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0056 ELAINE ROAD - Health
56 ELAINE RD., HYANNIS A = ��� _ ice► i r- DATE'. i7/7/01----- - PROPERTY AOORE? SS : 55. Elaine Road ------- ---Hyannis_---_--__— Mass. On Iho above dale, I Inapooied the septlo ays10M at the above address. ThIl syslem conslals of the lollowing; 1 . 1 -1000 gallon septic tank. 2. 2 . 1 -Distribution box. 3. 4-infiltrators 36 ' X11 ' - ealed on my Inipecllon, I certify the following oonditlons; 4 . This is title five septic syste. 5. The septic system is in proper working order at the present time. 6. Pumped the septic tank at time of inspection. Heavy scum & solids layers were present. ,510 N AT V R E t./ ....L':JG%K Company; Jo• •�h_P ;, N•comb.r_b Son , Inc , °� �'� l0 � A d d r e a a ;_ Box— 66 ---------- --Con He_-026�2-0066 Phone;--- 508_775,- 3338------- THIS CCRTIFICATIOH OOCS NOT CONSTITVTff A OVARANTY OR WARRANTY JOSEPH P, MACOMBER & SONI INC, . T+nk+.O�i►pool� l.�+chll�ld+ 00 Pvmpld 4 Inilillld Town Sowfr Connrotloni P.O. Box 66 InIIrylil1 6/1 Z 26J2-0066 RECEIVED JUL 3 0 2001 F, TOWN OF BARNSTABLE HEALTH DEPT. �-\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION i TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 55 Elaine Road Hyannis,Mass- - Owner's Name: Ch r Owner's Address: Date of Inspection:�01 Name of Inspector: (please print) J.P. Macomber ,7r Company Name:Joseph P. macomber & Son Inc Mailing Address: Box 66 C entervi 1 1 P m= 09632 Telephone Number: 50A_775_j318_ _ CERTIFICATION STATEMENT I certify that 1 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _kZ Passes Conditionally Passes _ Needs Further Evaluation by the Local Approving Authority _ Fails Inspector's Signature: Date: The system inspector shall Zoa copy of this inspection re ort to the Approving Authority(Board of Health or DEP)within 30 days'of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority.. Notes and Comments •*•'This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Paee 2 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Properry Address: 55 Elaine Road Y Owner;Charles Garrapy Date of lospectioo; Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A yst�Passes.- A I have not found y information which indicates that any ofthe failure criteria described in 310 CM.R 15.30 or ui 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B. System Conditionally Passes: d1 _ One or more system components as described in the "Conditional Pass"section need to be replaced or rcpaved. 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. A)d_ 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 sepric tank will pass inspection if it is snctwally sound, not leaking and if a Certificate of Compliance Indicating that the tank is less than 20 years old is available. ND explain: .JA 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: 2 h Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 55 Elaine Road Hyannis,Mass. Owner: Charles Carrapy Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require her evaluation by the Board of Health in order to determine if the system i further s failing to protect public health,,safety or the environment, I. System will pass unless Board of Health determines in accordance with 310 CMR I5.303(1)(b) that the system is not functioning in a manner which will protect public bealtb, safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is witbin 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 bealth, safery 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 rributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. A2PThe system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. AlhThe system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a pris'ate water supple well Method used to determine distance 'This system passes if the well water analysis, performed at a DEP cenifted 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: 3 . Page 4 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 55 Elaine Road yannis, ass. Owner: Charles Garrapy Date of inspection: 7/7/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no" to each of the following for all inspections: Yes No/ _ t/ 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 I��l�Jyj,i ✓ Liquid depth in•se9speel is less than 6'below invert or available volume is less than ''A day now Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped j . _ 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 I 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 collform 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 forma IV6 (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 now 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 l� th system is within 200 feet of a tributary to a surface drinking water supply sensitive area Interim Wellhead Protection Area— IWPA or a mapped _ the system is located to a nitrogen Sens (_ ) pp Zone 11 of a public water supply well a 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. 4 Page 5 of I I ' OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 55 Elaine Road Hyannis,Mass. Owner:Charles Garra y Date of Inspection: 7 7 01 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes Tv'o Pumping information was provided by the owner, occupant, or Board of Health ZWere any of the system components pumped out in the previous two weeks _/Has the system received normal flows in the previous two week period? &1ACz 9U1') Have large volumes of water been introduced to the system recently or as part of this inspection ? Were as built plans of the system obtained and examined?(If they were not available note as N/A) -Z _ 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,114luding 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 ? 4Z_ 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 field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)) 5 • Page 6 of I 1 10 OFFICIAL INSPECTION FORM -NOT FO R VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:55 Elaine Road Hyannis,Mass, Owner: Charles Garrap_ y Date of Inspection: 7/7/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 1 10lgpd x# of bedrooms): Number of current residents: lAc4i7— Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage systems or no): ` [if yes separate inspection required) Laundry system inspected(yes or no): Seasonal use: (yes or no):O— Water meter readings, if available (last 2 years usage(gpd)): Sump pump(yes or no): _ — ,Gl*l; Last date of occupancy: y � yQ COMM E R C IA L/IND U STRIA L Type of establishment: AM Design flow(based on 310 CMR 15.203): AX gpd Basis of design flow(seats/persons/sgft,etc.): 4AJ Grease trap present(yes or no): 0 Industrial waste holding tank present (yes or no):XO Non sanitary waste discharged to the Title 5 system (yes or no): L44 Water meter readings, if available: Last date of occupancy/use: dA OTHER (describe): z"4 GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection (yes or no): If yes, volume pumped: gallons .- How wa quantity pumped determined?141--ounew Reason for pumping: ,I- - .all ® ' z TYP OF SYSTEM Septic tank,distribution box, soil absorption system ,1�0 Single cesspool IL&2 Overflow cesspool /Z:�p Privy /0 Shared system (yes or no)(if yes, attach previous inspection records, if any) /L)& Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank 44� Attach a copy of the DEP approval /L Other(describe): Ap�rqximate a S of all coinponenls, dat installed (if known)and source of informatio Were sewage odors detected when arriving at the site(yes or no):.� 6 Page 7 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:55 Elaine Road Hyannis,Mass. Owner: Charles Garrapy Date of Inspection: 7/7/0 1 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: /cast iron ✓ 40 PVC dother(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of leakagP,mhP gVstam is s vented through the house vent. SEPTIC TANK: (locate on site plan) Depth below grade: # Material of construction: concrete )flberglass,1P N�other(explain) If tan}, is metal list age: �0 Is age confirmed by a Certificate of Compliance(yes or no):,�(attach a copy of certificate) n Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:._ Scum thickness: 6_ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bo m of outlet tee or baffle: How were dimensions determined: 0 '4)-7� or Comments (on pumping recornmendati�or s,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of-leakage, etc.): Pump the septic tank ever 2-3 years. Inlet & outlet tees are in piace.The tank is structurally sound and shows no evidence of leakage. GREASE TRAPr1/r&_(locate on site plan) Depth below grade: A.14 Material of constructionyconcrete,�meta4t/_' fuberglass9 polyethylene mother (explain): IV4 Dimensions: ,{Jib Scum thickness: 141-4 Distance from top of scum to top of outlet tee or baffle: AJl Distance from bottom of scum to bottom of outlet tee or baffle: 414 Date of last pumping: aA Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease trap is not present - 7 Page 8 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 55 Elaine Road yannis, ass. Owner: Charles Garrapy Date of Inspection: 7/7/01 TIGHT or HOLDING TANMY (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of constructi concrete (//9 metal 1I4 fiberglass �s Polyethylene WA other(explain): Dimensions: Capacity: 4111 gallons Design Flow: 40 gallons/day Alarm present (yes or no): :a:: Alarm level: Alarm in working order(yes or no): Date of last pumping: Z�f_ Comments (condition of alarm and float switches, etc.): Tight or holding tanks are not present. DISTRIBUTION BOX:/(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 4.0 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.): Distgibution box has one lateral.No evidence of Golds carry over-No evi denc-P of 1 PakagP into or crrnit- of the hnx PUMP CHAMBEW6tt (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no):-Z? Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): Pump chamber is not present. 8 Page 9 of I 1 ' OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 55 Elaine Road Hyannis,Mass. Owner:Charles Garrapy Date of Inspection: 7 7 01 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Located. Type _Aoleaching pits, number: .,:�j leaching chambers, number:.tT�r-A'Vb-#rATbr 5 leaching galleries,number: V &J)_ leaching trenches,number, length: leaching fields,number,dimensions: 4 overflow cesspool, number: 0 , innovative/altemative system Type/name of technology: l�141 'Gel Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Loamy sand to medium fine sand.No signs of hydraulic failure or ponding.Soils are dry and stone is dry around the infiltrators.Vegetation is nornal. House has been vacant for two months. CESSPOOLS43j�,(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Z) Depth—top of liquid to inlet invert: ,04 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.): Cesspools are not present. PRIVY_(locate on site plan) Materials of construction: Dimensions: Depth of solids: 44 Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy is not present. 9 Page 10 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 55 Elaine Road yannis,Mass. Owner: Charles Garrapy Date of Inspection: 1/777 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. _ r yz � y � zl to h s Page I I of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 5:5 Elaine Road Hyannis,Mass. Owner: Charles Garrapy Date of Inspection: 7/7/01 SITE EXAM Slope Surface water ' Check cellar Shallow wells Estimated depth to ground water feet jheckved dicate (check)all methods used to determine the high ground water elevation: ta' ed om system ddesi� Tans on record- If checked, date of design plan reviewed: sersite abuttin roe 7observation hole within 150 fest�f A with local Board of Health-explain: ��Qj�Lri;/ f/ Ji7 :�/_Checked with local excavators, installers- (attach documentation) _ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used water table contours map. Gahrety & Miller Model 1 2/1 6/94 11 1 '**tr+.-nl•r7/"tbarn.-mr•ITeRsl+rtr7+Rmrr.7e+t1♦r►lwR�nrin qe►\7iTls'�r��nwT �..-p-r..�'...:..-. r... k TOWN OF Barnstable BOARD OF HEALTH SUDSHFACE SEWAGR DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION0 I •••T••f�T••••.'t-T.II1.�.TTTM1T 1111'll.'RI TIRIRrf>IRTT'T.1�1•T rIVtT�>�R�T-TnR�f t7 rtR1 •.'*r•TT'T•�• �..^ -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRES$ 55 Elaine Road Hyannis,Mass. ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME Charles Garrapy PART D - CERTIFICATION NAME OF INSPECTOR _Joseph P. Macomber Jr.. COMPANY NAME Joseph P. Macomber V ion Inc COMPANY ADDRESS Box 66 Centerville Ma 02632 Street Town or City State LIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposai, system at ID his address and that the information reported is true , accurate , and omplete as of the time of inspection . The inspection was performed and any ecommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one ; System PASSED _ The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 160303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection which I have con tcted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 3.10 CMR 16 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature r Date 7W .. :,� of this c tification must be provided to the OWNER, the BUYER Dne--copy where applicable ) and the BOARD OV HEAL'I`it, I f the inspection FAILED, the owner or•Ihop erator shall u* P P pgrade ' the eyatem within one year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CMR 16 , 306 , partd .doc fZ BRUCE P. GILMORE ATTORNEY AT LAW 1170 ROUTE 6A WEST BARNSTABLE, MA 02668 (508) 362-8833 FAX: (508) 362-5344 Mailing Address E-MAIL: gilmores@gis.net P.O.BOX 714 www.capecodlawyer.com WEST BARNSTABLE, MA 02668 October 20, 2000 RECEIVED OIC T X, 3 2000 TOWN OF BARNSTABLE HEALTH DEPT. Glen Harrington Board of Health Barnstable Town Hall 367 Main Street Hyannis, MA 02601 Re: 55 Elaine Road, Hyannis, MA Dear Glen: Enclosed please find a copy of a memo from John Drew which indicates that my clients' tenant, Kim Shannon, won't allow anyone into the house to make any necessary repairs until the middle or end of next week. If you have any questions, please don't hesitate to contact me. Very truly yours, Bruce P. Gi re /gg enc. FROM SASSAMON HOLDINGS PHONE NO. 508 2914322 Oct. 20 2000 09:27AN P1 } FRECEIVED MEMORANDUM: 2000 TO: Bruce P. Gilmore TOWN OF BARNSTABLE HEALTH DEPT. FROM: John Otis Drew RE: 55 Elaine Road,Hyannis,MA 02601 Following up on yesterday's meeting and correspondence to Kim Shannon, I would like to report that Kevin Pierce contacted Kim late yesterday. Kevin reported to me last evening that Kim refused to allow him to visit the property on either Friday,October 20, 2000 or Saturday, October 21, 2000 to survey the problems outlined in the Barnstable Board of Health,Notice of Violations,and to begin repairs to the premises. Kevin was told to call back on Sunday afternoon,October 22,2000.to discuss with Kim the possibility of a raid ur late week site visit(October 251h to 27d'). Clearly,we will be unable to comply with the time schedule outlined in the Barnstable Board of Health Notice received on October 18'h,based on Ms. Shannon's refusal to allow access to the premises. Please advise with any directions for either Kevin Pierce or me relative to this matter. Will you be reporting this to the Barnstable Board of Health? 1 can be reached through any of the following numbers: (508) 775-1404, Hyannis office; (508)295-0025, Wareham office,(508)728-5442,mobile phone. Delivered via fax& US Mail 10/20/00 John A. Drew, Realtor Real Estate and 776 Main Street Appraisal Services Hyannis,MA 02601 Established 1953 (508) 775-1404 Certified Mail#P 051 841 712 Return Receipt Requested October 19, 2000 Ms. Kim Shannon 56 Elaine Road Hyannis, MA 02601 Dear Kim: Confirming the message that I left on your answering machine earlier today, I am in receipt of a notice from the Public Health Division of the Town of Barnstable concerning apparent violations of the State Sanitary Code at 55 Elaine Road, Hyannis, Massachusetts. Either later today or tomorrow morning, you will receive a phone call from our contractor,Kevin Pierce, who will be arranging for the repairs outlined in the aforementioned letter. If you have not received a phone call from Kevin on or before 5:00 P.M. on October 20, 2000, please notify me at either (508) 774_1404 or(508) 295-0023. Very truly yours, Jo Otis Drew President JOD/pah Cc: Thomas A. McKean Bruce P. Gilmore, Esq. Carol Shaeffer,-Esq. j F f Town of Barnstable Regulatory Services Thomas F. Geiler, Director • Public Health Division ensxsrABM v� Thomas McKean, Director �fDW1A'�A 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 October 16, 2000 Charles &Elizabeth Garrapy c/o John Drew, Realtor P.O. Box 487. Hyannisport, MA 02647 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE H, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE, ARTICLE 51 The property owned by you located at 55 Elaine Road, Hyannis, was inspected on September 25, 2000 by Glen Harrington, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code H, Minimum Standards of Fitness for Human Habitation were observed: 410.100: The kitchen ceiling was observed to have peeled and chipped plaster and paint. 410.351: The bathroom subfloor was observed to be rotted. The linoleum floor was observed to be cracked. Both conditions due to leaky tub enclosure. 410.452: The rear concrete porch was observed to be cracked and broken. 410.500: The garage door was observed not tooperate as intended. 410.504 C : The bathroom tub seal was observed to be broken. 410.500: Mold was observed in rooms with exterior walls due to leaky ceiling. You are directed to correct the above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PE ORDER OF THE BOARD OF HEALTH mas A. McKean Director of Public Health g h A CF THE 1p� R WABL& • Town of Barnstable MASS. $ 4' i639• '0 Board of Health AlED MA'S A 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 Susan G.Rask,R.S. FAX: 508-790-6304 Ralph A.Murphy,M.D. Brian R.Grady,R.S. OG-l- 43 2000 G/d S(2 Bea- r-C9 . d0A z07 Wyaupjoort, �ti9 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00,STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 _ The property owned by you located at 5 Lam p was inspected onf 12000 by Glen Harrington,R.S.Health Inspector for the Town of Barnstable,because of a complaint. The following violations of 105 CMR 410.00,State Sanitary Code II,Minimum Standards of Fitness for Human Habitation were observed: Lj lV, �� T 1��� �(.�i��0� e L/lO r SZ , "—VA CC-"Glt-)47 P'V-d, WOW N aAJJ e-wn/ Q�/ (W 6*-,1Lf-4eV0� Lll o.s-oY(c) 'ri� 7 1®°..$rU 7� �/� ,.J� /t?� /� wa-� ��IZrYccP �� ,-�o-o-w,f w�-�Lj �,�C.�Q�•.�ar w�//) � dry 4y.!O�Careirect e o this on of 2 wit ' twe - ou 0 r You are 40 directed to correct the above listed violations within seven(7)days of receipt of this notice. J You may request a hearing if written petition requesting same is received by the Board of Health within seven(7)days after the date order is received. However,these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than$500. Each separate day's failure to comply with an order shall constitute a separate violation. Renting the above property with uncorrected violations is a violation of the State Sanitary Code and the Town of Barnstable Rental Ordinance,Article 51,section 6-2. PER ORDER OF THE BOARD OF HEALTH Thomas A.McKean Director of Public Health P�� Enclosur64opy of Inspection Report THE COMMONWEALTH OF MASSACHUSETTS FORM30 C&W HOBBS&WARRENrm BOARD OF HEALTH CITY/TOWN o DEPARTMENT ADDRESS � 2 o o p TELEPHONE Address`-'S '�Ja`""d lrc et44"_2 Occupant .-r 4 A t1W"_, Floor Apartment No. No. of Occupants Z No.of Habitable Rooms ��� No.Sleeping Rooms �j No. dwelling or rooming units No.Stories Name and address of owner_� o�� d' E/i2� _ ► '' S r` QU ,� � Remarks Reg. Vio. YARD Out Bld s.: Fences: OL Garbage and Rubbish 14 of¢µrQcp( Containers: Drainage Infestation Rats or other: STRUCTURE EX Steps,Stairs, Porches: P,."--r v'a-1 C y/V W 4 Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT' Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceilin : Hall Lighting: o d 0"i C.; ravv-,S- We v4o /0 S�v Hall Windows: %e.a.k- (4e IV 4 HEATING 6 Chimneys: Central B'(� ❑ N Equip. Repair TYPE: g,,'¢ Stacks, Flues,Vents: PLUMBING: Supply Line: pz.r� wa ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten. as,' il, Elect.: & Stacks, FI ents,Safeties: Kitchen Facilities Sink 1 fl —O(o Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: lfe,04 0 k . ul- Secs,/ -v /eca., /O SD C Wash Basin,Shower or Tub: 5,1. /Frr vv Ad f ,F" evv C q c Grp i7 /O 35"7 Infestation Rats, Mice, Roaches or Other: A) lea V.y Ivb del""e Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR TITLE A.M. DATE / ZS TIME Z `Cto THE NEXT SCHEDULED REINSPECTION Yp4-1 6� Ut fec J^� A.M. ( CJ� P.M. ..,V i +ttft:lA`r 'fi^*w,n • ::aV?'1i.. .tar.+T-,ir'4q,+PS,�',t..Y..'ry,n a �`� + £ -;.:, .,,vM t "�" ye'y:l 4W T 1 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or impair the heaith, or safety and well-being of a perscn or persons occupying the premises. This listing is composed of those items which are deemed to always have the potentiai tc endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, includinggarbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. 9 9 P 9 9 (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulator or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. Health Complaints 18-Sep-00 Time: 11:06:33 AM Date: 9/18/00 Complaint Number: 2550 Referred To: GLEN HARRINGTON Taken By: LS Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 55 Street: ELAINE ROAD Village: HYANNIS Assessors Map_Parcel: ,�� Complaint Description: SAID THAT THE HEATER WORKS ON AND OFF AND IT WAS SUPPOSED TO BE FIXED IN MAY. THERE IS ALSO PEELING PAINT ON CEILING ABOVE STOVE. THERE ARE LEAKING PIPES IN BASEMENT NEXT TO WASHER AND DRYER. THE OWNER' S LAST NAME IS GARRAPHY AND HE LIVES IN CONNECTICUT. THE REALTOR IS SUPPOSED TO BE HANDLING ANY PROBLEMS, BUT HE TOLD TENANT NOT TO ASK ABOUT THINGS TO BE FIXED. IT APPEARS THAT THE REALTOR IS A FRIEND OF THE OWNER AND HE DOESN'T WANT TO BOTHER HIM. SHE WILL CALL TO MAKE AN APPOINTMENT BECAUSE OF THESE THINGS HAVE BEEN GOING ON A LONG TIME. Actions Taken/Results: Investigation Date: Investigation Time: 1 No. �/ 'r' �l9 7 Fee���� ' g THE COMMONWEALTH OF MASSACHUSETTS Enteredincomputer:. a0 s ak PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplicatfon for Mt5po5al *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. / T� Owner's a >Address and Tel.No. Assessor's Map/Parcel Cjf9�J✓c Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �06�lV�3g9 Type of Building: 7 Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder(//e Other Type of Building t° G? No.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 33e gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 15N Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable)�4);o-le ✓��,� 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 b his d o He / Signed Date Application Approved b Date Application Disapproved for the following reasons Permit No. Date Issued No. x,/ Q F u+ 1' THE COMMONWEALTH OF MASSACHUSETTS . ., =PMPuter: , �. be? /Y 1 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS Application for Miopogal *potent Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon,( ) ❑Complete System ❑Individual Components Location Address or Lot No. / Owner''s Nam ,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 71-f3W Type of Building: Dwelling No.of Bedrooms_ Lot Size sq.ft. Garbage Grinder(41c 7 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //G' gallons per day. Calculated daily flow 3341 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ." Type of S.A.S. 11 9 `4fIDY�I��' �ii/f✓41�/S Description of Soil Nature of Repairs or Alterations(Answer when applicable)�71)tle IZ?r �-1O/r , Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore describedon-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 b this o d o Health., .--" Signed Date Application Approved b . Date 41 '! t Application Disapproved for the following reasons Permit No. `, 1 Date Issued A0 //49 5F!1 ----------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS -. �. ZHS-10 7 BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TYCE TIFY that the On-site Sewage Disposal System Constructed( )Repaired( UpgradedAbandoned( )byl 4Z e V-57- at P 61i 5 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. .• dated//S —Z/l 9 Installer , Designer / r A The issuance of this p s o o strued as a guarantee that the syWt�mill tion dest x d.' Date Inspector 0 /W v l -------------------------------------'"�=— No. Fe THE COMMONWEALTH OF MASSACHUSETTS 7 qq—/4 PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Migogal 6potem Conotruction Permit Permission is hereby granted to Construct( ) epair(0 Upgrade( )Abandon( ) System located at `` L6jw/fie y - ��fll9rli 5 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of t 's ermit. "" Date: �� Approve " J CA O O 0 r� w lip t� t/6199 NOTICE: This Form is To'Be-Used For the Repair Of Failed Se-tic'Systems Only: CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) >; 1�,of J, �o��Go /^ , hereby certify that the application for disposal works construction permit signed by me dated lelll y concerning the property located at 5 SZXa)h' �'� �l�1/7�5 meets all of the following criteria: W The failed system is connected to a residential dwelling g only. There are no commercial or business uses associated with the dwelling. e soil is classified as CLASS I and the percciation rate is Iess than or equal to 5 minutes per inca. There are no wetlands within 100 fert of the proposed septic system 4/ here are no private wells within 1-0 feet of the proposed septic system 1/ 7 increase is no inease in flow and/or change in use proposed There are no variances requested or needed ]/The bottom of the proposed leaching&cility will not be located less than five feet above the ma.xdmum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] V/If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the ma.-amum adjusted groundwater table elevation, Please complete the following: W w A) Top of Ground Surface Elevation(using GIS information) ( ` B) G.W.Elevation Z +the MAX F iigh G.W.Adjustment. C/= 2 3 DIFFERENCE BETWEEN A and B U t SIGNED : DATE: 6l/l 7 [ h pmpoad Plan of system on back]. qP haft Bolder.mkt TOWN OF BARNSTABLE Q/ LOCATION M41 49ill& 12511 SEWAGE # VILLAGE CI�/�'/S Q A SES/S�OR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size)DA j NO.OF BEDROOMS BUILDER OR OWNER p PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ck 55 Elaifie Road Hyannis,mass. 02601 Owner Charles Garrapy 1 -1000 gallon septic tank. 1 -Distribution box. 5-infiltrators ' 3-bedrooms j l' \ E3 J� I i M _ -J SJG/ TOWN OF BARNSTABLE LOCATION �/r�' ff�i'. SEWAGE # VILLAGE_ Cr� �%'/5 A SESSOR'S MAP & LOT ' INSTALLER'S NAME&PHONE NO. P C—<3V%'5f SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size)Djj NO.OF BEDROOMS BUILDER OR OWNER D PERMIT DATE: ��_j ! COMPLIANCE DATE: Separation Distance Between the: . Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by -4,1 TOWN OF BARNSTABLE LOCATION lid !a%/9� / SEWAGE # VILLAGE A SESSOR'S MAP & LOT Z4f�'76� INSTALLER'S NAME&PHONE No. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) , NO.OF BEDROOMS BUILDER OR OWNER ppp PERMTTDATE: COMPLIANCE DATE: Separation Di4tance Between the: Maximum Adjusted Groundwater Table to the Bottom.of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by l3 � - ��� LOCL1,TIOKI (�5EWQC,E PERMIT Ub, WSTALLER•S UWAE ADDRESS 1J �1./�E � ADDRESS DL�TE PERNAVT DATE COMPLI W-ACE ISSUED ; E �� �.�, �� 1 �i �� M� I i �/c 0 ...... FRic ........ ..... THE COMMONWEALTH OF MASSACHUSETTS ..... BOARD OF HEALTH -----OF...... ..........................--------- Appliration -for Uiiivwial Works Towitrurtion Pprutit Application is hereby made for a Permit to Construct or Repair L-<an Individual Sewage Disposal System .............................................................. ... ... . ... .........--- ---- ---- Address or Lot No. M- ------------- - ---------- --- -- ------ -- -------- -----------------------------------------*-------------------------------------------------------- Ow er iL J---------- ------ --------------------------------------------Address .................... ............................. Installer Address 'T"y")eof Building Size Lot---------_----------------Sq. feet Dwelling No. of Bedrooms----------------------------------------_-Expansion Attic Garbage Grinder ( ) Other—Type of Building ----------------------_--- No. of persons---------------------------- Showers Cafeteria ( ) Otherfixtures ----------------------------------------------------------_-------------------------- -----------_-----_--_--_- ---------_----------------- Design Flow............................................gallons per person per day. Total daily flow-____._______-.-__.----_--- __---.-..-_:.-gallons 9 Septic Tank—Liquid capacity------------gallons Length________________ Width................ Diameter_---..__...---- Depth.............--. Disposal Trench—No---------------------- Width___-___-_---_----_-- Total Length_-_-_---_----___-__. Total leaching area----- --------------sq. ft. Seepage Pit No_____________________ Diameter..................._ Depth below inlet-------------------- Total leaching area------------------sq. ft. 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...-_..._--.----_.-..._. Test Pit No. 2................minutes per inch Depth of Test Pit....._.............. Depth to ground water--__-.-_---._-.--_.-__-- ---!� ---------------------------------------------------------------------------------------------------------------------------------- 0 Description of Soil----- .... �-----------------------------------------------------------------------------------------------------�4 ------------------------- ---------- ---------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ U ----------------- -------------- -------------------------------------------------:................. - ----- - ---------------------------- a-41 U Nature of.Repairs qE4Alterations—Answer when a 11 ------ l ............41..2... ----------------------------.............. -------- ---------------------------------------------------------------------------- Agreement: �') The undersigned agrees to install the atoredescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bswssued by the b9jrd ?J h3alth. ,SiAd ----- ............ ------- ------- 111� /at�p'lopp- Application Approved By---.... .. ..... "VA001 Ad__A4 &A 'L ............... ....//-------r------------------- ;14 Date Application Disapproved for the following reasons:................................(��..................................................................... . ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------- / ( ' 2�Date PermitNo......................................................... Issued-- ............ ................................... Date ------------------------------------- e § K � 4 - FEE .. 1 - THE COMMONWEALTH OF MASSAC~ > r 1 HUSETTS - �"" BOARD .�OF HEALTH Nank ,,.- 'ra 1....(JZCfLI.: O F 1tr t� fur i uAal parks Towitrurtion pr �Yt Application is hereby made for a Perm>t to Construct ( )'.or Repair ( an Individtl Sewage Disposal- s system . __ /�/J a .._ `�1/YJY_ ______ __ !. ..__..__ ................................ ....................................................... t n-�Qddress or Lot No. r — .— ---- -- fi...................................... :................•-•--• - .. v. W ` Ow er + , AJ ° � k Address r w .r' . JAI - � _____________ ............................. ________._______..___.....__-_._.__.__.. _______ _. ____�� ` T•�' - Installer• - - 5_. Address Y • r TYPe of Buildi , , Ke. Size Lot_-•-----•-•--•----- --_Sgi:`feet Dwelling No.,7-of# Bedroorrls________________' . Expans?©n Attic ( ) Garbage Grinder ( ;) aOther=Typerof, Building -. _ __. ................ No. of persons \`. ___________ Showers ( ) — Cafeteria a' Other fixtures -- - d _- ------- ---- -------- --- -- - Design Flow-_-,-- _:________________gallotrs'per.person per day. Total daily flow........................ ______ _- gallons 4 W Septic Tank Liquid capacity- __gallons Length----------------- Width---------------- Diameter................ Depth_............... \ ��K x Disposal Trench-No. ________ ________ Width-------------------- Total Length___-_________.____. Total leaching area_-__-_______-______Sq. ft Seepage Pif No_.........__________ Diameter----------------------- Depth'below inlet:____:_____________ Total leacliing''irea_:_. sq. ft. 'Y Other Distribution box Dosing tank r ` ' Z ( ) g ) x ~" Percolation Test Results Performed by-._ '`. - --------- ------ ---• `Date Test Pit No. 1______________ m ntites per inch Depth of. Test Pit ____ Depth to, round water.........____-_- _-_---- GT Test-_Pit No. 2__.............minutes per, inch Depth of Test Pit-__:"__:_________. Depth to'ground Water---------------.___---. u' ............................................. D Description of Soil-_-__.: �% f } -- - - ---- ------------ -------- 2J U W ---- -- - ---- ----•----•--- ------- --- L-v" f ' jj f� U Nature of Repairs or Alterations—Answer when aphcable - _ j • ------ ------- ---.__------------- .x t j} greent The undersigned agrees to install. the. aforedescribed Indivrdpal'Sewage Disposal System in accordance with the provisions of Article XI of the State Salutary;Code—The undersigned further agrees riot to place the system in �^operation until a Certificate of Compliance has be ssued by t'he b rd of h lth. S1g iCd ------ �r g c (`G"�Y WF ./✓.. �.. I fi z• --•- ---____ > ' Date„ APPlication Approved BY s` .R. 1jef �_ r _fit f�=' ` "�f._:._`1:. f ` ---- Date Application Disapproved for'kT2e follozeiing reason a'=------------- _..._._______ . _ --Y: 1. -,...t -- 1 -- 2• Date Permit No------ Issued. -- t u ° Date THE COMMONW LTH OF MASSACHUSETTS BOARD OF HE LT . G" OF - .. �er �.!..........r". ................ tifirate of,dam haurr "> -07r No � T I IS CERfIF , T11at'the Iitdiv ual Sewage Ihrsposal System constructed ( )'or Repaired by t G "u , .................... --•- ---- r, -- r -- �. - .c" i at .- �----- ------ ,s � ................................w . -- has l eei' installed m accor ance with the provisions particle XI of Tl e State Sanitary.Code a described m,the a' apph'aatign for Disposal"works Construction^P>4r'mit No.:_: ""— __ dated,:_ �- `r'_ :_ _ TKE ISSUANCE-OF THIS CERTIFICATE SHALL NOT BE CO r QED AS�A. N.TEE THAT:T1FIE SYSTEM WILL FUNCT ON S TISFA TY • ,• /I � �� e'er C DATE--- - r 4 c _ .. - spe for � � " _+• ••'c)tjz�' S` din,•: •s�,3s4,a',. +.i.+k�•" .',.' `„.. a . -: ah --..r 4 t ��°�� t 1 ua�*�+aM�.�.'G,:'k r 'iah ro'�'a?m„"'•/v* .. g.. ,. r � �, d a `" • TH,EtCO1�M�7NV1/EA'LTH.iOF MASSA�G;HU§ETTS # ' yy r ; f 3 �► `' BOAR `O� HE> 1L H i it *�. fn•- d r > Kr ,t No ! t5Vatial ark C11,0, �T rrmtt 1 r- - ' - _ lllFFf y Permission is htereby',granted = -_.- }__ "wto ConstffjFf-k1!') erparr ( a n�'vi ual S 'age"Disposal ystem at,ANAo ' _�S.1_ _ ---• t k� 5 Street [ F • as s io vn on thc�applicatiom for Disp'o �Worl.s Coikstrnction I?µermit,No, )_)Dated..........` --_ ' w f '' (, I` - e i✓_:,r. ..✓... > F• f e+ A r ,y ? ♦ Y , , " B d h t ' oars o F , cnr. D�1 +E *t v `;S r •--- �vT ;�c --• .H f e t 3 f ea}t y - -•- -- - i FORM'ii255 HOBBS 813 W4/RR!`N`:TN i4; B uy.,'�".. .�±... ....' ti �,u:•. ...�,sr�>ss.._.x ......�" �, ...E