HomeMy WebLinkAbout0241 CASTLEWOOD CIRCLE - Health A=
.� Rf MOO
a - APR 3 2000
TO BARNS4a
le11F �NDEPr
COMMONWEALTH OF MASACHUSETTS 4'
EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS 9
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET BOSTON MA 02108(617)292-3500
TRUDY COXE
Secretary
A
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Goyemor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 241 CASTLEWOOD CIRCLE HYANNIS, MA 02601 M273 P050 L128
Name of Owner SCOTT MCCRACKEN
Address of Owner: 965 MAIN ST.DENNIS MA.02638
Date of Inspection: 3/31100
Name of Inspector: JOHN GRACI
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636
Telephone Number: 608-664-6813 FAX 608-664-7270
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems.The system:
X Passes
_ Conditionally Passes
_ Needs Further Evalu tion By the Local Approving Authority
Fails
Inspector's Signature: Date:4/1/00
The System Inspector shall Slit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.The original should be sent to the
system owner and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND COMMENTS
"The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My
inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life"
THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTE!,:4 EVERY TWO YEARS FOR PROPER MAINTENANCE.
revised 9/2/98 Page 1 of 11
A r
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 241 CASTLEWOOD CIRCLE HYANNIS, MA 02601 M273 P050 L128
Name of Owner SCOTT MCCRACKEN
Date of Inspection: 3/31/00
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluate
are indicated below.
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.
Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not.
nta The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliancd
attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,
whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The
system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health.
n1a Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due
to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health).
_broken pipe(s)are replaced
_obstruction is removed
_distribution box is levelled or replaced
n& The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if
(with approval of the Board of Health):
_broken pipe(s)are replaced
_obstruction is removed
revised 9/2/98 Page 2 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 241 CASTLEWOOD CIRCLE HYANNIS, MA 02601 M273 P050 L128
Name of Owner SCOTT MCCRACKEN
Date of Inspection: 3/31/00
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 the public health,safety
and 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 ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well,
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm,Method used to determine distance to (approximation not valid).
3) OTHER
n/a
4
revised 9/2198 Page 3 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 241 CASTLEWOOD CIRCLE HYANNIS, MA 02601 M273 P050 L128
Name of Owner SCOTT MCCRACKEN
Date of Inspection: 3/31/00
D. SYSTEM FAILS:
You must indicate either"Yes"or"No"to each of the following:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is
identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
_ X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
_ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool.
_ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
_ X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow,
_ X Required pumping more than 4 times In the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Q.
_ X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
_ X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
_ X Any portion of a cesspool or privy is within a Zone I of a public well.
_ X Any portion of a cesspool or privy is within 50 feet of a private water supply well,
_ X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality
analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,
ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must indicate either"Yes"or"No"to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and
safety and the environment because one or more of the following conditions exist:
Yes No
_ X the system is within 400 feet of a surface drinking water supply
_ X the system is within 200 feet of a tributary to a surface drinking water supply
X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the
Department for further information.
revised 9/2198 Page 4 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 241 CASTLEWOOD CIRCLE HYANNIS, MA 02601 M273 P060 L128
Name of Owner: SCOTT MCCRACKEN
Date of Inspection: 3/31/00
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health.
X - None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.
Large volumes of water have not been introduced Into the system recently or as part of this inspection.
X _ As built plans have been obtained and examined.Note if they are not available with N/A.
X _ The facility or dwelling was inspected for signs of sewage back-up.
X _ The system does not receive non-sanitary or industrial waste flow.
X _ The site was inspected for signs of breakout.
X _ All system components,excluding the Soil Absorption System,have been located on the site.
X _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of
construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been
determined based on:
X _ Existing information,For example,Plan at B4O,H,
X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)J
X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal
Systems.
revised 9/2/98 Page 5 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 241 CASTLEWOOD CIRCLE HYANNIS, MA 02601 M273 P050 L128
Name of Owner SCOTT MCCRACKEN
Date of Inspection: 3/31/00
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 110 g.p.d./bedroom
Number of bedrooms(design): 2 Number of bedrooms(actual):
Total DESIGN flow: 220 gpd
Number of current residents:1
Garbage grinder(yes or no):YES
Laundry(separate system)(yes or no): NO If yes,separate inspection required
Laundry system inspected(yes or no): NO
Seasonal use(yes or no): NO
Water meter readings,if available(last two year's usage): n/a gpd
Sump Pump(yes or no): NO
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a
Design flow: n/a gpd(Based on 15.203)
Basis of design flow:n/a
Grease trap present:(yes or no): NO
Industrial Waste Holding Tank present:(yes or no): NO
Non-sanitary waste discharged to the Title 5 system:(yes or no):NO
Water meter readings.if available: n/a
Last date of occupancy:n/a
OTHER: (Describe)
n/a
GENERAL INFORMATION
PUMPING RECORDS and source of information:
1996 BY CANCO
System pumped as part of inspection:(yes or no):NO
If yes,volume pumped n/a gallons
Reason for pumping:n/a
TYPE OF SYSTEM
X 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)
_ I/A Technology etc.Attach copy of up to date operation and maintenance contract
_ Tight Tank Copy of DEP Approval
Other:n/a
APPROXIMATE AGE of all components,date installed(if known)and source of information:
1986 A NEW PIT WAS INSTALLED 86-791
§@wage odor's deteEted when arriving At the Bite:(ye§of no) NO
revised 9/2198 Page 6 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(coi•itinued)
Property Address: 241 CASTLEWOOD CIRCLE HYANNIS, MA 02601 M273 P050 L128
Name of Owner SCOTT MCCRACKEN
Date of Inspection: 3/31/00
BUILDING SEWER:X
(Locate on site plan)
Depth below grade: 30"
Material of construction: _ cast iron _ 40 Pvc X other(explain)
Distance from private water supply well or suction line: n/a
Diameter: 4"
Comments: (condition of joints,venting,evidence of leakage,etc.)
THE SYSTEM HAS TOWN WATER.
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 24"
Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other
explain: n/a
If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO
Age: n/a
Dimensions: 1000G L 8'6"H 6'7"W 4'10
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 32"
Scum thickness: 1"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 17"
How dimensions were determined: MEASURED
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,
etc.)
THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS.
GREASE TRAP: _
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other
Explain: n/a
Dimensions:n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle n/a
Date of last pumping: n/a
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,
etc.)
n/a
revised 9/2198 Page 7 of 11
• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 241 CASTLEWOOD CIRCLE HYANNIS, MA 02601 M273 P050 L128
Name of Owner SCOTT MCCRACKEN
Date of Inspection: 3/31/00
TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection)
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other
Explain: n/a
Dimensions: n/a
Capacity: n/a gallons
Design flow: n/a gallons/day
Alarm present: NO
Alarm level:N/A Alarm in working order:NO
Date of previous pumping: n/a
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
n/a
DISTRIBUTION BOX:_
(locate on site plan)
Depth of liquid level above outlet invert: n/a
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
n/a
PUMP CHAMBER: _
(locate on site plan)
Pumps in working order:(Yes or No): NO
Alarms in working order(Yes or No): NO
Comments:
(note condition of pump chamber,condition of pumps and appurtenances.etc.)
n/a
revised 9/2/98 Page 8 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 241 CASTLEWOOD CIRCLE HYANNIS, MA 02601 M273 P050 L128
Name of Owner SCOTT MCCRACKEN
Date of Inspection: 3/31/00
SOIL ABSORPTION SYSTEM(SAS): X
(locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods)
If not located,explain:
n/a
Type:
leaching pits,number:(1)1000 GAL 6'X 6
leaching chambers,number: (n/a)n/a
leaching galleries,number: (n/a)n/a
leaching trenches,number,length: (n/a)n/a
leaching fields,number,dimensions: (n/a)n/a
overflow cesspool,number: (1)6'X 6'BLOCK CESSPOOL
Alternative system: Wa
Name of Technology: n/a
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
THE LEACH PITS ARE STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE NEW PIT HAS NOT HAD MORE THAN 1'
OF WATER IN IT.
CESSPOOLS: _
(locate on site plan)
Number and configuration: n/a
Depth-top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer. n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a
PRIVY:
(locate on site plan)
Materials of construction: n/a Dimensions: n/a
Depth of solids: n/a
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a
revised 9/2198 Page 9 of 11
Y
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 241 CASTLEWOOD CIRCLE HYANNIS, MA 02601 M273 P050 L128
Name of Owner SCOTT MCCRACKEN
Date of Inspection: 3/31/00
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
CpuiL
14
revised 9/2/98 Page 10 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 241 CASTLEWOOD CIRCLE HYANNIS, MA 02601 M273 P050 L128
Name of Owner SCOTT MCCRACKEN
Date of Inspection: 3/31/00
NRCS Report name: n/a
Soil Type: n/a
Typical depth to groundwater: n/a
USGS Date website visited: n/a
Observation Wells checked: NO
Groundwater depth: Shallow_ Moderate_ Deep_
SITE EXAM _ Slope
_ Surface water
_ Check Cellar
Shallow wells
Estimated Depth to Groundwater 12 Feet+
Please indicate all the methods used to determine High Groundwater Elevation:
_ Obtained from Design Plans on record
Observed Site(Abutting property,observation hole,basement sump etc.)
Determined from local conditions
Checked with local Board of health
_ Checked FEMA Maps
_ Checked pumping records
Checked local excavators,installers
X Used USGS Data
Describe how you established the High Groundwater Elevation.(Must be completed)
UGSS MAPS AND CHARTS-12 FEET
revised 9/2/98 Page 11 of 11
�Ya...« r- -.w ....._.�,,..��-.+ .+�..r..r--...y*fin-.r-. w+-:.4-,1,--.x.'+rS`:-.--r•-+:.t.w. ---�•-r`+ :"�,..-'.`.---- r.«^..,..ri.--•..1 -.�--
�_Pt
'1— c
THE ALTH OC F,MAS A CHUSETTS
i
BOARD I- �l E�'1 L T H
a,�'' �
CITY/TOWN
--
s W JjF D
B D PARTMEN� �
0 N
ADDRESS' -
� 'J�f Q'
'GSM. Svey' /'J ��f I TEL P�_���
YMNINS
Address /A Occupant1j#A
Floor_ Apartmen ro._ No. Occupa� r
nts
No. of Habitable Rooms No. Sleeping Rooms A
No. dwelling d rooming ofo nest .�_�F�1Q. S pfirrs_ p7 - i,/A J� (' O�/�fh/
Name and address of owner ��/r `k _! �l/V l`.� l�/"�1
Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish:
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps, Stairs, Porches:
Dual Egress: and Obst'n.:
❑ B ❑ F ❑ M Doors, Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen. Sanitation:
Dampness:
Stairs:
_ Lighting:
STRUCTURE INT. Hall, Stairway:
co Obst'n.:
co
14 . Hall, Floor, Wall, Ceiling:
Hall Lighting:
Hall Windows:
z HEATING Chimneys:
z Central ❑ Y ❑ N Equip. Repair
W TYPE: Stacks, Flues,Vents:
a PLUMBING: Supply Line: _
3 ❑ MS ❑ ST ❑ P Waste Line:
m H.W.Tank(s) Safety and Vent(s)
ca
ELECTRICAL Panels, Meters, Cir.:
0
❑ 110 ❑ 220 Fusing, Grnd.:
C1 AMP: Gen. Cond. Distrib. Box:
�° Gen. Basement Wiring:
DWELLING UNIT
Ventil. Lgtng. Outlets Walls Ceils. Wind. Doors Floors .Locks
Kitchen
Bathroom
— Pantry
Den
Living Room
Bedroom 1
-- _Bedroom (2)- —
Bedroom (3)
Bedroom (4)
Hot Water Facil. Sup.Ten., Gas, Oil, Elect.:
Stacks Flues Vents Safeties; A,
Kitchen Facilities Sink
Stove
Bathing, Toilet Facil. Vent Plumb., Sanit'n.: �� �� I C _ k.
ash Basin Shower or Tu_b:
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Building Posted: MT/
Locks on doors: �'� ,�,.►� r-
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION HICH
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&OF PERJURY." O
6
INSPECTOR TITLE /
7� A. ,M,pp
DATE Tl E P.
Eq A.M. i:
THE NEXT SCHEDULED REINSPECTION P.M.
410.750: Conditions. Deemed to-Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises,
shall be deemed conditions which•may endanger or impair the health, or safety
and well-being of a person or persons occupying the premises. This listing
is composed of these items which are deemed to always have the potential to
endanger or materially impair the health or safety, and well-being of the
.occupants or the public. Because Chapter II, 105 CMR 410.000 through 410.499
state minimum requirements of fitness for human habitation, any violation has
the potential to fall within this category in any given situation but may not
do so in every case and therefore cannot be included in this listing. Failure
to include shall in no way be construed as.a determination that other
violations may not be found to fall within this category. Nor shall failure
to include affect the duty of the local health official to order repair or
correction of the violation(s) pursuant to 410 CMR 410.830 through 410.833
nor shall it affect the legal obligation of the person to whom the order is
issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure
and temperature, both hot and cold, to -meet the ordinary needs of the occupant
in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or
longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper
venting or use of a space heater or water heater as prohibited by 105 CMR
410.200(B) and 410.202.
(C) Shut-off and/or failure to restore electricity or gas.
(D) Failure to supply the electrical facilities required by 105 CMR 410.250(B),
410.251(A), 410.253(A), 410.253(B) and the lighting in common area required
by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage system in operable
condition as required b 105 CMR 410.150(A)(1) and 410.300.
q Y
(G). Failure to provide adequate exits, or the obstruction of any exit,
passageway or common area caused by an object, including garbage or trash,
which prevents egress in case of an emergency 105 CMR 410.450 and 410.451.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(I) Failure to comply with any provisions of 105 CMR 410.600 through 410.602
which results in any accumulation of garbage, rubbish, filth or other causes
of sickness which may provide a food source or harborage for rodents, insects
or other pests or otherwise contribute to accidents or to the creation or
spread of disease.
(J) The presence of lead-based paint on a dwelling or dwelling unit in
violation of the Massachusetts Department of Public Health Regualtions for
Lead Poisoning Prevention and Control 105 CMR 460.000.
(K) Roof, foundation, or other structural defects that may expose the
occupant or anyone else to fire, burns, shock, accident or other dangers or
impairment to health or dafety.
(L) Failure to install electrical, plumbing, heating and gas-burning
facilities in accordance with accepted plumbing, heating, gas-fitting and
electrical wiring standards or failure to maintain such facilities as
are required by 105 CMR 410.351 and 410.352 so as to expose the occupant
or anyone else to fire, burns, shock, accident or other danger or impairment
to health or safety.
(M) Any of the following conditions which remain uncorrected for a period
of five or more days following the notice to or knowledge of the owner
of said condition or conditions:
'(1) . lack-of a kitchen sink-of •sufficient -si-ze and capacity for
washing dishes and kitchen •utensils-or`lack of a stove and oven
or any -defect that renders eithsr_operab-le. — -
(2.) failure to provide• a_washbasin and a shower or-bathtub—as required
in 105 CMR,410.150(A)(2) and_410.150(A)(3) and any defect which
renders them inoperable._,
(3) any defect in the electrical, plumbing,For heating system which makes
such system-or any part thereof in violation of generally accepted
plumbing heating, gas-fitting, 'or electrical wiring standards
that do not create an immediate hazard.
(a) failure to maintain a safe handrail or protective railing for every
stairway, porch balcony, roof or similar place as required by
105 CMR 410.503(A) and 410.503(B).
(5) failure to eliminate rodents, cockroaches, insect infestations and
other pests as required by 105 CMR 410.550.
(N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A)
through (M) shall be deemed to be a condition which may endanger or materially
impair the health or safety and well-being of an occupant upon the failure of
the owner to remedy said condition within the time so ordered by the' board
of health.
I, 0CATION E A. � _ �7/
VILLAGE
I I4 S T A L L 6'S N A M E ADDRESS
J. CRZAIG Pi'E IPZOS ugh
�. —' 7raclungz �cl�ia�g
4PVffMffoR OR OWNER Hyannis, Moss. /-7 -o-28
b 7-7'— G
s<19<-7
DATE PEPMIT ISSUED
g.L..'e-1/11
DATE COMPLIANCE ISSUER ���
� �.
�� � �
� , � �
� �'
� �
�Q,
4
C
(�( v
°iV�. �
\ � �
� � '
� �
b
No... _�?�... l
Fitz/
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..................OF......�..�"�
Appliratiun for Disposal Works Toustrurtiun frrutit
Application is hereby made for a Permit to Construct ( ) or Repair 411) an Individual Sewage Disposal
System at:
......
v—�—•j�- --canon- dress
Lot No.
�._ . ,.......................................... .......................... ... � " -... .�
• ` �!i ' / ��Ci C.A l�0 ZP •........�.. �.. A e l-� �� ....
Installer Address
Type of Building Size Lot..................:......... q. feet
�-, Dwelling—No. of Bedrooms a ............................................Expansion Attic ( ) Garbage Grinder ( )Other—Type Type of Building ___-_.._•------•-_._.._••••- No. of persons..................0.......... Showers ( ) — Cafeteria ( )
P4 Other fixtures
W' Design Flow............................................gallons per person per,day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width---0................ Total Length....-............... Total leaching area....................sq. ft. ,
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date...................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
a
x
•• ..........
•
. -----------•------•-----•-•----------------------------------------------
Description
o Soil..... ......•• .. .--- ° ..-•-••---••••-••--•--••••-•••--•••-•-.....••••..-:.....•••-•-............•...._...........
W ................................................................................•... ••.._ .....-•--•••-•-.....-•••••••••--........••-••••--•••............••-•.........-••- --....---•...._..........
V Nature --pp�airss--o++r Alterations—Answer when applicable.....c,
..... -•--•- ......-......-.............................
Agre t: "_A
ge Di sThe undersigned agrees to install the aforedescribed Individua Sewage Di,, System In accordance with
the provisions of LITL2. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued y the board of healt .
k
Signe . ----- s .............................. ...... •-•
Date
ApplicationApproved By..••-•••••-•••--•••••••-•-•--•••--•-•••-••••......-••---•-........•.............•••------•-.----- .........................0............
..
Date
Application Disapproved for the following reasons:................................................................................................................
............................................................-........................:...................................................................................-.................•-----••.-----
Date
PermitNo................................................... Issued...................-----•--••------•----•-----.....-----
Date
OCJ
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
oF.: .�1 e
Appliration for Uhipmat Workii Tontrur#ion Prrmit
,.
Application is hereby made for a Permit to Construct ( ) or Repairr, Individual Sewage Disposal
Illy
System at:
�y/�
l�' if 1+rruaM 4/M✓' Y't.0 f °'I� W �� 1 y., _:...° �✓• • .. + .rtY Ax /.
�! _
cation-/�.ddress L ',,,,� if tt1»o�Lot No i�
. ........- C9 � � 4a u � � ��� � ��
-----------------------
'us'it Address
Type of Building Size Lot............................ q. feet-
.+ Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures ..... .........
W Design Flow.:..........................................gallons per person per day. Total daily flow.._:.........................._.._.........gallons.
1:4 �%'Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter:_. t , ...... Depth................
W ,
x Disposal Trench=No...............:. .. Width.................... Total Length..................... Total leaching area................... ft.
3 . Seepage Pit No..................... Diameter.............._..... Depth below inlet.................... Total leaching area..................sq. ft.
Other Distribution box ( ) Dosing tank ( )
'-' 'r
est Test Results Performed by..........................a ...............................•---...-•-•---... Date.........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
rZ Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O Description of Soil...
----------- ---•----------•----
� r-�
W . ......... .................... •-• •-----•• ---- ... .......
_.
.......................................................... �+
U Natur o pa>rs or Alterations—Answer when applicable..:.._, _t �„ 1 .�L 1`...._._ f?- ? -��-- I
____________________ ._... ------Tp 9..�'�:
...................... ...
T.
Agreetpent: r •�/"�
The undersigned agrees to install the aforedescribed .Individual�Sewage Disposal System in accordance with
the provisions of A.
TIT: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in"
operation until a Certificate of Compliance has b en issue by the board of healt .
t Signer t- ' z . 1
.� --- --
e Date
Application Approved BY.............................................:........ .. .
Date
Application Disapproved for the'following reasons:.. = '! ._...
........................•--...........................-•----•----........----....-•---.......----.........--------------....... ---•--•-•---...... ..._............_-----...Date ..C.F.......
PermitNo....................................................--.... Issued......................................................
Date
—_---_..._.., -----
THE COMMONWEALTH OF MASSACHUSETTS
--� BOARD OF HEALTH
.............
.��.-- '....................OF..... ......................
.........................................................
Tertifirat a of Toutplittnrr
TH IS TOKgERTIFY, T� V t the In�tividual Sewn Disposal System constructed ( ) or Repaired ( )
by "i' `='c - -. _..... l?.±:P: '3-- �" ...
/l, x f Snsta�*
has been installed in accordance with the provisions of TITLE 5'of,. h�}}State Sanitary •Code'as described in the
application for Disposal Works Construction_ Permit No.___......%`..i�._....�:1.._._... dated-...................... . .
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WIL�U CTI N SATISFACTORY. ��
DATE. -----------------•-------- Inspector... ---- ..... •..
THE COMMONWEALTH OF MASSACHUSETTS-,
. ' ����/.��i�/Y4..3[.H'/''.a✓��yJ7CJY j�F /`wr�,��i:r
BOARD OF HEALTH CJ`
p
FEE.....................
�t��o tt1 urko �o ��; ion rruxi#
•
Permission is hereby granted... ....................... ...........I',..................................................''�""
..............................................
to Construct ( ) or�Reyair ( a .individual v► ge Disposal S stem
atNo.........��~ }. ... - '4:!.- - a le ? .... ................................-..................................
Street pp
as shown on the application for Disposal Works Construction Permit No".g........_... Dated......... . .....Q..-.T E?......
...................................... =...........................................
DATE.. Ll
Q.... Board of Health
4 g...... •---------------•-•.