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HomeMy WebLinkAbout0009 CASTLEWOOD CIRCLE - Health 9,CASTLEWOOD`.CIRCLE, HYANNIS A=273-060 r . 1 0 ° G ° r c a o ° ;I r Olaf Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �w 9 Castlewood Circle Property Address Eddy ' Owner information Owner's Name is required for z; every page. Hyannis MA 02601 12/4/18 Cityrrown State Zip Code Date of Inspection ' . h�7 rj' 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. A. General Information 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Ail h#A 12/4/18 Insp i Signat Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Castlewood Circle Property Address Eddy Owner information Owner's Name is required for every page. y H annis MA 02601 12/4/18 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: i B) System Conditionally Passes: ❑ one or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): I t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Castlewood Circle Property Address Eddy Owner information Owner's Name is required for every page. Hyannis MA 02601 12/4/18 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yy< 9 Castlewood Circle Property Address Eddy Owner information Owner's Name is required for every page. Hyannis MA 02601 12/4118 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Castlewood Circle Property Address Eddy Owner information Owner's Name is required for every page. y H annis MA 02601 12/4/18 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a . design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 9 Castlewood Circle Property Address Eddy Owner information Owner's Name is required for every page. Hyannis MA 02601 12/4/18 Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined? (If they were not ® El Were note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ❑ ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Castlewood Circle Property Address Eddy Owner information Owner's Name is required for every page. Hyannis MA 02601 12/4/18 Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupiedDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6116 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Castlewood Circle Property Address Eddy Owner information Owner's Name is required for every page. Hyannis MA 02601 12/4/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped 1 yr ago per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I , ssachusetts Commonwealth of Ma Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Castlewood Circle Property Address Eddy Owner information Owner's Name is required for every page. Hyannis MA 02601 12/4/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Original septic tank, new d-box and infiltrators 1998 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1 Depth below grade: 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.): Septic Tank(locate on site plan): 6" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: 2" t5ins.doc•rev.6/16 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Castlewood Circle Property Address Eddy Owner information Owner's Name is required for every page. Hyannis MA 02601 12/4/18 City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle '12 Scum thickness trace-1/2" Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3 years to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Castlewood Circle Property Address Eddy Owner information Owner's Name is required for every page. Hyannis MA 02601 12/4/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,.•'' 9 Castlewood Circle Property Address Eddy Owner information Owner's Name is required for every page. Hyannis MA 02601 12/4/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Poly D-box is 3' below grade, it was excavated and appears to be structurally sound, no adverse. conditions Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *if pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 9 Castlewood Circle Property Address Eddy Owner information Owners Name is required for every page. Hyannis MA 02601 12/4/18 City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The infiltrators were video inspected, effluent level is approximately 8" below the invert at this time, top of chambers is 3' below grade, no indication of past hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Castlewood Circle Property Address Eddy Owner information Owner's Name is required for every page. Hyannis MA 02601 12/4/18 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Soils are compact and dry Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Castlewood Circle Property Address Eddy Owner information Owner's Name is required for every page. Hyannis MA 02601 12/4/18 City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately D- r� 3 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Castlewood Circle Property Address Eddy Owner information Owner's Name is required for every page. Hyannis MA 02601 12/4/18 City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >15'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: 1998 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: 4' seperation per 1998 compliance ❑ Checked with local excavators, installers--(attach documentation) ® Accessed USGS database-explain: TOPO mapping You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Castlewood Circle Property Address Eddy Owner information Owner's Name is required for every page. Hyannis MA 02601 12/4/18 Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file r t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Certified Mail#7003 1680 0004 5458 2438 oF�►�, . Town of Barnstable Regulatory Services a► vsrAaM Thomas F. Geiler, Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February11,2004 Mr. Warner Cadet 137 Windshore Drive Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND ARTICLE 51 OF THE TOWN RENTAL ORDINANCE. The property owned by you located at 9 Castlewood Circle, Hyannis, was inspected on February 10, 2004 by Donna Z. Miorandi R.S., Health Inspector for the Town of Barnstable, because of a complaint. The following violations of the State Sanitary Code were observed: 105 CMR 410.351: Owner's Installation and Maintenance Responsibilities: The refrigerator is rusty:, leaking water and is missing it's ventilation face plate. The washing machine is inoperable due to the fact that it has no discharge connection available and was previously being discharged via an illegal hose to the backyard. The ventilation system for the house has not been maintained. The vents through out the house are loaded with dust and dirt. 105 CMR 410.350: Plumbing Connections: Every wash basin shall be connected to a sanitary drainage system in accordance with accepted plumbing standards. The washing machine was previously being discharged to the backyard via an illegal hose. 105 CMR 410.253: Light Fixtures Other than in Habitable Rooms or Kitchens: The owner shall provide and so locate electric light switches and fixtures in good working order so that illumination may be provided for the safe and reasonable use of every laundry, stairway, storage place, cellar and passageway. The two paneled rooms in the basement have no electric light switches or fixtures. Q:Health/Order letters/Housing violations/9 Castlewood Circle.doc 105 CMR 410.451 and 410.452: Egress Obstructions and Safe Condition: No person shall obstruct any exit or passageway. The owner is responsible for maintaining free from obstruction every exit used or intended for use by occupants. All wood structural members shall be treated to prevent rotting and decay. The bulkhead stairs are not useable for entering or exiting the basement due to the fact they have rotted and collapsed. 105 CMR 410.481: Posting of Name of Owner: An owner of a dwelling which is rented for residential use, who does not reside therein shall post in the interior of such dwelling in a location visible to the residents a notice constructed of durable material, not less than 20 square inches in size,bearing his name, address and telephone number. None of the above exists. 105 CMR 410.482: Smoke Detectors: No smoke detectors in dwelling. One in basement that is inoperable. The board of health shall immediately notify the fire prevention official of the local fire department of any violation of 105 CMR 410.482 which is observed during an inspection of any dwelling. 105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements: Every owner shall maintain the foundation, floors, walls, doors, windows, ceilings, roof staircases, porches, chimneys, and other structural elements of his dwelling so that the dwelling excludes wind, rain and snow, and is rodent-proof, watertight and free from chronic dampness, weathertight, in good repair and in every way fit for use intended. Windows are not weathertight and are covered with plastic. In addition, there are faceplates missing on the electrical outlets in the children's bedroom. All outlets must have faceplates on them. Your property is in the Zone of Contribution to our public water supply on .17 acres of land. The house was built and designed as a three bedroom house and could never have any more bedrooms due to the fact that it is in the Zone of Contribution and has an on-site septic system. You are directed to correct the violations listed above within Thirty (30) Days of your receipt of this notice. You are also directed to install smoke detectors within 24 hours of receipt of this notice. 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 could result in a fine of up to $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDE THE BOARD OF HEALTH Thomas A. McKean, R.S. Director of Public Health Town of Barnstable Cc: Frank Mora,tenant I Q:Health/Order letters/Housing violations/9 Castlewood Circle.doc PH.0,PJ,E CALL FOR V r I DAT TIM42 L (LP.M. r IM OF PHONED RETURNED PHONE C) 7 (7 �^ q YOUR CALL REA C BER E TEN ON EASE CALL MESSAGE WILL CALL AGAIN CAME TO SEE YOU WANTS TO SEE YOU SIGNED Miversal' 48003 Z O m Gl COLS (303L v o e , (� Certified Mail#7003 1680 0004 5458 2438 own of Barnstable Regulatory Services sn >: Thomas F. Geiler, Director NAM Q blic Health Division m Thomas McKean, Director 0 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Februaryl 1,2004 Mr. Warner Cadet 137 Windshore Drive Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND ARTICLE 51 OF THE TOWN RENTAL ORDINANCE. The property owned by you located at 9 Castlewood Circle, Hyannis, was inspected on February 10, 2004 by Donna Z. Miorandi R.S., Health Inspector for the Town of Barnstable, because of a complaint. The following violations of the State Sanitary Code were observed: 105.CMR 410.351-:-Owner's`Installation and- Ma><ntenancerRespons><b><hhes: The refrigerator is rusty:, leaking water and .> mussing it's ventilation face plate. The washing machine`is moperalile`due to the-fact'that-it-has-no-discharge connection-available land was previously being discharged via an,illegal hose to the backyard.JThe ventilation system for the house has not been (—maintained.-The vents through out the house are loaded with dust and dirt. 105 CMR 410.350: Plumbing Connections: Every wash basin shall be connected to a sanitary drainage system in accordance with accepted plumbing standards. The washing machine was previously being discharged to the backyard via an illegal hose. 105 CMR 410.253: Light Fixtures Other than in Habitable Rooms or Kitchens: The owner shall provide and so locate electric light switches and fixtures in good working order so that illumination may be provided for the safe and reasonable use of every laundry, stairway, storage place, cellar and passageway. The two paneled rooms in the basement have no electric light switches or fixtures. Q:Health/Order letters/Housing violations/9 Castlewood Circle.doc 105 CMR 410.451 and 410.452: Egress Obstructions and Safe Condition: No person shall obstruct any exit or passageway. The owner is responsible for maintaining free from obstruction every exit used or intended for use by occupants. All wood structural members shall be treated to prevent rotting and decay. The bulkhead stairs are not useable for entering or exiting the basement due to the fact they have rotted and collapsed. 105 CMR 410.481: Posting of Name of Owner: An owner of a dwelling which is rented for residential use, who does not reside therein shall post in the interior of such dwelling in a location visible to the residents.a notice constructed of durable material, not less than 20 square inches in size, bearing his name, address and telephone number. None of the above exists. 105 CMR 410.482: Smoke Detectors: No smoke detectors in dwelling. One in basement that is inoperable. The board of health shall immediately notify the fire prevention official of the local fire department of any violation of 105 CMR 410.482 which is observed during an inspection of any dwelling. 105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements: Every owner shall maintain the foundation, floors, walls, doors, windows, ceilings, roof staircases, porches, chimneys, and other structural elements of his dwelling so that the dwelling excludes wind, rain and snow, and is rodent-proof, watertight and free from chronic dampness, weathertight, in good repair and in every way fit for use intended. Windows are not weathertight and are covered with plastic. In addition, there are faceplates missing on the electrical outlets in the children's bedroom. All outlets must have faceplates on them. Your property is in the Zone of Contribution to our public water supply on .17 acres of land. The house was built and designed as a three bedroom house and could never have any more bedrooms due to the fact that it is in the Zone of Contribution and has an on-site septic system. You are directed to correct the violations listed above within Thirty (30) Days of your receipt of this notice. You are also directed to install smoke detectors within 24 hours of receipt of this notice. 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 could result in a fine of up to $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S. Director of Public Health Town of Barnstable Cc: Frank Mora,tenant Q:Health/Order letters/Housing violations/9 Castlewood Circle.doc �j COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS g DEPARTMENT OF ENVIRONMENTAL PROTECTION a MC411162 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A 1 CERTIFICATION Property Address: Cc,S T l2 laoo) Cyr /40,00411, 0,460 Owner's Name: Owner's Address: / ✓ RECEIVED b Date of Inspection: fTr o/ // /moo / /� DEC 2 0 2001 Name of Inspector: (please print) rho / company Name: C'Nill D - 7-EC-1-1 TOWN OF BARNSTABLE Mailing Address: O 9 /d 9Y HEALTH DEPT. G, 0-2 6 4 d Telephone Number: c, 711s- i CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: -L/P sses Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails g Inspector's Signature: / ! G✓ `/ Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A n CERTIFICATION (continued) Property Address: '7 C"-A.Woo d C 1/' Owner• of u e Date of Inspection: ot'J 0 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A./System Passes: have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is 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. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: C(/' Do2 6 O Owner• Id it T Date of Inspection: // 9 0 C. Further Evaluation is Required by the Board of Health: IV Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: / �Qs/ ��C CIS / gr�nis O/ Owner: Z L 6Lu Date of Inspection: P. 9 D D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _�Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z 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. 7 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ ►� Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] 0 (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply I — the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed The owner or.operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 9 CAS l�e�✓ce d . Cr✓' Owner: J GAG&U . Date of Inspection: // p Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupapt,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 1/ Were as built plans of the system obtained and examined?(If they were not available note as N/A) j�_ 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 _V1 _ 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 _V/ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no Existing information. For example,a plan at the Board of Health. _✓ _ Determined in the Geld(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] r Page 6 of 11 a OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C Q SYSTEM INFORMATION Property Address: / Car#Q wocj C4 /� a.�.1,s A Od 6p Owner: G Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: 02 Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):W[if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no):/V�' �/000 `/Coo Water meter readings,if available(last 2 years usage(gpd)): o 000 oo l Sump pump(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: fie /Jtiwr✓IrC� — w►^-e Was system pumped as part of the mspection(yes or no):*C If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: T7SOF SYSTEM V Septic tank,distribution box, soil absorption system _Single cesspool Overflow cesspool Privy _Shared system(yes or no)(if yes, attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components, toA Iled(if known)and source of pinformation- Were sewage odors detected when arriving at the site(yes or no): /�V i Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 4 / SYSTEM INFORMATION(continued) Property Address: / C c? / I i.,0L) / C i r, HilQ0414, 60/ Owner: L o2u e Date of Inspection:_ BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: ✓cast iron c"40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:✓(locate on site plan) Depth below grade: / Material of construction: 1/concrete_metal_fiberglass polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) �11 Dimensions: 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: Qo le g o� a(C <<� Comments(on pumping recommendations,inlet and utlet tee or baffle condition, structural integrity, liquid levels as related to outlet vert,evide�ce f 1 ge,etc.): . 1 �(Ar✓l�f�gcj ✓jt'e- C�f �t'i/S T, ✓Y!2 i /' cati GREASE TRAP:w(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels ' as related to outlet invert,evidence of leakage,etc.): i Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C q SYSTEM INFORMATION(continued) Property Address: / GG� �2 4,,00c/ G �" O� Owner: .T O ti . Date of Inspection: // cy TIGHT or HOLDING TANK:&(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:Z(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: ✓0/*;"r ti 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.): /�o X IS7 le ve /!� S %,�l s e 4,C. t-eg 4'sr- PUMP CHAMBER:I(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): a Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C a SYSTEM INFORMATION(continued) Property Address: 7 G05�1 wcoC Gi,- ti an41ST W G 0 Owner: ,TAG o N e Date of Inspection: 72179 /Of SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ 0 ki e- leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): c' 40 F-��^ 4M,1' C�N ✓tP %o or•� i a C cc' Cea ge .c o,,-lr to lo-- le_ 1 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 or no): Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 9 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 4",-0 T1WOOC n f tin' Oo26�'/ Owner: TGGcS¢w e Date of Inspection: / d 0 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. 131 yi L r 070 hb�Se i S 41 - 12 / ' Gl d' 3 - 41p/ Page 11 of 11 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C /SYSTEM INFORMATION(continued) Property Address: � 71e 4lw Gi►, �, tirn,3 �bp� Owner: J/a c d2 L�.e Date of Inspection: 7 0 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water�� S feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: T40 t.� Checked with local excavators,installers-(attach documentation Accessed USGS database-explain: You pst scribe how yo✓uestablishhedlthe high ground wat r eleva on: Uo7/�M OT i2t�'I7�^g1�r - A.� 7 SiOrr� 6., ,4/Oc✓ /o,��� rI:/ R i S S r S ti ✓e his ti 0y., a �llwa4� Zo vie G To F e�Bi rl(7�} �O Ill. � G•!G'�tr�Cwc,�.� G1L� • OF 9. 1 2 •J C�—�K Closing Date: �JC 1 y1,30 I Tel. Number: CLy d y Comm onhitaltb of A a.5.5 a C b Uq e t t5 DEPARTMENT OF FIRE SERVICES—DIVISION OF FIRE PREVENTION P.O. Box 1025 - State Road,. Stow, MA 01775 HYANNIS _/J// 2"10 2001 (date of application) APPLICATION FOR CERTIFICATE OF COMPLIANCE CHAPTER 148, SECTION 26F, M.G.L. NOTE: SUBMIT APPLICATION TO LOCAL FIRE DEPARTMENT HEADQUARTERS () 1 Application is hereby made to install approved smoke detectors as required by Massachusetts General Law, Chapter 148,Section 26F. Location of Property: r � � 1 ` Owner of Property: J e. /i N Buyer: ,,4..��L ! ') Number of Dwelling Units: Signature of Applicant: Nloa,,R Inspection/Testing Completed on: 2� , 2001 by t (Inspector 6Pn FEE: $10(per.unit)(148, Sec 10A) Fire Chief: Harold S. Brunelle (Fire Dept copy) Battery Electric [ ] "HYANNIS.FIRE PREVENTION BUREAU" HYANN S FIRE OEP'ARTMENT 95 NIGH X11,00L RD. EXT HYANNIS, MA 02601 HYANNIS FIRE DEPARTMENT HYANN/S 95 HIGH SCHOOL RD. EXT. HYANNIS,MA. 02601 HAROLD S.BRUNELLE,CHIEF 'RFOFDpRTN'E1L� YIUUlIIf AWANLNCSE OG iIUC EOUiATIUK FIRE PREVENTION BUREAU BUSINESS PHONE: (508) 775-1300 FACSIMILE PHONE: (508) 778- LT.DONALD H. CHASE,JR., CFI LT. ERIC F..HUBLER, CFI FIRE PREVENTION OFFICER FIRE PREVENTION OFFICER Chapter 148 - Section 26F Smoke Detectors p in resale properties 1. House number is posted on the house and posted at the end of the driveway if the house is not visible from the roadway. 2. Smoke detectors have been installed in the house. 3. Smoke detectors have been tested and are in working condition. 4. Smoke detectors have been installed on the ceilings and not on the walls. The detectors are located on each level and also out of the bedrooms. (NOTE: Detectors can only be installed on walls where the construction or structure of the building prohibits installation on the ceiling.) Effective September 1, 1984, a re-inspection fee of $10.00 will be assessed if the above items have not been complied with. I certify that the above items have been checked and are as stated. Signature: ' � !- j The Hyannis Fire Department appreciates your cooperation. Thank you. Fire Prevention Office For: Harold S. Brunelle, Chief Hyannis Fire Department NOTE: ANY PROPERTY WITH FIVE (5) OR MORE UNITS WILL BE CHARGED A FLAT FEE OF$50.00 THIS ALSO APPLIES TO.A RE-INSPECTION,IF NECESSARY. ITEM 4.OTHER ROOMS USED Yes NO IN ,�•'a, j p, FlNAL No. FOR LIVING&HALLS Pass COMMENT ' r f APPRDV. 1 i z INmAUDATE 4.1 Room Code'- ..-Room Location: IS ck `e U Ri FiVCen er eft Check One ❑ Front/Center ear Floor Level I= ,;" 4.2 -Electricit7111umi6atio - 4.3 1 Electrical Haia ds - r 4.4- r'Security 4.5 Window Condition - 4.6 Ceiling Condition 4.7 Wall Condition 4.8 Floor Condition 4.9 Natural Light •4.1 Room Code' Room Location Check One) ;❑ Ri ht/Center Left Check One ❑ FronU nter/Reap Floor Level 4.2 Electrici /Illumination 4.3 Electrical Hazards 4.4 Security 4.5 Window Condition 34.6 CeilingCondition 4.7 Wall Condition, 4.8 Floor Condition 4.9 =Haords Light ^•1 4:1 Room Location (C ck One) ❑/RighU enter/Left (Check One) ❑ Front/ enter/ ear Floor Level 4.2 ination 4.3 , rds 4.4., 4.5 Window Condition i 4.6 Ceiling Condition 4.7 Wall Condition 4.8 Floor Condition 'ROOM CODES: 1=Bedroom or any other room used for steepinglFegardless of type of room) Second Uvin Room,Femily Room,Den,Playroom,N ROOM 6=Additional Bathroom 7.Geroge 9=Other 2.Dining Room.or Dining Area 4 Enhance Halls,C ritlors,Halls,Staircases 6=Attic 8.La ITEM 5,ALL SECONDARY ROOMS YES NO IN.. ' No.. Rooms not used for Livin PASS FAIL Conic e ! �C' M T _ �A PA. ' P.5.1'. .NONE 'Go to M nA/DATE .Part 6 •� - 5.2 -.Securit' 5.3 Electricsl:F9azards < OOther.Potentially Hazardous - , - 5 El ' 4 Fealufes in n of these Fooms 6.BUILDING EXTERIOR YES NO IN.- FINAL... PASS -AIL CONC COMMENT ov. Cond on of Foundation INMALIDATE ConcJ G n of Stairs,Rails,and Porches f F r J / j .. 6.3 Conditl n of Roof and Gutters _ ' 6.4. Conditio of Exterior Sudaces 6.5. Condition of Chimney • 47 Manufactured Homes:Tie Downs 6.8 Manufactured.Homes:Smoke betectors ITEM T HEATING&PLUMBING YES No IN.= �► PASS FAIL coNc COMMENT I FINAL 7.1 Adequacy of Heeling Equipment 7.2 Safety of Heating of Equipment 7.3 Ventilation/Coolin ` 7.4 Water Hg`ater Gas/ lec/Oil 7.5 Approvable W er S ly ; - 7.6 Plumbing , 7.7 Sewer-Connection ITEM 8.GENERAL HEALTH YES No. IN.- FINAL NO. .'AND SAFETY • PASS FAIL .d NC COM17 APPRov. 8.1 Access to Unit .- 17 , INmAUDATE 8.2 Lead Paint;LOC .'. Applicable 8. .Evidence of Infestation 8.4 Garbage and Dbbris 8.5 1 Refuse isposal xi 8:6 Interior Stairs-and Common Halls 8.7 Otherinterior zards 8.8 Elevators of Applicable 8.9 Interior Air Quality r 8.10 Site and Neighborhood Conditions 8.11 `Entry boor Security Not Applicable , 9.1 eati'g System Type Gas ❑ Oil ❑ Electric ❑ Other REM YES No. PASS No CONC COMMENT o`v. .353 Asbestos Material INMAUDATE 482 : Smoke Detectors This inspection'has been performed to det rmine compliance under the HUD/DHCD Section 8 Programs.While some of the inspection requirements may be similar or identical to.provisions of the Icoal codes this inspection does not certify compliance with said codes. In all instances,it is the Owner's responsibility j to main ain'property to meet all applicable state and local codes and.aj, nant's ri ht to request an ins ectiprrb the-local code enforcement agency.., j Ag Puny Present at Inspection :' Inx ctor Signoture -( ' ./ •C . .) Date 1 .. Date Date /) L4Y J/.+► --1i0USING•CHom0 ^*1I°-C :,�•�<-.QUvC_.J,-IWP��0GRA PXO VIII..4,,Ll_„�f I�ON CHECKLIST HECKLIST NAMEOF F 1 _ ON EN �`. E INSPECTOR ' PHONE O. DATE OF INSPECTION . 1. TYPE OF INSPECTON ❑ Audit Q Initial ❑ Special b Annual LAST INSPECTOR: '`•, INFORMATION STREET UNIT#. Number of Children HOUSING TYPE-.. UNIT in family with (Check as appropriate). GRADE Elevated Blood Level CITY STATE ZIP CODE ❑ nufactured Home / FAMILY COMP M LE FEM LE E A ADULTS Ingle Family Detached _ ❑ Duplex or Two Family B Q• NAME OF OWNER OR AGENT AUTHORIZED TO LEASE UNIT INSPECTED PHONE O.�s MINORS ❑ 3 Family House C ❑�' ADDRESS OF OWNER OF AGENT `9 ~y / 2 CHILDREN ❑ Row House or Town House D Q ' cj� _ �)/y (UNDER 6) El Low Rise:3 or 4 Stories // including Garden Apartment • • FAMILY SUBSIDY SIZE: ❑ High Rise:5 or s more s le Pass ❑•Pass Repair ❑ Staff ❑ Multi Family Date as a No.of rooms used for sleeping LOC YES Fail ❑ Inconclusive Cl Maint. pL G (or could be used if unit is vacant) Q ❑ BUILDING PERMIT ❑ YES INSPECTION rTEM 1.LIVING ROOM PASS `FAIL INCL. COMMENT DATE PASSED 1.1 Living Room Present 1.2 Electricity 1.3 Electrical Hazards 1.4 Security/Heating Elem. " 1:5 Window Condition,Screens 1.6 Ceiling Condition 1.7 Wall Condition 1.8 Floor Condition ! M: 't2 `KITCHEN PASS FAIL INCL. DATE COMMENT. PASSED, 2.1 'Kitchen Area Present �' t E' 2.2 Eiectricity %r .2.3 Electrical Hazards .2.4.. Security/Heating Elem. 2.5 Window Condition,Screens r 2.6- Ceiling Condition 2, Wall Condition r 2.8 Floor Condition 2.9 Stove or range with oven (TT) ( - / Ele Gas 2.10 Refrigerator (1 T) i 2.11 Kitchen sink 'i`� '1 2.12 Kitchen space forstorage&prep.l 2.13 Ventilation' JTEM 3.BATHROOM easy FAIL INCL DATE' } COMMENT i PASSED 3.1 .Bathroom.Present 3.2 Electricity 3.3 Electrical Hazards 3.4 Security/Heating Elem.. S: 3.5 Window Condition,Screens 3.6 Ceiling*Condition 3.7 Wall Condition f i 3.8 Floor Condition 3.9 Flush Toilet in enclosed room in unit 3.10 Fixed washbasin or lavatory in unit u 3.11 Tub or Shower in u it 3:12 entilation f i in 4.OTHER ROOMS•USED -. PASS FAIL INCL DATE FOR LIVING&HALLS COMMENT ; `, PASSED 4.1 'Room Code'ajRoom Location (Check_One) Ri hUC ter/Left Check One ❑ Fron;tCente(/Ral Floor Level 4.2 Electricity/Illumination ' i I .4.3 ' Electrical Hazards 4.4 Window Condition 4.5 Security/Heating Security/Heating Elem. rn 4.6 Ceiling Condition Z 4:7 Wall Condition 4.8 Floor Condition U 4.9 Natural Light 1 J ROOM CODES: 1=Bedroom or any other room used forAre-ping(regardless of type of room).•3=Second Living Room.Family Room,Den,Playroom,TV ROOM 5=Additional Bathroom 7=Garage 9=Other 2=Dining Room,or Dining Area 4=Entrence Halls,Corridors,Halls,Staircases 6=Att c 8=Laundry � White Copy for Agency-Yellow Copy for Landlord-Pink Copy for Tenant- AsBuilt Page 1 of 1 TOWN OF BARNSTABLE r„ LOCATION 9 C. 9S-11C 1A1001) C/;'Gle- SEWAGE #CI'F" 5-8 7 VILLAGE Al g,✓1,7 i.S ASSESSOR'S MAP G LOT.171_ 0(e17 INSTALLER'S NAME & PHONE NO. A. & B Cm= 775=6264 .SEPTIC TANK CAPACITY - /Qr6l 141,4/&D17 LEACHING FACILITY:(type)Z',,F,.)"e�/oe aQli�itl NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER ✓ BUILDER OR OWNERf�lji�G�Q DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 9f VARIANCE GRANTED: Yes No a�� fbAlA� 15 • �''S�o�c ,ai/5%as http://iss 12/intranet/ ro data/ rebuilt.as x?maPPar=273060&se =1 12/3/2018 TOWN OF BARNSTABLE C LOCATION Clfl,S��e /i(/On!) C/�Gl� SEWAGE VILLAGE ��/,�,�,�i,5 ASSESSOR'S MAP Sk LOT 2�-- p �p INSTALLER'S NAME & PHONE NO.-A & B CANCO 775-6264 - SEPTIC TANK CAPACITY /fOB tl,4&,) 4 LEACHING FACILITY:(-type)1;1F,Aw-gi G,Q�q,�i/�IIZI NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ,Qrle,,,C jfA opr� -71Z DATE PERMIT ISSUED: AM DATE COMPLIANCE'ISSUED: VARIANCE GRANTED: Yes No a l�5 40 5'lone, Q//5,,Px5 TOWN OF BARNSTABLE LOCATION C'RS-�/� IA,1001) G'/�'cG/.� SEWAGE # / 7— 5-8 7 VILLAGE i,s ASSESSOR'S MAP & LOT 27 " n L�,a INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 .SEPTIC TANK CAPACITY /tDB 4,41% 4 LEACHING FACILITY:(type) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER t/ BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: - a 9- 99 VARIANCE GRANTED: Yes No No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Migogal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. ��fT 4ArV r/r Owner's Name,Address d Tel o. Assessor's Map/Parcel _'1?_3 D 13? / ;ki /Jsha�,C �1 P. 14-t 7 ;Ls yy Installer's Name,AddressAn&ONICANCO Designer's Name,Address and Tel.No. . 350 Main Street W. Yarmouth, MA 02673 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft.. Garbage Grinder( ) Other Type-of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow y7 6 gallons per day: Calculated daily flow 7 7 y gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank A&Un £x%rf:n c Type of S.A.S. Description of Soil Su a�j� c�/aA l'A Nature of Repairs or Alterations(Answer when applicable) Znj/4 P cSTtdke d?7 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 T 1 Signed Date Application Approved by Date Application Disapproved for the following reaso Permit No. Date Issued iJ .. ..,.NO. f •,�� v .•• 'No. / Fee S U ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 16 Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for Migogal *pgtem Congtruction 30ermit Application for a Permit to Construct( )Repair( )Upgrade(. )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 9 /9S1t WUU �i Y� /O,wn)er's Name,Address Tel. o. Assessor's Map/Parcel ` �J "`-'4,t I e , C''�Wp t , a�3 D /3 r. 14 V 770 J yeil Installer's Name,Address,anif" OWN Designer's Name,Address and Tel.No. 350 Main Wmlof Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder Other Type of Building V No. of Persons. - Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow %?7 U gallons. ` Plan Date _- !�, Number of sheets Revision Date r Title t Size of Septic Tank of S.A.S. 11 p i Descri lion f of Soil fi4ucPr y/A�t ,(✓� .Rj Nature of Repair's or Alterations(Answer when applicable 1 r►3>'A I 3- iU a)(ilM i Z P 1 r (! / j �. ••,.,-Dateaast inspected: "Agreement: ` /\\ The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system J in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operatibn until a Certifi- cate of Compliance has been issued by this Board of It a ' 1, Signed 'J Date. - �,lApplicationApprovedby Date t Application Disapproved for the following reason ` \� Permit No. ~Date Issued9 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS r .j Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( Upgraded( ) Abandoned( by 0 at ,'r' /V h constructed in ac rdance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Deigner E4- 7 The issuance of this permit shall not be construed as.a guarantee that the system wil function as designed. Date . . �' . q V Inspector -- �-- ' •- -- -•---•----•--' No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BA,RNSTABLE, MASSACHUSETTS Migpogal *pgtem Congtruction Vermit ti Permission is hereby gr nted to Construct( )Repair(�)U grade( )Abandon( ) System located at 9 rA.5 ale- &Aa a� �: 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: t, Provided: Construction ust be co ' ted within three years of the date o Date: Approved by /1 A 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT s ENGINEERED PLANS) 5 1, J t C hereby certify that the application for disposal works construction permit signed by me dated Q— 10 ' 0' B , concerning the property located at Q CA-s (e Waarf C1 r- /4Z meets all of the following criteria: • There are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system ✓ • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will=be located-less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) gF B)Observed Groundwater Table Elevation.(according to Health Division well map) J •3 SIGNED : DATE: /o Q LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert O r C SEPTIC 'STEM DESIGN l LV W � �• .,� BZDIWOAfS AT HQ GAL/DAYI BEDROOM = GAL DAY SEPTIC TANK: GAL/DAY z 2 DAYS GAL USE /Coo GALLON SK.FTIC TANK LEACHING AREA.- USE S INFILTRATORS LMAXIMIZER CHAMBERS WITH 4' Off' STONE ALL AROUND If z 2' DEEP) SIDE ;AREA: (SO + 11)2 z 2 164 Sj' (.74) _ . & GAL/DAY D_ 0rTDH ARZA: 30' z t1' _ 330 SF (74) _ 244 GAL/DAY CAPACJTY = 365 GAL/DAY