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0028 GENERAL PATTON DRIVE - Health
28 General Patton Drive Hyannis A = 292 113 a°^ ° ° ° ^ ° ° A ° ° ° n L ' Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -Not fo,r Voluntary.Assessments M 28 GENERAL PATTON f Property Address RICE Owner Owner's Name information is required for HYANNIS MA 02601 8/13/13 every page. Cityrrown 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 A. General Information forms the D computer, r,use 1. Inspector: V v only the tab key � v to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. DOUGLAS A BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 Cityrrown State Zip Code 508-420-4534 S14297 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 Title 5-(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority A...y 8/13/13 ` Inspecjafs Signature Date ?" X__ The system inspector shall submit a copy of this inspection report to the App.` I g Authorit oard of Health or DEP)within 30 days of completing this inspection. If the system"is a sharee#system- or has a design flow of 10,000 gpd or greater, the inspector and the system ov ner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the., ste-, wner 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•3/13 Title 5 Official Inspectione: surfaceSewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments 28 GENERAL PATTON Property Address RICE Owner Owner's Name information is required for HYANNIS MA 02601 8/13/13 every 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: SYSTEM WAS FOUND TO BE IN WORKING ORDER AT TIME OF INSPECTION WITH NO SIGNS OF FAILURE 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 GENERAL PATTON Property Address RICE Owner Owner's Name information is required for HYANNIS MA 02601 8/13/13 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain*below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 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 28 GENERAL PATTON Property Address RICE Owner Owner's Name information is required for HYANNIS MA 02601 8/13/13 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 I , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 28 GENERAL PATTON Property.Address RICE Owner Owner's Name information is required for HYANNIS MA 02601 8/13/13 every 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 i M 28 GENERAL PATTON Property Address RICE Owner Owner's Name information is required for HYANNIS MA 02601 8/13/13 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,.•�''t 28 GENERAL PATTON Property Address RICE Owner Owner's Name information is required for HYANNIS MA 02601 8/13/13 every page. City/Town State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT SYSTEM CONSISTS OF A 1500 GALLON TANK D-BOX AND 2 500 GALLON CHAMBERS Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ff No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: NOT AVAILABLE AT TIME OF CALL ACCORDING TO HYANNIS WATER DUE TO COMPUTER PROBLEMS Sump pump? ❑ Yes No Last date of occupancy: Date Commerciallindustrial 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•3/13 Title 5 Official Inspection Foim: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 , 28 GENERAL PATTON Property Address RICE Owner Owner's Name information is required for HYANNIS MA 02601 8/13/13 every page. Cityrrown State Zip Code Date of Inspection M System Information (cont.) Last date of occupancy/use: CURRENTLY Date Other(describe below): General Information Pumping Records: Source of information: DEBARROS SEPTIC Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? TANK TRUCK Reason for pumping: MAINTENANCE 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 GMt 28 GENERAL PATTON Property Address RICE Owner Owner's Name information is required for HYANNIS MA 02601 8/13/13 every 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: ACCORDING TO AS-BUILT 2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron LN 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 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 1500 GALLON Dimensions: Sludge depth: t5ins•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 28 GENERAL PATTON Property Address RICE Owner Owner's Name information is required for HYANNIS MA 02601 8/13/13 every page. Citylrown 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 Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? AS-BUILT CARD 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 WAS PUMPED AT TIME OF INSPECTION FOR MAINTENANCE 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•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 M , 28 GENERAL PATTON . Property Address RICE Owner Owner's Name information is required for HYANNIS MA 02601 8/13/13 every page. Cityfrown 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 15ins-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 28 GENERAL PATTON Property Address RICE Owner Owners Name information is required for HYANNIS MA 02601 8/13/13 every 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 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): BOX LEVEL NO SIGNS OF LEAKAGE OR SOLID CARRY OVER BOX WAS VIEWED BY CAMERA BECAUSE THERE WAS A SMALL ABOVE GROUND POOL OVER IT AT TIME OF INSPECTION THE POOL GETS REMOVED IN THE FALL EVERY YEAR Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-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 28 GENERAL PATTON Property Address RICE Owner Owner's Name information is required for HYANNIS MA 02601 8/13/13 every,page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): AT TIME OF INSPECTION THERE WAS 6" OF LIQUID WITH NO SIGNS OF FAILURE Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts _ v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 GENERAL PATTON Property Address RICE Owner Owner's Name information is required for HYANNIS MA 02601 8/13/13 every 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.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3113 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 28 GENERAL PATTON Property Address RICE Owner .._.__. ------- Owners Name information is required for HYANNIS MA 02601 8/13/13 every page. Cityrrown 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 GENERAL PATTON Property Address RICE Owner Owner's Name information is required for HYANNIS MA 02601 8/13/13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ®,Shallow wells Estimated depth to high ground water: GREATER THAN 5 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: 8-12-13 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: DESIGN PLAN ATTACHED Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•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 GM , 28 GENERAL PATTON Property Address RICE Owner Owner's Name information is required for HYANNIS MA 02601 8/13/13 every 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Assessing As-Built Cards Page 1 of 2 TOWN OF ARNSTABLE LOCATION t'a 6P.r1e•N.11 PA SEWAGE .. ��7 vELLAGE ��y��IS ASSESSOR'S MAP dt LOT 9c a' 1� INSTALLER'S NAME do PRONE NO. SEPTIC TANK CAPACITY rag LEACHING FACILITY:(type) a— Sb SA� IT • NO.OF BEDROOMS 3 BUILDER OR OWNER M 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 leac ' g facility))t—� l Feet Furnished by !2Af A l3A&k ED . � a O � 4 / a , 33 3 � 3a ag 01 3 314 3� y o 6 yo httn://www.town.bamstable.ma.us/Assessing/RMdisDIay.asD?maDDar=292113&sea=1 8/10/2013 1 Commonwealth of Massachusetts --- Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification Important: When filling out 1. Property Information: forms on the L1 1 3 computer,use 28 General Patton Drive 11 only the tab key Property Address to move your Today Real Estate q 11 cursor-do not use the return Owner's Name key. 1533 Falmouth Road Owner's Address Centerville MA 02632 City/rown State Zip Code l Date of Inspection: 02/09/08 Date 2. Inspector: MR. ROBERT A. DRAKE Name of Inspector KCJ ENGINEERING ; Company Name a 66 GREENVILLE DRIVE ~ Company Address z FORESTDALE MA 1102644 Cityfrown State -,� ip Code { 508-477-5048 Telephone Number C ; Certification Statement: I certify that I have personally inspected the sewage disposal system at this address a d that the information reported below is true, accurate and complete as of the time of'the ' e inspection was performed based on my training and experience in the proper function a on site sewage disposal systems. I am a DEP approved system inspector purl ect' of Title 5(310 CMR 15.000).The system: o SOBE. � DRAKE ® Passes civl6 Cn ❑ Conditionally Passes o ilsNo:41642 o `n Cids Further Evaluation by the Local Approving Authority 9aFFss�pNa� �G\` I Co-A - Inspector'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. 28 General Patton Drive-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cunt.) 28 General Patton Drive Property Address Hyannis MA 02601 City/Town State Zip Code Today Real Estate 02/09/08 Owner's Name Date of Inspection 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: All components appear to be structurally sound and working properly. No signs of leakage or blockages. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND)in the❑for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: 28 General Patton Drive-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2of16 I , ' Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ` Subsurface Sewage Disposal System Form A. Certification (cont.) 28 General Patton Drive Property Address Hyannis MA 02601 Cityrrown State Zip Code Today Real Estate 02/09/08 Owner's Name Date of Inspection 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 ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: 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 28 General Patton Drive-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cunt.) 28 General Patton Drive Property Address Hyannis MA 02601 Cityrrown State Zip Code Today Real Estate 02/09/08 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 28 General Patton Drive-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M A. Certification (cunt.) 28 General Patton Drive Property Address Hyannis MA 02601 Cityrrown State ZipCode Today Real Estate 02/09/08 Owner's Name Date of Inspection 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'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] Yes No ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 28 General Patton Drive-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments y` Subsurface Sewage Disposal System Form M A. Certification (cont.) 28 General Patton Drive Property Address Hyannis MA 02601 City/rown State Zip Code Today Real Estate 02/09/08 Owner's Name Date of Inspection 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. 28 General Patton Drive-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form ° Not for Voluntary Assessments y Subsurface Sewage Disposal System Form B. Checklist 28 General Patton Drive Property Address Hyannis MA 02601 Cityrrown State Zip Code Today Real Estate 02/09/08 Owner's Name Date of Inspection Check if the following have been done. You must indicate"yes"or"no"as to each of the following: YES NO ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of r this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 28 General Patton Drive-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information 28 General Patton Drive Property Address Hyannis MA 02601 City/Town State Zip Code Today Real Estate 02/09/08 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 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 Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 176 gpd 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: July 2007 Date Commercial/Industrial Flow Conditions: Type of Establishment: N/A 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: Last date of occupancy/use: Date Other(describe): 28 General Patton Drive-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8of16 Commonwealth of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 28 General Patton Drive Property Address Hyannis MA 02601 Cityrrown State Zip Code Today Real Estate 02/09/08 Owner's Name Date of Inspection General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: N/A gallons How was quantity pumped determined? N/A Reason for pumping: N/A 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) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: House built in 1940. System was upgraded in 2001. Town Of Barnstable Health Department records. Were sewage odors detected when arriving at the site? ❑ Yes ® No 28 General Patton Drive-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 28 General Patton Drive Property Address Hyannis MA 02601 City/Town State Zip Code Today Real Estate 02/09/08 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: approx. 2.25' feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints,venting, evidence of leakage, etc.): Joints appear to be structurally sound, no signs of leakage. Septic Tank(locate on site plan): 1.40 Depth below grade: et feeet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) Tank appears to be structurally sound and functioining properly. If tank is metal, list age: N/A years Is age confirmed by a Certificate of Compliance?(attach a copy of ❑ Yes ❑ No certificate) Dimensions: 1,500 Gallon Sludge depth: Approx. 0" Distance from top of sludge to bottom of outlet tee or baffle approx. 30" Scum thickness Approx. 0" Distance from top of scum to top of outlet tee or baffle approx. 8" Distance from bottom of scum to bottom of outlet tee or baffle approx. 18" How were dimensions determined? MEASURED IN FIELD 28 General Patton Drive-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 28 General Patton Drive Property Address Hyannis MA 02601 Cityrrown State Zip Code Today Real Estate 02/09/08 Owner's Name Date of Inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): All components appear to be structurally sound and working properly.The existing PVC tees are in place and appear to be in good working condition.Water level at invert of outlet pipe. Grease Trap(locate on site plan): Depth below grade: N/A 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): i Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): I 28 General Patton Drive-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 28 General Patton Drive Property Address Hyannis MA 02601 Cityrrown State Zip Code Today Real Estate 02/09/08 Owner's Name Date of Inspection Tight or Holding Tank(cont.) Dimensions: N/A 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.): Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert at invert of outlet 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.): Water level at invert of outlet pipe. No signs of carryover or backups. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 28 General Patton Drive-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 28 General Patton Drive Property Address Hyannis MA 02601 City/rown State Zip Code Today Real Estate 02/09/08 Owner's Name Date of Inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2-500 gallons ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Existing leaching field appears to be working properly. No signs of ponding,vegetation is normal. 28 General Patton Drive-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments G M V•J•. Subsurface Sewage Disposal System Form C. System Information (cont.) 28 General Patton Drive Property Address Hyannis MA 02601 City/Town State Zip Code Today Real Estate 02/09/08 Owner's Name Date of Inspection Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: N/A Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 28 General Patton Drive-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 28 General Patton Drive Property Address Hyannis MA 02601 City/Town State Zip Code Today Real Estate 02/09/08 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Aye`_ i J r � Z8 Qf�cK. � z -S A 2- ^ 3 r 3 A I 37.E A(-I - y© .Y B 2 = '2- , 28 General Patton Drive-T5INSPI.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 28 General Patton Drive Property Address Hyannis MA 02601 Cityrrown State Zip Code Today Real Estate 02/09/08 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 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: 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: Barnstable GIS Groundwater Maps indicate high groundwater elevation is at approx. =24', GIS Contour Maps indicate ground elevation is at approx. 40', Approximately 16'of separation between ground and high ground water. Approximately 10' + separation between bottom of SAS and HGW. 28 General Patton Drive-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 Town of Barnstable pp1HE 1pk Regulatory Services BAMSTABLE ; Thomas F. Geiler,Director MAM prEo j�A Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private,inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within.this report. 9 In addition,by receiving this report the Town of Barnstable Health'Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form Not for Voluntary Assessments V "Y M • 28 GENERAL PATTON DR Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 9/9/07 every 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. Important` A. General Information When filling out forms on the computer,use 1. Inspector: -E. y 3 only the tab key to move your MICHAEL DEDECKO rn cursor-do not Name of Inspector t - use the return a key. COMPASS REALTY DEV CORP Company Name ' r� P.O. BOX 2384 '7 Company Address € y, MASHPEE MA »>� 02649 �� City/Town State 9 Zip Code' 508-221-5003 Telephone Number License Number L • .r- I'rf B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.'The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑-Fails ❑ Needs Further Evaluation by the Local Approving Authority 9/9/07 Inspector'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. 25 GENERAL PATTON•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments. 28 GENERAL PATTON DR Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 9/9/07 every 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: ® 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: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. if"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 25 GENERAL PATTON•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 28 GENERAL PATTON DR Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 9/9/07 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 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. . I . ❑ 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. 25 GENERAL PATTON•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 GENERAL PATTON DR Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 9/9/07 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. '25 GENERAL PATTON•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 GENERAL PATTON DR Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANNIS MA 02601 9/9/07 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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 ❑ 4 ❑ the system is within 200 feet of a tributary to a surface drinking water supply y' the system is located in a nitrogen sensitive area (Interim Wellhead Protection ❑ El the —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. 25 GENERAL PATTON•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 28 GENERAL PATTON DR Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 9/9/07 every page. Cityrrown 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 CMR 15.302(5)] • L25ENERAL PATTON•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'r 28 GENERAL PATTON DR ~ Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANNIS MA 02601 9/9/07 required for . every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 0 Number of current residents: 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 Seasonal use? ❑ Yes ® No N/A Water meter readings, if available(last 2 years usage(gpd)): Sump pump? El Yes ® No N/A Last date of occupancy: Date 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? El Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 25 GENERAL PATTON-08/06 Title 5 official Inspection Forth:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 28 GENERAL PATTON DR Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANNIS MA 02601 9/9/07 + required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How'was quantity pumped determined? Reason for pumping: 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ ` Other(describe): Approximate age of all components, date installed (if known) and source of information: N/A Were sewage odors detected when arriving at the site? ❑ Yes ® No 25 GENERAL PATTON•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 8 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 GENERAL PATTON DR Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 9/9/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 29 Depth below grade: feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): joints tight, yes vented, no sign of leakage. Septic Tank (locate on site plan): Depth below grade: 1� feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years a Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1500 GAL -Sludge depth: 211 Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness Distance from top of scum to top of outlet tee or baffle ' 1111 Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? MEASURED 25 GENERAL PATTON•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w. 28 GENERAL PATTON DR Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANNIS MA 02601 9/9/07 required for State Zip Code Date of Inspection every page. cityrrown 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.): NO NEED TO PUMP,TEES INTACT,STRUCTUALLY SOUND,LIQUID EQUAL WITH OUTLET INVERT,NO LEAKAGE 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 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): 25 GENERAL PATTON•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 28 GENERAL PATTON DR Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANNIS MA 02601 9/9/07 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Tight or Holding Tank (cont.) 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 pu m ping.contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): EQUAL WITH OUTLET INVERTS Depth of liquid level above outlet invert 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 LEVEL AND DISTRIBUTION EQUAL, YES SOLID CARRYOVER, NO LEAKAGE. Pump Chamber(locate on site plan): Pumps in working order: El Yes ❑ No Alarms in working order: ❑ Yes ❑ No 25 GENERAL PATTON-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 28 GENERAL PATTON DR Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANNIS MA 02601 9/9/07 required for State Zip Code Date of Inspection every page. Cityrrown D. System Information (cont.) 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: Type. ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: y Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SOIL SAND/GRAVEL,NO SIGNS HYDRAULIC FAILURE , PONDING DRY, NO DAMP SOIL,' VEGETATION NORMAL. 25 GENERAL PATTON-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 I Commonwealth of Massachusetts _ Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments o 28 GENERAL PATTON DR Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANNIS MA 02601 9/9/07 ' required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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 i Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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 25 GENERAL PATTON-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 r— Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 GENERAL PATTON DR Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANNIS MA 02601 9/9/07 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Y j � i 3 "y Title 5 Official inspection Form:Subsurface Sewage Disposal system-Page 14 of 15 25 GENERAL PATfON-08/06 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w„ 28 GENERAL PATTON DR Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANNIS MA 02601 9/9/07 required for State Zip Code Date of Inspection every page. Citylrown D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: 4e0.00' 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: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with localexcavators, x avators installers- attach documentation) ® Accessed USGS database-explain: BARNSTABLE GIS You must describe how you established the high ground water elevation: BARNSTABLE GIS 25 GENERAL PATTON•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable FtHE l°� Regulatory Services snxxsrns Thomas F. Geiler, Director 9� 6 9. •0� Public Health Division pTfD MA'S A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts,Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. No. Fee d — n THE COMMONWEALTH OF MASSACHUSETTS Entered in com P.ter. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Mi6pooal Opotem Con!Aruction Permit Application for a Permit to Construct( )Repair(t/)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �� (y�y L097VIN AP-11V Owner's Name,Address and Tel.No. & j� / Assessor'sMap/Parcel Installer's Name,Address,and Tel.No. 11dr16 Designer's Name,Address and Tel.No. ll Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank !P0 60 ion Type of S.A.S. U 04 1 all^^ erJ Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 E ' nmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue this�o of ?alth Signed Date Application Approved by Date 'Z Application Disapproved for the following reasons Permit No. Date Issued IL 2 ,�^ No. g��,i '` ) _ 3f0 ppn. ,/ a — Fee Q t` uter. THE COMMONWEALTH OF MASSA6HUSETTS Entered in com p .t Yes � r PUBLIC HEALTH.DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS a 0(pprication for Digposdl *p5tem Conotruction Permit Application for a Permit to Construct( )Repair(V Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. p�Q UC/7 �, A771-01k/,0R1U Owner's Name,Address and Tel.No. � &/f/yQ 1. Assessor's Map/Parcel } �1 ,��1A ✓,Z 135omlC� 40, q - 113 ` - Installer's Name,Address,and Tel.No.'t2 tlaT6 Designer's Name,Address and Tel.No. aU T�Z�Erc�UR R✓/�`• �`3 �3 ,t�EE�Q.N°Cl�u-�D, 1' Type of Building: Dwelling No.of Bedrooms Lot Size/0,60,5 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( 4 Cafeteria( ) Other Fixtures Design Flow �✓�C) gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title SOU br lon T e of S.A.S. G C �n�b�rJ G✓ '-1 f�� Size of Septic Tank yp Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 ry/ea nmentaI Code and not to place the system in operation until a Certifi- = cate of Compliance has been issued this olth Signed Date -,X-G Application Approved by ~ - �- '�'~� �- -ti. �- Date 2 (c c 1 I Application Disapproved for the following reasons Permit No. C Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE IFY, that the On-site Sewage Disposal System Constructed( )Repaired Upgraded( ) Abandoned( )byRl�y �yo 77i- at L 10A7TOMI LML6 has been constructed in accordance with the prov' 'ons of Title 5 and the for Disposal System Construction Permit No..?CQA +'2 7 dated Installer 1/9/t/ B4/OmT- Designer The issuance.of e t shall not be construed as a guarantee that the sy�em wil function a desi ed. Date - , Inspector 4 ��. ----\---------------------------------— -- No. -3 �)1 Fee t� P THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Digogai *p!gtem Construction Permit Permission is hereby granted to Construct( )Repair Upgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty,to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. j Date: t I � 'y Approvedb 011, 5/25/01 NOTICE: This Form: Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION 'PEST AND SOIL EVALUATION EXEMPTION. FORM I, rNl�, hereby certify that the engineered plan signed by me w dated_tt cat 01 concerning the property located at meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. The soil is classified as-CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or.change in use proposed • There are no variances requested or needed. • atom e prop se leaching a ty will not b ted less h o en (1 et o the. axi um uste group ater tab e elev `on. djust, group ater ble using e Frim r ethod wh licable) 1 Please complete the following: A) Top of Ground Surface Elevation (using GIS information) is 5r .,6o,1- B)-G.W. Elevation + adjustment for high G.W..4'nX - 'Iv 1 .. 6 � �JS DIFFERENCE BETWEEN A and B eOa A SIGNED : 4 DATE: o S'01� ecAN NOTICE 1�Sralia ` "? o Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. ON q:health Folder.percexmp Town of Barnstable Department of Health, Safety, and Environmental Services • aAxtasrests. META � Public Health Division t639 prFDMA'�1, 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health September 19 1997 Ms. Roberta Mendes 28 General Patton Drive Hyannis, MA 02601 Dear Ms. Mendes: On Thursday September 11, 1997, the Public Health Division Office Clerk received a complaint from you regarding potential housing violations at 28 General Patton Drive, Hyannis. You complained about loose floor tiles in the bathroom and an overflowing toilet. On Wednesday September 17, 1997, Health Inspector Donna Miorandi conducted an inspection of the dwelling and found no loose floor tiles. She did observe the toilet which contained feces and other debris. Then on September 18, 1997, Bill Heath of B & H Plumbing Services went to the dwelling, removed the toilet and observed "six sanitary napkins, 2 pair of women's pantyhose and a piece of wood obstructing the pipe." Now this waste pipe is clear. You also complained to Ms. Miorandi that the screen was again detached from the front screen door. Please be advised that the screen was re-attached by the owner of the dwelling, Scott Colantino, on or about October 4, 1996 as witnessed and videotaped by Health Inspector Jerome Dunning and I. Attached is a copy of the tenant's responsibilities. Maintenance of toilets and sinks are the responsibility of the tenant (Sec. #1 attached). Based upon the above findings, it is my opinion that these conditions which you claim to be health code violations, are actually conditions due to a lack of care and maintenance by the tenants of this dwelling, not by the owner. Therefore, no health code violation correction orders will be issued against the owner of the property, Scott Colantino. 1 r A copy of this letter will be mailed to Susan Rask the Board of Health Chairperson, Howard Wensley of the Massachusets Community Sanitation Department, Mr. Reuben Martin of the Housing Assistance Corporation, Jack Gillis of the Consumer Affairs Division, Legal Services, and Scott Colantonio the owner of the dwelling. Sincerely yours, Thomas A. McKean Director of Public Health cc: Susan G. Rask, Chairperson Board of Health cc: Howard Wensley, MA Community Sanitation Dept. cc: Mr. Martin, Housing Assistance Corporation cc: Jack Gillis, Consumer Affairs Division cc: Legal Services cc: Scott Colantonio TOWN OF BARNSTABLE LOCATION SEWAGE # Qcoj— 7_?'7 VILLAGE—awhas ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO._SPlo*l SEPTIC TANK CAPACITY LEACHING FACILITY: (type)Q l 5 (size) 0 X NO. OF BEDROOMS BUILDER OR OWNER. PERMTTDATE: --o 1 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 ICI 7ANVA 3� r DAM �Q;7®0 �r C#191'AWtS i � E r Town of Barnstable o� Department of Health, Safety, and Environmental Services MASS i639• Public Health Division �j ♦0 P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health March 8, 2001 Ms. Robin M. Perry 28 General Patton Drive Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II,MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE, ARTICLE 51 The property owned by you located at 28 General Patton Drive, Hyannis,was inspected on March 6, 2001 by.Donna Miorandi, R.S., Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II, Minimum Standards of Fitness for Human Habitation were observed: 410.602 Much old wood, broken furniture, rusted lawn mower, mattresses, clothes dryer, propane tanks, household garbage and rubbish on the ground. Also four (4) unregistered vehicles at this property. You are directed to correct the violation of 410.602 within twenty-four (24) hours of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However,these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH omas A. McKean Director of Public Health cc: Police Department I cc:David Houghten i 65 � o P�oYTM Town of Barnstable 8LE Department of Health, Safety, and Environmental Services 6 ,�� Public Health Division P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director f Public Heal[h lule\/ NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 q The properly owned by you located at was, inspected on )TA06 , 2001 by Donna Miorandi, R.S., Health Inspector for the Town of Barnstable. The following violations of 105 CMR 410.00, State Sanita COoVeI Mini}j��um Standards of Fitness for Human Habitation were observed:��/ �grn�y�Fd1jV 410.602: U D�D WOO Dl.[J r')P V 1—r0?6 lC U 00,4%, y>;r�10 v s Sys/ 440 fbon " 1816 U� l You are directed to correct the violation of 410.602 within twenty-four (24) hours of receipt of this notice by removing debris from the property. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing Please be advised that failure to comply_ with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violations. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD PF HEALTH Thomas A. McKean Director of Public Health oliveria Wm. E. Robinson, Sr. Septic Service P.O.Box 1089 ' Centerville,MA 02632 L L L L � (508)775-8776 Fax(508)790-1694 September 18, 1997 Barnstable Board of Health 367 Main Street Hyannis, MA 02601 Attention: Thomas McKean and To Whom it May Concern Re: 28 General Patton Drive The septic system located at 28 General Patton Drive in Hyannis, was cleaned out on April 5th 1997 by Robinson Septic Service for Scott Colontonio. On September 17, 1997 Mrs. Colontonio called to inquire as to the date we were last there (which was 4/5/97) stating the tenant had complained there was a problem with the septic system. We refferred the Colontonios to a plumber, Bill Heath of B &H Services, and he went to 28 General Patton Drive on September 18, 1997. After removing the toilet, he discovered in the line were 6 sanitary napkins,a pair of woman's pantyhose and a piece of wood obstructing the pipe. Sincerely, Wm. E. Robinson, Sr. � . Wm. E. Robinson Sr., Septic Service y�FTHE t��♦ The Town of Barnstable { Dnx,T,n _ Department of Health, Safety and Environmental Services °moo 9�,� Public Health Division 367 Main Street,Hyannis,MA 02601 Office 508-790-6265 Thomas A.McKean FAX 508-775-3344 Director of Public Health October 9, 1997 To Whom This May Concern: On August 30, 1993 Jerome Dunning,Health Inspector for the Town of Barnstable,performed an inspection at 28 General Patton Drive,Hyannis. At that time Roberta Mendes,prospective tenant stated she had to move in immediately and that she would take care of the painting and the living room floor. Sincerely, Jerome Dunning Health Inspector r Town of Barnstable • Department of Health, Safety, and Environmental Services HARNsrABLE, public Health Division .y MA99. i639• �� prEosp 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health September 19, 1997 Ms. Roberta Mendes 28 General Patton Drive Hyannis, MA 02601 Dear Ms. Mendes: On Thursday September 11, 1997, the Public Health Division Office Clerk received a complaint from you regarding potential housing violations at 28 General Patton Drive, Hyannis. You complained about loose floor tiles in the bathroom and an overflowing toilet. On Wednesday September 17, 1997, Health Inspector Donna Miorandi conducted an inspection of the dwelling and found no loose floor tiles. She did observe the toilet which contained feces and other debris. Then on September 18, 1997, Bill Heath of B & H Plumbing Services event to the dwelling, removed the toilet and observed "six sanitary napkins, 2 pair of women's pantyhose and a piece of wood obstructing the pipe." Now this waste pipe is clear. You also complained to Ms. Miorandi that the screen was again detached from the front screen door. Please be advised that the screen was re-attached by the owner of the dwelling, Scott Colantino, on or about October 4, 1996 as witnessed and videotaped by Health Inspector Jerome Dunning and I. Attached is a copy of the tenant's responsibilities. Maintenance of toilets and sinks are the responsibility of the tenant (Sec. #1 attached). Based upon the above findings, it is my opinion that these conditions which you claim to be health code violations, are actually conditions due to a lack of care and maintenance by the tenants of this dwelling, not by the owner. Therefore, no health code violation correction orders will be issued against the owner of the property, Scott Colantino. r A copy of this letter will be mailed to Susan Rask the Board of Health Chairperson, Howard Wensley of the Massachusets Community Sanitation Department, Mr. Reuben Martin of the Housing Assistance Corporation, Jack Gillis of the Consumer Affairs Division, Legal Services, and Scott Colantonio the owner of the dwelling. Sincerely yours, Thomas A. McKean Director of Public Health cc: Susan G. Rask, Chairperson Board of Health cc: Howard Wensley, MA Community Sanitation Dept. cc: Mr. Martin, Housing Assistance Corporation cc: Jack Gillis, Consumer Affairs Division cc: Legal Services cc: Scott Colantonio DIVISION ROTOR SEE BINDING TERMS ON REVERSE )015 ROTO-ROOTER SERTiCES COMPANY 0100TER0 175 MAKE T SERVICE TECHNICIAN'S NAME STO V 10HMIK M OM DATE OF SERVICE • Mfg SEP111997 PE OF SERVICE �, I SEWER A DRAIN PLUWMG HVAC El YOUR DEPENDABLE PLUMBER R1D MIAL p I.P. S.TP. CUSTOMER NAME CUSTOMER NO. CUSTOMER CLASS Q-fp� �o�E���"Cou�pI ❑MASS MEDIA ❑DIRECT SALES JOB ADDRESS o APT.NUMBER FEDERAL I.D.• N 31.1102M CITY STATE/PROVINCE ZIP/POSTAL CUSTOMER TELEPHONE NUMBER P.O.NUMB AUTHORIZATION ESTIMATE WORK ORDER AUTHORIZATION . My estimate for I authorize Roto-Rooter to perform the described services and I agree to pay the amounts indicat ��u We start R ,-R er is n res sible for broken, performing this work is: settled,rusted,deteriorated,or lead pipes,fixtures,or clean outs and any damage resulting from c �in� nA�u _ (PRINT NAME) (SIGNATURE) t T I / o ` J COMPLETION I acknowledge completion of the below described work which has been done to my complete salisfac.0on. (SIGNATURE) ❑ MAINLINE ❑ KITCHEN SINK ❑ FLOOR DRAIN ❑ BATHROOM SINK/TUB/SHOWER Q'TOILET BOWL LAUNDRY LINE ❑ OTHER \�.,i. `��,�� U�*\. �5 �b `�.V-�V► `moo\��� 1� ttZ TIME DISPATCHED TIME ARRIVED TIME DONE INVOICE TOTAL RESIDENTIAL GUARANTEE COMMERCIAL GUARANTEE PAYMENT LABOR $ DRAIN CLEANING DRAIN CLEANING B+ =PARTS S ❑Main Line ❑6 mos. ❑All Lines ❑30 days ❑ CASH / 1 ❑Other Lines ❑3 mos. ❑Toilet Bowl ❑24 hrs. [e CHECK/CHEQUES N0. ' ' OTHER $ ❑Toilet Bowl ❑24 hrs. ❑Jetting ❑30 days ❑ ❑Other ❑ ❑Other ❑ CREDIT CARD TAX $ ! PLUMBING PLUMBING Q i ❑Repair ❑90 days ❑Repair ❑90 days ❑ NET 30 DAYS TOTAL $ ` I ❑ Replace ❑ 1 year ❑Replace ❑ t year OVER 30 DAYS=LATE CHARGE OF 1 1/2%PER MONTH ❑Other ❑ ❑Other ❑ 'In the event check/cheques Is returned,the COMPANY will Explain charge the CUSTOMER A$25.00 processing fee. I PLEASE PAY FROM THIS INVOICE- • • • • Toilet Tanked Im PLEASE COMPLETE AND RETURN When plumbing breaks, remember Roto-Rooter o THE ATTACHED SURVEY. does fast, dependable, Fuaranteed plumbing. or any installation, repair oo a op YOUR OPINION IS or service, give us a call. IMPORTANT TO US. R070- We do plumbing ROOTER. riusrsces ,f,�.:+ca ,r ,., t1 . F :y,�;, r.n ,n �. _r t `t.,;: fFs i"` rn•;n n-. .. (P x?n \a'spiK7:."a7r 4,—, TOWN OF BARNSTABLE �`e�' ` BAR.,W 3 9 Ordinance"or Regulation WARNING"NOTICE Name of Offender/Manager r h?R..K_ dob Address Offender_ 2� �emai" arc v-e My/MB Reg.# Village/State/Zip /Tf C-41 )2 02(.6 / SS# or � Business Name U ai pm, on -� 19_ , Business Address Signature of Enforcing Officer Village/State/Zip Location of Offense .2 6 ehL*--e- En orcing Dept/Division Offense Ajul S ce Facts (,Ja�ti� Lill All This will serve only as a warning. At this time no , legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. �-„_' '74� _r*�I�* x OWN OF BARNSTABLE t -" BAR: Ordinance' or:Regulations ; WARNING NOTICE Naive. of Offender/Manager's ` `, "{' ,ti1` Address of Offender .'-as . .6'emeu—rz rtyz MV/MB Reg,# f. Village/State/Zip !'T4 cx-mt?i SE (o cij Business Name pm; on 19 � Business Address Signature of Enforcing Officer Village/State/Zip Location of Offense Enforcing .Dept/Divisioir Offense uts c- f Facts W a^hr 0 ! e.+ )voc-/r lint 44 th -7.3 ,OGV#-S,. This will servo only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. TOWN OF BARNSTABLE 4( E BAR-W 1239 Ordinance •or Regulation +� WARNING NOTICE Name of Offender/Manager Pt#b3-r P. ..�` Address of Offender rt MV/MB Reg.# Village/State/Zi S- J k'4. 61 Business Name am pm; on /A VI 9 Business Address ' Signature of Enforcing Officer: Village/State/Zip f Location of Offense ', l�,f / ` � -�P we ,f x) Enforcing Dept/Division Offense kAj, Sc hLr e ilP. Facts a_ u.. "'ZIV.3 1 This will serve onlyras a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. ".bri. n 's^' 'F �" °.a a ,,,-.. R .,.�. ::.- ..r: ew r 034+ 'A`� r a sv^'�.,y.�"t -•;rr ,p _ TOWN OF :BARNSTABLE BAR"W �# Ordinance tor.'Regulation F - WARNING 'NOTICE', Name of Offender/Manager ,b c11 Address of Offender ' j-� 1+ �.,: 4. d MV/MB Reg # Village/State/Zip In .S' QliQ f. # _�lYt Business Name /pm, on 197(a Business Address � s✓ Signature of Enforcing Officer Village/State/Zip Location of Offense 6en&-r-1 P �64 / Al'oQ. `� , �S Enforcing Dept/Division Offense AJyISCLn4► � fe , ✓ e 1 °� I'" /6i.4-4Gt 7 Y • ?, Facts WZAI`PA M h45S Oj `�` j� �yatk ��ta n oile l� ain hn 4 l(�j -� f� // c��-��,.� -2 ,1.wtr, S40W ih 6d4tl A -r` This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. n, :klw TOWN OF BARNSTABLE BAR-W 4 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager tb k4K-_ Ad611 Address of Offender ,Yk -AV Ve MV/MB Reg.# Village/State/Zip Aao h/—,1', :/�} L to f , Business Name # /pm; on lg( Business Address Signature of Enforcing Officer Village/State/Z_ip Location of Offense__ r ._ '*46 #tAe /,04 /-x, 1 a {{ En'forcing Dept/Division Offense Put l la; .. f IA4,,; Facts xf, h<l,5 ' S"+� l ► ( ! + . - 1 ° r„ . t.d This will serve only as.-a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. PAGE 1 OF 2 �1HE � Town of Barnstable Department of Health, Safety, and Environmental Services B, MAS&1639. . Public Health Division 9�FD pA�p1� 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health October 4, 1996 Scott Colantonio 25 General Patton Drive Hyannis, MA 02601 Dear Mr. Colantonio: The property owned by you located at 28 General Patton Drive, Hyannis was reinspected on October 4, 1996 at 10:10 a.m. by Christina Kuchinski, Health Inspector for the Town of Barnstable. The reinspection was conducted in order to follow-up on the inspection conducted September 16, 1996 when sixteen (16) violations of the State Sanitary Code, 105 CMR 410.000 were observed. Thomas McKean was also present with a video camera to document the violations on September 16, 1996 and all the corrected violations on October 4, 1996. This letter shall serve as official notification to you and all other parties involved, that all sixteen(16)violations of the September 16th inspection were corrected. It is recommended, however, that you hire a licensed septage hauler to pump the cesspool(s) due to the fact that the wastewater in the kitchen sink drained somewhat slower than normal. You stated the cesspool had not been prepared within the past three (3) years. There is no regulation, code, or ordinance which requires you to pump the cesspool(s). However, the tenant has complained,aM several occasions, that the kitchen sink has clogged (as we witnessed when we first arrived on October 4, 1996) and drains very,slowly. mendes PAGE 2 OF 2 All sixteen (16) State Sanitary Code violations were corrected within the deadline a• established, as ordered in the letter to you dated September 20, 1996, received by you on September 25, 1996. Sincerely yours, Thomas A. McKean Director of Public Health Town of Barnstable cc: Roberta Mendes; Thomas Lynch lI, orsts'. Jswy ` ' MSPCC —wt� cC& Salvation Army/ (e n e o '10O Na* mendes TOWN OF BARNSTABLE ?,'THE r0� OFFICE OF 1 DAHd9TABL 3 BOARD OF HEALTH NAM i639• ��' 367 MAIN STREET. HYANNIS, MASS.02601 . October 7, 1996 Scott Colantino 25 General Patton Drive Hyannis, MA 02601 Dear Mr. Colantino: The Board of Health held a hearing on Tuesday October 1, 1996 regarding State Sanitary Code violations observed at 28 General Patton Drive,Hyannis. After hearing your testimony, statements from Roberta Mendes, the occupant, and observing several photographs supplied by you and Ms. Mendes, the Board of Health voted unanimously to uphold the orders contained in the letter from Thomas McKean, Director of Public Health, dated September 20, 1996. Therefore, you are ordered to correct all sixteen (16) health code violations as described in the order letter dated September 20, 1996. These violations shall be corrected on or before October 4, 1996. PER ORDER OF THE BOARD OF HEALTH S san G. Rase,R.S. Chairman Board of Health Town of Barnstable TM/bcs scoff o`the ea�p.55ee. � �I Town of Barnstable ` Health Department 1 """ 1 367 Main Street, Hyannis, MA 02601 /1 V tv •1 n 10 • W\ 2639. Office 508-790fi265 Thomas A. McKean FAX 508-775-3344 Director of Public Health September 20, 1996 Scott Colantonio 25 General Patton Drive Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00 STATE SANITARY CODE II MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE ARTICLE 51 The property owned by you located at 28 General Patton Drive, Hyannis was inspected on September 16, j 1996 by Christina Kuchmski, and Jerome Dunning Health Inspectors for the Town of Barnstable because of a complaint. Thomas McKean was also present with a video camera document all the conditions. The following violations of the Town of Barnstable Rental Ordinance Article 51 and the Sanitary Code II were observed and shall be corrected by you,the landlord: The base and bottom shelf of the kitchen cabinet near the sink was water jbql-0—.500 damaged and rotted. yd 410.552: The self closing devices on the tront and side storm doorwere not present. The tenant stated that she had removed these because they were bent. The health inspectors inspected the devices and observed the rod was in fact bent. dOO410.351: There was an exposed electrical wire in the kitchen cabinet beneath the sink. `,p '410.501: An air gap could be seen on the top left area of the front door. C��v ��P-L%410.501: Between the front door and the prime door frame;weather stripping was detached and needs to be re-applied. 14 0.351: The kitchen faucet sprayer was broken and a long round narrow stick stuck into the water supply line. The stick had been placed there by the tenant to stop any water from leaking out. dc-9 til 0.351: There was an air gap around the outside edge of the small electric panel found in the porch area. The tenant stated that hornets had entered the house through this opening. 410.500: The ceiling area around the edge of kitchen light fixture showed evidence ✓ of water leaking as it was water stained. d0A--L0--5-0-0: There was a small hole in the kitchen wall above the stove. This is where an exposed electrical wire had once been. �410.500: Several carpet squares in the living room were not secured to the floor. • )0.410.500: Several floor tiles in the porch area and kitchen were not secured to the floor and there were several little holes in the floor tiles near the kitchen __ pp sink. 4.504: Several corner tiles were missing around the bathtub. ( 0.504: Several comer tiles around the bathtub lifting off. da-410.501: The felt piece for the weather stripping on the side door was loose. � CJ0.351: The refrigerator had a puddle of water on the inside bottom surface below` the vegetable crispers. c� Rental Ordinance 4-5: Insufficient number of receptacles provided to the tenant for storing rubbish and .4arbage at this dwelling. Also, there was no tight fitting lid provided on the one trash barrel observed in front of the dwelling. * The wastewater in the kitchen sink drained somewhat slower than normal. It is recommended that you, ' the landlord, invesitigate whether the plumbing lines are clogged or the cesspool is malfunctioning. Also, the tenant showed the health inspectors an area on the wall in the children9s bedroom which was dor" cracked) indented, and painted over. It is recommended that'you apply a small amount of caulking or spackling compound to the cracked, indented area prior to re-painting. You are directed to correct the above listed violations within seven (7)days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. For your information, violations regarding illegal refuse storage were observed behind the dwelling. A written warning notice was mailed to the tenant, Roberta Mendes, on September 20, 1996 ordering her to store all refuse properly in receptacles with tight fitting.lids. PER ORDER OF T1 BOARD OF HEALTH Thomas A. McKean Director of Public Health cc: Roberta Mendes Thomas Lynch Salvation Army Case Worker MSPCC 1 SENDER: ., . V ■Complete items t and/or 2 for additional services. I also wish+ y ■Complete items 3,4a,and 4b. following servic 0 sPrint your name and address on the reverse of this form so that we can return this extra fee): card to you. ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Addre permit. d ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery t ■The Return Receipt will show to whom the article was delivered and the date « delivered. Consult postmaster for fee. 3.A ' Addrss ed to- 4a.Article Number ' CL � � �. Ems' 4b.Service Tye m iiy� ❑ Registered d� Certified Im N L d> Qom" ' " '" ❑ Express Mail ❑ Insured E ¢ / "�/� ❑ Return Receipt for Merc andise ❑ COD ma �/►�► /�:'!d!;/!�' // L�`r2� 7.Date ojQqqybry a 0 z 5.Rec ved B : Print Name) 8.Addre a 's Address my i r uested c w and to is paid) 6.Sign r . A s dent) o X 0 P form 3811, cember 1994 Domestic Return Receipt Health Complaints 12-Sep-96 Time: 11:45:00 AM Date: 9/12/96 Complaint Number: 433 Referred To: CHRISTINA KUCHINSKI Taken By: CHRISTINA KUCHINSKI Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 28 Street: General Patton Drive Village: HYANNIS Assessors Map-Parcel: Complaint Description: 1. Sink malfunctioning 2.toilet not flushing3. water coming through kitchen light fixture 4. leak in kitchen faucet 5. staining in kitchen cabinet 6. water in bottom of refrigerator 7. kitchen floor tiles scatter when tenat walks on them . Actions Taken/Results: Investigation Date: Investigation Time: 1 Town of Barnstable ` Health Department ! "'i I 367 Main Street, Hyannis, MA 02601 9. Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health September 20, 1996 Scott Colantonio 25 General Patton Drive Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 28 General Patton Drive, Hyannis was inspected on September 16, 1996 by Christina Kuchinski, and Jerome Dunning Health Inspectors for the Town of Barnstable because of a complaint. Thomas McKean was also present with a video camera document all the conditions. The following violations of the Town of Barnstable Rental Ordinance Article 51 and the Sanitary Code II were observed and shall be corrected by you,the landlord: 410.500: The base and bottom shelf of the kitchen cabinet near the sink was water damaged and rotted. 410.552: The self-closing devices on the front and side storm doors were not present. The tenant stated that she had removed these because they were bent. The health inspectors inspected the devices and observed the rod was in fact bent. 410.351: There was an exposed electrical wire in the kitchen cabinet beneath the sink. 410.501: An air gap could be seen on the top left area of the front door. 410.501: Between the front door and the prime door frame;weather stripping was detached and needs to be re-applied. 410.351: The kitchen faucet sprayer was broken and a long round narrow stick stuck into the water supply line. The stick had been placed there by the tenant to stop any water from leaking out. 410.351: There was an air gap around the outside edge of the small electric panel found in the porch area. The tenant stated that hornets had entered the house through this opening. 410.500: The ceiling area around the edge of kitchen light fixture showed evidence of water leaking as it was water stained. 410.500: There was a small hole in the kitchen wall above the stove. This is where an exposed electrical wire had once been. w 410.500: Several carpet squares in the living room were not secured to the floor. 410.500: Several floor tiles in the porch area and kitchen were not,secured to the floor and there were several little holes in the floor tiles near the kitchen sink. 410.504: Several corner tiles were missing around the bathtub. 410.504: Several corner tiles around the bathtub lifting off. 410.501: The felt piece for the weather stripping on the side door was loose. 410.351: The refrigerator had a puddle of water on the inside bottom surface below the vegetable crispers. Rental Ordinance 4-5: Insufficient number of receptacles provided to the tenant for storing rubbish and P garbage at this dwelling. Also, there was no tight fitting lid provided on the one trash barrel observed in front of the dwelling. * The wastewater in the kitchen sink drained somewhat slower than normal. It is recommended that you, the landlord, invesitigate whether the plumbing lines are clogged or the cesspool is malfunctioning. *Also, the tenant showed the health inspectors an area on the wall in the children's bedroom which was cracked, indented, and painted over. It is recommended that you apply a small amount of caulking or spackling compound to the cracked, indented area prior to re-painting. You are directed to correct the above listed violations within seven(7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. For your information, violations regarding illegal refuse storage were observed behind the dwelling. A written warning notice was mailed to the tenant, Roberta Mendes, on September 20, 1996 ordering her to store all refuse properly in receptacles with tight fitting lids. PER ORDER OF TH =OARDOF HEALTH Thomas A. McKean Director of Public Health cc: Roberta Mendes Thomas Lynch Salvation Army Case Worker MSPCC (2-6 Lam- ► U-4 e� �3 SsU)4-1- a l�h�d r NOTICE TO, ABATE VIOLATIONS OF 105 CMR 410,00, STATE SANITARY CODE 11, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND TILE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at AP � � -bf/Was inspected on % 1994 by 04h� ,, P� JD Health Agent for the Town of Barnstable because of a complaint. 'I'he following violations of the Town of Barnstable Rental rdin nce �� 4a.A%� Article 51 and tl a 't Code Il were observed: �tl 6e.c�,�:l _ y0, (2103(� dev(ce_ o(/I � f �a'�cO S-FOrw� a00,-S be,c�� @o,6(A r � f d 6bg ^ 4f/O.s�► .e. 4e Pv-tw•e J 0 a �OVS- s� .c 7� Sao® wP -r l G e3u-:�-j-,cde u as - Nlo.,�Si AF- '—i`Q- ��v � �c.f Up�v►is y/U.SU o lk iZs T l f/ /,oJ 4C: , . a:&u cue -tom s-fv ve a 7-lit- J s �.✓ _ 4.at �-'�e� C? ���' !t C� (� Lee,., 6,, --- ,4- l.�a d b ee�h � 61 y/a. boa -r�;v ea.p r�, s�u�r' lh` . � frv�oSG�aQr� ltio �e ce,-f� -At) q4Loa, o v 4 rue y/01 5"vo Sezr ftror t (.e_r rN `f-Ax— por- `k d L`.ev-e— �e l�v S 1c1 4 4' J 6 0 eaF:V a a„ Gee f2z�e � Serik IF.... y�o Sod/ 5� / oCv �i LDS' �we) l*-Y-' yl G o o r Tom. -ref-1 p e e W, fiy � � s x ° v� 41,(� S'z.de_ l-kl-- L/(01 f LO m rs c 'OA d i r t d t co a th viol on 2turce b You Are Airected to correct the remaining above listed violations within seven (7) days of receipt of this notice. received b the Board of T" You may request a hearing if written petition requesting same is y ��2 1lealth within seven (7) clays after the (late order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate (lay's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. Enclosed are citation numbers due to violations observed on PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health Town of Barnstable TOWN OF BAR STABLE B -W 1243. Ordinance' or:.Regulation WARNING. NOTICE. Name of Offender/Manager tjG{�Q I�I PA es- Address of Offender �+ �. ... // ` �� G'eru�e/ ��7�hrl y�. MV/MB Reg.# Village/State/ZipGZV1h/1�. ����/ o Business Name /pm; on 19��� Business Address Signature of Enforcing Officer Village/State/Zip Location of -Offense, 6� � � -/veq. Enforcing Dept/Division Offense �IV� Q.II(10 l�� lc�y � oea)/h Facts IdaA 0"rA TY,a.P,�i i na � b� O� "fi-�d�► ./+� D�LGki y utC (.tG�in c I► 4ihkj .�o � i� �[/l-9(n -72 k4w-s-, Pow Q-l/ —h-al. /A riderr-f� This will serve only as a warning. At this. time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town . Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will .result in appropriate legal action by the Town. w C` C4 VC100If FORM30 HOBBSa WARREN,INC.NOV.1979.1983 THE COMMONWEALTH OF MASSACMUSETTS BOARD OF HEALTH Ba+ Co r. v ' CITY/TO N � n i b DEPARTMENT a s � ADD S TELEPH NE Address �� G �� �Y61� Occupant 41-ei--fa �J 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'Q Remarks Reg. Vlo. YARD Out Bld s.: Fences: � Garbage and Rubbish L' r(, g S�1ve cz�r�,y Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches e 4 & re,a Dual Egress:and Obst'n.: �{ ❑B ❑ F ❑ M Doors,Windows: r,c/ &Bibs"- &-, fA, dze e0(jS",&1 USS1 Roof �X v e/eC-lAre a Gutters, Drains: i-'Q Walls: Foundation: `. Chimney: t / .�r. v / f c /D• BASEMENT Gen.Sanitation: ('�1, Dampness: Jlynttl Lz& i 1Awy(, "o t,e c / ,s Stairs: • l Lighting: STRUCTURE INT. Hall,Stairway: h(o �' � A44 CkS°D Obst'n.: 5"r- swr,// Cis Hall, Floor,Wall,Ceilin : se,-ekc/ a"-<A &Ay" Hall Lighting: Jab-fe 6 Hall Windows: <S'c.olP LA/ r t..ea ,e t� S{r r� 4(/D,s0/ HEATING Chimneys: dp,� ' Central ❑Y ❑ N Equip. Repair S TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: j• made - -50"a// (410 s- ❑ 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 Lhdng Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facll. Sup.Ten.,Gas,Oil, Elect.: Stacks,Flues,Vents,Safeties: Kitchen Facilities Sink 31 r✓h S J, -//6-1.3S 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 BuIldina Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED,UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR �t'W y 'C41ry /1-f TITLE 00 f' DATE�lo/9�� 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 these items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential to fall within this category in any given situation but may not do so in every case and therefore cannot be included in this listing. Failure to include shall in no way be construed as.a determination that other violations may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of the violation(s) pursuant to 410 CMR 410.830 through 410.833 nor shall it affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to -meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. - (C) Shut-off and/or failure to' restore electricity or gas. (D) Failure to supply the electrical facilities required by 105 CMR 410.250(B), 410.251(A), '410.253(A), 410.253(B) and the lighting in common area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. .(F) Failure to provide a toilet and maintain a sewage system in operable condition as required 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 an object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450 and 410.451. (H) Failure to comply with the security requirements of 105 CMR 41'0.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.6.02 which results in any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of lead-based paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regualtions for Lead Poisoning Prevention and Control 105 CMR 460.000. (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or dafety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilities as are required by 105 CMR 410.351 and 410.352 so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any of the following conditions which remain uncorrected for a period of five or more days following- the notice to or knowledge of the owner of said condition or conditions: (1) lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either operable. (2) failure to provide a washbasin and a shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3) and any defect which renders them inoperable. (3) any defect in the electrical, plumbing, or heating system which makes such system or any part thereof in violation of generally accepted plumbing heating, gas-fitting, or electrical wiring standards that do not create an immediate hazard. (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. (N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A)` through (M) shall be deemed to be a condition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the board of health. y FTHE T The Town of Barnstable DeDalTeDL Department of Health, Safety and Environmental Services o 9 M,� Public Health Division 367 Main Street,Hyannis,annis,MA 02601 Office 508-790-6265 Thomas A.McKean FAX 508-775-3344 Director of Public Health September 6,1996 Mr. Scott Colantonio 25 General Patton Dr. Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE 11, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE, ARTICLE 51 The property owned by you located at 28 General Patton Drive, Hyannis was inspected on August 28,1996by Jerome Dunning, Health Inspector for the Town of Barnstable because of another complaint by the.tenant, Roberta Mendes. The following violations of the Town of Barnstable Rental Ordinance Article 51 and the State Sanitary Code were observed: 410.504: No self-closing devices connected to the rear and side screen storm doors. 410.504: Weather stripping peeling off rear and side screen storm doors. 410.500: Hole observed in wall over the stove. 410.500: Bathroom wall was warped because of past leak. 410.500: Kitchen floor tile had several holes. Several kitchen floor tiles were detached. 410.500: Livingroom tiles were detached. 410.500: Bedroom ceiling is cracked. You are directed to correct the above listed violations within seven (7) days of receipt of this notice. r You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH Thomas McKean Director of Public Health Town of Barnstable September 6,1996 Mr. Scott Colantonio 25 General Patton Dr. Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY � CODE H, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDIN LE 51 / The property owned by you located at 28 General Patto D w�s i et e on yl by -- Jerome Dunning, Health Inspector for the Town of Barnsta le because of a complain The following violations of the Town of Barnstable Rental Ordinance Article 51 an the State Sanitary Code were observed: , ,, 410.504: Rear and side screen storm doors ather stripping peeli off. LX Proom4vWaarped 410.500: Hole wall over stove a b ause of past leak,, �Q 111.tchen floor tile ha ol ivingroom floor 4 v r nee g. ; cei-l-i re vio a if o wit in n -fou ours of receipt of t noti You are also directed to correct he above listed violations within seven (7) days of receipt of this notic . 7 You may request a hearing if wr tten petition requesting same is received by the Board of Health within seven (7) days a er the date order is received. However, this violation must be corrected regardless o any request for a hearing. r Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health Town of Barnstable Mr:MFS P O ;-6 01 NOTICE TO. ABATE VIOLATIONS OF 105 CMR 410,00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at a. V S-e 'Q fwas inspected on 1994 by t ,A -S I lealth Agent for the Town of Barnstable because of a complaint. The following violations of the Town of Barnstable Rental Ordinance Article 51 and the Sanitnry Code 11 were observed: v �l 10. 5-0 r You are directed to correct the violation of within 24 hours of receipt of this notice by You Are also directed to correct the remaining Above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Ilealth within seven (7) clays after the (late order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate (lay's failure to comply with an order shall constitute it separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. Enclosed are citation numbers due to violations observed on PER ORDER OF THE BOARD OF IIEALTH Thomas A. McKean Director of Public Health Town of Barnstable •FORM30 HOBBSB WARREN,INC. THE COMMONWEALTH OF MASSACHUSETTS • � �,_,,.., BOARD OF HEALTH CITY/TOWN DEPARTMENTAi T l ,�.j Ivy e ADD SS .— TELEPHONE Address f/at nee' Occupant— .� 06 Floor Apartment No. No.of Occupants— No.of Habitable Rooms x_No.Sleeping Rooms No.dwelling or rooming units No.Stories Name and address of owner Remarks Reg. Vlo. 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: ` ro a .5'Q Y Roof Gutters, Drains: r . ede Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: QYAL Hall Li htin Hall Windows: o _ n-, HEATING Chimneys: Central ❑Y ❑ N Equip. Repair A mot, TYPE: Stacks,Flues,Vents: Q o (� PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusin a,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 OF PERJURY." nn INSPECTOR �1 .,,,.�,�j TITLEr . p A.M. DATE ` I TIME P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions. Deemed to Endanger or Impair Health or Safety .� . ' s The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of these items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential to fall within this category in any given situation but may not do so in every case and therefore cannot be included in this listing. Failure to include shall in no way be construed as.a determination that other violations may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of the violation(s) pursuant to 410 CMR 410.830 through 410.833 nor shall it affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shut-off and/or failure to restore electricity or gas. (D). Failure to supply the electrical facilities required by 105 CMR 410.250(B); 410.251(A), 410.253(A), 410.253(B) and the lighting in common area required by 105 CMR 410.254. . (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage system in operable coadition 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 an object, including garbage or trash, Which prevents egress in case of an emergency 105 CMR 410.450 and .410.451. (R.) Failure to comply with the security requirements of 105 CMR 4110.480(D). (I) . Failure to comply with any provisions of 105 CMR 410.600 through 410.602 "hich. results in any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects -,.or other pests or otherwise contribute to accidents or to the creation or -:.spread of disease. (J) The presence of lead-based paint on a dwelling or dwelling unit in .violation of the Massachusetts Department of Public Health Regualtions for Lead Poisoning Prevention and Control 105 CMR 460.000. '(R) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or i*AfrMent to health or dafety. (1:) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilities as are°required by 105 CMR 410.351 and 410.352 so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment ryto:.health or safety. (1� 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: (`t) 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 operable. (2) failure to provide a washbasin and a shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3) and any defect which renders them inoperable. (3) any defect in the electrical, plumbing, or heating system which makes such system or any part thereof in violation of generally accepted plumbing heating,, gas-fitting, or electrical wiring standards that do not create an immediate hazard. (�) failure to maintain a safe handrail or .protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A) and 410.503(B). (5) failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A) through (M) shall be deemed to be a condition which may endanger or materially ii:pair 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 Health Complaints 27-Aug-96 Time: 5:17:56 PM Date: 8/27/96 Complaint Number: 389 Referred To: JEROME DUNNING Taken By: THOMAS MCKEAN Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 28 Street: General Patton Drive Village: HYANNIS Assessors Map-Parcel: Complaint Description: (1)The septic tank needs to pumped or replaced-the bathroom sink and kitchen sink backs-up, sometimes the toilet does not flush, (2)The carpeting is not secured to the floor, it is also worn and badly stained, (3) Hot water is too hot, sometimes the hot water tank shuts-off, (4)The furnace caused her daughter to get pneumonia and her son now has asthma- requests an inspector to check the filters, (5)The kitchen sink is leaking-cabinets are now rotting underneath the sink, (6)the refrigerator is collecting water again, (7)the plaster is falling down from the ceiling in the back bedroom, (8) the door is coming apart in the front bedroom, (9)the small electrical box in the back room is not covered allowing hornets to enter the house through the hole, (10) tiles are falling off the wall in the tub area, (11) the kitchen tiles are lifting again because peel stick was used to attach them, (12) there is a hole in the wall where the landlord pushed the exposed wire through above the stove, (13) the landlord did not weatherstrip properly, he pounded two nails into a three foot strip of weather stripping at side entrance door, (14) the front storm door has no spring attachments. The tenant said she removed it because it was bent and did not 1 Health Complaints 27-Aug-96 work. That door did not close properly. It took the last two inches of her dogs tail off, (15) the landlord never fixed the cracking wallplaster located at the bottom of the window which faces the street, and (16) the warped bathroom wall was not repaired. An appointment was tentatively scheduled on J. Dunning's calendar for Wednesday August 28th around 10:30 or 11:00 a.m. The tenant does not have a phone but she stated she will be there all day. Actions Taken/Results: Investigation Date: Investigation Time: 2 r - - 105 CMR: DEPARTMENT OF PUBLIC HEALTH 10.500:awhere sponsibility to Maintain Structural Elements owner shall maintain the foundation, floors,walls,doors,windows,ceilings,roof, porches, chimneys, and other structural elements of his dwelling so that the xcludes wind,rain and snow,and is rodent-proof,watertight and free from chronic weathertight, in good repair and in every way fit for the use intended. Further, aintain every structural element free from holes, cracks, loose plaster, or other re such holes,cracks,loose plaster or defect renders the area difficult to kecp cic:ui or constitutes an accident hazard or an insect or rodent harborage. 410.501: Weathertight Elements (A) A window shall be considered weathertight only if: (1) all panes of glass are in place, unbroken and properly caulked; and (2) the window opens and closes fully without excessive effort; and (3) exterior cracks between the prime window frame and the exterior wall are caulked; and (4) one of the following conditions is met: (a) a storm window is affixed to the prime window frame, with caulking installed so as to fill exterior cracks between the storm window frame and the prime window frame; or (b) weatherstripping is applied such that the space between the window sash and the prime window frame is no larger than 1/16 inch at any point on the perimeter of the sash, in the case of double hung windows and 1/32 inch in the case of casement windows; or (c) the window sash is sufficiently well-fitted such that, without weatherstripping, the space between the window sash and the prime window frame is no larger than 1/16 inch at any point on the perimeter of the sash in the case of double hung windows and 1/32 inch in the case of casement windows. (B) An exterior door or a door leading from a dwelling unit to a common passageway shall be considered to be weathertight only if: (1) all panes of glass are in place, unbroken and properly caulked; and (2) the door opens and closes fully without excessive effort; and (3) exterior cracks between the prime door frame and the exterior wall are caulked;and (4) one of the following conditions is met: (a) a storm door is affixed to the prime door frame,with caulking installed so as to fill exterior cracks between the storm door frame and the prime door frame; or (b) weatherstripping is applied such that the space between the door and the prime door frame is no larger than 1/16 inch at any point on the perimeter of the door or (c) the door is sufficiently well-fitted such that,without weather-stripping,the space between the door and the prime door frame is no larger than 1/16 inch at any point on the sides of the door or'A inch at any point on the top or bottom of the door. (C) A wall,floor,ceiling or other structural element shall be considered weathertight only if all cracks and spaces not part of heating,ventilating or air conditioning systems are caulked or filled in as to prevent infiltration of exterior air or moisture. 410.502: Use of Lead Paint Prohibited No paint that contains lead shall be used in painting any surface of any dwelling. (See 105 CMR 460.000.) 410.503: Protective Railings and Walls (A) The owner shall provide a safe handrail for every stairway that is used or intended for use by the occupants. !1 i t 4/22/94 105 CMR - 1627 105 CMR: DEPARTMENT OF PUBLIC HEALTH 410.503: continued < . (B) The owner shall provide a wall or protective railing at least 36 inches high enclosing every porch, balcony, roof or other similar place which is more than 30 inches above the ground and is used or intended for use by the occupants. All stairways used or intended for use by the occupants must be enclosed on both sides by a wall or protective railing at least 36 inches high. (C) All protective railings required by 105 CMR 410.503(B)shall have balusters placed at intervals of no more than six inches,or any other ornamental pattern between the railing and floor or stair such that a sp a ches in diameter cannot pass through. 10.504: Non-absorbent Surfaces (A) The floor surfaces of every room containing a toilet, shower or bathtub and ev kitchen and pantry shall be covered by a smooth,noncorrosive,nonabsorbent and waterproo material. This shall not prdhibit the use of carpeting in kitchens and bathrooms,nor the use of wood in the kitchen provided they meet the following qualifications: (1) Carpeting must contain a solid,nonabsorbent backing which will prevent the passage of moisture through it to the floor below; and (2) Wood flooring must have a water resistant finish and have no cracks to allow the accumulation of dirt and food, or the harborage of insects. (B) The walls up to a height of 48 inches(1.2 meters)of every room containing a toile or bathtub shall be covered by a smooth, noncorrosive, nonabsorbent and waterproof ma 'al. (C) The wall areas above built-in bathtubs having installed shower heads, and ' shower compartments,shall be covered by a smooth,noncorrosive,nonabsorbent wate oof material to a height of not less than six feet(1.8 meters)above the floor level. walls shall form a watertight joint with each other and with either the tub,rec , or shower floor. 410.505: Occupant's al Elements • The occupant shall exercise reasonable care in the use of the floors, walls, doors, windows, ceilings, roof, staircases, porches, chimneys, and other structural elements of the dwelling. 410.550: Extermination of Insects, Rodents and Skunks (A) The occupant of a dwelling containing one dwelling unit shall maintain the unit free from all rodents, skunks, cockroaches and insect infestation, and shall be responsible for exterminating them, provided, however, that the owner shall maintain any screen, fence or other structural element necessary to keep rodents and skunks from entering the dwelling. (B) The owner of a dwelling containing two or more dwelling units shall maintain it and its premises free from all rodents, skunks, cockroaches and insect infestation and shall be responsible for exterminating them. (C) The owner of a rooming house shall maintain it and its premises free from all rodents, skunks,cockroaches and insect infestation,and shall be responsible for exterminating them. (D) Extermination shall be accomplished by eliminating the harborage places of insects and, rodents, by removing or making inaccessible materials that may serve as their food or breeding ground,by poisoning,spraying,fumigating,trapping or by any other recognized and legal pest elimination method. All use of pesticides within the interior of a dwelling, dwelling unit, rooming house, or mobile home shall be in accordance with applicable laws and regulations of the Department of Food and Agriculture's Pesticide Board,including those appearing at 333 CMR 13.00, which provide, among other things, that pesticide applicators or their employers must give at least 48 hours pre-notification to occupants of all residential units prior to any routine commercial application of pesticides for the control of indoor household or structural indoor pests. 4/22/94 105 CMR - 1628 Form A310 RESIDENTIAL LEASE Apartment - Condominium - .House BY THIS AGREEMENT made and entered into op Sept8m�er 1 1993 between Colonial Management Company, Scott l & W&rredtoasLessor, and Roberta Mende s ,h ein referred to as Lessee, Lessor leases to Lessee the premises situated at 28 General Patten rive, :. , in the City of Hyannis , County of Barnstable , State of Massachusetts ,and more particularly described as follows: Single Family Dwelling together with all appurtenances, for a term of one y e a r s, t o commence on Se tember 1, , 19 93. , and to end on August. 31, , 1�93 , at o'clock M. 1. Rent. Lessee agrees to pay, without demand, to Lessor as rent for the demised premises the sum of Seven hundred twenty five dollars Dollars($ 725.00 per month in advance on the 1 S t day of each calendar month beginning September 1, , 19 9�, at 35 Greenfield Lane City of Scituate , State ofMassachusettfbt such other place as Lessor may designate. Z. Security Deposit. On execution of this lease, Lessee deposits with Lessor Seven` .tyrerity—five Dollars ($ 725 .00 ), receipt of which is acknowledged by Lessor, as security for the faithful performance by Lessee of the terms hereof, to be returned to Lessee, without interest, on the full and faithful performance by him of the provisions hereof. 3. Quiet Enjoyment. Lessor covenants that on paying the rent and performing the covenants herein contained,Lessee shall peacefully and quietly have,hold,and enjoy the demised premises for the agreed term. 4. Use of Premises. The demised premises shall be used and occupied by Lessee exclusively as a private single family residence, and neither the premises nor any part thereof shall be used at any time during the term of this lease by Lessee for the purpose of carrying on any business, profession,or trade of any kind, or for any purpose other than as a private single family residence. Lessee shall comply with all the sanitary laws, ordinances, rules, and orders of appropriate governmental authorities affecting the cleanliness, occupancy,and preservation of the demised premises,and the sidewalks connected thereto,during the term of this lease. 5. Number of.Occupants. Lessee agrees that the demised premises shall be occupied by no more than S persons,consisting of 1. adults and + children under the age of years, without the written consent of Lessor. 6. Condition of Premises. Lessee stipulates that he has examined the demised premises, including the grounds and all buildings and improvements,and that they are,at the time of this lease, in good order,repair,and a safe,clean,and tenantable condition. 7. Assignment and Subletting. Without the prior written consent of Lessor, Lessee shall not assign this lease, or sublet or grant any concession or licence to use the premises or any part thereof. A consent by Lessor to one assignment, subletting, concession, or license shall not be deemed to be a consent to any q g subsequent assignment, subletting, concession, or license. An assignment, subletting, concession,or license without the prior written consent of Lessor, or an assignment or subletting by operation of law, shall be void and shall,at Lessor's option, terminate this lease. 8. Alterations and Improvements. Lessee shall make no alterations to the buildings on the demised premises or construct any building or make other improvements on the demised premises without the prior written consent of Lessor. All alterations, changes, and improvements built, constructed, or placed on the demised premises by Lessee,with the exception of fixtures removable without damage to the premises and movable personal property,shall,unless otherwise provided by written agreement between Lessor and Lessee, be the property of Lessor and remain on the demised premises at the expiration or sooner termination of this lease. 9. Damage to Premises. If the demised premises, or any part thereof, shall be partially damaged by fire or other casualty not due to Lessee's negligence or willful act or that of his employee,family, agent, or visitor, the premises shall be promptly repaired by Lessor and there shall be an abatement of rent corresponding with the time during which, and the extent to which, the leased premises may have been untenantable.; but, if the leased premises should be damaged other than by Lessee's negligence or willful act or that of his employee, family, agent, or visitor to the extent that Lessor shall decide not to rebuild or repair, the term of this lease shall end and the rent shall be prorated up to the time of the damage. 0 53926 20045 o (Reviud 3t93) IV. UN I gCI 04.1a Ile 444tA W0. W— thing of a dangerous, inflammable, or explosive character that might unreasonably increase the danger of fire on the leased premises or that might be considered hazardous or extra hazardous by any responsible insurance company. 11. Utilities. Lessee shall be responsible for arranging for ind )r all utility s..rvices required on the premises,except that no utilities shall be provided by Lessor. .12. Maintenance and Repair. Lessee will, at his sole expense, keep and maintain the leased premises and appurtenances in good and sanitary condition and repair during the term of this lease and any renewal thereof. In particular,Lessee shall keep the fixtures in the house or on or about the leased premises in good order and repair;keep the furnace clean;keep the electric bells in order;keep the walks free from dirt and debris; and, at his sole expense,shall make all required repairs to the plumbing,range,heating,apparatus; and electric and gas fixtures whenever damage thereto shall have resulted from Lessee's misuse, waste, or neglect or that of his employee, family, agent, or visitor. Major maintenance and repair of the leased premises, not due to Lessee's misuse, waste, or neglect or that of his employee, family, agent, or visitor, shall be the responsibility of Lessor or his assigns. Lessee agrees that no signs shall be placed or painting done on or about the leased premises by Lessee or at his direction without the prior written consent of Lessor. 13. Animals. Lessee shall keep no domestic or other animals on or about the leased premises D 0� thout the written consent of Lessor. ` 14. Right of Inspection. Lessor and his agents shall have the right at all reasonable times during in the term of this lease and any renewal thereof to enter the demised premises for the purpose of inspecting the premises and all building and improvements thereon. 15. Display of Signs. During the last 30 days of this lease, Lessor or his agent shall have the privilege of displaying the usual "For Sale" or "For Rent" or "Vacancy" signs on the demised premises and of showing the property to prospective purchasers or tenants. 16. Subordination of Lease. This lease and Lessee's leasehold interest hereunder are and shall be subject, subordinate, and inferior to any liens cr encumbrances now or hereafter placed on the demised premises by Lessor,all advances made under any such liens or encumbrances,the interest payable on any such liens or encumbrances,and any and all renewals or extensions of such liens or encumbrances. 17. Holdover by Lessee. Should Lessee remain in possession of the demised premises with the consent of Lessor after the natural expiration of this lease, a new month-to-month tenancy shall be created between Lessor and Lessee which shall be subject to all the terms and conditions hereof but shall be terminated on 60 days'written notice served by either Lessor or Lessee on the other party. 18. Surrender of Premises. At the expiration of the lease term, Lessee shall quit and surrender the premises hereby demised in as good state and condition as they were at the commencement of this lease, reasonable use and wear thereof and damages by the elements excepted. 19. Default. If any default is made in the payment of rent, or any part thereof, at the times hereinbefore specified, or if any default is made in the performance of or compliance with any other term or condition hereof, the lease, at the option of Lessor, shall terminate and be forfeited, and Lessor may re-enter the premises and remove all persons therefrom. Lessee shall be given written notice of any default or breach, and termination and forfeiture of the lease shall not result if, within 10 days of receipt of such notice, Lessee has corrected the default or breach or has taken action reasonably likely to effect such correction within a reasonable time. 20. Abandonment. if at any time during the term of this lease Lessee abandons the demised premises or any part thereof, Lessor may, at his option, enter the demised premises by any means without being liable for any prosecution therefor, and without becoming liable to Lessee for damages or for any payment of any kind whatever, and may, at his discretion, as agent for Lessee, relet the demised premises, or any part thereof, for the whole or any part of the then unexpired term, and may receive and collect all rent payable by virtue of such reletting, and, at Lessor's option, hold Lessee liable for any difference between the rent that would have been pyable under this lease during the balance of the unexpired term, if this lease had continued in force, and the net rent for such period realized by Lessor by means of such reletting. If Lessor's right of re-entry is exercised following abandonment of the premises by Lessee, then Lessor may consider any personal property belonging to Lessee and left on the premises to also have been abandoned, in which case Lessor may dispose of all such personal property in any manner Lessor shall deem proper and is hereby relieved of all liability for doing so. 21. Binding Effect. The covenants and conditions herein contained shall apply to and bind the heirs, legal representatives, and assigns of the parties hereto, and all covenants are to be construed as conditions of this lease. 22. Other Terms:LESSEE SHALL FILL TAaNK WITH BEFORE QUITTING TENANC . LESSOR AND -LESSEE A� THE AFOREifENTIOivED IS BY A REEME OF BOTHoo E LESSOR AND LESSEE.. I ITNE HEREOF par ties have executed this lease at Hyannis, Massachusetts, County of B nst ear first above written. ssor d 2 5 113 Lessee m E-Z Legal Forms.Before you use this form`.read it,fill in all blanks,and make whatever changes are necessary to your particular transaction. consult a lawyer if you doubt the form's fitness for your purpose and use. E-Z Legal Forms and the retailer make no representation or warranty, express or implied,with respect to the merchantability of this form for an intended use or purpose. r 10. Dangerous Materials. Lessee shalt not xccp ur have on we leascU p►enllses any atucle 01 thing of a dangerous, inflammable,or explosive character that might unreasonably increase the danger of fire on the leased premises or that might be considered hazardous or extra hazardous by any responsible insurance company. 11. Utilities. Lessee shall be responsible for arranging for ind Jr all utility s..rvices required on the premises,except that no utilities shall be provided by Lessor. 12. Maintenance and Repair. Lessee will, at his sole expense, keep and maintain the leased premises and appurtenances in good and sanitary condition and repair during the term of this lease and any renewal thereof. In particular, Lessee shall keep the fixtures in the house or on or about the leased premises in good order and repair;keep the furnace clean;keep the electric bells in order;keep the walks free from dirt and debris; and;at his sole expense,shall make all required repairs to the plumbing,range,heating,apparatus, and electric and gas fixtures whenever damage thereto shall have resulted from Lessee's misuse, waste, or neglect or that of his employee, family, agent, or visitor. Major maintenance and repair of the leased premises, not due to Lessee's misuse, waste, or neglect or that of his employee, family, agent, or visitor, shall be the responsibility of Lessor or his assigns. Lessee agrees that no signs shall be placed or painting done on or about the leased premises by Lessee or at his direction without the prior written consent of Lessor. 0,14. 13. Animals. Lessee shall keep no domestic or other animals on or about the leased premises thout the written consent of Lessor. 14. Right of Inspection. Lessor and his agents shall have the right at all reasonable times ring the term of this lease and any renewal thereof to enter the demised premises for the purpose of inspecting the premises and all building and improvements thereon. 15. Display of Signs. During the last 30 days of this lease, Lessor or his agent shall have the privilege of displaying the usual "For Sale" or "For Rent" or "Vacancy" signs on the demised premises and of showing the property to prospective purchasers or tenants. 16. Subordination of Lease. This lease and Lessee's leasehold interest hereunder are and shall be subject, subordinate, and inferior to any liens cr encumbrances now or hereafter placed on the demised premises by Lessor,all advances made under any such liens or encumbrances,the interest payable on any such liens or encumbrances,and any and all renewals or extensions of such liens or encumbrances. 17. Holdover by Lessee. Should Lessee remain in possession of the demised premises with the consent of Lessor after the natural expiration of this lease, a new month-to-month tenancy shall be created between Lessor and Lessee which shall be subject to all the terms and conditions hereof but shall be terminated on 60 days'written notice served by either Lessor or Lessee on the other party. 18. Surrender of Premises. At the expiration of the lease term, Lessee shall quit and surrender the premises hereby demised in as good state and condition as they were at the commencement of this lease, reasonable use and wear thereof and damages by the elements excepted. 19. Default. If any default is made in the payment of rent, or any part thereof, at the times hereinbefore specified, or if any default is made in the performance of or compliance with any other term or condition hereof, the lease, at the option of Lessor, shall terminate and be forfeited, and Lessor may re-enter the premises and remove all persons therefrom. Lessee shall be given written notice of any default or breach, and termination and forfeiture of the lease shall not result if, within 10 days of receipt of such notice, Lessee has corrected the default or breach or has taken action reasonably likely to effect such correction within a reasonable time. 20. Abandonment. If at any time during the term of this lease Lessee abandons the demised premises or any part thereof, Lessor may, at his option, enter the demised premises by any means without being liable for any prosecution therefor, and without becoming liable to Lessee for damages or for any payment of any kind whatever, and may, at his discretion, as agent for Lessee, relet the demised premises, or any part thereof, for the whole or any part of the then unexpired term, and may receive and collect all rent payable by virtue of such reletting, and, at Lessor's option, hold Lessee liable for any difference between the rent that would have been pyable under this lease during the balance of the unexpired term, if this lease had force and the net rent for such period realized b Lessor b means of such reletting. If Lessor's continued In P Y Y right of re-entry is exercised following abandonment of the premises by Lessee,then Lessor may consider any personal property belonging to Lessee and left on the premises to also have been abandoned, in which case Lessor may dispose of all such personal property in any manner Lessor shall deem proper and is hereby relieved of all liability for doing so. 21. Binding Effect. The covenants and conditions herein contained shall apply to and bind the heirs, legal representatives, and assigns of the parties hereto, and all covenants are to be construed as conditions of this lease. O2 22: Other Terms:LESSEE SHALL FILL T 'TANK WITH BEFORE QUITTING TENANC .' LESSOR AND LESSEE'W THE .AFOREMENTIONED IS BY A REEME OF BOTHOE LESSOR AND LESSEE. I ITNE HEREOF parties have executed this lease at Hyannis, Massachusetts, County of B nstd car first above written. a ssor d 5 113 Lessee 9 - �n - p3 O E•Z Legal Forms.Befoe you use this form,read it,fill in all blanks,and make whatever changes are necessary to your particular transaction. Consult a lawyer if you doubt the form's fitness for your purpose and use. E-Z legal Forms and the retailer make no representation or warranty, express or implied,with respect to the merchantability of this form for an intended use or purpose. Health Complaints 12-Sep-96 Time: 5:17:56 PM Date: 8/27/96 Complaint Number: 389 Referred To: JEROME DUNNING Taken By: THOMAS MCKEAN Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 28 Street: General Patton Drive Village: HYANNIS Assessors Map-Parcel: Complaint Description: (1)The septic tank needs to pumped or replaced-the bathroom sink and kitchen sink backs-up, sometimes the toilet does not flush, (2)The carpeting is not secured to the floor, it is also worn and badly stained, (3) Hot water is too hot, sometimes the hot water tank shuts-off, (4)The furnace caused her daughter to get pneumonia and her son now has asthma- Ms. Mendes requests an inspector to check the filters, (5)The kitchen sink is leaking-cabinets are now rotting underneath the sink, (6)the refrigerator is collecting water again, (7)the plaster is falling down from the ceiling in the back bedroom, (8) the door is coming apart in the front bedroom, (9)the small electrical box in the back room is not covered allowing hornets to enter the house through the hole, (10) tiles are falling off the wall in the tub area, (11) the kitchen tiles are lifting again because peel stick was used to attach them, (12) there is a hole in the wall where the landlord pushed the exposed wire through above the stove, (13) the landlord did not weatherstrip properly, he pounded two nails into a three foot strip of weather stripping at side entrance door, (14) the front storm door has no spring attachments. The tenant said she removed it because it was bent and did not 1 Health Complaints 12-Sep-96 work. That door did not close properly. It took the last two inches of her dogs tail off, (15) the landlord never fixed the cracking wallplaster located at the bottom of the window which faces the street, and (16) the warped bathroom wall was not repaired. An appointment was tentatively scheduled on J. Dunning's calendar for Wednesday August 28th around 10:30 or 11:00 a.m. The tenant does not have a phone but she stated she will be there all day. Actions Taken/Results: Investigation Date: Investigation Time: 2 Health Complaints 12-Sep-96 Time: 5:17:56 PM Date: 8/27/96 Complaint Number: 389 Referred To: JEROME DUNNING Taken By: THOMAS MCKEAN Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 28 Street: General Patton Drive Village: HYANNIS Assessors Map-Parcel: Complaint Description: (1)The septic tank needs to pumped or replaced-the bathroom sink and kitchen sink backs-up, sometimes the toilet does not flush, (2)The carpeting is not secured to the floor, it is also worn and badly stained, (3) Hot water is too hot, sometimes the hot water tank shuts-off, (4)The furnace caused her daughter to get pneumonia and her son now has asthma- requests an inspector to check the filters, (5)The kitchen sink is leaking-cabinets are now rotting underneath the sink, (6)the refrigerator is collecting water again, (7)the plaster is falling down from the ceiling in the back bedroom, (8) the door is coming apart in the front bedroom, (9)the small electrical box in the back room is not covered allowing hornets to enter the house through the hole, (10) tiles are falling off the wall in the tub area, (11) the kitchen tiles are lifting again because peel stick was used to attach them, (12) there is a hole in the wall where the landlord pushed the exposed wire through above the stove, (13) the landlord did not weatherstrip properly, he pounded two nails into a three foot strip of weather stripping at side entrance door, (14) the front storm door has no spring attachments. The tenant said she removed it because it was bent and did not 1 Health Complaints 12-Sep-96 work. That door did not close properly. It took the last two inches of her dogs tail off, (15) the landlord never fixed the cracking wallplaster located at the bottom of the window which faces the street, and (16) the warped bathroom wall was not repaired. An appointment was tentatively scheduled on J. Dunning's calendar for Wednesday August 28th around 10:30 or 11:00 a.m. The tenant does not have a phone but she stated she will be there all day. Actions Taken/Results: Investigation Date: Investigation Time: 2 Town of Barnstable 1 RAW Health Department t6�p 367 Main Street, Hyannis,MA 02601 Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health October 27, 1995 Scott Colantonio 25 General Patton Drive Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 C MR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS_OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 28 General Patton Drive, Hyannis was inspected on October 25,1995 by , Health Inspector for the Town of Barnstable because of a complaint. The following violations of the Town of Barnstable Rental Ordinance Article 51 and the Sanitary Code II were observed: 410.504: Floor tile surfaces were peeling and worn and no longer nonabsorbent. 410.351: Electric outlet in kitchen next to stove was not functioning. 410.351: There was an exposed wire hanging from wall over kitchen stove. 410.351: The refrigerator had large amounts of water on bottom surface beneath vegetable crisper drawers. 410.501: Side entrance door was not weathertight. 410.500: A screw in the self closing device of the front storm door was not secure. The spring in the self closing device was not functioning, causing the storm door to slam shut. 410.500: Wallplaster was cracking near bottom of window facing street. 410.500: Bathroom wall near single was warped due to past water leak in shower/ tub plumbing. colant/q I- 410.150(D): Wooden toilet seat did not have a smooth and impervious surface which makes it very difficult to keep clean. 410.500: Tile soap dish was starting to come unattached from tile wall in shower. 410.500: Carpeting in livingroom, hallway and bedroom is stained and worn. You are directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH �omasMcKean Director of Public Health cc: Housing Assistance Corporation colanr/q c a des '�' / Cvt�►v1 il` ��16� o a.(' 0/ wareueM • NI►ed Town of ,Barnstable Health Department 367 Main Street, Hyannis MA 02601 Thomas A. McKean offices 508-190-6265 Director of Public He FAM 5o6-715-3341 0 D4 e)! TARY NOT ICE TO ABATE VIOLATIONS OF 105 CMR 410.00 STATE AB AT ON CUUE 1 I MINIM 8I1SItTNS��S RENTAL ORDIN CE FOR HARTICLE 1 N1U THE TOWN OEurela�k�� owned you located at The property °�a �� by, �j �=r Health Inspector for inspected on complaint. The the Town of Barns ble, because of a following violations of the Town of Barnstable Rental cTT Ordinance Article 51 and the San to Co a II were o serve N/U" 5-0V FlcoY ix Yw Co� S'dr4ac2.7C g d vv-e s l r '`/lU 3�I L//0. 3.5/ 01, lCe ,Pry of` S*Vw C)W k- wev 7t- 0 -11 cep 11 1110, 500 I�f�SI-ems s� G GPC-, � v- �o ►� �l l a. S"0 0 j3 ,L P-do M,&111 1L OoO)-eo, 7�f 1� Se.O-+ 1� , � so (�) i SC�►�o o-f h v p� t ve t d�r.!` Scs i��Q L A c CD lly,aVaS j4- U64,,-y o'� rcv1� k' e(62,h . y/6o 5"va S'� wu ti 1 u u l h�Yr3o h-,✓ 1 GCS jCc.� 111 O tin ,a y Yo ar dire �d to come h v la on of w' t went r (2' ours o eceipt of this notice You are o directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day' s- failure to comply with an order shall constitute a separate violation. You are 'also subject to non-criminal citaitons of $40.00 for the first violation and $15.00 for each additional violation. Tickets wil be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health C h/v�Sts/. hoc? oz /(DC) lam• r �► -�"'���='� f��'►h c.� �� G a2� 0/ FORM30 HOBB88 WARREN,INC.NOV.1979.1963 THE COMMONWEALTH OF MASSACHUSETTS BOARD /O_ F HEALTH - CITY/TOWN a - DEPARTMENT ADDRESS 9 U_, " TELEPHONE Address -�-k (�e,��n vz (. "1=:f/�,( l��- �o Occupant ;!�Imo:c-+« (•'1 �_-J. : Floor Apartment No: `- No.of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No.Stories r' -Name and address of owner 5 (r=rrit5�,��. 1- =rUl�: �f✓C I/y n r.i. h/1r'7 U,) marks Reg. Vlo. YARD Out Bld s::=Fences: ' -Gaeba a and Rubbish . Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual E ress:and Obst'n.: ❑B ❑ F ❑ M Doors Windows: _+ ROOF /)(rl l,�-1 r r-r r f f .P,I, L- .. Gutters, Drains: lam,-! ,!-r>�,r Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: W S Dampness: _ Stairs: --Fv r r'.,,.. Li htin + ,�' "�` i , �,.,�)-�- STRUCTURE INT. Hall Stairway: A Obst'n.: &e- 4 oe m Hall Floor Wall Ceiling: AT/ Hall Lic Oliting: 0- Hall Windows: �� clEr� ,..,. /� /r'o J/in-y �/c',v i c� HEATING Chimneys: Central ❑ Y ❑'N E ui .'Re air TYPE: Stacks Flues Vents:. l�-(n. !�) s /--, ,.,)-i.��� ,,. r)r,t-•' v;�., ,c. /: PLUMBING: Supply Line: ❑ MS ❑ST O-P, , Waste Line: H.W..Tank s Safety and_Vent s n 67" r, i l LT ELECTRICAL Panels Meters,Cir.: �,r-v�Ckm.• L��C�// k a9a C p ❑ 110 ❑220 Fusing,Grnd.: AMP: Gen"Cond.'Distrib. Box: 1 k?ram•%I 'Gen:Basement Wirin : 'DWELLING UNIT ,,, c 77 „ C l�_6 L-1 r- If ..Ventil. L to . Outlets .Walls Ceils.. .Wind. . Doors' Floors r Lock Kitchen Bathroom Pantry ,P ra I v I �. V-Ud Vd Den (-ti��^ Mr..:ft LMna Room 1�14_ a/.�_ ( , 1(1 Y 41' Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Su ..Ten. Gas.Oil Elect.: Stacks Flues,Vents,Safeties: Kitchen Facilities Sink.r .:Stove;. Bathing,Toilet Faeil. Vent.,Plumb.,Sanit'n.:' Wash Basin Shower or Tub: Infestation Rats 'Mice;Roaches or Other: Egress Dual and Obst'n: General Buildina 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) r "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED_ UNDER THE PAINS AND PENALTIES OF PERJURY." la, 1N8PECTOR TITLE / A.M. DATE. /ol'1�- 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 these items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential to fall within this category in any given situation but may not do so in_every case and therefore cannot be included in this listing. Failure to include shall in no way be construed as.a determination that other violations may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of the violation(s)-pursuant to 410 CMR 410.830 through 410.833 nor shall it affect the legal oblige-tion of .the person to whom the order is issued to comply with such .order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. `— (B) Failure to provide heat as required by 105 M 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shut-off and/or failure to restore electricity.or gas. (D) Failure to supply the electrical facilities required by 105. CMR 410.250(B), 410.251(A), 410.253(A), 410.253(B) and the lighting in common area required by 105 "CMR 410:254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage system in operable condition as required by 105 CMR 410.150(A)(1) and 410.300. (GJ Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by an object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450 and 410.451. (H) Failure to comply with the security requirements of 105 CMR 4110.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.602 which results in any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of lead-based paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regualtions for Lead Poisoning Prevention and Control 105 CMR 460.000. (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or dafety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilities as are required by 105 CMR 410.351 and 410.352 so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment , to health or safety. (M) Any of the following conditions which remain uncorrected for a period of five or more days following the notice.to or knowledge of the owner of said condition or conditions: (1) lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a.stove and oven or any defect that renders either operable. (2) failure to provide a washbasin and a shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3) and any defect which renders them inoperable. (3) any defect in the electrical, plumbing, or heating system which makes such system or any part thereof in violation of generally accepted plumbing heating,. gas-fitting, or electrical wiring standards that do not create an immediate hazard. .W. failure to maintain a safe handrail or .protective railing for every stairway, porch balcony, roof or similar.place as required by 105 CMR 410.503(A) and 410.503(B). (5) failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A) through (M) shall be deemed to be a condition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the board of health. October 27, 1995 Scott Colantonio 25 General Patton Drive Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410 00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE, ARTICLE 51 The d b you located at 28 General Patton Drive, Hyannis was inspected property owneY on October 25,1995 by , Health Inspector for the Town of Barnstable because of a complaint. The following violations of the Town of Barnstable Rental Ordinance Article 51 and the Sanitary Code II were observed: K1 k 4, t f)��" 4 .5 4� Floor tile surfaces were peeling and worn and no longer nonabsorbent. p 41 Electric outlet in kitchen next to stove was not functioning. 410.351: There was an exposed wire hanging from wall over kitchen stove. 410.351: The refrigerator had large amounts of water on bottom surface beneath vegetable crisper drawers. Aj do Side entrance door was not weathertight. t 410.5 �A screw in he self closing device of the front storm door was not secure aA .The spring in the self closing device was not functioning, causing they storm door to slam shut. 40 Wall Laster was crackin near bottom of win ow faci street L v�� � � t�,_,,,' v� ,I 410.50 Bathroom wall near single was warped due to past water leak in hoover/ � C tub plumbing. � (a t J t colandq 410150(Dl: Wooden toilet seat did not have a smooth and impervious surface which makes it very difficult to keep clean. ,)dt- 410.500: Tile soap dish was starting � rtin to come unattached from tile wall in shower. k.VS 410. Carpeting in livingroom, hallway and bedroom is stained and worn. (z`1,a (1 to ) lam. ! . U" You are directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health cc: Housing Assistance Corporation colant/q TOWN OF ARNSTABLE LOCA ^�� 6P�/1Cf/.l I AIMn SEWAGE #.C91MI' 7a7 VILLAGE jd y4011115 ASSESSOR'S MAP & LOT094- al INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY rW LEACHING FACILITY: (type) Off" SOb �A�• (size) 3x ayxa NO.OF BEDROOMS BUILDER O £( R OWNER J I O h•►e PERMUDATE: 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 leac •ng facility) l Feet Furnished by Sow IIh Z Lol .. � 4 a3a' ag Oy 3 3-7 b 3s, y yo 6 yo _ TOWN OF BARNSTABLE L'6CAnON 601 P47TO/V� '�/� SEWAGE # Qoal-'72 VILLAGE� /,d1/VL� ��ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SPINft SEPTIC TANK CAPACITY , �t7� `LEACHING FACILITY: (type)Q ]� Cftln&kK (size) 13 X q x NO. OF BEDROOMS BUILDER OR OWNER M1 Jtl0 PERMITDATE: /mom 1 � 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 .. �. P q s /'1 � � s 1 • � ® -, � J , 3 � _ �. �1 o � � F LEGEND s�� F TON 9a PROPOSED CONTOUR ROUTE 28 P A 99 PROPOSED SPOT GRADE Rd � P;;duo 110 EXISTING CONTOUR 11 G EXISTING SPOT GRADE8,6 3 fD g TEST PIT h �' W-`-- EXISTING WATER SERVICE o. a O 1 e Eldri a Pa{ton Cz WATER METER Q 30,E �' LOCUS 0 2 L/ 'LOT 19 N s , ,- ' MAP 292 N PARCEL 113 99,9 LOCUS MAP N.T.S. 10,605+S.F. w z x99.6 a I GENERAL NOTES: ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL ' 99�6 BOARD OF HEALTH AND THE DESIGN ENGINEER. i �x .SING 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS RapM ,��Na LC]T 20 OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE D 0 Q LOCAL RULES AND REGULATIONS. 3 OBE E 0#Z x �Q o 0 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR N ' 99,E - TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE �p DESIGN ENGINEER. LOT B R? x995 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING o FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN S ENGINEER BEFORE CONSTRUCTION CONTINUES. 99� ALL ELEVATIONS BASED ON ASSUMED DATUM. x993 W 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF T % THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF x988���� SEL7IC x HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. TANK x - D BOX 99 Z� �• ��" 7• WATER SUPPLY PROVIDED BY TOWN WATER. 99, 8. THERE ARE NO PRIVATE WELLS LOCATED WITHIN 100 OF THE S.A.S. BENCHMARK �`� , 10� -���:" <;t ���\ SEPTIC SYSTEM COMPONENTS SHALL BE INSTALLED AS DESCRIBED ORANGE PAINT MARK z G. . :: \N IN 310 cMR 15.000 SUBPART C. TOP CONCRETE PAD x _ ` 1::.' ;;.1 fU \� 10. ALL AREAS CLEARED FOR CONSTRUCTION ARE "TO BE LOAMED AND 98.f3 '�� 1::: N SEEDED UPON COMPLETION OF CONSTRUCTION. 1 i f EL:100.00 Assumed . 1 1�':. � y J x � ..::j :...<:i cA L 99.2 ,LLi 11. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 12. PROPERTY LINES SHOWN HAVE BEEN COMPILED FROM EXISTNG PLANS 4' + AND DEEDS OF RECORD AND ARE APPROXIMATE ONLY. THEY DO NOT N x REPRESENT AN ACTUAL ON THE GROUND PROPERTY LINE SURVEY. EXISTING CESSPOOLS (TV BE PUMPED & FILLED W/ SAND) x 112 \ 97 S\S062 9100�� �� PETER T. McENTEE C1V1L N PROPOSED SEPTIC SYSTEM UPGRADE } No. 35109 RFcsiER�� �� 28 GENERAL PATTON DRIVE, HYANNIS, MA Prepared for: Ed Toland, 52 Boardley Road, Sandwich, MA Engineering by: SCALE DRAWN JOB. NO. SCALE, 1�-20' �� �s Engineering Works 1"=20' P.T.M. 111-01 23 Deer Hollow Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. 0 RO 40 (508) 477-5313 1 1/01/01 P.T.M. 1 of 2 j - TO VENT FEL: LAB NOTE: FINISH E GRADE SHALLLUNOT H E PROPOSED< E97 3 F.G. EL: 99.2± FOR A DISTANCE OF 1 AROUND THE 7± PERIMETER OF THE S.F.G. EL: 99.1±(EXISTING)HOUSEENTRAN E) F.G. EL: 99.9±(EXISTING) F.G. EL: 99.7±(EXISTING) �� MAINTAIN 2% MIN SLOPE VER S.A.S. MAX. COVER = 36" INSTALL RISERS OVER INLET & OUTLET I INSTALL RISER OVER D—BOX TO L =10' TO WITHIN 6" OF FINISH GRADE WITHIN 6' OF FINISH GRADE PRO E A 2'X2'X4' SPLASH OF 3/4'-1 1/2' 4° SCH 40 PVC L —24' L =9'(MAX) D❑UBL ASHED STONE AT ACH INLET ENTRANCE L 4" SCH 40 PVC 4" SCH 40 PVC ! ' @ S= 2% (MIND io• O PROPOSED ta• @ S= 1% (MIN.) ® @ S= 1% (MIN.) 6' EFF. , ^�� 2 1500 GALLON INV, ELEV.=97.06 INV. ELEV.=96.89 DEPTH w SEPTIC TANK I INV.ELEV.=96.80 2' 3 NITS = 18.75' 1-2- TIE INTO EXISTING 4"C.I. PIPE 5' FROM HOUSE INSTALL INLET & OUTLET TEES INV.EL: 97.75±(EXISTING) GAS BAFFLE TO BE INSTALLED ON INV.EL: 97.30 EFFECTIVE LENGTH 22.75' OUTLET TEE AS MANUFACTURED BY USEg3SURSR OF 3—STANDARD INFILTRATOR CHAMBERS (H— ) IN INV.EL:97.55 TUF—TITE, ZABEL, OR EQUAL SEPTIC TANK & D—BOX SHALL BE SET LEVEL AND TRUE TO SERIOUNDED W/STONE TO FORA 20.4' X 22.75' S. . GRADE ON A MECHANICALLY COMPACTED SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). SOIL ABSORPTION SYSTEM (PROFILE) KTA /Z 2' LAYER OF SEPTIC SYSTEM PROFILE BREAKOUT ELEV.=97.30— WASHED STONE DOUBLE N.T.S. BOTTOM ELEV.=96.30 3/4'-1 1/2' DOUBLE WASHED STONE 5' MIN. ABOVE BOTTOM OF 3 2,8' 3' 2,8' 3' 2.8' 3' (3) 5" DwouTLETs T.P. EXCAVATI❑N OR G.W. EFF, WIDTH = 20.4' �F Mgff i�ss• W 16' • NO G,W, OBSERVED AT EL, 892 SOIL ABSORPTION SYSTEM (SECTION) ��Q� q�yG i'MAX. ADJUSTED G.W. ELi 91.0 Krs z o PETER T, BASED ON G,I,S. GROUND ELi 40 a GROUNDWATER ELi 25 MCIVILE 15.8• f- L- �; a, WELL A1W 230, ZONE D ADJUSTMENT=6,8', ❑CTOBER 2001 DESIGN CRITERIA o No. 35109 v 6' FOR MAX. G.W. ELF 31.8 OR 8.2' BELOW GROUND SURFACE o Sj�R�% H-10 LOADING 2' NUMBER OF BEDROOMS: 3 BEDROOMS 9pFFSS1 -BOX SOIL LOG SOIL TEXTURAL CLASS: CLASS I rrs DESIGN PERCOLATION RATE: <2 MIN/IN 0 DATE: NOVEMBER 1, 2001 DAILY FLOW: 330 G.P.D. U I�Q 3 - 20" Dia. Covers SOIL EVALUATOR: PETER T. MCENTEE P.E. DESIGN FLOW: 330 G.P.D. INSPECTOR: NOT REQ'D GARBAGE GRINDER: NO PROPOSED SEPTIC TANK: 1500 GAL. CAPACITY Elev. TP—1 De th LEACHING AREA REQUIRED: (330) = 445.9 S.F. ®®®® 0 ®®®f® i —�— ®®®®®®®®I®®® 33" 99.2 A 0" 74 N ®®®®®®®®®®® LOAMY SAND Ea�IHII31®®®®®® 1OYR 4/3 4" USE 3 ROWS OF 3—STANDARD INFILTRATOR UNITS (TOTAL=9) 6" Dia. Outlets 98.9 B LOAMY SAND 1N A 20.4' X 22.75' FIELD CONFIGURATION AS SHOWN 102" 1 4" 10YR 5/6 SIDEWALL AREA: NOT APPLICABLE 97.2 C 24" BOTTOM AREA: 20.4' x 22.75' = 464.1 S.F. a' KNocI Q r TOTAL AREA: 464.1 S.F. DESIGN FLOW PROVIDED: 0.74(464.1 S.F.) = 343.4 G.P.D. 20' DLk COVER jLevel KNOCKOUT O4' KNOCKOUT 62" 5'-8" 4'-7 48" Liquid 4'-4" I -C SAND 2.5Y6/4 E(508) 477-5313 ROPOSED SEPTIC SYSTEM UPGRADE a" KNOCKOUT 4" >20%GRAVEL .,. GENERAL PATTON DRIVE HYANNIS MA ared for: Ed Toland, 52 Boardley Road, Sandwich, MA 500 GALLON CAPACITY, H-10 LOADING 1500 GALLON CAPACITY, H-10 LOADING by: SCALE DRAWN JOB. NO. CHAMBERS SEPTIC TANK ss.2 12°" NTS P.T.M. 111-01 Kra• NO G.W. ENCOUNTERED, ADJUSTED HIGH G.W. EL: 91 ring Works Krs low Road, Forestdale, MA 02644 DATE CHECKED SHEET N0. PERC RATE: <2 MIN/IN. "C" HORIZON 11/O1/O1 P.T.M. 2 Of 2