBRIS ONLY. HE SAID THAT IT WAS SITTING IN THE.YARD, SO THEY PUT IT IN THE DUMPSTER SO IT WOULDN'T BLOW ALL OVER THE YARD. THEY ARE GOING TO REMOVE THE TRASH THIS WEEK WITH THEIR WEEKLY TRASH PICK UP. Investigation Date: 3/25/2002 Investigation Time: 3:20:00 PM "".'c'•^"•v�,'"`*'�`..'v.if;'�+':.' � _ '}.,,-":.-'�•.r.3.. "�.,;� 1�f�"."07 Y 4"n�",�'."'" r:C T'•"�?�a^ ^'Tr!��?,�{.�x:�.-, xsfi,',�f.+� .+-;.7'°" --�.'[a r. .sr.;..,,,,.x,..ry�..rrm•--�.- - - -r.z-tw•. - ..rt.- .,a *.r*.+ army '?r :�, TOWN OF BARNSTABLE BAR-W 1420 3878 --- Ordinance or Regulation WARNING NOTICE Name of Offender/Manager � ,t. � ` 11s\1 Address of Offender ' 1``\� et �; $.�i� -'4 MV/MB Reg.# Village/State/Zip 't,..-Pk �``�����`�',} Business Name am/pm, on '�'� � 20La W ,- Business Address C; r -``�, �. •, z....A,�., . Signature of Enforcing Officer Village/State/Zip Location of Offense t Enforcing Dept/Division Offense � � t r'l .l t i1 r, t. t .�, r t ` #� i�. • # t'!t { � C ;j4 \:1� . ,' . µ_ Facts J / jl"ky"7k I tf +` 't r',..' ;�r 1 . t >F s j '�. ; �,9c� �' 1 t� 4 t!( 1 is ..��.0 .f A'w ^� �'\� �) r t ie i"t . This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. " Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. Health Complaints 22-Apr-02 Time: 9:00:00 AM Date: 4/12/02 Complaint Number: 3367 Referred To: LEE MCCONNELL Taken By: DANIELLE ST.PETER Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name: Number: 50 Street: BETH LANE Village: HYANNIS Assessors Map-Parcel: Complaint Description: THERE IS STILL A DUMPSTER ON SITE WITH HOUSEHOLD RUBBISH AND THE LID DOES NOT STAY CLOSED. THESE NEIGHBORS ARE STARTING TO GET VERY UPSET BECAUSE THEY STILL ARE SEEING RATS AND ARE HAVING TO PICK UP THE TRASH ON THEIR LAWN. LAST WEEK THERE WAS THREE FAMILIES LIVING IN THIS HOUSE. Actions Taken/Results: LM VISITED LOCATION ON 4/12/2002 AT 2:45PM. DUMPSTER IS STILL ON PROPERTY FILLED WITH HOUSEHOLD TRASH TWO WEEKS AFTER DS HAD BEEN OUT TO SPEAK TO THEM. I EXPLAINED TO YOUNG GIRL WHO ANSWERED THE DOOR THAT THEY COULD NOT CONTINUE TO USE C & D DUMPSTER FOR HOUSEHOLD REFUSE. INSPECTED GROUNDS FOR RODENTS,WHICH I DID NOT SEE. SENT OUT A WARNING NOTICE (4/22/2002)TO OWNER OF PROPERTY. KWOK WEI CHAN, 5 NORTHLAND RD, SHREWSBURY, MA 01545. Health Complaints 22-Apr-02 Investigation Date: 4/12/02 Investigation Time: 2:45:00 PM 2 f ✓ ��'��4 Dili'%�,'� '! r� I f� r 0 c� F-+ b �-+ 'O :� ... � Ya ' a'l 1.3 V f y n c;- rm -.,.+.a„T"''AM*�.rt'..a',.. .r.,*"°"r'" Y!e...`rn�av�x.-.a'. rim+ .�r�a�?3.`Yti i�+r jrs+F,r�'�+'""g' �^7 f - .;"c'Ffncuy Y�x�,(S';!A"""^`,rx' �^S e..�+,-nr.r"T:s:' ';"r `•r k�' TOWN OF BARNSTABLE BAR NQ 3639 Ordinance or Regulation WARNING .NOTICE Name of Offender/Manager k LJ0 r Address of Offender YT MV/MB Reg.# Village/State/Zip Business Name 3:10 am/pm, on 3 �_ 200 Business Address- � 3a . Signfature `of Enforcing Officer Village/State/Zip Location. of Offense , y " Enforcing Dept/Division Offense ( rtf ( +�ti�� ,�t+V^ I.6J ��S�rtc �v��wRev / f. } 11 Facts ' , .te r M— IV t��151j cry-�� lAu1��,H�;>� ttr*��ur,l� This will serve only as' a warning.{ At this .time no legal action has been taken.. It is the goal of , Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the .Town. WHITE.-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER' GOLD-ENFORCING DEPT. .�'_ ..`.r*,T,^'w-++Y-3.;...w.-I"s'_4"'" '"?'_r`.'-7"'"rr^+ry a- :cam �,q+.-:w w'aR'' -�i'^� 3 N.Y."'3 'eg',`: t ....,.* �...'m s�-.a� n b •,r.1 TOWN OF BARNSTABLE BAR-W Ordinance - or Regulation E Y, WARNING4 NOTICE Name of Offender/Manager k Ljt ,* Address of Offender ;) MV/MB Reg.# Village/State/Zip n / Business Name am/pm; on 20_ Business Address Sig' ture of Enforcing Officer 7 e. Village/State/Zip Location of Offense t k_ (( Enforcing Dept/Division Offense € t �, tT,y^ !•Dy HIV���� r. u,,�-�,) ��� � . 1 Factsts A4 �'a 1' � :1. ,���'t�! €,�"•r' A r This will serve only as` a warning. At this ,time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent, violations _ will result in approprkate-legal action by the Town. WHITE .OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. Health Complaints 26-Mar-02 Time: 9:05:00 AM Date: 3/25/2002 Complaint Number: 3331 Referred To: Taken By: DANIELLE ST.PETER Complaint Type: NUISANCE CONTROL REG, 1 RUBBISH Article.X Detail: Business.Name: Number: 50 Street: BETH LANE Village: HYANNIS Assessors.Map.Parcel: Complaint Description: NEIGHBOR HAS HAD A DUMPSTER IN THEIR YARD FOR ABOUT THREE MONTHS NOW. IT IS SUPPOSED TO BE FOR CONSTRUCTION DEBRIS BUT THEY ARE PUTTING HOUSEHOLD RUBBISH INTO IT. THE DUMPSTER DOES NOT HAVE A LID AND HAS NOT BEEN DUMPED FOR QUITE SOME TIME. THERE IS RUBBISH THAT BLOWS ONTO THEIR YARD AND THEY JUST FOUND A DEAD RAT IIN THEIR YARD. Actions Taken/Results: THERE IS HOUSEHOLD WASTE IN THE DUMPSTER, I TOLD THEM THEY CANNOT PUT HOUSEHOLD TRASH IN THAT DUMPSTER,AND THAT IT IS FOR DEMOLITION DEBRIS ONLY. HE SAID THAT IT WAS SITTING IN THE YARD, SO THEY PUT IT IN THE DUMPSTER SO IT WOULDN'T BLOW ALL OVER THE YARD. THEY ARE GOING TO REMOVE THE TRASH THIS WEEK WITH THEIR WEEKLY TRASH PICK UP. Investigation.Date: 3/25/2002 Investigation Time: 3:20:00 PM 1 40. AT ION -�f SEWAGE PERMIT p0. J5®�3e La H�e VILLAGE INSTA LLER'S NA-ME i ADDRESS ` JOH,N X AALTO RACKunF- c;rRa 4ioe 150 Walnut Street WPSt.Rnmctahle Mrs-00,6659 BUILDER OR OWNER Cho yk 9, —r-ly 4 h D_A T E PERMIT ISSUED DATE C 0 M P L I A N C E ISSUED 2 ^ 2 _ 7� 0 N ^' �� e � � . �� / i� \, i � .^/� � "3 �. �! ��\ i�� t � � \ %, \��\�' � .- � II ,�.r 1� �\ \'_ �4ti \ �' � � `� \ � � ` \ \ \ \ A � �� I _- f ., �� ��,, _ » t •.- _O'er No................. ....... Fmc...............J................. � THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE L �l!1 .....OF........ ... ..����� ..��-------- ........................... Appliratiou for Uiipniial Works Tontitrurtiun ramit Application is hereby made for a Permit to Construct (X) or Repair ( } an Individual Sewage Disposal;,:;,, S System at #= 1. ,.a. :. �.....:. T.f . 1-�........:f�'�Y�Nwis.. ... _ -------------- ........... o�c/atsio'n /� `�j �`t 02. °/� /_.. .7./!! dd=es4..�1....L3N� RS ........ FF-.._ �7f.:! of!_l��- �C'..:............. Owner Add ess ............................ ...... . �tl ..�,�.... ..G� Installer Address Q Type of Building; Size Lot_.�,;F ........Sq. feet V Dwelling—No. of Bedrooms--.•----__-___-a________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons................------------ Showers ( ) — Cafeteria ( ) a' Other fixtures -__•_ W Design Flow.................�_�o �s�.gallons per person per day. Total daily flow_.............�.3_C�_...............gallon. WSeptic Tank—Liquid capacityjbd�?-gallons Length.....0.6_. Width,f�. .-- Diameter__._____•__••__- Depth...,�..�.. x Disposal Trench—No..................... Width.................... Total Length..................:_ Total leaching area....................sq. ft. Seepage Pit No........1........... Diameter..C,....... Depth below inlet........ ...... Total leaching area----Z8.1s".-sq. ft. Z Other Distribution box ( Dosing tank ( ) a .Percolation Test Results Performed by..4_'_�:).t... '_P�_ _{................................... Date..S .C...70....._.. Test Pit No. LA minutes per inch Depth of Test Pit----t_z-........ Depth to ground water____19L__________ (i Test Pit No. 2.. .....minutes per inch Depth of Test Pit....LZ........ Depth to ground water........ or.t a -------- ------- Description of Soil ..- �, n''w„c.� ------ -----------•-----------------------------•-•--•....----•--------.....--. x v W ------------------------------------------------------------------------- -------------------------•------------------------------------------......------``---------•--•----•-•------•-••......-------- 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 TLITi:11, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. b mrr Si 0 - . •---••- ••••••--- //- V„ Application Approved By...... •••..... ... .. ... .. . • --........................... --• � Date Application Disapproved for the following reasons:................- ---------•--•-•----••--•--•••--------•-----••-------------•--•-••---•••--•••--••-----•._...--- ••--------------------•--------•------•--••--•-••...•----••--------••--•••-•--••--•-----•-•-••--•--•------------------••••---------- ------------- ------ -------- DatePermit No......................................................... Issued-- --------------- - --------------- Date No....1P..T `...... Fint THE COMMONWEALTH OF MASSACHUSETTS BOAR OF TH . ..........OF . .------ .. •-• ---------••---------------•- 4 Apli iratinn for Ilispniia1 Works Tongtrnrtiun Famit Application is hereby made,for a Permit to Construct (,A) or Repair ( ) an Individual Sewage Disposal System at• --........ro Tfr.....1 ....-. 4.... ... .......... .or..a .......................................... do ress j 0 ,��� r t No, w D N AA _�We!------------- �,� yT�T'...�` ,tf'���.1.� . a +� ._....... Installer Address d Type of Building Size Lot__ GSq. feet U Dwelling—No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ...................................................... wDesign Flow..........................................___gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.............gallons Length................ Width................ Diameter................ Depth................ "v 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 ( )' . Dosing tank ( ) Percolation Test Results Performed by..........---------------------------------------------•-_--.............. Date........................................ aTest 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........................ P6 ------------------------------------ •-------------------------------------------------------------- •------- _------- _____-____........ •------------------------ 0 Description of Soil....................................................................................................................................... -----------•-------•---•---- x w Z. 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 TIT L; 5 of the State Sanitary Code— The undersigned further agrees not to place the system in t operation until a Certificate of Compliance has been • sued�by�the Jbo rd 1 lth. / Sig / V / ----------------- le._.... ..... .. ................. ......... ................... :_. �__. / a Application Approved By f Date Application Disapproved for the following reasons:---------- - --------------------•--------•-------•--------------•---- ............................... --•-------•---•--•-••--------•----•----------------------e-•----•-•--•••---.._.............•-----.........•--------••-••----•-------------•-•------•-••---•---•-------•--- Date Permit No...... Issued...: ._. 77 r` -------------------•••-. x Date 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH " ..O F............. '�' '""k-..................................... F. j/ V r#ifiratr rr •'� THI IS TO CER .Y, - the individual Sewage Disposal S-stem constructed r Repaired g P �' ( ) ::.. . . ......... ............. ...................... .......................i......by Instal at -- �... � - - has been C�1 d in accordance with the provisions of 5 f,T e tate Sanitary Co�cia4 djsTi4ec►Whe application for Disposal Work_s Construction Permit No. ___.---- _._.. _..... dated-........................._.._.........___..... THE{ISSUANCE OF OBIS CERTIFICATE SHALL NOT BE'CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTI N SATISFACTORY. DATE Inspector�� - / ...................................... - - THE COMMONWEALTH .OF MASSACHUSETTS BOARD OF/)HEALTH .oF:. :: ....................................... S_ O.C) . ..... ............. ..... FEE........................ ur iivit amit Permission,is,.her by granted. """` to Construct ({ r Re pa a dr ual �a e Dis oral,System ...... z ` stre -ft / " as shown on the application for Disposal Works Construction-Pe No." Dated.___---.................................. �".. / Board of Health DATE •----- ;-._.. .` FORM 1255 HOBBS & WA`JREN, INC., PUBLISHERS - - t L ASSESSORS MAP : Z�1 Z NOTES: TEST HOLE , LOGS PARCEL : 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH FLOOD ZONE: SOIL EVALUATOR : 1�" ! 'F' L �- THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF 10 WITNESS : NIA 1s � BOARD OF HEALTH REGULATIONS. REFERENCE:' DATE: (b to v 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, r PERCOLATION RATE L 2 MIS G SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO le q / /� S P� 2 1 b INSTALLATION. TH- I TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION �e ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE ' y A WI'M� DETERMINATION. 4) ALL PIPING-TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS SPECIFIED OTHERWISE) LOCATION MAP(KTS) �� � IaYR-i S) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A N17 A- GARBAGE DISPOSAL. 26,► q7.6q N M 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED)�nlU NI MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON S t� 7/ G �5,,1 A BASE OF 6"OF CRUSHED STONE. if :PVMP-r_t S> l! ` 5 ��l oi�!�v_w_�►z�-�...�!,J L�0_��P!��cam? ti;�-�,��-o--.- SEPT'I C SYSTEM DESIGN /p) l�lo v�F2t Y__"_off_hF ✓�'° A ' FLOW ESTIMATE !V 25.E Sb BEDROOMS AT GAL/DAY/BEDROOM GAL/DAY .__-.... _._._.�._._._.__....�.. _.'._w.".._...�.. � SEPTIC .TANK Ib ygxg L-LLGAL/DAY x 2 DAYS - GAL 3s 4 s� USE 1&� GALLON SEPT I C' TANK eXSTlnl y-RePLA-GE w///Sooc //o� ,o 5 ►'i7c l � r� DAM t O q SOIL ABSORPTION SYSTEM o vN OE t.may} s ' i / a N . �° Fxrsn„ j -wf 4' >T /VF- o/ /It& Sr12F-5 C33.5tY-)3fyju2�p� E J G/STRN 25r o '7),rNk -- SIDE AREA:[ (33.5)S-03 Y C 6�7V 137, 6 y s N/ RiP �o De BOTTOM AREA: 33,S X 1-3 x 6, 7y 2-Z Z q rA i o k _ j UN 77- ( XlSnN4 ! SEPT I C SYSTEM SECTION 14 —Y 3 h� --27 645 !r _ 1 jz / y�ys I GAL f f' �- _ ' � G SEPTIC TANK (a � -r---�- �� T SITE AND SEWAGE PLAN �l AIVE LOCAT I ON : cS0 2 60 / PREPARED FOR : R co,V E DARREN-M. MEYER R.S. SCALE :/ 2,0 i 43 VINE STREET DATE: °03- DUXBURY, MA-02332 DATE HEALTH AGENT (781) 585-0293 ----------------------- F. F, 53 ,00 , TYPICAL SYSTEM PROFILE AREA PLAN FDN TOP FINISH GRADE= NOT TO SCALE ► FINISH i SCALE : I _ SIC? t t�0 FINISH GRADE OVER TANK= s1,0C� _51 , (JQ GRADE - OVER PIT ` LOT 24 BET H S LANE 0 . PVC OR p , O O ... • , . • • • I �„�C. i. TEES " . •• '-•• fit$•33 � . e � e '• --i t 5 000 5, , �48 4�4 . .. � 48.5ca ' 'r • • o / • • e o � e 4 5,BSaT ) 0 00 GAL. 4„ ► • r ► e � • • e • � , e FLR__ 48. 2S REINFORCED DIST. BOX „ • e a • • • • • • e • 1 " T BINSTALLEDe • • • • • • • . o • • 0 E ON .. CONCRE.T.E. " •. .. . 8_ A LEVEL STABLE BASE • ► r • • o • e SEPTIC TANK TO BE INSTALLED ON A • • • ' • e F LEVEL ' STABLE BASE a ,• • . . • , , c I u Ii n r • 1 • • / • • • • • • • J. 2 -1/8 I/2 WASHED PEASTONE ALL BRICK &,MORTAR COURSES AS / '• • : , . • • . • • • • 'AROUND FREE OF IRONS, FINES , REQUIRED TO BRING COVER TO GRADE AND DUST 1N PLACE LEACHING PIT I, 3 4 :TO I 12 WASHED CRUSHED _ 24 C.I.;MANHOLE COVER a / / FRAME SEE DETAIL STONE ALL AROUND FREE OF BASE TO BE :LEVEL IRONS, FINES AND DUST IN PLACE FOR FIN. GRADE SEE SYSTEM PROFILE SOIL AND PERCOLATION j qp n� B TH LANE _. ; I _ DATA N t 3 5 — —— -- 2 5 g E 8" :: -: T.T.. PERC. RATE : MIN- IN. 12 _ _ 1 " FOR INV.ELEV SEE ' W _ 4 ♦ C. D. SPOHR ' INLET SYSTEM PROFILE „.: ' TAKEN BY : cat TOWN WP►-r' R - ,, , g M . " _ LC�T 2I FRONT � v�L I N E � , -: , _ p � ° O N ice- ,A N STAB t=£:Ut?.OR NCAI.TN LOT 2 5 WITNESSED BY. 0 0 OPENINGS W/4 1/8 d 25'.. 68(51 DE) �� . OUTER DIA. 81 1 -3/4 . DATE: C?E t`3 7$ story a 1 IA. e l 16 _ _ PROP05Et� # 7 _ ♦ o NSIDE D , , � TEST PIT GND ELEV, 5 CT 2� o Q• Q ,6 0 O 3 Q o TOTAL 1 5,0GO S. � u os _ AREA o 3 ,5, N4 RZ.fST.:.1 E 1� o o L0A S 1 0 M ._ you A (1 ° . -. , �a � , o 0 0 D 0 - RR iN 7 2 8S 5.F 0 0 t o a { ,�11fA~ I 1000 A L, PRECAST CON+CtZEY`E r _ L�1�' 0000 ry, : ♦ .. T G K Pf2+DFl LE -0 „ . - SW TIC_ TA,i�t SEE tV .p O p p o o ° ` R 14Q 0 p r ; c `.+vim DISTRI C1 PRE A Tlr > unAR = _ - ox , shl� �al�l L E , ERAVEL 'r:}#. 6 6 DIA. 2' ( Z f 2 - 125,4 4 , BOTI P R;G. HOLE` PRF_CA5T C0WC9!ETF_ LEA"1 NG, t0 # E F F E C T I V E DIA h: ., PIT PETAI►.S Pl?.6FILE 1 3 W DOWN lr s 2� s� � LEACHING PIT - SECTIONt (I �qD 2 NO SCALE DESIGN DATA NOTE* T Y 0 E DO NO RUN HEAVY EQUIPMENT OVER SYSTEM BEDROOMS ", DISPOSAL, DISPOSAL LEACHING PIT- NOTES: 33c�• EST. TOTAL DAILY EFFLUENT GALS. 1 200 . CONC. TO BE 4000 P.S.1 a °28 DAYS . SEPTIC TANK GAL. 2. REINF. W 6 X 6 �� .6 GA. W.W. M. OWNERS BUILDER 3. 2 AND 4 SECTIONS ARE AVAILABLE FOR GREATER DEPTH REQUIREMENTS; GENERAL NOTES C.t-A K . . F i�`�. au I�.-C� - I . ALL SYSTEM COMPONENTS HA TA D. L S S S LL BE INSTALLED IN BACON FAR M : ROAID NOTE. , ACCORDANCE WITH TITLE5 OF THE STATE SANITARY CODE EXCAVATE TO ELEV. -40.00OR LOWER AS DATED DULY 1,1977 81 ANY LOCAL-RULES-APP!(CABLE. l F T A�L�v1 C�L3 � • �� REQUIRED TO REMOVE ALL LOAM AND CLAY CONTAINING - - 2. ANY CHANGE TO THIS- PLAN MUST BE APPRD. :BY THE MATERIAL BENEATH PIT. REPLACE EXCAVATED MATERIAL BD. OF HEALTH AND CHARLES D. SP HR. I 0 WITH CLEAN,CLAY 'FREE GRAVEL, 'MECHANICALLY COMPACTED IN PLACE. 3. WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING r_ F NOTIFY THE ENGINEER OR INSPECTION. SIDE AREA �S.F.�_S.t=./GAL .__GALS , B. _ 4. FOUNDATION ELEV. MUST BE CHECKED WHEN COMPLETED. K NOTE BOTTOM AREA= —'S.F. O S.F./GAL 5� GALS _:Z �� 5. THESE ELEVS. MUST NOT BE HANGED WITHOUT WRITTEN , N TOTAL AREA � S. F. TOTAL GALS ., . ALL C. IS -BASEDUN PAT I►.+t ., ,� APPROVAL BY CHAR ES D. SPOHR c' t ' 6. � A ss U 4ED ,.EL...E�# 5c•44 LEGEND FOUNDATION :INSPECTION READ. WHEN EXCAVATED. EX IST.I T. R , 50.0 S GROUND .ELEV. + e AREA A _ w _ , PL N FINISH - C 50.0 N SH GROUND ELEV. UNDERLINED;: : R 'T R I P7I 47 50 PIPE INVERT., ELEV. EV D E DESC ON R�� ,F�,otu s��.�✓�r:�, Iu L �, O _ SEWAGE I-_SP 5 . -1, - -ST M ' FOR •. : . r - _ - SE C TANK r �yr- C A .. L R FLYNN ,� ,.B , �. Sr , DISTRIBUTI -` BOX ' ' -- " " - a / :. ./ :.f. , ., . L 4 C I . PIPE , r h C a�d•el . �, ; _ . . ,:: ,_ :• _ _ 4 :.BIT.FIBER PIPE.-TIGHT OINT E -1tii-F+tti-- . J S _,. Sf��2R , WA 1 DES GN�D._ b T�. y• dd ._ .., DRAW fiV.C� ,. NO . „. PROPERTYLINEs .'._ 0 fi E R N.AW .,5SCALEHOW _ - I , MIN. CODE` DISTANCE - L L MAP SEO PC LOT,.. CHECK Eo, C. D. S .