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HomeMy WebLinkAbout0122 CANTERBURY CIRCLE - Health 122 Canterbury Circle Hyannis A= 249-128 r • TOWN OF BA//RNSTABLE LOCATIONW92 SEWAGE # .260-`�5 � " VILLAGE h g . ASSESSOR'S MAP & LOT2y?—/29 INSTALLER'S N &PHONE NO. ..:LeB - y2D- ?,7 ✓as�P`i ��/3i�v.�3 SEPTIC TANK CAPACITY 15'eO' LEACHING FACILITY: (type) S'-SDO ��,.q �/�/S (size) Al) NO. OF BEDROOMS 5� BUILDER OR OWNER �lirlSTigh /yiyly/y/ � PERMITDATE: /D,30-,O 3 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 Wedand`and Leaching Facility (If any wetlands.exist . " within 300(eet of leaching facility Feet Furnished bye / e ' . ' M L"� �n � �� � � g � v V � — --— `� '�.S �J '�� _� � �'� '^ ��. Commonwealth of Massachusetts fH� i Title 5 official Inspection For - ; ,1 Subsurface Sewage Disposal System Form Not for Voluntary Assessments y 122 CANTERBURY CIR f - Property Address --- - --�--—�-- -----^ — i R_IGOBERTO BONILLA_ Owner Owner's Name — -- -- information is — _ required uired for every HYANNIS _ _MA 02601 5/21/2021 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:out f When f 51�r IS�t3 3 illin out forms A. Inspector Information on the computer, use only the tab _Trevor Kellett key to move your Name of Inspector — --- — cursor-do not Cape Cod Septic Services use the return key. Company Name 350 Main St_ _ s` rzh Company Address --------------------------------------------------- W Yarmouth __— _ _ MA 02673 _ City/Town State Zip Code arum "` 508-775-2825 _ SI-13744 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails G " _ _ _ _ 5/27/2021 _ Inspector's$gnature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of r� 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts 1 I`Mp Title 5 Official Inspection Form h) Subsurface Sewage Disposal System Form - N p Y of for Voluntary Assessments 122 CANTERBURY CIR Property Address RIGOBERTO BONIL_LA _ Owner Owner's Name information is HYANNIS required for every —...._.-._--------------.----_...----�,.__._.. MA-- 02601 5/21/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.- 1) 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: SYSTEM IS IN WORKING CONDITION 2) 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 statement's. 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): t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection For i}. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,A� .:'-�Y 122 C_ANTERBURY CIR _ Property Address ---- RIGOBERTO BONILLA___ Owner Owner's Name information is _ _ _ required for every HYANNIS MA_ 02601 _ 5/21/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): Elbroken pipe(s) are replaced ❑ Y ElN ❑ 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(§). 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): I i 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts - i'w/ Title 5 Official Inspection r I'. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 122 CANTERBURY CIR Property Address ---- — ----- - --- RIGOBERTO BONILLA Owner -- information is required for every HYANNIS_ -_ MA 02601 5/21/2021 _ page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 l5insp.doc•rev.7/26/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts -; �s Title 5 Official Inspection Form - —�- - — 11� Subsurf ace Sewage Disposal System Form No t for Voluntary tary Assessments 122 CANTERBURY CIR _ Property Address -- RIGOBERTO BONILLA Owner Owner's Name on required HYANNIS— --- -__-__-_----__..---------------_._ -State- 0260e_--- Date o20 _a v _ 21 page. City/Town p Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cost.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Z Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd, ❑ ® 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. 5) 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 CA. 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts ;M1)C Title 5 Official Ins ection Form ,u, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments _ SJ 122_CANTERBURY CIR _ Property Address -- - -- RIGOBERTO BONILLA Owner Owner's Name information is required for every HYANNIS__ MA _ 0_26_01_ 5/21/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no" for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts --_� Title 5 Official Inspection Form ^! Subsurface Sewage Disposal System Form - Not for Voluntary Assessments <;. 122 CANTERBURY CIR _ Property Address - RIGOBERTO BONILLA Owner Owner's Name information is y HYANNIS — required for ever _MA 02601 _ 5/21/2021 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 — Number of bedrooms (actual). 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: Number of current residents: 6 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: --------- Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): '20 -424 GPD Detail: '19 -317 GPD Sump pump? ❑ Yes ® No Last date of occupancy: CURRENT Date t5insp.doc-rev 7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts /p Title 5 Official Inspection Form 18 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 122 CANTERBURY CIR Property Address RIGOBERTO BONILLA Owner Owner's Name-- -._--- ---------- ------- --- information is required for every HYANNIS _MA_ 02601 5/21/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: — —^— Last date of occupancy/use: Date -- Other(describe below): 3. Pumping Records: Source of information: N/A_ Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: — ---- —_— _ gallons How was quantity pumped determined? --- Reason for pumping: ------- 15insp dcc•rev 7!2E!2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of (Massachusetts --a -, Title 5 Official Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 122 CANTERBURY CIR Property Address --- RIGOBERTO BONILL_A Owner Owner's Name --- information is HYANNIS required for every _ _ _ MA 02601_ _ 5/21/2021 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: 2003 PER PERMIT ON FILE AT BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer (locate on site plan): Depth below grade: 23- feet Material of construction: ❑ cast.iron ® 40 PVC ❑ other (explain): ----- --- Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): LINE CHECKED WITH SEWER CAMERA AND WAS FOUND TO BE CLEAN AND PROPERLY PITCHED t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 °y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 122 CANTERBURY CIR ~—( Property Address -- -- -- ---- ---- - - RIGOBERTO BON__ILLA_ Owner Owner's Name — information is required for every HYANNIS._-_ _ _-- —__— — MA 02601 _ 5/21/2021 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 15" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 GALLON Sludge depth: 411 Distance from top of sludge to bottom of outlet tee or baffle — - — Scum thickness - 3" -- --- 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? ESTIMATED Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500 GALLON TANK IN GOOD CONDITION. PVC TEES IN PLACE AND CLEAN. TANK AT NORMAL OPERATING LEVEL. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 _ . Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface N Form stem Sewage Disposal S -9 p Y of for Voluntary Assessments 122 CANTERBURY CIR_ Property Address R_IGOBE_RTO BONILLA _ Owner Owner's Name ---- information is HYANNIS required for every _____.- -- _MA _ 02601 5/21/2021 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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-- Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 El other(explain): Dimensions: Capacity: gallons Design Flow: ----— ------- - ---- gallons per day t5lnsp doc•rev.7i2o/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts GYX� �- 1- `title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 122 CANTERBURY CIR_ _ Property Address ---- ---- — RIGOBERTO BONILLA_ Owner Owner's Name required for is y HY_ANNIS required for ever _ __ MA 02601 5/21/2021 _ page. City/Town State Zip Code Date of Inspection ®. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: ---- — Alarm in working order: ❑ Yes ❑ No Date of last pumping: dace — — Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert EVEN 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 LEVEL AND WATERTIGHT l5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18. � monwealth of Massachusetts com Matt Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address Owner information is required for every HYANNIS MA 02801 5/21/2021 page. C � StateD. System Information (cont.) Zip Code Date of Inspection — 10. Pump Chamber (locate on site plan): Pumps in working order: F-1 Yes F-1 No* Alarms in working order: El Yea El No* � Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): ° |f pumps nr alarms are not in working order, system ina conditional pass. . 11. Soil Absorption System (SAS) (locate on site p|an, excavation not required): If SAS not |ocated, explain why: ` Type: E] leaching pits number: --- leaching chambem number 4'500GALL[)N El leaching galleries number -- leaching trenches number, length: LJ leaching fields number, dimensions: | El overflow cesspool number EJ innovative/oltennoUvauysbem ' Type/name oftechnology: t5i"sp.uoc'rev.n,61m`n Title o Official inspection Form:Subsurface Sewage Disposal System'Page mmm i� � Commonwealth of Massachusetts' Title 5 Official Inspection Form 5i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,� 122 CANTERBURY CIR _.. -- --- ---- ---- ---.— Property Address .-.- RIGOBERTO BONILLA Owner Owner's Name --_ _---_-_ --- information is required for every HYANNIS MA_ 02601 5/21/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 4-500 GALLON CHAMBERS FOUND WITH 7" OF EFFLUENT DURING INSPECTION WITH NO EVIDENT STAINING. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i5insp.doc•rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form — , Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 122 CANTERBURY CIR _ Property Address --- — --- — — RIGOBERTO BONILLA Owner Owner's Name -- ---- - -- -- Information is required for every HYANNIS _ __—_— MA _ 02601 5/21/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: - -------------------.--__ _ Dimensions --------- - - — -----,.--- - — Depth of solids ---- ------ --------- -..--- Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l 15insp.doc-rev.7/26/2016 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of MassachUsetts } iY Title Official Inspection. . For i-.f Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 122 CANTERBURY CIR Property Address _..--------------_.._---- RIGOBERTO BONILLA Owner ---- -------- ... --- - - -- --- --------. information is Owner's Name required for every HYANNIS _._.___.___.._.._......._ .. _ MA 02601 _ 5/21/2021 _ page. City/Town — State Zip Code Date of Inspection _ D. System eu���olrll ation (cont.) _.._ - 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below; ® hand-sketch in the area below ❑ drawing attached separately FE r i i5;nsp ou •rav ;;_.;."20111; Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments y 122 CANTERBURY CIR ------- ---- Property Address — --- -- --- ---- -- RIGOBERTO BONILLA Owner Owner's Name - - information is HYANNIS required for every .--_-__ _.____.______ __ MA— 02601 — 5/21/2021 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to 9 high round water: +12' _ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed:, pate ® 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: HAND AUGER PERFORMED ONSITE AT TIME OF INSPECTION TO 12'3" ENCOUNTERED NO GROUNDWATER. BOTTOM OF SAS AT 5' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection For 1 J Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 122 CANTERBURY CIR Property Address RIGOBERTO BONILLA _ Owner Owner'e r--_-_._....-----—--- ---------------------- -- 's Name — information is HYANNIS _ _ required for every _. MA_ 02601 5/21/2021 - --------------------- page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7I26P2018 - Title 5 Official Inspection Form:SubSUrfaCe Sewage Disposal System•Page 18 of 18 1©® No. 3v�-- Fee' THE COMMONWEALTH OF MASSACHUSETTS • Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplicatfon for Miopool *pgtem Conotruction 3permit Application for a Permit to Construct( air( )Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. /'12 L'o;~y.Trt-O vey 4j Ow�n+er' Name,Address and Tel.No. Assessor's Map/Parcel �y9 - 28 z Installer's Name,Address d Tel.No. S*8 Z/2-0--97 YF Design 's Name Addres el o. -fog-Y,? —17 2 I�/�/ �' � ��1//c 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repas ir r Alterations(Answer when applicable) V ` DO '4 , i" /- �, PA- do � & 6 cv D a - ' Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi Boar of th. Signed Date 10 A43 Application Approved by Date 1D�.3�itr 3 Application Disapproved for the following reasons Permit No. 3 Date Issued f 4/30 ---- - ----------------_-----_----------------------------- Fee a " THE COMMONWEALTH OF MASSACHUSETTS - Entered in computer: .; PUBLIC HEALTH DIVISION--TOWN OF BARNSTABLE. MASSACHUSETTS Yes - ricatiott for4Wipoal bpotem Con!5truction Permit Application for a Permit to Construct(4r,)'Repair( )Upgrade(* )Abandon( ) O Complete System' O Individual Components Location Address or Lot No. 111 /9'r(;r, 411ex Owner's Name,Address and feel No. _ t Assessor's Map/Parcel � Installer's Name;Address„ d Tel.No. �`� "y ZQ ��:3� Designer's Name Address�+and Tel.No. iypf^� rk1��! �!�/1G1 ,s Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( j) Other Fixtures 1 Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Descripiion of Soil Nature of Repairs or Alterations(Answer when applicable) �a95T �� (-,g.� 1<0! �r r/ 7.,wk S 00 l-A/ ZIF AV" / � Aooy .r'i- L`.Jr 7 57 2. ----------------- Date last inspected: „. Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi Board off Health. Signed L _ �r_A.�L ,�' Date Application Approved by .: ,.":. `..: - .. -` Date 4 Application Disapproved for the following reasons Permit No. 900 3 "5 a-y Date Issued 1 ------ ------------- THE COMMONWEALTH OF:MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( 4.),tepaired( )Upgraded( )' Abandoned( )by t&S ,� at /2 �/*s�J!"ry ✓e 5 has en constructed in ac ordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2-00 -52 b dated 10 .30 D.3 Installer 1 r' j�k� v^ Designer 9 F 13 4e4e ..,)^tom VI615 5 I/.a0Of19a/"L/ The issuance of this p fmiv hall not be construed as a guarantee that the system wt 'f`�'ctio�a� deys�' / .- Date 3 a 3 Inspector_ u ;1i / Y /C ' --------------------------------------- No. r 3 — .�C Fee '�- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi!5poe;ar by.5tem Construction Permit Permission is hereby granted to Construct( L.)Repair( )Upgrade( )Abandon( �) System located at /�2 Ctewt?'/=d'`aus�u &�"f l Ni as desc;~abed i_^.the aboveApplication for Disposal System Construction Permit.The applicant recognizes his/her d!ity to coi.iply with Title 5 and the followini :^cal provisions or special conditions. ,,d Cons"- uvn must be completed witiiir «z.:!!'years of Rhe date of�Is e Date I —"� -, C�136?� ___ Approved a Barnstable Assessing Search Results Page 1 of 2 rUPC V'1*1 ;i�r U ri w %kV& r i ;'• s ' g;; ��C��'�fib! f� � y ..." Cr •�� � �' ,,:: �"„",vc>_ _.f^^' ,:,,Sri /i.,.a.s...r ,.,. -„ ... �.. .' .�.,�a.?� •, .. `...a,,. •:. Home: Departments:Assessors Division: Property Assessment Search Results 122 C rT Owner: Property ketch Legend NEWMAN, CHRISTIAN A Map/Parcel/Parcel Extension 249 /128/ Mailing Addressa� ,33 NEWMAN,CHRISTIAN A f 1 122 CANTERBURY CIR3r HYANNIS, MA.02601 +� 2004 Assessed Values: r Appraised Value Assessed Value Building Value: $ 113,000 $ 113,000 Extra Features: $3,200 $3,200 Outbuildings: $8,600 $8,600 Land Value: $ 112,600 $ 112,600 Interactive Property Map: ap requires Plug in: Totals:$237,400 $237,400 1 have visited the maps before c Show Me The Man April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: NEWMAN,CHRISTIAN A 10/31/2001 14389/111 $ 1 NEWMAN, MARK E&CHRISTIAN A 9/15/1994 9351/144 $ 1 NEWMAN, MARK E& 8/15/1994 9334/110 $ 1 NEWMAN, DENICE A& 5/15/1986 5085/186 $ 1 NEWMAN, DENICE A 9/15/1984 4268/259 $61,600 POMEROY,JAMES&SIDIA 2163/223 $0 2004 Tax Information: Tax Rates: (per$1,000 of valuation) 4 Town Tax $ 1,569.21 Town Fire District Rates . Other Rates 6.61 Barnstable 2.01 Land Bank 3%of Town Tax Hyannis FD Tax $481.92 C.O.M.M. 1.10 Cotuit 1.52 http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/,, 10/30/2003 Barnstable Assessing Search Results Page 2 of 2 Land Bank Tax $47.08 Hyannis 2.03 West Barnstable 1.36 Total: $2,098.21 Due to rounding differences these values may vary Land and Building Information n Land Building Lot Size(Acres) 0.3 Year Built 1971 Appraised Value $ 112,600 Living Area 1703 Assessed Value $ 112,600 Replacement Cost$ 134,479 Depreciation 16 Building Value 113,000 Construction Details Style Cape Cod Interior Floors Carpet Model Residential Interior Walls Drywall Grade Average Heat Fuel Gas Stories 1 1/2 Stories Heat Type Hot Water Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 6 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 2 Bathrooms Total Rooms 8 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL2 Fireplace 1 $2,500 $2,500 SPL2 Pool Vinyl 512 $8,600 $8,600 FPO Ext FP Opening 1 $700 $700 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) III , http://www.town.bamstable.ma.us/tob02/Depts/Administrative Services/Finance/Assessin€... 10/30/2003 A rl L Y- 7:7 I u Z Id WEr,:OT ?-00?- 2T 'ciaS '0h< X�-1 wodi Certified Mail#7006 0810 3525 6535 �t Tad, Town of Barnstable Regulatory Services BARNseABM = MASS. $ Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: '508-862-4644 Fax: 508-790-6304 Lb October 3, 2011 l Christian Newman V�➢ e�- 142 (A) Quakermeeting House Road I East Sandwich, MA 02537 ���'"NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE 11 — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 122 Canterbury Circle, Hyannis was inspected on September 28, 2011 by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received by the Town of Barnstable. The following violations of the State Sanitary Code were observed: 105 CMR 410.500- Owner's Responsibility to Maintain Structural Elements There were holes observed at the front garage door entrance and at the side door within said garage. Holes appeared to be from the gnawing of rodents. 105 CMR 410.550(A): Extermination of Insects, Rodents and Skunks. There were large amounts of rodent droppings throughout garage and in the dwelling. You are directed to correct the violations listed above within twenty-four (24) hours of your receipt of this notice by hiring a licensed exterminator to exterminate all rodents with the dwelling which includes garage; by repairing said holes to exclude all rodents. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER Oh R + TH ALTH ef; as . cKean, R.S., CHO Director of Public Health QAOrder letters\Housing violations\122 canterbury.doc Citizen Web Request Page 1 of 1 I v i BhRT'STA LE, Citizen Request Management - Internal Use `�4 i�3a. two _ter Request ID: 35812 Created: 9/27/2011 12:11:49 PM Status: Assigned To Staff Assigned To: O'Connell,Timothy Health Office Anonymous: No Category: Chapter II : Housing Substandard E.C. Date: 10/12/2011 Created By: Wadlington, Ellen Citations: Health Office Time Worked: 0 Response Time: 0 Requestor Details: Email: Request Location: 122 CANTERBURY CIRCLE Hyannis, Ma 02601 Parcel Number: Map: 249 Block: 128 Lot: 000 Request: Landlord stopped trash pick up and they put garbage in garage, awaiting pickup. Lots of mice came in garage and house. Landlord told them they could call an exterminator. Request Work History: Internal Note History: Entered on 9/27/2011 12:11:49 PM by Wadlington, Ellen Tenant wishes to remain anonymous. Only gave name so you could contact her. System entry on 9/27/2011 12:11:49 PM: Assigned to O'Connell,Timothy http://issgl2/InternalWRS/WRequestPrint.aspx?ID=35812 9/28/2011 Health Master Detail Page 1 of 1 Logged In As: TOWN\oconnelt Health Master Detail Wednesday,September 28 2011 Application Center Parcel Lookup Selection Items Parcel ( Septic Perc Well Fuel Tank Parcel: 249-128 Location: 122 CANTERBURY CIRCLE, HYANNIS Owner: NEWMAN, CHRISTIAN A Business name: Business phone: Rental property: Deed restricted: 1- Number of bedrooms :F oil Contaminant released: G Fuel storage tank permit: r Save Parcel Changes Return to Lookup Parcel Info Parcel ID: 249-128 Developer lot:LOT 25 Location: 122 CANTERBURY CIRCLE Primary frontage: 124 Secondary road: Secondary frontage: Village:HYANNIS Fire district:HYANNIS Sewer acct: Road index:0224 Asbuilt Septic Scan: 249128_1 Interactive map Town zone of contribution:WP (Wellhead Protection Overlay District) State zone of contribution:IN Owner Info Owner: NEWMAN, CHRISTIAN A Co-Owner: Streetl: 122 CANTERBURY CIR Street2: City:HYANNIS State:MA Zip: 02601 Country: Deed date: 10/31/2001 Deed reference: 14389/111 Land Info Acres: 0.30 Use: Single Fam MDL-01 Zoning:RB Neighborhood: 0105 Topography:Level Road:Paved Utilities:Public Water,Gas,Septic Location: Construction Info Building No ear Buil Gross Area Living Area Bedrooms Bathrooms 1 1971 5256 2004 6 Bedrooms2 Full Buildings value:tt189,700.00 Extra features: o4,700.00 Land value: x103,700.00 http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=249128 9/28/2011 FORM30 C,W HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF S 0A�7 H CITY/TOWN F RTMENT 'p^ ADDRESS M sey`0 TELEPHONE C Address Occupant Floor Apartment No. No. of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No.Stories Name and address of owner _ t"I 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. -- Chimne : BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin STRUCTURE INT. Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: - PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: ZVI Infestation Rats, Mice, Roaches or Other: — �j Sv Egress Dual and Obst'n: General BuildingPosted /? / 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 PENALTIE Y." INSPECTOR ` TITLE 11 ire / I� A.M goo- DATE �S ( / TIME _ t P P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger cr Impair Health or Safety The following conditions, when found to exist in residential premises,shall be deemed conditions which may endanger or - impair the health, or safety and well-being of.a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation,any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be feurd to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the perscn to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410,254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents ecress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else:o fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impa r 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. -�"';k...ti.k.,,-..,,,.�;.,,.r„„�„�'v'e�1v^..••r-r-,-...'tw-.-M. ,;•.+id1'amr .;.P�...+-.....+-....,..r...++.'---'- ' THE COMMONWEALTH OF MASSACHUSETTS FORM 30 HOBBS&WARRENM .». BOARD OF EAI� /V s' 4021 CITY/TOWN = W t DEPARTMENT -: I GSM Sve y`0" ADDRESS f TELEPHONE �.�^`✓"""'�"� C ji Address Occupant Floor Apartment No. No. of Occupants No. of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units_ No.Stori s Name and address of owner —W A Remarks Reg. Vio. YARD Out Bld s.: Fences: tf Garbage and Rubbish •""' Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: < # r r. Dual Egress:and Obst'n.: xr ❑ B ❑ F ❑ M Doors,Windows: Roof . , <:•.,- Gutters, Drains: t Walls: Foundation! — J Uh Chimney: BASEMENT Gen.Sanitation: JDam ness: (Stairs: 06 Li htin f/ STRUCTURE INT. Hal4—&a0yya" % 1 Obst'n.: /' LlJ 11i • Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows:; r.- HEATING f �Chimne`"s: Central .®Y N,i;. "E'quip. Re air -- TYPE: Stacks;Flues,Vents: -� PLUMBING: J—`$ bpl Line: ❑ MS ❑ ST ❑ P r `Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom —Pantry Den " Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: _ Wash!=B'asiii;Shower or Tub ` Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: _ p L` o General Building Posted I %ry I— 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 SS OF,�PER URY." INSPECTOR / TITLE (i ��t I , � A.M. DATE TIME ' P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises,shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11. 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water suff cient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3). Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. Hyannis 508-771 -4648 Falmouth 508-539-1166 l ,, South Shore t Plymouth 508-888-0999 Cape hod PEST' P ROS� w� PEST PRO`S;, P.O. Box 486 TERMITE & PEST CONTROL Forestdale, MA 02644 TERMITE & PEST CONTROL HOME OWNER PEST CONTROL AGREEMENT ►'1f Name: , , , S C.uV CO Gtr'1 Address: 121 Co nfc,("(ov r y C r N �y City: v 00 ED Home Phone: �� .3641 0 317 Q Home Phone: Business Phone: Business Phone: Buildings or Places to Service t-i6J 1. WE WILL PROVIDE SERVICE FOR THE FOLLOWING PESTS: Coq- 2. WE WILL SERVICE ALL OF THE AREAS LISTED BELOW WHEN ACCESSIBLE OR ONE OF THE THREE, EI- THER: (1) Inside the building (2) Underneath the building. (3)or,Around the outside of the building. 3. LENGTH OF THIS CONTRACT IS FOR /.-a MONTHS. Note:A 12 month contract will continue in force after the expiration date, unless the customer notifies Cape Cod Pest Pros Termite&Pest Control in writing. 4. THE EXTERMINATING COMPANY WILL SERVICE CLIENTS PREMISES AT LEAST FOUR TIMES PER YEAR, and more often if needed a no extra charge. a a 5. Customer Agrees to Pay$ �C70 "oo for the initial service and$ (YO per quarter. All service charges are due within 30 days of service rendered. Upon failure to make such payments,the customer agrees to pay all cost of collections, including a reasonable attorney's fees. Not INCLUDED,would be Wood-Boring insects, such as Termites, Power Post Beetles, Gnats, Mosquitoes or other free flying insects(unless offered and accepted), because their inclusion would not allow this job to be so reasonable in cost. However,we will inspect for evidence of Termite Attack. (Early detection can save you costly repairs,should Termite infestation go unnoticed.) Should you desire to have us do this work, please sign and return Contract. Sales Representative �e- S Date Customer Signature � Date �U r 9 , SPECIAL INSTRUCTIONS: All bills unpaid after 30 days are subject to service charge of 1 1/2% per month and collet ' n fees. "YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGH THIRD BUSINESS DAY AFTER THE DATE OF THE TRANSACTION. SEE THE NOTICE OF CANCELLATION FORM ON BACK SIDE FOR AN EXPLANATION OF THIS RIGHT." TOP OF --- FOUNDAT�ON EL 95' GROUND SURFACE E� --- STANDARD NOTE GROUND SURFACE EL_ ' " M111r 1) THIS PLAN IS FOR THE INSTALLATION OF.A SEPTIC SYSTEM. OUTLET PIPE LEVEL + 2) ALL IN PROCEDURES' AND MATERIALS,SHALL CONFORM TO 310 CMR 15.000, rd& STATE ENYIRONMENTAL CODE, �""--- FIRST TWO FEET 3 /a PENT REQUIRED . . TITLE A. AND THE TOWN OF _='��NS�"�'�'� SUBSURFACE DISPOSAL REGULATIONS. - • LIQUID LEVEL. TOP EL 41 —1 MIN 2' LAYER DOUBLE WASHED 3) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE OF A VAILABLE PROPERTY INFORMATION WITH RECORDED DEEDS INVERT EL 10 *SYVMB4 ve•-�1i2• STONE OR ZONING REGULATIONS. , 14" 4) TOWN WATER SERVICES THIS PROPERTY. I -� _ 4 ,� _ �, EFE CTIVE GAS BAIF'FLE AT OUTLET INVERT EL ,ay - -- .� _ - _ , 7. p 7 SIDEWALL 5) THERE ARE NO KNOWN PRIVATE WELLS ON THIS PROPERTY OR WITHIN'1 OF.THE PROPOSED SOIL ABSORPTION SYSTEM. INVERT EL INVERT EL 6) ALL COVERS OF SYSTEM COMPONENTS' SHALL BE BROUGHT TO WITHIN 12" OF FINISHED GRADE, WTI'H 0_NE COVER OF THE 13 61 � D - Box 4l0 .3 �'^ C�j°'" �" 3/4'- i i/2' DOUBLE' SEPTIC TANK BROUGHT WITHIN 6" OF GRADE. 6" STONE BASE L�VVERT EL (Typioai) !.a S � Ort �, ,s� WASHED STONE 7) ALL SYSTEM COMPONENTS; SHALL REMAIN ACCESSIBLE FOR INSPECTION. NO STRUCTURES' SHALL BE LOCATED DIRECTLY INVERT EL / 1 �o o Gal Septic Tank Z.� 5 roN�" erg° 51d e� �'" 4 'S UPON OR ABOVE THE COMPONENT ACCESS LOCATIONS, WHICH WOULD INTERFERE WITH THE PERFORMANCE, ACCESS, INSPECTION (Typical) BOTTOM EL .PUMPING OR REPAID 3o E� 8) NO DRIVEWAY,_� PARKING OR TURNING AREA,_ OR OTHER IMPERVIOUS AREA SHALL BE LOCATED ABOVE A SOIL ABSORPTION /O BO M OF TEST HOLE SYSTEM, EXCEPT WHEN VENTING HAS BEEN PRO RDED. 1 ' 9) SEPTIC TANKS, GREASE TRAPS, DOSING CHAMBERS AND DISTRIBUTION .FOXES SHALL BE PLACED ON 6" S7iDNE BASE TO ENSURE STABILITY AND PREVENT SETTLING. 10) OUTLET DISTRIBUTION LINES SHALL REMAIN LEVEL FOR A MINIMUM OF THE FIRST TWO FEET OF THEIR LENGTH 11) ALL SYSTEM COMPONENTS' SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR H THIN 10' OF DRIVEWAYS OR PARKING OR TURNING AREAS, IN WHICH CASE H-20 COMPONENTS' SHALL BE USED. 12) ALL BUILDING SEWER LINES SHALL HAVE AN INNER'DIAMETER OF 4" AND SHALL BE CAST—IRON OR SCHEDULE 40 PVC. 13) THE DEPTH OF THE TOP OF ALL SYSTEM COMPONENTS SHALL NOT EXCEED 36" UNLESSS VENTING HAS BEEN PROVIDED. 14) IN THE AREAS OF EXCAVATION, EXLSTING GRADES SHALL BE REESTABLISHED UNLESS NOTED AS PROPOSED CONTOURS. t ' 15) IF SOILS' ARE ENCOUNTERED DURING THE EXCAVATION OF THE SOIL ABSORPTION SYSTEM, THAT DIFFER NOTABLY FROM r THE DEEP OBSERVATION HOLE LOG, .CONTACT THE ENGINEER BEFORE .PROCEEDING. - r 16) CONTRACTOR TO VERIFY LOCATION OF ALL UNDERGROUND UTM TIES. C4�r EXCAVATION NOTES T r I) EXCAVATE ALL MATERIAL ABOVE SOIL HORIZON C (SEE DEEP OBSERVATION HOLE LOG) AT APPROXIMATE ELEVATION �'-,9 POR A LATERAL DISTANCE OF 5' DESIGN DATA (WHERE POSSIBLE) IN ALL DIRECTIONS BEYOND THE OUTER PERIMETER OF THE LI•'ACFUNG.AREA. • J '~ -, 2) FILL MATERIAL SHALL CONSIST OF CLEAN GRANULAR.SAND, FREE FROM ORGANIC ( 1 MATTER AND OTHER DELETERIOUS SUBSTANCES, WHICH MEETS THE TEXTURAL !t J -��7JS 6'9,•¢B. � D, EEP OBSERVATION CRITERIA PUT FORTH IN SECTION 15.255(3) OF TITLE 5. r t � 4 j1 Number of Bedrooms: q HOLE LOG 3) SCARIFY THE BOTTOM SURFACE OF THE EXCAVATION PRIOR TO PLACEMENT r t Exist 1 r t Garbage Grinder: NO Test Hole #1 OF FILL INTO THE RETAINING STRUCTURE. l t Water v ,� f i (EL 4) PLACE FILL ONLY 'WHEN BOTMM SURFACE IB DRY. 1 '� t Line ! O O i r Design Flow (� D�pt�h �teo soli so11 sou t DJ t 0 1 tia) WO Horizon Tezture Color (110 Gal/BR/Dap x Number of BR) y F, I (vsD�t) (launseu) I Septic Tank: / 5 O C� `f 36 . A t oA ,%4. ' 1a Yk f t �_ � ,�'' �, � - 3 D Ott,q Proposed r' tt ; _ i / , 5p � (Minimum = Design Flow x 200%) �1q .g -'U ? sy2 ! 2 Car r t . \, p oo' Leaching Area: 54 -1� 8,7.`f L �, �o r/Z 6-/& . Garage , J+ No te.J Sidewall: ecrsc. S�� Existing Building is 5 bedroom �2 z_ � � / " 1 Exist . f Z Sidewalk x __ Ft x MFt).+ 'Deep Obe Hole Date: /O/ib�t� ` j '' Gas h o use, proposed n e w �design is ,o `� soil Evaluator.L=� 51L*j- i !� Line 2 End walls x _Ft x __�_Ft) Z q Witnessed a mRatde-H� Z rv�t a ,.� C� (pb r $ ,_ i r a four bedroom 13 o use. — soil survey Denoription / CARVER _ / Bottom: r — l �s�e r y l / GJ !°, /M ,�l o.i", G k i ervurs tz 3dah.rSa 6U7 R'ASIf ��!(y 1 t — � Depth to Standing Water. NA /T L 2� (—��-1''t x _Ft} Depth to Weeping Water. NA t t t T�F 8edroQ , t o Long Term Acceptance Rate .(LTAR): 0. 74 Depth to YottiinQ(Color): NA - PROPOSED LEACHING VrG FACILITY -,� *� I �L _ � , t �Seasonal o�rvatiion a u: NA �� _ _ IOo o Leaching Area-Design Capacity: �{ �� Date of Last Yeaaurement NA Fo ur 4 —8 x8 -6 .x24 deep t ' - - _ �� t 00P �� . ^► coxtunenta concrete 500 gal chambers t' Exist , F - _ t t _ (Sidewall Area + Bottom Area) x LTAR Deck (or similar w/4 ' stone on t , t� ' - ends and 7' stone on sides Exist > Cesspool to be '9°�r4)r" — _t , , _ r t Exist pool to be To tal area = 42 x 10 � ' t removed and filled y removed as required --� 1 ........;.-. t t : 1 t t t with cyan send 1 ... 4' . ' A , Proposed, 1,500 Gal . ... .... ............. ' ' w+ Septic Tank N 34e. 4 ..... :�:::::...... P Test + .ias Pit � asTE °�����. QvAL.x19� See xcava Ion . . 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