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HomeMy WebLinkAbout0014 FRESH HOLES ROAD - Health Fresh Hoes :Road - Hyannis 292 184 o I. '� 1 ` W Rk Town of Barnstable ah, " Regulatory Services • BnxxsrABLE, * . "�: r Public Health Division ArFD�AO�A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 29, 2016 OCWEN PO Box 24665 West Palm Beach, FL 33416 EMERGENCY CONDEMNATION AND ORDER TO VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L. c.111, sec. 127A and 127B, 105 CMR 400.000: State Sanitary Code, Chapter I: General Administrative Procedures and 1.05 CMR 410.000: State Sanitary Code, Chapter II: Minimum Standards of Fitness for Humans, Jim Parziale, R.S., Health Inspector for the Town of Barnstable, on June 29, 2016 conducted an investigation of a dwelling unit located at 14/16 Fresh Holes Road;Hyannis, MA. The owner of this dwelling is OCWEN. Based on the results of that investigation; the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR410.831 the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling, which give rise to the emergency finding of unfitness and determination of immediate danger, include: 410. 750: Conditions Deemed to Endanger or Impair Health or Safety 410.750 (C) Dwelling does not have electric service. Based upon these findings any and all occupants are hereby ordered to vacate and the landlord/owner is ordered to secure the subject dwelling within 48 hours of receipt of this order. If any person refuses to leave a dwelling or portion thereof, which was ordered vacated she may be forcibly removed by the local Board of Health (Massachusetts General Laws C. 127B), or by local police authorities at request of the Board of Health. I Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from$10-$500. Each day's failure to comply with an order shall constitute a separate violation. Any person needing access to the inside.of the dwelling must get permission from the Board of Health prior to entry. Note: This is an important legal document. It may affect your rights. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, CHOIRS Director of Public,Halth Town of Barnstable { i 14-16 Fresh Holes Rd Public Records Hi, Building violation?There is a notice posted at the property about unsafe structure so we want to confirm if there is an outstanding violation. Please see below. d w +r1as: �u i s Thanks, Dess Altisource Desserie Jacob I Code Compliance Specialist I Code Violations—Field Services desserie.jacob .alitisource.com P: 770-612-70071 Ext. 293015 1 F: (770)989-7133 m Altisource P.O. Box 105460 Atlanta, GA 30348-5460 www.Altisource.com Subject: RE: 14-16 Fresh Holes Road, Hyannis MA Good Morning: I need more information from you. What type of violation? Thank you, Ann M Quirk, CMC/CMMC Town Clerk/Town of Barnstable From: Jacob, Desserie T [mailto:Desserie.Jacob@altisource.com] Sent: Tuesday, October 10, 2017 5:07 PM To: Quirk, Ann Subject: 14-16 Fresh Holes Road, Hyannis MA . Good day, I am writing to verify if we have any outstanding violation at this time. I am looking forward to your response.. Thanks, Dess Altlsource i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 14-16 FRESH HOLES ROAD Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 01/30/2015 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not JOHN P GRACI SR use the return Name of Inspector key. GRACI SEPTIC INSPECTIONS LLC $- reb Company Name PO BOX 2119 Company Address ;b TEATICKET MA 02536 LP City(Town State Zip Code 508-641-6694 S 1468 Telephone Number License Number 7 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 rther Evaluation by the Local Approving Authority 01/30/2015 Inspector's Sig ure Date The system spector shall submit a copy of this inspection report to the Approving Authority (Board of Health or EP) 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 DER 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•3113 Title 5*peSubsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14-16 FRESH HOLES ROAD Property Address BANK OWNED Owner Owner's Name information is HYANNIS MA 02601 01/30/2015 required for every page. Cityfrown 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: ® 1 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: AT TIME OF INSPECTION SHARED SYSTEM APPEARS TO BE STRUCTUARLLY SOUND AND FUNCTIONING PROPERLY. 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): NA t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14-16 FRESH HOLES ROAD Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 01/30/2015 page. City/Town 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): NA ❑ 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): NA 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 l5ins-M3 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 M 14-16 FRESH HOLES ROAD Property Address BANK OWNED Owner Owner's Name information is HYANNIS MA 02601 01/30/2015 required for every page. City/Town 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: NA ** 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: NA 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 '/2 day flow t5ins•3/13 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 M 14-16 FRESH HOLES ROAD Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 01/30/2015 page. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14-16 FRESH HOLES ROAD Property Address BANK OWNED Owner Owner's Name information is MA 02601 01/30/2015 required for every HYANNIS page. City/Town 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? i ❑ ® 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 El ® this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® El 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: 4 Number of bedrooms (design): I — Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 14-16 FRESH HOLES ROAD Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 01/30/2015 page. City/Town State Zip Code Date of Inspection D. System Information Description: 1500 GALLON SEPTIC TANK, DISTRIBUTION BOX AND 3-500 GALLON DRYWELL 34, X 3' X 2' WITH 4 FEET OF STONE AROUND. UNABLE TO INSPECT UNDER NORMAL USEAGE. Number of current residents: VACANT 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)): TOWN Detail: rE pL c RIS u N iT 14 — 2,013 -e- 2014 -6- U N tT 1 to — 2n 13 _& 20 VA--9— Sump pump? ❑ Yes ® No UNKNOWN Last date of occupancy: Date Commercial/Industrial Flow Conditions: NA Type of Establishment: Design flow(based on 310 CMR 15.203): NA Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): NA 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: NA l5ins-3/13 Title 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 �M 14-16 FRESH HOLES ROAD Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 01/30/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) NA Last date of occupancy/use: Date Other(describe below): NA General Information Pumping Records: NA Source of information: Was system pumped as part of the inspection? ® Yes 0 No NA If yes, volume pumped: gallons How was quantity pumped determined? NA NA 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 14-16 FRESH HOLES ROAD Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 01/30/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: SEPTEMBER 2004 I Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: (6)tSIX INCHES fee Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: GREATER THAN 10+'feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: re)tTWO INCHES Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) I NA If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Sludge depth: (5) FIVE INCHES l5ins•3/13 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 14-16 FRESH HOLES ROAD Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 01/30/2015 page. 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 (29) TWENTY NINE INCHES ZERO Scum thickness 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 MEASURED How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, . liquid levels as related to outlet invert, evidence of leakage, etc.): SEPTIC TANK APPEARS TO BE STRUCTUARLLY SOUND AND FUNCTIONING PROPERLY AT TIME OF INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS. UNABLE TO INSPECT UNDER NORMAL USEAGE. Grease Trap (locate on site plan): NA Depth below grade: feet I Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): NA NA Dimensions: NA Scum thickness Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA NA Date of last pumping: Date t5ins•3/13 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 14-16 FRESH HOLES ROAD Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 01/30/2015 page. City/Town 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.): NA Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): NA Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): NA NA Dimensions: NA Capacity: gallons NA Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: NA Alarm in working order: ❑ Yes ❑ No Date of last NA pumping: Date Comments (condition of alarm and float switches, etc.): NA Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No (Sins•3113 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 14-16 FRESH HOLES ROAD Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 01/30/2015 page. Cityfrown 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 BOTTOM OF PIPE 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.):- D-BOX APPEARS TO BE STRUCTUARLLY SOUND AT TIME OF INSPECTION. UNABLE TO INSPECT UNDER NORMAL USEAGE. 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.): NA * 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: NA t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14-16 FRESH HOLES ROAD Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 01/30/2015 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 3-500 ❑ 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.): (3)THREE-500 GALLON DRYWELLS WITH (4) FOUR FEET OF STONE APPEARS TO BE FUNCTIONING PROPERLY AT TIME OF INSPECTION. UNABLE TO INSPECT UNDER NORMAL USEAGE. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA Number and configuration Depth—top of liquid to inlet invert NA Depth of solids layer NA Depth of scum layer NA Dimensions of cesspool NA Materials of construction NA Indication of groundwater inflow ❑ Yes ❑ No l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 14-16 FRESH HOLES ROAD Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 01/30/2015 page. Cityrrown 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.): NA Privy'(locate on site plan): Materials of construction: NA NA Dimensions NA Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): NA 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14-16 FRESH HOLES ROAD Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 01/30/2015 page. CityTrown 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 F91LAI ° A g �A, t31 2- 0 0 � /t A-./ 42- 3TO AJ B'6 E 3( (P .� 15 C-4 Vp 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Ix Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14-16 FRESH HOLES ROAD Property Address BANK OWNED Owner Owner's Name information is HYANNIS MA 02601 01/30/2015 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells depth to high round water: NO GW FOUND AT 9'4" Estimated de P 9 9 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: ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: HAND AUGER Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 14-16 FRESH HOLES ROAD Property Address BANK OWNED Owner Owner's Name information is required for every HYANNIS MA 02601 01/30/2015 page. CitylTown 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 1,5 or attached in separate file l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 YOU WISH TO OPEN A BUSINESS? For Your(Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which R' you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: 6 �6 Fil in please: APPLICANT'S YOUR NAME/S: �•LL•.'i '!fi!i�" '�� m�a3 BUSINESS YOUR HOME ADDRESS: `1. - v. TELEPHONE #, Home T Iephone Number - -3 b M NAME.OF CORPORATION: C,L e4a, yv� ' NAME OF NEW BUSINESS�a-��/ TYPE OF BUSINESS ✓� �n IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS s MAP/PARCEL NUMBER (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you-may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO ISSIO ER'S OFF CE This individ al s e r e o %nper it requirements that pertain to this type of businesUST COMPLY WITH HOME OCCUPATION Au S�gna' e** RULES AND REGULATIONS. FAILURE TO e COMPLY MAY RESULT IN FINES. COMMENT - 2. BOARD HEALTH MUST COMPLY WITH ALL This individual has informed o e per i requirements that pertain to this type of business. HAZARDOUS MATERIALS REGULATIONS uthorized Signature* COMMENTS: '3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Date: l �S- f TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF'BUSINESS: 61, a- j C I eG n r•a, b�. L3 BUSINESS LOCATION: S -� S c� INVENTORY _I � ��� Vl� �� � � ll �.lcUnn� Q IIVVEN�Y MAILING ADDRESS: _)S FreSA ho1e_� kd. N NAidl, .3 1,f) 2 K o TOTAL AMOUNT- TELEPHONE NUMBER: b 4-0 (S ( CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: A nrl MSDS ON SITE? TYPE OF BUSINESS: (� �.n , n �s ��oci S INFORMATION / RECOMMENDATIONS: Fire District: j // n /OG n �o IS-6 I In Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils' , Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel.Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish-removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes { Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug.and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ApplicantIs Signature / i2Staff's Initials � 3 Date filed: Current Status: Foreclosing Party's representative(s) for property (entry, management, repair, etc.)(name, title,): Company if different from foreclosing a Address: Phone: email: other: If an exemption is claimed,please do not complete the remainder. Other representative(s) (if foregoing representative is primarily responsible for property and/or foreclosure and is most likely to be able to address town matters concerning the property and/or foreclosure, please so state and do not complete contact information (i. e. "none" or"see above")). Name, title, other: Darren D Wisniewski-Waltham Resident Company (if different from foreclosing party): Altisource Solutions, Inc. Address: 1000 Abernathy Road Northpark Town Center Building 400, Suite 200,Atlanta, GA 30328 darren.wisniewski@altisource.com Note:Please mail correspondence to Phone(s): (617)728-6130 email(s): other: Atlanta office,Darren is local to address pupertywildidullband mergency Name, title, other: Alma Emery-Assistant Manager matters. Company (if different from foreclosing party): Altisource Solutions, Inc. Address: 1000 Abernathy Road, Northpark Town Center, Building 400, Suite 200,Atlanta, GA 30328 Phone: 866-952-6514 email: VPR@altisource.com other: Attorney representing foreclosing party Firm name (if different from attorney's name): Korde and Associates P C Address:. Lowell,MA Phone(s): (978)256-1500 email(s): other: I acknowledge that the information provided is accurate and correct. I also understand that any inaccurate information will result in non-compliance with section 224-3 of chapter 224 of the de of the Town of arristable. 4S aw 0= "" wo Date: Name: Title: r REGISTRATION AND CERTIFICATION FORM FOR FORECLOSING/FORECLOSED PROPERTY Thank you for registering in accordance with Town of Barnstable Code chapter 224 sections 224-3 and 224-4. Please complete one form for each property in foreclosure (section 224-3) or already foreclosed for which possession has been taken (section 224- 4). Please file the original with the Building Commissioner and a copy with the Chief of the Fire District in which the property is located. If you claim you are exempt from registering under Massachusetts law,please state the o reason(s) and complete section 1 (property information) and the first paragrap of Z section 2 (foreclosing party, court, etc. and foreclosing party representative, b�1 of others o representatives and attorney) so that the Town can review the exemption and to its records: `° a CP Section 1 —PropeM Information C::o 14-16 Fresh Holes Rd,HYANNIS,MA 02601 Property Address: Assessors Map#: 292 Parcel #: 184 Land area and description Building(s) description and contents Occupied: No Occupant(s)(if borrowers so state and include name(s)) Tracey Oringer c/o Ocwen Loan Servicing LLC I Phone: email: other: Vacant: yes Date: 12/26/2013 Anticipated Length of Vacancy: Last occupant(s) )(if borrowers so state and include name(s)) Phone: (800)746-2936 email:PropertyRegistration@ocwen.comother: If so,please explain"and complete and file the Has possession been taken maintenance and security plan form (unless exempt as stated above) Section 2 Foreclosing Party Information - Foreclosing Party (full name/title) Foreclosure Case Court: Docket# f" REGISTRATION AND CERTIFICATION FORM FOR FORECLOSINGNORECLOSED PROPERTY Thank you for registering in accordance with Town of Barnstable Code chapter 224 sections 224-3 and 224-4. Please complete one form for each property in foreclosure (section 224-3) or already foreclosed for which possession has been taken (section 224- 4). Please file the original with the Building Commissioner and a copy with the Chief of the Fire District in which the property is located. If you claim you are exempt from registering under Massachusetts law,please state the o reason(s) and complete section 1 (property information) and the first paragra of 0 section 2 (foreclosing party, court, etc. and foreclosing party representative,bA of others O representatives and attorney) so that the Town can review the exemption and. to its 2 records: �? C Section 1 —Property Information r- Property Address: 14-16 Fresh Holes Rd,HYANNIS,MA 02601 Assessors Map #: 292 Parcel#: 184 Land area and description Building(s) description and contents Occupied: No Occupant(s)(if borrowers so state and include name(s)) Tracey Oringer c/o Ocwen Loan Servicing LLC Phone: email: other: Vacant: yes Date: 12/26/2013 Anticipated Length of Vacancy: Last occupant(s))(if borrowers so state and include name(s)) Phone: (800)746-2936 email: PropertyRegistration@ocwen.comother: Has possession been taken If so,please explain and complete and file the maintenance and security plan form (unless exempt as stated above) Section 2 Foreclosing Party Information Foreclosing Party (full name/title) Foreclosure Case Court: Docket# I hereby certify that the above-named foreclosing party is in compliance with the provisions of section 224-3 of chapter 224 of the Code of the Town of Barnstable. Date: Building Commissioner, Town of Barnstable • Y n Certified Mail#7006 0810 0000 3524 5164 oFTMF=aq, Town of Barnstable Regulatory Services mmsriim ' ' Thomas F. Geiler, Director °39. 1. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 2, 2011 V Bank of America , Tenant Access . 101 W. Lewis Henna Blvd. Suite 200 Austin, TX 78728 ( , NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at 14 Fresh Holes Road, Hyannis was inspected on November 2, 2011 Timothy O'Connell, R.S.,Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received by our department. The following violation(s) of the State Sanitary Code were observed: 105 CMR 410.750(F)—Conditions Deemed to Endanger or Impair Health or Safety: The toilet, kitchen sink and the bathtub within this dwelling unit are not able to be flushed or drain due to obstructed waste line or failed septic system. 105 CMR 410.550— Extermination of Insects, Rodents and Skunks Observed large amount of live and dead cockroaches throughout dwelling unit. You are directed to correct the violations listed above within twenty-four (24) hours of your receipt of this notice by ensuring toilet works as intended to. By ensuring all other waste pipes are draining into functioning septic system; by exterminating cockroaches with a MA Licensed Exterminator. QAOrder letterMousing violations\Rental ordinance\14 freshholes rd 11-2-1 Ldoc You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after.the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any .questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. P OF TH OARD OF HEALTH c ea R.S., C O Director of Public Health Town of Barnstable Q AOrder letters\Housing violationsaental ordinance\I4 freshholes rd 11-2-11.doc .r THE COMMONWEALTH OF MASSACHUSETTS FORM 30 C&w HOBBS WARREN'" BOAR OF H ciT Row �� W G RTMENT iN I G,M Sa4"`ems ADDRESS TELEPHONE Address _ Occupant_ Floor Apartment No. No.of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units_ No.S Name and address of ow er Al" _ tot W' .&K^--- 7X., 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 An Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: j Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: r ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Venf(sj 6 / ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den —Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: — Co G K TINT !) 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 O� INSPECTOR TITLE (' f DATE �` �( TIME A.M. FtNEXT SCHEDULED REINSPECTION P.M. i C 410.750: Conditions Deemed to Endanger or mpair Health or Safety The following conditions,when found to exis-in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of'a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this-category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such 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 OMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to-provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1),and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of Ieadbased paint on a dwe ling 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 electiical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns,shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the releF-se 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 remEin uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or corditions: (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 upori the failure of the owner to remedy said condition within the time so orde-ed by the Board of Health. 7- Iwo TM THE COMMONWEALTH OF MASSACHUSETTS FORM 30 C&w HOBBS 8 WARREN BOARS aF H , 4sv . C f Y/cf :.!/l� X � t DEPARTMENT -. ADDRESS 4„M yv>y`ee TELEPHONE Address t "I _ Occupant_: ''"" Floor ��`/� paW_nent,No. No.of Occupants No:•of>Hdabitable Rooms No.Sleeping Rooms— No.dwelling or rooming units_ No.S,ories j�yY►^.v►z Name and address of owner tot W- ! -Q/YVv 111ju� 7X- Remarks Reg. Vio. YARD '" Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: n Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof n k r Gutters, Drains: Walls: Foundation: t ' � Chimney: BASEMENT Gen.Sanitation: VV � kiDampness: Stairs: - Li htin STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: p 7 ❑ MS ❑ ST ❑ P Waste Line: 7�6CF� H.W.Tanks Safetyand Vents .�- ' - �' t! / ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom —Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink - r ----Stove---, Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: _- Wash-Basin,Shower or'Tub: n Infestation Rats, Mice, Roaches or Other: — Co C 1110 j�V 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 INSPECTOR - ! TITLE r 7 . 1 ABM. DATE t TIME A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. I (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. i (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns,shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner ` to remedy said condition within the time so ordered by the Board of Health. I e Commonwealth of Massachusetts vTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14& 16 Fresh Holes Rd. Property Address American Home Motgage Owner Owner's Name information is required for every Barnstable (Hyannis) Ma. 02601 10/22/10 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brian S. Lane use the return Name of Inspector key. Lane Septic Inspection Service Q Company Name 1 State St. Company Address Walpole Ma. 02081 City/Town State Zip Code 508-212-2916508-212-2916 laneseptic@verizon.net 2280 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of LU Title 5(310 CMR 15.000).The system: cc I< 19 Passes ❑ Conditionally Passes ❑ Fails C� y Needs Further Evaluation by the Local Approving Authority ca ry o - . 10/24/10 CD Inspe s Signature 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. ****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-09108 Title 5 Official Inspection Form:Subsurface Sewage posal System-Page 1 of 17 :J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "( 14& 16 Fresh Holes Rd. Property Address American Home Motgage Owner Owner's Name information is required for every Barnstable (Hyannis) - Ma. 02601 10/22/10 page. 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: 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): t5ins-09= Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 14 & 16 Fresh Holes Rd. Property Address American Home Motgage Owner Owner's Name information is Barnstable (Hyannis) Ma. 02601 10/22/10 requi arns yann red for every ) page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 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): T ❑ 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 ❑ NDJExplain 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-09/08 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 14 & 16 Fresh Holes Rd. Property Address American Home Motgage Owner Owner's Name information is required for every Barnstable (Hyannis) Ma. 02601 10/22/10 page. Cityfrown 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 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 %day flow t5ins•09/08 Title 5 Official Inspection forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of.Massachusetts upTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14 & 16 Fresh Holes Rd. Property Address American Home Motgage Owner Owner's Name information is gamstable (Hyannis) Ma. 02601 _ 10/22/10 required for every _ page. Cityrrown State Zip Code Date of Inspedion 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14& 16 Fresh Holes Rd. Property Address American Home Motgage Owner Owner's Name information is required for every Barnstable (Hyannis) Ma. 02601 10/22/10 page. 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? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)(310 CM 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins•09/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 ,A Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y� 14& 16 Fresh Holes Rd. Property Address American Home Motgage Owner Owner's Name information is required for every Barnstable (Hyannis) Ma. 02601 10/22/10 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: 77.9 gpd avg for#16, 151.6 gpd avg for#14 Sump pump? ❑ Yes ® No Last date of occupancy: 10/22/10 for#14Date 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-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14& 16 Fresh Holes Rd. Property Address American Home Motgage Owner Owner's Name information is every Barnstable H required for eve (Hyannis) Ma. 02601 10/22/10 page. 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: system has not been pumped installed in 2004 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-09= Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official- Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14& 16 Fresh Holes Rd. Property Address American Home Motgage Owner Owner's Name information is required for every Barnstable (Hyannis) Ma. 02601 10/22/10 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 6 years old, design plan dated Sept.9, 2004 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: town water see sketch feet Comments(on condition of joints, venting, evidence of leakage, etc.): pipes go out under concrete slab castiron under floor pvc into septic tank Septic Tank(locate on site plan): ,1r Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.3'x5.5'x5' 1500gal Sludge depth: 211 t5ins-09108 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 '( 14& 16 Fresh Holes Rd. Property Address American Home Motgage Owner Owner's Name information is required for every BarnstableH_ (Hyannis) Ma. 02601 10/22/10 page. Cityrrown 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 32" Scum thickness 3" 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 13" How were dimensions determined? tapemeasure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tank is concrete in good condition, no evidence of leakage, pvc inlet and outlet"T"s, liquid level is at outlet invert, recommended pumping tank to the property manager, also recommend pumping every three years as per state guidelines 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•09108 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 14& 16 Fresh Holes Rd. Property Address American Home Motgage Owner Owner's Name information is required for every Barnstable (Hyannis) Ma. 02601 10/22/10 page. Citylrown 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 t5ins•09108 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 y` 14 & 16 Fresh Holes Rd. Property Address American Home Motgage Owner Owner's Name information is required for every Barnstable (Hyannis) Ma. 02601 10/22/10 page. 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 liquid level is at outlet inverts 0" i 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.): D-Box is concrete in good condition, liquid is at outlet inverts flow is equal and box is level, flow levelors are present in the box, no evidence of leakage into or out of box found, some carryover found but not excessive i 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09108 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 14 & 16 Fresh Holes Rd. Property Address American Home Motgage Owner Owner's Name information is required for every Barnstable (Hyannis) Ma. 02601 10/22/10 page. Cityrrpwn State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 3@8.5'x5'x2'dee p 500 gal each ❑ 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.): soil is dry sand and gravel, no evidence of hydraulic failure, vegatation is lawn in normal condition, chambers have two inches of liquid at the bottom of them 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•09/08 Title 5 Official Inspection Fomr.Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts uTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14& 16 Fresh Holes Rd. Property Address American Home Motgage Owner Owner's Name information is required for every Barnstable (Hyannis) Ma. 02601 10/22/10 page. City/Town 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.): 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.): I t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14&16 Fresh Holes Rd. Property Address Owner Owners Name information is required for every Barnstable (Hyannis) Ma. 02601 10/22/10 page. Cityrrown State Zip Code Date of Inspedion 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 "c 07 Hof Al V l c,.�a evaf3 �;7�r,/6l t�✓ 3(.S 34t S 17 5 ,1-19WK 38.5 32.o Al-T- t5me.ggW Title 5 oflldal to peWw Fo Sum Swap 04asal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °t 14& 16 Fresh Holes Rd. Property Address American Home Motgage Owner Owner's Name information is i bl t Barnsae (Hyannis) Ma. 02601 10/22/10 required for every ) page. Citylrown 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: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Sept. 9, 2004 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: testhole was performed for the septic design plan on Aug. 4, 2004 and no ground water was found at a depth of twelve feet, bottom of system is 4'down Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•09108 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14 & 16 Fresh Holes Rd. Property Address American Home Motgage Owner Owners Name information is required for every Barnstable (Hyannis) Ma. 02601 10/22/10 page. 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 ® too, 00 Dow A 09 &t rs �I - t tins'09108 Title 5 Official Inspection Form:Subsurface Sewage D Isposal System•Page 17 of 17 r Certified Mail#7008 3230 0002 5177.9626 P�oFt"E rOwti Town of Barnstable Regulatory Services x A1ittNS`TA8M . y MASS' a 00 16.q. ,�w Thomas F. Geiler, Director Alf°M Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 October 18, 2010 Bank of America Tenant Access 101 W. Lewis WJV Henna Blvd. Suite 200 Austin, TX 78728 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY: CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION:. The property owned by you located at 14 Fresh Holes Road, Hyannis was inspected on October 18, 2010 Timothy O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received by our department. The following violation(s) of the State Sanitary Code were observed: 105 CMR 410.750(F)—Conditions Deemed to Endanger or Impair Health or Safety: Toilet within dwelling unit not able to be flushed due to obstructed waste line. You are directed to correct the violations listed above within twenty-four(24) hours of your receipt of this notice by insuring toilet works as intended to. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate.violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. ORDER OF HE BOARD OF HEALTH Jean,R.S.,.CHO Director of Public Health Town of Barnstable QA0rder letterMousino violations\Rental ordinance\14 freshholes rd.doc FORM30 ��W HOBBS&WARREN'"' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H L CITY/TOW I b y v v c Q DEPARTMENTqv 1/� wM Syeyve ADDRESS r ltxe,, �1 ri/' TELEPHONE Address- � / Occupant_. Floor Apartment No. No.of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units_ No.S orie N e and addr s f yx"ow er 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: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE:. Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: 1 H.W.Tanks Safety and Vents r' Tr- ELECTRICAL' Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den —Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES INSPECTOR TITLE DATE 16 a TIME / ` �U A A. A.M. THE NEXT SCHEDULED REINSPECTION M( I P.M. H Y 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person tc whom the order is issued to comply with such order. r " (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 CUR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A),410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other_structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) •Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMiR 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. i Certified Mail#7005 1160 0000 0191 0157 oFjHEr Town of Barnstable Regulatory Services > AAIM BLE. iMAS& Thomas F. Geiler, Director rf°M Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508=862-4644 Fax: 508-790-6304 February 6, 2008 Tracey Oringer 1855 Long Pond Road Brewster, MA 02631 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY j CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION j AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 14 Fresh Holes Road Hyannis, was inspected j on February 5, 2008 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint. i The following violations of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Observed black mold within both bedrooms. Mold was observed within closet of South Eastern bedroom and on the Southern wall of said bedroom. There was also mold observed on the Northern wall of Northern bedroom. Also observed soffit on Southern and Northern part of home with large holes in them. This maybe leading to chronic dampness which could be inhibiting mold growth. j The following violations of the Town of Barnstable.Code were observed: 170-4- Certification of Registration. Home is not registered with Town of Barnstable Health Division. You are directed to correct the violations listed above within (14) fourteen days of your receipt of this letter by removing all mold in said home and to correct all sources of chronic dampness. (i.e. old roof, soffit) You are also order to register this property and all properties you offer for rent within (5) five days of the receipt of this letter. QAOrder letters\Housing viol ations\Rental ordinance\14 Fresh Holes Road.doc i You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE B OF HEALTH T as A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Timothy O'Connell, Health Inspector Cc: Brian Whittemore I QAOrder letters\Housing violations\Rental ordinance\14 Fresh Holes Road.doc HOBBS&WARREN'M THE COMMONWEALTH OF MASSACHUSETTS FORM 30Ca BOARD OF H TH CIT I d DEPARTMEJTJ / ADDRESS y�TELEPHONE • Address —\ Occupant Floor Apartment No. No.of Occupants— No. of Habitable Rooms No.Sleeping Rooms_ No.dwelling or rooming units—_^No.Stories Name and address of owner r ( Remarks Reg. Vio. YARD Out Bld s.: Fen s: 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: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS O 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 " O Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION R P LT S IGNED AND CERTIFIED UNDE %THE PAINS AND A PENALTIES 0 PER , Y s. INSPECTOR TITLE /> II DATE b 1 TIME v P• U .M A . THE NEXT SCHEDULED REINSPECTION- IP.M. - */u/nv: Conditions Deemed mEndanger The following conditions,when found to exist in residential premises, shall be d6emed condition's which may endanger or � impair the health,or safety and well-being of a person or persons occupying the premises.This listing is composed of those � items which are deemed 0a always have the potential to endanger or materially impair the health m safety, and well-being of-the � occupants or the public. Because Chapter 11, 105 CIVIR 410.100 through 410.620 state minimum requirements offitness for human habitation, any other violation has the potential to fall Within this�at6oryinanygivonopnc'ihooituakionbutmoync8douo � in every case and therefore is not included in this listing. Failure to include shall in noway be construed oxo determination that other violations or'oondiUonu may not Uofound to fall within this category. Nor shall failure to include affect the duty ofthe|ouu| health official Vo order repair orcorrection cd such viu|akion(o) pursuant to 105CMR 410.830thmugh 410.833 nor shall failure to include affect the legal obligation of the pAmonVo whom the order iu issued V»comply with such order. . (\) Failure to provide asupply of water sufficient in quantity: pressure and temporatum, both hot and oo|d. to meet the ordinary . needs of the occupant in accordance with 1O5CMR41O.18Oand 41O.1SO for operiod of24 hours orlonger. (B) Failure to provide heat as required by 105 CIVIR 410.201 cv improper venting or use ofuspace heater mwater heater as prohibited by1O5CMR41O.2OU(B)and 41O.2O2. � (C) Shutoff and/or failure to restore electricity orgas. — (D) Failure to provide the electrical facilities required by 105 CMR 410i250(8). 410.251(A). 410i253 and the lighting incom- mon area required by 105CMR410.254. (B Failure to provide u safe supply o(water. (F) Failure Vx provide a toilet and maintain a sewage disposal system in operable condition uo required by1O5CMR 41O.15O(A)(1)and 4103OO. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage ortrash,which prevents egress in case ofanemergency 105CMR 410.450. 410.451 and 410.452. (H) Failure to comply with the security requirements cd1O5CIVIR410.48O(D). ` � (|) Failure 0a comply with any provisions of 105 CMR 410.000. 410.001 ov4lO.G02which nmuho in any accumulation ofgm` bago, mbbiah, filth or other causes of sickness which may provide afood source or harborage for rodents, insects orother pests or otherwise contribute to accidents orVo the creation or spread ofdisease. (J) The presence of|oadbaoed paint ono dwelling or dwelling unit in violation cf the Massachusetts Department ofPublic Health Regulations horLoudPoiauningPrevonhonand �on�m|. 1O5C�R4OO�OD0� (Soo ��G�Lo� 111 6D(� 19O|hmugh1OOj � � (K) Roof,foundation, or other structural defects that may expose the occupant"6r anyone else to fire, burns, shock, accident or other dangers orimpoirmont.to health o,safety. � � (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards ov failure 0o maiintein such faoihiem oo are required by 105 CMR 410.351 and 410.352. � so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust orwhich may result in the release of powdorod, crumbled or pulverized asbestos material in violation of 105 CMR41O.353. ' (N) Failure to provide a smoke detector required by 105 CwR 410.482. (0) Any of the following conditions which remain uncorrected for a period of fiv.-or more days following the notice to or knowledge of the owner of said condition orconditions: (1) Lack cdakitchen sink cduu#ioiontoizeand oapaoityhurwuahing Uiohoo and kitchen utensils or lack��ao�voand oven . � or any do�o that mndeme�ho ihopomblo. � (2) Failure 0z provide a washbasin and shower 6r bathtub ao required in1O5CMR41O.15O(A)(2)and 41U.15OVV(3)urany defect which renders them.inofkrab|o. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereofin violation od generally accepted p|upnbing, hmating, gmsfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain aoado handrail or protective railing for every stairway, porch baloony, roof orsimilar place as required by 1O5CMR41O.503(A)and 41O.5O3(B). ` (5) Failure to eliminate rodents, nooknoaoheo, insect infestations and other pests aorequired by 105CIVIR410.550. (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- ditionwhichmoyondungorormatehaUyimpair1hohoaKhoroafetyondwel|'beingcdan000upantupon8hohai|umofOmmwnor . to remedy said condition within the time 000rdered by the Board of Health. . - � . � � ` , - ` ^ | ' i s 44 o c c� O . 1 rwari1 o � r� Id5 n. V� QO s � � 0 5u ' r TOWN OF BAP#STABLE LOCATION I �"� SEWAGE # 1 VILLAGE S SOR'S MAP & LOT 2j '—I INSTALLER'S NAME&PHONE NO. � SEPTIC TANK CAPACITY -LEACHING FACILITY: (ty ) (size) NO.OF BEDROOMS -BUELDER OR OWNER PERMTTDATE: L-0 COMPLIANCE DATE: Vi Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 l w '� No. G% I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Z(pprication for ]Digpotai *pg;tem Construction Permit Application for a Permit to Construct( . )Repair)Upgrade( )Abandon( )XComplete System El Individual Components Location Address or Lot No. .I LI P10 Re5b&3 -?,At Owner's Name,Address and Tel.No. �a,rc Assessor'sMap/Parcel "1 I�� a. '5OX �-3�l4Pi?Ld1CRPOer,t- A Installer's Name,Address,and Tel.No. 1ZOtpQq'�gC W C, Designer's Name,Address and Tel.No. g`8—O 1-,)k Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder(N Other Type of Building &)CW F_ No.of Persons(e Showers(1/ ) Cafeteria Other Fixtures t-O UG 4r-*� 1C.�r!?e�a. 5 Lq� . Design Flow o gallons per day. Calculated daily flow gallons. Plan Date 191 @ 4 Number of sheets Revision Date Title Size of Septic Tank GZ Type of S.A.S. lc;m CN Q\ C'cg -s Description of Soil � � Q 1 t a'X 15 X21 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees o ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provis ns of Title 5 of the Environmental Code and not to place the system in operation un '1 a Certifi- cate of Compliance has been i ed b Bo ealt b gned Date Application Approved Date Application Disapproved for.the following reasons � Permit No. j Date Issued "nn 1, �� �. .. '.�-�-r.� •f'^�'wwen^wr �ra+R�7rJ".e�1�".'11`i*". .,sw�-.r.-.j.e.-r�:., .. >., .. La _ �Y ;, •T�•) .�ll � }::�:. �.j.�y,. ` o, ALL, ' FeeN . / O � -�- V THE COMMONWEALTH OF MA�SACHUSETTS Entered in computei: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS -� ZippYication for �Ng'ogal *pgtem Cowaruction Permit Application for a Permit to Construct( i)RepairX)Upgrade( )Abandon( omplete System ❑Individual Components Location Address or Lot No. r e5v cae5 101 trl Owner's Name,Add ess and Tel.No. t"lO4ZC-6 W tNER_ Assessor's Map/ParcelqI8 �a` �OX -3q, Apt11CN FOOT, MA C5d Installer's Name,Address,and Tel.No 54C. Designer's N e,A dresstca�r and Tel.No.'� S�ICs.S'-le-0�0(, s "C�2n�oc�S't-, � Mo►�-� 511--���-'Y �nV (oL4Q oa53 Type 4 Building: it Dwelling No.of Bedrooms 4Lot Size�1'��01 sq.ft. Garbage G 'nder(1J Other Type of Building N oNl� No. of Persons Showers(�) Cafeteria Other Fixtures QL)� + ' Design Flow "44 0 gallons per day. Calculated daily flow .441 ,C)4" gallons. Plan Date O'4 Number of sh ,ets Revision Date N A Title — - � C yS>RM �G Size of Septic Tank �b C k �k_ Type of S.A.S. _3' SZK�\ Cam S xZ' Description of Soil C Y Nature of Repairs or Alterations(Answer when applicable) 1� 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 un•il a Certifi- cate of Compliance has b s e b this Board of, alt gn" ed / Date D Application Approved by Date Ob U Application Disapproved for the following reasons I Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFfY. that the On- ite Sewage Disposal System Constructed ( ) Repaired ( )Upgraded l.X-&Abandoned( )by d atth � �--� /1 at k e51� ae S has been constructed in cccrdance with the pro siongo� dAthef osal System Construction Permit No. a �l-L� dated /U U Installer 0 Designer The issuance of th' duel itstall not be construed as a guarantee that the s will fu c�ion as des tied. Date I Wo Inspector No.—d"�—L��y 7 r-------------------------Fee /C>(J ^� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS �Bigogal *p$tem Congtruction Permit/ Permission is hereby g ed,to,;o�nstruett( �)/fRe air( )Up�'ade, )Aband /I( System located at w 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 he completed within three years of the dat�f this p it Date: )/ U Approved v� TOWN OF B STABLE ` LOCATION j � r`� SEWAGE # —� ��� VULLAGE OR'S/yMMAPP & LOT 29-2 9 J INSTALLER'S NAME&PHONE N0. SEPTIC TANK CAPACITY LEACHING FACU,=: (ty ) lAA1 te &e (size) NO.OF BEDROOMS-- V BUILDER OR OWNER PERMTTDATE: v COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 Wetlarid and Leaching Facility(If any wetlands exist within 300 feet of Jeaching facility) Feet Furnished by �@ brow ,41' 3�. 1 S` �3, 33 , 12/14/2014 02:37 FAX IM 002/002 Town of Barnstable • '�`'�` Regulatory Services Thomas F. Geiler, Director HARK rain. >� SR 6 9. Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 09/16/04 Designer: JShay Environmental Services, Inc. Installer: Robert Septic Services. Address: P.O. Box 627 East Falmouth Address: 5 Trenton Street MA 02536 Yarmouth. MA On 9/10/04 Robert Septic Service was issued a permit to install a (date) (installer) septic system at #14& 16 Fresh Holes Road . Hyannis MA based on a design drawn by (address) Shay Environmental Services, Inc. dated 9/09/04 (designer) XX I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. H OF M,iS C taller s Signa �o� CARMEN yG, o E. 1 SHAY N No. 1181 '-(Designer's Signature) (Affix , P11!ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARN TABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/SepticlDcsigncr Certification Form SEP-16-2004 THU 01:57PM ID: PAGE:2 LOT."-NO. OWNERS NAME: SEWAGE PERMIT NO. : 602 (.!5-NEW: REPAI " ,� DATE ISSUED: DATE INSTALLED:` Y� i INSTALLERS NAME : INSTALLATION OF: WATER TABLE : FINAL INSPECTION BY: DRAWING OF INSTALLATION ON REVERSE /IDI( °, `J '�. �,, �'C r� � �' r TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �s LEACHING FACILITY: (type) (size) r ENO. OF BEDROOMS ..o BUILDER OR OWNER 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 IL FEE THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH • ��. L� Appliratiun- for Diupuuttl Works Tonutrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ()<) an Individual Sewage Disposal System at: (R&(.fit_.. k� 1��oCt o,.. t5---------- -----••------------•--•---•--•-------.----------- --.......-•-•--•-•--------.......-•-•------•-- L cat on-A dre s .••• or LotNo. bt ......... -U.__ .... -------- AA ....Y ei.'f. ... . '............ .......�.5...4 . ress Installer Addless Type of Building Size Lot.............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers a YP g --------•------•------------ P ( ) — Cafeteria ( ) Q' Other fixtures ---------------------------------- W Design Flow....:............. ...................�a�� ............._gallons per person per day. Total daily flow .................gallons. WSeptic Tank—Liquid'capacity.._..._.....gallons Length................ Width...,............. Diameter---------------- Depth............._.. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.............__.___. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '~ Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+ --------------- ----• -------•-•-• ---•----•--- O Description of Soil----- .. .5---•--- a'!/ c' .Q.u' DNEY- �`71fi.�/.....� fi.�l? If.......... xC.a (tlD.-•----------------------------•-•-----••--•-•-•----••----•---.--------•---......------------ W ----•-•-••••••••---------------•----•-----------•--.._..------•-•••••--••-•-••••--•-------•-•-•-••••--•-•-•••••-•------•--------•••---------•••-•••-------•--•-••-•-••-••-••--•-•... U Nature of pairs or Alterations Answer when applicable.... __ �...A►. . VU4 Agreement: The undersigned agrees to install the afor escribed Individual wage Disposal System in accordance with the provisions of TIME 5 of the State Sanitar Code—The undersi e further agrees not to place the system in operation until a Certificate of Compliance has ee issued b the bo h q gne ................ .......••. •••- --- ----------- . ....- f/$Z ate Application Approved By--••-•• .t...... ... . . . .. ............. ........Z/,��j......L.. Date Application Disapproved for the f o w' g reasons:--•--------------•-------.....------•--•-•--•---------......-•-------------- ••---•-•----.............••.. ....................•------...---....-------•------------.....--••-----•--•-•------------.......-----------•........--••---------•-•------•-----••--•-•-••---•----------•••--•---••-----•-............. Date PermitNo................................................... - Issued-........................................................ Date No.._ -.G S FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF.......................................................................................... ApplirFafiun for Dispoti al Warks Tomitratr#iun flrrmi# Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: ... ........-......... .. ._.._ .................• No.. .....................................Lot ....L�)o1A�. °4 1(� , .r, �r +t lam. - •----••...............•------•-------------•-------------..•---- •.................•-••----.........-•-•----...._......._......._..---•--•--•------................ Owner % �ress ,-� --•...............•--•-----•-------------.....----------..................••....... ..............................°................................................................. Installer Address Type of Building Size Lot............................Sq. feet 1-1 Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria dOther fixtures .---•------------------------------------------•-----.-------•--•----------------•-----•--•--- W Design Flow................ ��7 . ..........._..__gallons per person per day. Total daily flow..............._.7 70.................gallons. W Septic Tank—Liquid' capacity.._._._.._..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil.....��1� '� �t t �� E =�!!- !_t !�---... '��l�4' - �/ _._.t b r iil-a l�� E C�=•-_•-•. v ......................� I) = ••---•---•---••----------•------------------•---•----••----------....-•---•-------------------------------•----....----------------........--•--••---------------- w ----- ----- ----- --------------------- ----- --------- ------- ------ --- U Nature of epairs or Alterations Answer when applicable .... ................................................... I,rllr -T � - ,K,' .a r�u, 41 .d �� i �, e 4.� ?: i'� -1 rT Agreement: The undersigned agrees to install the afored'escribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary"Code— The undersiehe further agrees not to place the system in operation until a Certificate of Compliance has been issued by,,the board of health. ..... 1'...^J �. Jute Application Approved By........ .w...:-40--- Dal �...._.. a Application Disapproved for the following reasons:-•-•--....-•-----•-•-----•-------------•--•------...-•---••--•--•--•---•---•------------....---------------•---- .., .............:i�. ........................•......-_Date------------- PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tertif irate of TuntpliFanr THIS IS CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by............ ...r.....-- . ............................................. ------•-------•-•-••----•--...............................-----•-----........---•-•----•-. / Instal I ----------------------------............................ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described-in the application for Disposal Works Construction Permit No.._.e r��__ s _.S__...... dated................................................ THE ISSUAN E OF THIS CERTIFICATE SHALL NOT BE CONSTR E® S A GUARANTEE THAT THE SYSTEM WI FUNCTION SATISFACTORY. DATE....��.Z L --------------------------•--------------•----•-- Inspector.••.._ .... .............................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD .OF HEALTH 2 �Z oF..........................-•...........`...---........ ......................... No._., Lc- �................ FEE=........................ Disposal urku T�anutr ton rriit Permission is hereby granted �"t ...._y�.......�......... U-_,-............................` it -"•-•-•- at No. r� � )! .._.....1--� al System to Construct ( t) or Repair ( l Individual Sewage Disposal � , S . I QV ............... Street as shown on the application for Disposal Works Construction Permit No____________________ Dated.......................................... ........................................... ,Oofrd of Health DATE............................ ------------------- FORM 1255 A. M. SULKIN. INC.. BOSTON 7. Y p, r is Y ..ALL WRC1 IM fl,\1A IIS .,:;,.. � �'. r TIOR�(SHALL flE '_,: • CTIO�N A t'34 inches tall .: _, $.� m ..,... 1 ., VENT PIPE O leas 2' OONCtiE1E;COVFR SET u vEl roR LEI►Sr 2 rT ,., , .. ,4 SCHEDULE 40 P.V.C. ., . �+ - <. . . :., NOTE..ALL PIPES'ARE rT0 ,BE, . . t ,; , _ Schedule:4� P1AC w Ctwrcoal Odor Fil or 1b-min.:from . ; , . . __ ..•, I• LEACSIN SYSTE" a �, :PROFLE 'YIE OF �r_ tic--tank Be to s t . :: :,_• , ; , ;; _ . ., Existing Found otton septic -. J ,.. , . - ,. ,, ICHocic Ts tonic'oowre ou x fN1eIMd /r w 9n Must be S. El Evr 96 00 - . e ow SA . _. ! . xOUILET «._ `Orod�mw D=6wx lHl.Oo - y :,. f'.i aws arw: t .-1 swiss wwi�w., � . t r o•ea.ever renk tie.0o � +. h aar+.d v /t- /+'. +: ss` � raFr, F 4 :' .. , .. _. .. ...... lei S ••>). 3 Pt01 E H to S�O.i of SAS-pev.�94.75 fII5 f 0 t)IST. 805c" 3" Yaodmurn Cower; aP Wirer 4 -�SCH ,40 T LDS' r ` a OR OFtEA NEW TER 5- 0.010" per foot 1.5w GAL t o N SS-SECTION C3 C3 u�o' :; PLAN SECTIO ��� �c q SEPTIC TANK, o Efhatl„e Deptl, O Q _ - . e q rn H- O ro o o 1 N 3 tA,Its Q 9.5 a 255 , e.rw . .t O r 0 11 1 25.5 3.2 f-uu.nw►iw1>o� o. . a , , 1 I T B U Tl. N $ r a HOLE-H O D S RI 0 BOX ». 4 0 o i 4 $ cv o • p. I i._.+ of NOT TO SCALE e b.of 3/4'-t R/2' o 9 S 019N1wfEo Y M PROFILE o o u EfPective Length w"'► ��"`� ( --- �. 5�.�. tee stone 3 Not 3o scale Effe[tNe Width > > o SOIL ABSORPTION SYSTEM (SAS) .; GENERAL- NOTES - - T WI NS PR CASTContra ;,; 500 C H 10 LEACHING UNI S 1 GGI E 6 F.oi 3/4*-1 1/2 0 1. Contractor is responsible ,for Dlgsafe'notificaton compacted stone m and : rotection of all under round utilities and , s. Not to Scale,. , a P 9 PIPe NOTE: . ALL COMPONENTS MUST HAVE.RISERS TO WITHIN 6" BELOW GRADE Bottom of Teet Hole / Bev.-M-00 : 2-The"se tic'''tonk on distribution box shoN,be .set _ s _. :-.�, : ". slevel on ,6" of 3/4�,-1 , t 2 stone., . ♦Obs. Groundwater , Test Hole 1 Elev. NONE OBSERVED - _ 3.;'Bockfill should be clean sand or 'gravel with no stones over-3' in'rsize." "This,system 1s subject to inspection during installation r-- --- -------_� by Carmen :t. Shay,- Environmental 'Services, Inc. l I 5_The contractor shall`install this:system in 'accordance 1 I ... With°Title V of the Massachusetts state -code, :the approved plan PERCOLATION TEST ASPHALT I and-:Local .Regulations. LOT #8 I DRIVEWAY i 6•` K, during installation the contractor encounters any Date of Percolation Test: AUGUST 4, 2004 I i LOT #9 i soil conditions or'site conditions that";are different Test Performed By. CARMEN E. SHAY, R.S., C.S.E. i �__ from those`shown .on the soil log or in our design - `Results Witnessed By. WAIVER (per BARNSTABLE B.O.H.) I "-- •� installation must:halt & immediate notification be Excavated By. SHAY ENVIRONMENTAL SERVICES, 'INC. t i Percolation Rate: less Than C1 MPI I � I - made to Carmen E. Shay -• Environmental Services, Inc. q _-____ � ---------- 7.' No vehicle or heavy machinery shall drive over the ---- , 80.05 I "septfc`;system unless noted as H-20.septic :components. I ' ASPHALT I 8. install Tuf-rite gas baffles or equals .on all outlet tee ends. ` AL I O I 9.°All Distribution Lines shall .be 4 diameter Schedule',40 NSF PVC pipes. DRIVEWAY Test Hole a _ ASPHALT i 10. All solid piping, tees & fittings shall be 4"- diameter ----- ----------------------------- ------� DRIVEWAY i pipes" er tight joints. ` No. i � - - � eue•40 NSF PVC with'water -------- I 11. Municipal Water is Connected to •ALL;'OF`the Residence and Abutting DEPTH SOILS ELEV. I 1 Properties .Within 150-Feet. -- -_ 0 98.50 j i-- E4" PVC nt Sandy Loam V I >- f t f� �\ 11 i Vent Pie '` THE PROPERTY,',LINES ARE 'APPROXIMATE AND � I LOT #7 t � `I Failed I P , io tiR 3/z I I t COMPILED FROM THE;SURVEY PLAN GENERATED BY - Leach Pit 0"-12' Ae 97.00 O i i � � i BEARSE & KELLOG, `BARNSTABLE,,MA ENTITLED Sandy i Failed r`113 'SUBDIVISION PLAN OF LAND IN BARNSTABL.E, ,MA". LC 17786=C Loam I I P 0+ DATED MAY -21. 1954. R 'SHOULD',`BE USED FOR NO PURPOSE cesspool ..., _____- -f,, OTHER THAN THE SEPTIC SYSTEM INSTALLATION. . 10 rR s/e O I Failed I t l 12"- 42" 8e 93.50 I Cesspool y i �� ` • �d Modkim ~O i . #18 & 20 O O !• =.a " Sand 01 '-- -_-% i EXISTING LEACH PIT/CESSPOOLS TO .BE PUMPED OUT, AND 10 rR 7/4 �` I 98 -`� �` r1 s�__�i f • trl FILLED IN PLACE OR REMOVED TO FACILITATE INSTALLATION OF NEW SAS. 42"- 144 C, O EtN 1500 GALLON f 11 S TEST HOLE 1 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE SEPTIC TANK �' `7 ELEV 98,50 FROM THE"EXISTING L.EACHPIT/ CESSPOOLS TO BE DISPOSED OF AS PER BOARD OF HEALTH SPECIFICATIONS. ;a T _,- -_:. -_ .-_ __-- -_-_ - -- -NO-WT2t 1N05"ARE-PRESENT WITHIN 200 -OF-THE-PROPERTY- -- -- EXISTING 0, 4 BEDROOM ASSESSORS MAP 292, PARCEL`184 HOUSE to` LEGEND. CONCRETE SLAB \c FOUNDATION �\ 0 Perc 1 1 a•� .-DENOTES PROPOSED 1 ,--•--------, �5 104X 1 Depth to Perc: 42" to so" 1 SPOT GRADE Per Rate=.2 MPI i i i 3 LOT #6 PROJECT BENCH MARK Groundwater Not'Observed Q 9,422 Sq=re Feet +/- I TOP OF FOUNDATION DENOTES EXISTING No Observed ESHWT I I CO ELEV. = 100.00 (Assumed) X 104.46 SPOT GRADE ADJUSTED H2O Elev. = None ---- 3p 9 PL PROPERTY LINE r9 P PROPOSED CONTOUR - - - ---97 EXISTING CONTOUR LOT #5 3-24• MAL ACCESS MA►,HaLEs \t ® DEEP TEST HOLE & 10 - �'• II PERCOLATION TEST LOCATION 6 FOOT STOCKADE FENCE 10 � e # #1z WKEr , �+LEr • i J l «, , - THE ACCESS COVERS FOR THE SEPTIC TANK, i ' PLOT T PLAN .- i` DISTRIBUTION BOX AND LEACHING COMPONENT • ' '" SHALL BE RAISED TO WITHIN 6' of , STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE.-, OF PROPOSED SEPTIC SYSTEM UPGRADE PLAN VIEW INSTALL,TuF-nT> GAS BAFFLES OR eouALs -----4�_I-\ I PREPARED FOR ON ALL OUTLET TEE ENDS 3-24'REIWVASIX 00NERS HOWARD WINER AT 27, min.cNaranoa _ ,r # 14 Bc 1 6 FRESH HOLES ROAD rto a•mh� 2'mfw:rdet to outNl :r' OUner = S• --r H Y ANNIS MA 4'-e min. S e.e.w. U*M deptt, 7 Design Calculations of S REPARED BY: A s� Number of Bedrooms:;'4 Bedroom EXISTING,,,. . k.. r Garbage Grinder: No` CA A_e. CRM�' '. S„HA Y Leaching Capacity Required: 440 Gal./Day (MIN."PER TITLE V) o ND--SECTION Septic=Tank : - 2 440 Gal./Day880 +.'USE EXIST. 1,000 GAL. Septic Tank_ q SERVICES, INC. - ;,CROSS SECTION Ex , p p 20 40 5 ENVIRONMENTAL S , of < "min. inch - 0 0. SOIL,ABSORPTION AREA. , Using percolation rate 2 / ` Bottom Area: 0.74 gal/ :ft. x 416 q.'.ft. s 307.84 gallons ,Q O P.O. BOX 627 ,: 1 TES „ . PICA 1500 , GALLON SEPTIC TANK' Sidewoll Area: 0.74 al. s : ft. x,,,:160 . ft. _ 133.2 . aeons s TYPICAL g �' q q g EAST FALMOUTH,-MA 02536 s ,-,Providing: 441.04 gallons A \P r` - - NOT To SCALE „ TEL FAX :: 508 548 0796 0 TH Use:. 3 ECAST 5150-C UNITS HAVING A 2 „EFFECTIVE EP SCALE' 1 - O 0 ;LOADING SCALE.., 1 -20 DRAWN BY: CES DATE. SEPT. 9, 2004 TO BE USED WITH_4 OF WASHED-STONE ON THE SIDES AND .- F WASHED'' STONE ON-THE .ENDS. 3.25 _O PROJECT SD629 FILENAME.. SD629PP.pWG -SHEET u1 r ,