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HomeMy WebLinkAbout0020 REDWOOD LANE - Health 20 REDWOOD DR., HYANNIS A= � O�L o e I i ° I I i o II �y o II Commonwealth of Massachusetts W Title 5 Official Inspection Form / Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v` ryl 20 Redwood Lane, Hyannis ' Property Address Richard Bonini y Owner O wner's Name 77 information is Canton CT 06019 December 6 2016 required for every , page. City/Town State Zip Code Date of Inspection S. r.J1 Ra"1 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, / use only the tab 1. Inspector: key to move your cursor-do not David B. Mason use the return Name of Inspector key. —� Company Name 4 Glacier Path Company Address East Sandwich MA 02537 City/Town State Zip Code 508-833-2177 S 1287 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority December 6, 2016 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 � w d -o 401 _ f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �.� 20 Redwood Lane, Hyannis Property Address Richard Bonini Owner Owner's Name information is required for every Canton CT 06019 December 6, 2016 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Redwood Lane, Hyannis Property Address Richard Bonini Owner Owner's Name information is required for every Canton CT 06019 December 6, 2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ® Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ® distribution box is leveled or replaced ® Y ❑ N ❑ ND (Explain below): Distribution box has been replaced and riser installed. ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 20 Redwood Lane, Hyannis Property Address Richard Bonini Owner Owner's Name information is required for every Canton CT 06019 December 6, 2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** 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 0 ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Redwood Lane, Hyannis Property Address Richard Bonini Owner Owner's Name information is required for every Canton CT 06019 December 6, 2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 20 Redwood Lane, Hyannis Property Address Richard Bonini Owner Owner's Name information is Canton CT 06019 December 6, 2016 required for every page. CitylTown 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.doc•rev.6/16 Title.5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 20 Redwood Lane, Hyannis Property Address Richard Bonini Owner Owner's Name information is required for every Canton CT 06019 December 6, 2016 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d Yes 9 ( Y 9 (gp ))� Detail: 2014; 39,750 gallons and 2015; 21,000 gallons. Sump pump? ❑ Yes ® No Last date of occupancy: Current 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? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts. W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 20 Redwood Lane, Hyannis Property Address Richard Bonini Owner Owner's Name information is required for every Canton CT 06019 December 6, 2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Board of Health Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Redwood Lane, Hyannis Property Address Richard Bonini Owner Owner's Name information is required for every Canton CT 06019 December 6, 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: System Compliance for installation issued 10/17/1996 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: NA feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer line underground. Unable to view. Septic Tank(locate on site plan): Depth below grade: 91, feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Typical 1500 Sludge depth: 0 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Redwood Lane, Hyannis Property Address Richard Bonini Owner Owner's Name information is required for every Canton CT 06019 December 6, 2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 0 Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 0 Distance from bottom of scum to bottom of outlet tee or baffle 0 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Outlet PVC tees in place. Effluent level with outlet invert Maintenance pumping has been completed Grease Trap (locate on site plan): Depth below grade: feet Material of construction: [] concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments CGM , 20 Redwood Lane, Hyannis Property Address Richard Bonini Owner Owner's Name information is required for every Canton CT 06019 December 6, 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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: 0 Yes El No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): `Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Redwood Lane, Hyannis Property Address Richard Bonini Owner Owner's Name information is Canton CT 06019 December 6 2016 required for every , page. City/Town 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 level with outlet inverts 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.): effluent level with outlet inverts. Flow equalizers are in place. No evidence of carryover from septic tank. 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: Leaching is: leaching trenches without inspection ports. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Redwood Lane, Hyannis Property Address. Richard Bonini Owner Owner's Name information is required for every Canton CT 06019 December 6, 2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2-30' longx2" wide ❑ 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.): Probed area of the system with no indication of ponding or saturated stone. D-box is 18" below grade. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan).- Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 20 Redwood Lane, Hyannis Property Address Richard Bonini Owner Owner's Name information is required for every Canton CT 06019 December 6, 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Redwood Lane, Hyannis Property Address Richard Bonini Owner Owner's Name information is required for every Canton CT 06019 December 6, 2016 page. CityTTown 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.doc•rev.6/16 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 ° M 20 Redwood Lane, Hyannis Property Address Richard Bonini Owner Owner's Name information is required for every Canton CT 06019 December 6 2016 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: 12 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: groundwater contour map ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: based on groundwater contour map. z Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Redwood Lane, Hyannis Property Address Richard Bonini Owner Owner's Name information is required for every Canton CT 06019 December 6, 2016. page. City/Town 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE LOCATION -10 994,Wgm vs SEWAGE ii VILLAGE !}'r� ASSESSOR'S MAP&LOT92i''OlC INSTALLER'S NAME&PHONE NO.1f✓CAe<' (b,,054 -7?i Vrc.B SEPTIC TANK CAPACITY ��S-1" LEACHING FACILITY:(type) —IXtNCCN (size) 3c 5lY',y;t/ NO.OFBEDROOMS BUILDER OR PERMITDATE: A2 9cK COMPLIANCE DATE:_ Z ;"Z!J Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wedand and Leaching Facility(If any wetlands exist within 300 feet of 1? hing acility) Feet Furnished byrrRaf .xy- x' /a 30' . a�. http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=288082&seq=1 12/5/2016 T` I No. * Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(ppl.tation for MispoSal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No.., �40o �j/v� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel � CYO CP ®� Installer's Name,Address,and Tel.No. Designer'e,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 4%T�V = No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �� � � CV, � Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of th. � r Signed Date � j Application Approved by Date 16 6 Application Disapproved by Date for the following reasons Permit No. OW6 ot_�> Date Issued AV/ / . ' No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION — TOWN Of BARNSTABLE, MASSACHUSETTS Yes 2ppIication for Misposar 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No., �6J�j G!/D O �j Owner's Name,Address,and Tel.No. Assessor's Map/Parcel cA. CP DP 4�x r! y Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: s Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 41T No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) i i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of e th. Signed Date /;/t`" Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 9 L/ Date Issued / lD --------------------------------------------------------------------------------------------------------------------------------------- I THE COMMONWEALTH OF MASSACHUSETTS O&Z /BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by(j,:d♦� .�!'��a�y� �.f'�/� '�L� p L'"C { at o� ® '��lti Oa�j L lr 05✓y. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Npl_, /t� �jdated Installer t_�Vw .�s�, 0 /� Designer #bedrooms Approved paesino •/jam' gpd The issuance of llermit shall not be construed as a guarantee that the systemtion as desi ed. Date { Z I Inspector / Y� ---- -- - - ----------------------•---------- ------------------------------------------------------------------------- —)216 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal *pstrm Construction Permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at c zy &1e--te I!J 0.0 d /+� ,zj U i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. S Provided:Construction must be com 'leted within three years of the date of this pe it. Date ��p ��„ Approved by AsBuilt Page 1 of 1 IV -�---- TOWN OF BARNSTABLE LOCATION e2O ��O Vb ya SEWAGE# VILLAGE ASSESSOR'S MAP&LOT922'"0 % INSTALLER'S NAME&PHONE NO. /f/CKLS� c ,)Yz 77i V14 8 SEPTIC TANK CAPACITY S� LEACHING FACILITY:(type) i%�tn�a1� (size) '70 )!Y',Yz, NO.OF BEDROOMS BUILDER PERmrrDATE: ��"" �'"" 2K COMPLIANCE DATE: l4 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet . Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wedand and Leaching Facility(If any wetlands exist within 300 feet of 1 hing acility) Feet Furnished by_ ' /G ��✓ 3t►c.t� 36 m� /a 36 . http://issgl2/intranet/propdata/prebuilt.aspx?mappar=288082&seq=1 12/6/2016 TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date Z 3 Time: In Out Owner �G�'r9�p60A)I DJ Tenant °'►���)L � �""' Address I���&q 64��Z—J,, Address A R f'DW oo l tic., (�i�� . G I PYA otj is, P?A Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities l`J 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal Of 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms 3 Number of Vehicles Allowe ax) Number of Persons Allowed (max) Person(s) Interviewed Qc&y Inspector If Public Building such as Store or Hotel/Motel specify here 11//W�v A COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ay 1D DEPARTMENT OF MmRONl1lTENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSAL TEM FORMS PART A CERTII�TCATION Property Address: 02 G 4,1 Owner's Name: ar q O �� Owner's Address. O Off `- OX ,S Date of Inspecdon: /d 'f 0016 Sf,,f7 21 �: v Name of Inspector;( p*int) ol✓� �G��� Company Name: E,vvj MaOing Address: o ,� ,� :' Ziz Telephone Number S" r-- CERTIFICATION STATEMENT I cer*that I have personally,inspected the sewage below is true,accurate and l at this address and that the information reported training plate as a�the time of the inspection The inspection was pezforai I on my app��,tm 1 fi�nction maime�noe a�fon site sewage ems.I am a DEP inspector pu umft to n ISJO of Title S(310 CMR 1100q The system; Passes Conditionally Passes Needs Further Evaluation by the Local Approving Ate, Fails Inspector's Signature: , Date: The system inspector shall submit copy of this inspection completing this inspection,Uthe rt to the Approving Autho DEP)within 30 days of ' (Board of Health or gpd or 'the and the system owner shall is a shared q�or has a design flow of 10,000 DER The original should be sent to the svbmrt report to the appropriate region office of the authority system owner and copes sent to the buyer,if applicable,and the approving Notes and Comments •'*'This report only describes conditions at the time of itions of us time. This inspection does not address how the system wr7l��rm in the on and dfature nndeer the rthe same o at that conditions of use. ditferent Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART A CERTMCATION(continued) Props Address: 0 Z J o i Date Mspection: /� 0 'nspecdonSummmV Chwk A$,C,D or E/AL AY complete all of Section D A. Sy have not found any information which indicates that 1 my of the failure 303 3 in 310 CUR 13.304 exist.Any failru+e criteria not evaluated are afteria gibed in 310 CMR indicated below commeaft IL System Conditionally passex One or more system components as desca'bed in the"Conditional Pass"section need to be replaced or TU system,uPQu completion of the reps or repair,as approved by the Board of Heft will puL Answer y M no or not determined(Y,N,ND)in the for the following statements,if"not dWNdain. ply unsormd,exhibits�is metal and over 20 years old*or the (whether antial iffihaatian or ex6ltration or tank tank w metal or not)is strucpually odsdS tank is replaced with a compiying septic tank as by Is S��w�P��spection if the 'A metal septic tank will pass inspection if it is Much,sow, riot leaking and indicating that the tank is less than 20 years old is available, if a of Compliance ND explain; Obsw atim of selvage badcup or break out or high static water level in the Obstructed approval of Board or due to a broken,settled or uacven �m n box due to broken or distribution box. S pass inspection if(with been luhre(s)are nplaoed obstruction is removed distribution box is leveled or replaced ND explain; Mle system rewired Pumping more than 4 times approval of the the Board of Health a year due to pipets).The system will Pass inspection if(with broken or obstrucW broken pipes)are replaced obstruction is removed ND explain: Pape 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A TI�TCATION(continued) �Ixdy Addn=- oZ 0 �e Wood G Owner. Co�i n Date of Inspection: �- p C- //Itrtber Evdndon is Reynird by the Board of Health: ,LIL u ist which require further evaluation by tho Board of Health in is failing to protect public health,safety or the eavironment, order to determine if the system 1. System will pass unless Board of Health determines in accordanm with 310 CMR 11 1 system is not functioning in a manner whicb wig protect public health,s�dety and the�the --_ Cesspool ar privy.is within SO feet of a surface _ Cesspool or privy is within SO feet of a water bordering v wetland ar a snit marsh 2. System wM fail unless the Board of Health(and Public Water Supplier,if an rnbes system is�in a manner that protects the public health,safety and ea ronme that the MW surface wqe tank and a septic ta and soil absorption system(SAS)and the SAS is within 100 feet of a supply or taluary 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, _ TU system has a septic tank and SAS and the SAS is within 50 feet of a private water mPlilY wa private water�3'ac teak and SAS and the SAS is less than 100 feet but SO iAdmore from a well Method used to determine dista m of"This system passes if the well water bacteria and volatile o ems'Permed at a DEP certified lady;for coliform ds indicates that the well is free ftinpollution the presence of ammonia nitrogen and nitrate nitrogen is eequal to less than S form that facilityand failure criteria are triggered.A copy of the anabsis must be attached to this for.PPflk Provided that no other 3. Other: Pa®e4of11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertLAjddn4%L- ,;Owner.Date ofd D. System Fanure Criteria applicable to an systems: YOU mn indicate"Yee or"no"to each of the following for ate. ons. Yee N� -nBacbP Of seovage Into bcft or overloaded or — aigeol orpond qg of enlue t to the ground or surface orate due to an oMerdogged&AS or sspo od or cesspool or --. — X gtud.leyel in the n above outlet invert due to an o ed faded or clogged,SAS or pumping than 4 depth in cesspoa is less than 6"below invert or available vow is leas than%day now t more times in the lastyear—kQT due to clogged or s N PiPo( )• umber ✓Any �portion the SAS,cesspool or privy is below high groundwater elevation, porti,water may. cesspool or pmy is within 100 fed of a surface water supply or tributary to a surfaoo �A°y p�of a cesspool or privy is within a Zone 1 of a public well. portion of a cesspool or privy is within 30 fleet of a private water Any portion of a cesspool or Privy is less than 100 fat but greater dian S0 fed ftm a private water sup*well with no performed at a DEp�water�Y�ysi& Ih O'stem Paaeea if the well water analysis,eert�ed laboratory,for eoliform barber):and voladk organic impounds indkatea that the wen b free from Pollatlon from that f lea and nitrate p d ammonia free from to or less than S PPm,provided that no other faffure criteria are triggered.A copy of the analysis moat be attached to this form.) �--�_(Yes/No)The system LaU I have determined that one or more of the above failure criteria east as described in 310 CMR 15.303,therefore the system fails.The system owner should eoutac t the Board of Health to determine what will be necessary to correct the failum E. Large Systems: To be considered a large system the system most serve a f acinty with a design flow of 10,000 gPd to 13,000 You must indicate either`year or"no"to each of the following; (The following criteria apply to large Mien s m addition to the criteria above) Kesystem is within 400 feet of a surface drnbng water yappjy ystem is within 200 fed of a tributary to a surface drinking water supply the the�of is located in a public waters well Area area(Interim Wellhead Protection Area—IWPA)or a mapped If you have answered"yes"to any question in Section E the system is considered a si "Yes"in Section D above the large system has failed,The owner or operator of "�threat,or answered significant threat under Section E or failedunder SertioaD shall any�W*m considered a 15.304.The system owner should contact the appropriate regional�stem a0DDepirtment. 31Q.CUR 4 V Page 5 of i 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: �� �d woo Z- owner: O f/l-i Date�Info■: �� Check if the folio have been done:You mast iadicft es"or"no"as to each of the followin Yes o — _ mformaf=was provided by the owner,=Upa�or Board of Health eR�9 of the System cow pumped out in ae previous two wftb — _ Has�he system renewed normal Bows is the p�vw=two week period ._ `/ huge volumes of water been h*oduood to the system=ex*or as part of this iaspectioa Were as built plans of the system.obtained and examined?t?f they were not available note as N/A) Was the facility or dwelling i for� bads sewage up Was the site inspected for signs of break out Wens all system componeaf,mdudm the 1 8 SAS, ocatad aun site Wane the septic W*rnaahoies of the ar 1ees,material of o and the of the tank insp0c�bed for the condition'mom&Tth ot&pgK depth of sludge ad depth ofscum boa of ft �( if different from owner)Provided with b0browdon on the proper The size and location of the Soil Absorption System(SAS)on the site has been d based on Yes — _ information.For cmnpk a pian 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)P 10 ChM 15.302(3)(b)j 4 • Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY-ASSESSAWITS SUBSURFACE,SEWAGE-DISPOSAL SYSTEM INSPECTION'FORM PART C n SYSTEM $ TMN Property Address: l/`v �(Voo Owner. l ram. Date of Inspection 571 RESIDUCIUL w.CO1 ffWNS NWxW-of hakooaes(design):-,3 Number of bedoxws(achWr.3 DES104 flow bead.aa:3lo.OAR-15.203(fbr Ala Ilo Wd.x d of bednoo�j; ,� > Number of canreat residents: Does residence bane a image grinder(ya or no). Is laundry on a separ-te sewage system bes or no• /Lt� : )' Cayes separate rn�octron Seasonal�� e�ar no)._ Water meter=dM if available(last 2 years CWM). Sump pump(yes or no). ,09 Last date of occupancy; _(,�iz CO RCMLMMUSTRIAL TYpe of estabiSsbme : Design flow(based an 310 C119L 15.203): sad. Basis of design flow(sc8h00ersons/sgft etc.); Grease aw 1 (Ves or no):_ Industrial waste holding tank present:(m or no):_ Non-sanitary waste dlscharPd to the Trtk 5 system(yes or no):_ Water meter readings,if available: Last date of=upwW/bse: OTHER(descabe): GENERAL,EUORMATION Pumping Records Source of informadow 0 p-/— ..7 Was system pumped as part of the man(yes or ao): ZP �'f — B �-"�-.✓ UM volume pumped: eallons—How was quantity pumped determine Reason hr SYSTEM tank distribution box,soil absorption system Singh cesspool _Overflow cesspool _Rivy --Shared system(yes or no)(if yes,attach _hovativdAlternative techao �o�m' On records,if my) - obtained from system owner) 'Attach a ropy of the cement operatian and fiance contract(to be —_Tit;#tank _Attach a Copy of the DEP approval Other(desaft)• Approxunate age of all components,data,nctap�(ifo�a�aV source of in ormadon: A,)— //>- � _/so Were sewage odors detected when amving at the site(yes or no):zn? Page 7 of 11 OFFICIAL INSPECTION FORM—NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARYC SYSTEM INFORMATION( Property Addr+em QZ 0 QedwoOd G�/ owner. L,0111., Date of Inspection; 0 BUILDING SEWER Vacate. site pin) Depth belowMatmials Of graft: / Distance from private water ►wed ar °3be`( ; Commems(on C=Iffibonr ofiolnm:VAnhN;evideaoe of ages e�c r SEPTIC T • c/ANK.—(�.sift pbM) Depth below grads: Material of oonstitecfiom . �"_mew other( Fftadcism �;_ Of X (� a(yes air no):_(attach a copy of d . e Distance 4*slsido ScumP �/�_ bottoa'°f°adet .m baffie: oZ thicl®ess: Distance from top of scam.to UP of arotlet tee or bathe: 6 Distance from bottom of scm.to oatsdet ca tee or� �• How were dd / / ( mmem 0° �m,inlet and outlet asplaw to�":• or baffle condition,dal mph';liquid levels A 7�' r rn GREASE Tom;J( on site pian) Dqth below Va& Material of — ( )• concrete—mew—M=912=--P*Ohyke_othw Dimensiom: scum tom: Distance from tap of scum to top O(outlet tee or baffle: Dulanm l g of scum to bottom of outlet tee or be�ee: pImpin Comm(an punPng roD° ionsy inlet and outlet.tee or baffle conditio as related to Outlet invert,evidence of leakage,etc.): �Y,hgmd levels • Pars of 11 OFFICIAL INSPECTION FORAM=NOT FOR VOLMARY ASSESSMENK S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SY76-mloo INFORMATION(con�dj Property Addrem c2 0 9e � Z— Owner: o 0014 0/ Date of Inspecdom: i- TIGHT or HOLDING TANS:"(must be punted at Mime of ins wdOnxku*on site Plan) Depthbelow Material of onion: ooncmte metal _polyethylene odia(cqlain). coackk- ems. ea>tong . Des< n;I?low;: jaUwWda9 Alarm presert(yes orno,): Alarm level:- Alarm in working order(yes or no).. Date of last pining: Comments(eond tx n of alarm and RM switch(s,etc.): DISTR18II1'ION BOx: C¢pmscnt„mW be openedxlocate on site plan) Depth of timid level above outlet invert: y1O/v,,A a Comments(note if box is level and d+sb&Wou to outlets equal,any evidence of solids lase into oQ box,eta): �3' ,anY evidence of /s So/ i1j� 4e PUMP CHAMBER: on site plan) Pumps in working order(yes or no): Alarms in working order(yes ar no): Comment(note oon&fm afp=V dmiber,condition ofpnmps and qVmu=MCM eta): Pap 9ofi1 OFFICIAL INSPECTION FORM-NOT FOR VOLUPITARY ASSESSUE M SUBSURFACE SEWAGE DWOSAL SYSTM INSPILMON FORM PA.C. SYSTEM HOORMA'P ON(ooetia PO LaFAdder d D<e G✓oE� ��/ Owner: (r✓i oa-c o/ Date of Ind 0 SOII.ABSOBi!fXW S VS7 M .Waite plan,�cw:Bao aat.rhgir,� If SAS not lxateie�p W* > gPiW ;- `�,.� / , / ovedbw►cesspool, Comna�i systeaa .Typdname of technciw -------------- etc. aon on of soi,siges of hydra & Tlevel of ponding,damp soil,eon�ti of •�, o CIeA" G�7 CB L1L 4 ai MW be pumped as pW of is on site Pin) Numberaacf ; Depth of soma i Matte afcxssponl, Indcafmn of is�ow ao Cmmeft fm* of sod sight of h7dWic level ofponding,M&imafwpbbMar� PRE'�/L a�n si6e piaa) Mateoals of CmsftvCdW Dfinmajow Com=Ws fn mk&bm afs*am of* level ot'pcmdiag c�amditioa ofve e�c.3: J Page 10 of 11 OFFICIAL INSPECTION FORM-NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinno Properly Atldnim a o n�f Oe26�� Owner: � Date of hlspecdalu d SKETCH OF SEWAGE DEPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two perm mercrm benchmadm,Locate all wells within 100 feet.Locate when pobtic water supply enters the buddmg G1G ►'V f . Pale 11 of 11 OMCJFAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESS MENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C RM SYS INFORMATION(c n im eM Property Address Owner. Col/ 41 ,, Date of inspe�; o SITE EXAM Slope , Surface water check cellar Shallow wells �to�d water /ice �-� T O r _ (check)all methods used to dckmrmic the I &oimd water elewatm . an � �h witL; die ofdedg. SAS plan c wdmd with local Board of xeahh end - s t of SAS) � e -� You (atbch docmneffiati�l must dmcnl*spur you � io d kkk V002d water devaitos: ,1-G�.i - v o g �G Lc c l e p K✓� p o P rf Gi„�► zoLlr- — 2.9 CI-©LI✓`0�(n/c 7-�'�/ _ /� r Z 273 502 603 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Senft e um Po Office, ode Postage $ a Certified Fee Special Delivery Fee Restricted Delivery Fee to Retum Receipt Showing to Whom&Date Delivered n Retum Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ M Postmark or Date _ ri 07 i i Stick postage stamps to article to cover First-Class postage,certified mail fee,and ' charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return y PP 9 9 address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the a�i return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address °' rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the O O addressee,endorse RESTRICTED DELIVERY on the front of the article. 00 M 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. li 6. Save this receipt and present it if you make an inquiry. 102595-99-M-0079 d i .�� Town of Barnstable Department of Health, Safety, and Environmental Services BAMSTABM 059 Public Health Division 9� i639 ,�� ArFD1i"°rA P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health April 14, 2000 Kerry P. Aylmer, Trustee c/o Thomas Nastasia 62 Dunaskin Road Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE H, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 20 Redwood Lane, Hyannis, was inspected on March 30, 2000 by Glen Harrington, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code H, Minimum Standards of Fitness for Human Habitation were observed: 410.256: Five cable wires were observed entering the building through a basement window. 410.351: The baseboard heater covers were observed missing in living room. 410.351: A broken electrical switch plate and a loose ground fault circuit interrupt socket was observed in the bathroom. 410.351: An electrical outlet cover was observed missing in the living room. 410.351: The light/fan was inoperable in bathroom. 410.452: Broken bricks were observed in the stoop at the side entrance. 410.481: The dwelling was not posted with owners name, address and telephone number. 410.500: The sill at the side door was observed to be rotted. 410.500: The paint on the windows and trim was observed to be chipped and peeling. aylmer/wp/q/ls 410.500: A one foot square hole was observed in kitchen ceiling. 410.500: The floor in the bathroom was observed to have broken and loose linoleum tiles. This was apparently due to a water damaged and rotted subfloor. 410.500: There were no gutters installed on dwelling. 410.501: The screen to the living room window was observed to be broken. 410.501: The storm window on the rear bedroom was observed to be inadequate due to wrong size. You are directed to correct the above listed violations within seven (7) days of receipt of this notice. In addition, according to Town of Barnstable"Health Regulation Regarding Fuel and Chemical Storage Systems," the piping to the abandoned above ground fuel storage tank must be removed. 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 4s?McKean Director of Public Health COMMONWEALTH OF MASSACHUSETTS f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS h a DEPARTMENT OF ENVIRONMENTAL T 20 RIVERSIDE DRIVE, LAKEVILLE, MA 02347 508 W27 -P-y 41 Yo ARGEO PAUL CELLUCCI BOB DURAND Governor Secretary JANE SWIFT APR 4 WEN A.LISS Lieutenant Governor. WEN URGENT LEGAL MATTER: PROMPT ACTION NECESSARY CERTIFIED MAIL: RETURN RECIEPT REQUESTED April 12,2000 Cape Co Regional Transit Authority RE: BARNSTABLE—BWSC 4-0000477 Post OfceSox 2006 Fmr.Bradley's Drycleaner Dennis, Mass husetts 02638 242 Main Street NOTICE OF RESPONSIBILITY To Whom It May Co ern: The Massachuse epartment of Environmental Protection, Bureau of Waste Site Cleanup (the "Department"), is tasked w ensuring the permanent cleanup of oil and hazardous material releases pursuant to Massachusetts Ge ral Law Chapter 21E ("Chapter 21E"). The law is implemented through regulations known as the Massac usetts Contingency Plan,310 CMR 40.0000 et seq. (the"MCP"). Through the MCP,the Dep ent is currently regulating a release of hazardous material that has occurred at 242 Main Street,Bamstab Massachusetts. The Department was first notified of the release on September 23, 1987. The Departme t does not currently have in its files appropriate documentation indicating that the release is being address in the timely manner that is required by the regulations. The Department's records indicate t t you are the owner of the property where the release occurred. As the owner of the property, you ar a Potentially Responsible Party ("PRP") with potential liability for the release pursuant to Chapter 21E. e liability is "strict", meaning that it is not based on fault, but solely on your status as the owner of the roperty where the release occurred. This liability is also "joint and several", meaning that you may be he liable for the release and all response action costs incurred at the disposal site regardless of the existence any other liable parties. The purpose of this Notice is to inform you of y ur legal responsibilities under State law for assessing and/or remediating the release. Enclosed with th Notice is a summary sheet outlining the potential liability issues associated with Chapter 21E. Additio Ily, this Notice is to inform you that the response actions required to address the release are overdue. Spe 'fically, the MCP requires that either a Tier Classification, Response Action Outcome Statement or Down adient Property Status Submittal be submitted to the Department within a predetermined timeframe. The epartment's files indicate one of these documents was due to the Department by August 2, 1995. You should be aware that you might have.claims against third p ies for damages, including claims for contribution or reimbursement for the costs of cleanup. Such clai do not exist indefinitely but are governed by laws that establish the time allowed for bringing litig tion. The Department encourages you to take any action necessary to protect any such claims you y have against third parties. This information is available in alternate format by calling our ADA Coordinator at(617)574-6872. 1 DEP on the World Wide Web: http:/twww.magnetstate.ma.us/dep 10 Printed on Recycled Paper �FORM 30 HAW HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS CH BOARD OF HEALTH CITY/T WN a DEPARTMENT sv�y`0 F.°7 )17 ADDRESS O 6 -z -`i /q q M TELEPHONE Address Z C) L6 Occupan r2u t � Floor _Apartment No. No. of Occupanjs j"Ce- T.S g No. of Habitable Rooms (0 No.Sleeping Rooms1j!__ — Les I � �y' No. dwelling or rooming units No.Stories- /a Name and address of owner �—2,S, Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Draina e o v , ti.wie — tea; rc /0 S� Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: V- ve,, - . 0 SZ Dual Egress:and Obst'n.: Ywvt- CV�,,,, Y1a) v?jl ❑ B ❑ F ❑ M Doors,Windows:gjc,Vv% 4k-d-Si L1/G MV Roof Lv,, S't ze.- S L,. G1 Gutters, Drains: Walls:C ML, t. 7,,jW ivy 0 Foundation: - Chimne cy-V a,_ ad "• Z. es ce BASEMENT Gen.Sanitation: Dampness: x Cc Stairs: Lighting: 0 LIL • W aS 4 &- STRUCTURE INT. Hall,Stairway: Obst'n.: 0 Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Nl i-SS 6n5 COW-1-1 I'll Central ❑ Y ❑ N 'Equip. Repair b _ O f ( _Ve&tf TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: cc LtL �S'J ❑ 110 ❑ 220 Fusing,Grnd.: ITS kk I t4,q14_1A16kTs - AMP: Gen. Cond. Distrib. Bo : c`S) oy r;w JIV, /'0 Gen. Basement Wirin C� rt 3 Gv 2 to tea°d� f?:��frs DWELLING UNIT ' Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Dr}�1 Kitchen rF U Bathroom iwd Pantry ' Den Living Room C?k Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten., Oil, Elect.: / Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink i C h-A-5 eft ,� Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.. V" L-P, IDS 1p+ d , tti W 5--7fO Wash Basin, Shower or Tub: d44 ry vbr v N Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Buildin Posted a, t j 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." INSPECTO C / TITLE DATE 3 1 )30 I-ZVVV TIME 3 A.M. THE NEXT SCHEDULED REINSPECTION ,v��yyJ �L fI P.M. U Ii' r „P.v„r+""”;.,.._ ,,...cc..ik•�T".'µi„S.'A-�!R',�"•.K9w,aexmw...-...,n,,:v2r..,,,,..,..,. .ao... �, ,. •. . .. .r� .,��.; �nrY.�^..;��"�+ Fs -.r,S�+-r:iV*�{. ?.•{�:*,,irr}n vvf•F+rm: .y.;,,. -a�r':c.., ..� .. Y� r R,. 1 3 410.750: 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 heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a'determination that other violations or conditions may not be found',to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B)- Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by'105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, I including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K)` Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. -(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which•may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony-, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. 6 Z D L L.a.s (,- �r CzvaxQ CQ—�4k,�a r(�, i+,v 0 2& 3 z NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY r CODE H, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE, ARTICLE 51 The property owned by you located at 2St eet, was inspected on Alm.30, , 2000 by Glen Harrington, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code H, Minimum Standards of Fitness for Human Habitation were observed: % e C c,6 6 4,4,� o b Sevc,[c(7 e v ,fie..- �'j YL 4,.1 0&; >L6 r-,f 6 c- ell (OS 'L( f i, 3s clzi te d lw,;JJ 1-5tr � , d SGc(.<,� }- G✓a p6 fe�vQ� Cow rdv y''' Y e ecte orre ese atio it C v , re o s n is You aredirected to correct the above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health is lei— �jvfw�rc, ct.` G a 4 U o_ N 4 o rl- Kl- c u „ Ne 9 55CC n AYLMER, KERRY P TR %NASTASIA,THOMAS ter% 1 Al, 00001600 mot. 62 DUNASKIN RD ea Ad'ed 00 02632 CENTERVILLE MA ` � s � t 00-0000-000 040191 `� /i�/ �`/ R�,�►'� ',4` 7494 305 ` ,a+ //�� /:. �; "� a:rf cs� � F•�< .a� �C'FF' < fir..:��.'a,.,... AYLMER, KERRY P TR d MMYY 0491 eef f 7494/305 rq " yam F t 000030000 dd \' " 3 9 000063700 Exfix FED tt1'es- 0000000000 o abt 20"" REDWOOD LANE 1356 \ iia st' HY VV\/ d,x+ 0000 Frn g~~ 0000 Y „ J COMPLETESENDER: COMPLETE THIS SECTION . . DELIVERY 0 Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. ate of Delivery item 4 if Restricted Delivery is desired. zo -aO ■ Print your name and address on the reverse so that we can return the card to you. C.Si na re ■ Attach this card to the back of the mailpiece, X or on the front if space permits. Addressee MA D. Is delivery address diffe from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No �11� n� 3. Service Type 6 j IN Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2tI f {!!!!!ff itff if . it!? itif f !!! t!ti {{{! f t f} i i t _Edd iiii it itiii itii till i i it i i ii>�If PC 102595-99-M-1789 UNITED STATES POSTAL SERVICE First-Class Mail q LISP-Postage&Fees Paid j v+ i Permit No. G-10 .e j ! 1 • Sender: Please print yor name, address, and ZIP+4 in this box • I xi*Mmatluseth 02601 �G..r��1.l CJ J.`14r Ill}!}:t!itili�lll�ilTttli��}1!1t{1�1ti��}i�}1�1l1!}!{!4�t11t{� • 1 a\ COMMO.NW-E?,LTH OF MASSACHt;SETTS _ EhECt TI�'E OFFICE OF ENWIRONME.TAL AFFAJRS F DEPARTMENT OF ENVIRONMENTAL PROTECTION 0\E W1.TER STREE . BOSTO ' MA 0210c (6171 292-550u T RU DY COI-` Secreta-n ARGEO PAIL CELLUCCI DAVID B STP.:'HS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 20 R e d.wo o d. Dr . , Hyar1 ' s Name of owner Ke rr i A lme r ress of Owner: Date of Inspection: C, '—�—o--U Name of Inspector:(Please Prirn)Wm. E . Robinson Sr. 1 am a DEP approved systerq inspector rsuant to Section 15.340 of Title 5(310 CMR 15.000) CornpanyName: Wm. E . Robinson eptic Service Mai-lingAddress: PO Box 1069, Centerville , MA Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails / Inspector's Signature: CV I z" Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS r •o 2000 +� EP) revised •9/2/98 Page Iof11 • --led on Rea•cfrd Panr• - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 'ropertyAddress: 20 Redwood. Dr . , Hyannis Jwrw: Kerri Almer Date of Inspection: _,7„�� INSPECTION SUMMARY: Check B, C, or D: A. SYl/ PASSES: , I have not found any information which indicates that•any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. YSTEM 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. Indicat yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined-,explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached)indicating that the tank was installed within twenty (20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. — Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipets) or due to a broken, settled or uneven distribution box. The system will pass inspection if twith approval of the Board of Health). broken pipets) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipets). The system will pass inspection if twith approval of the Board of Health): broken pipets) are replaced obstruction is removed revised 9/2/98 Page 2ofII • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 20 Redwood. Hr. ,Hyannis Owner: Kerri Almer Date of Inspection: e —;L_b—e,) D. SYSTEM FAILS: You m st indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes o Backup of sewage into facility or system component due to an overloaded orclogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. _ 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of-a cesspool or privy is within 50 feet of a private,water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LA GE SYSTEM FAILS: You mu t indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No 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) The ow er or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office f the Department for further information. revised 9/2/98 Pap!4ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icorrtinued) Property Address: 20 Redwood. 'jr. , Hyannis Owner: Kerri Almer Date of Inspection: C. RTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) YSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310 CMR 15.303 1111(b)THAT THE SYSTEM NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of,a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised Page 3or11 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART 8 CHECKLIST Prop"Address: 20 Red.wood. Dr. , Hyannis Owner:Kerri Almer Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No �/ Pumping information was provided by the owner, occupant, or Board of Health. A/ _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. r _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. 7� _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. For example, Plan at B.O.H. X/ _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (1.5.302(3)(b)i - _ The facility owner (and occupants,if different from owner) were provided with information on the properxnaintenanca-0f SubSurface Disposal Systems. Z revised 9%2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION . Iroperty Address: 20 Red-wood Dr. , Hyannis Owner: Kerr i A lmer Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: B g.p.d./bedroom. Number of bedrooms(design): Number of bedrooms (actual): Total DESIGN flow `/5 Number of current residents:�e Garbage grinder(yes or no):,LL d Laundry(separate system) (yes or no)/I,0; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no):�O Water meter readings,if available(last two year's usage(gpd): 1 292-2000 258 , 750 gal. Sump Pump(yes or no):6O 1998-1999 150, 750 gal. Last date of occupancy: CO MERCIALANDUSTRIAL: Type f establishment: Desig flow: gpd 1 Based on 15.203) Basis •f design flow Greas trap present: (yes or no)_ Indust al Waste Holding Tank present: (yes or no)_ Non-s itary waste discharged to the Title 5 system: (yes or no)_ Water' eter readings, if available: Last d to of occupancy: OTH R: (Describe) Las of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)_ If yes, volume pumped: gallons Reason for pumping: TYPE ObSYSTEM ✓ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records;if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other (� APPROXIMATE AGE of all components, date installed(if known) and source of information: f 7c 9—E e Sewage odors detected when arriving at the site: Iyes or no) X- revLsed G/2/91 Papc6(of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'top"Address20 Redwood Dr. , Hyannis Owner: ��y.r i A lme r Date of Irsspe§'d6ri: BUI ING SEWER: (Loca a on site plan) Depth elow grade:_ Materi I of construction:_cast iron_40 PVC_other(explain) Dista ce from private water supply well or suction line Diam ter Co ents: (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK:_ (locate on site plan) r � Depth below grade: � Material of construction: (/concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ ls.age confirmed by Certificate of Compliance_(Yes/No) Dimensions: h ar L 'e 6 4 Sludge depth: C Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 6 t Distance from top of scum to top of outlet tee or baffle: 9 > > Distance from bottom of scum to bottom�pof outlet tee or baffle: /t/ How dimensions were determined: ;omments: (recommendation for pumping, condition of inlet and outlets or baffles, depth of liquid level in relatio to outlet invert, structural integrity, evidence of leakage,etc. 0-0 8 s X, J� s �^- 4 t.. %A.c `I A 5 42. G SE TRAP: (loca a on site plan) Depth below grade:. Meter 1 of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Diman ions: Scum hickness: Distan a from top of scum to top of outlet tee or baffle: Distan a from bottom of scum to bottom of outlet tee or baffle: Date f last pumping: Com ants: (rec mmendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, ev' nce of leakage, etc.) rev; sAd G/'2./5 C Page 7 or it SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) "roperty Address: 20 Redwood. Dr. , Hyannis owner: Kerri Almer Date of Inspection: C 'nG TOR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) Iloca a on site plan) Depth elow grade:_ Materi of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensi ns: Capacit gallons Design ow: gallons/day Alarm p esent Alarm I vel: Alarm in working order:.Yes_ No_ Date of previous pumping: Comm nts: Icon tion of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: D Comments: (note if level and distribution is equal, evidence��solids carryover, evidence of leakage into or out of box, etc.) PUMP HAMBER:_ (locate n site plan) Pumps i working order: (Yes or No) Alarms i working order(Yes or No) Comme ts: (note c ndition of pump chamber, condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(cortfinued) 'roperty Address:20 Redwood. '-Ir. , Hyannis Owner: Kerr i A lmer Date of Inspection: e—2_6--e> / SOIL ABSORPTION SYSTEM(SAS):_V (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers,number:_ leaching galleries, number:_ leaching trenches, number, length:-;?- leaching fields, number, dimensions: 6 overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, s of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.) A L e a e.� C POOLS:_ Iloca on site planl Numb rand configuration: Depth- op of liquid to inlet invert: 7epth f solids layer: Depth f scum layer: Dimens ns of cesspool: Materia s of construction: Indicati n of groundwater: inflow (cesspool must be pumped as part of inspection) Co mentS: (not condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY _ Ioocate on site plan) Materi Is of construction: Dimensions: Depth of solids: Com ents: (not condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) rev _se^ 5/2/9c rdgr9orn ..{ a' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Nop"Address: 20 "ed.wood. Dr. , HVannis Jwner: , Kerri Almer .)ate of Inspection: C_a-e,---ej SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) J IY o , r O . 1 3 a-Ld revised 9;2/9? page 10of11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(cortonued) "PertyAddress: 20 Redwood. Dr. , Hyannis Owner: Ker i Almer Date of Inspection: C v2 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater e II S Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property, observation hole, basement sump etc.) Determined from local conditions ✓Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (M_ st be completed) JCS i revise,; 9/2• Page I I or I1 • 2 Health Complaints 30-Mar-00 Time: 11:50:00 AM Date: 3/30/00 Complaint Number: 2291 Referred To: GLEN HARRINGTON Taken By: GLEN HARRINGTON Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 20 Street: REDWOOD LANE Village: HYANNIS Assessors Map-Parcel: Complaint Description: MOLD ON FLOORS FROM LEAKY ROOF FROM NEW ADDITION. DSS IS GOING TO TAKE KIDS BECAUSE OF IT. ELECTRICITY DOES NOT WORK IN NEW ADDITION. Actions Taken/Results: Investigation Date: Investigation Time: 1 oF� r�,ti Town of Barnstable Department of Health, Safety, and Environmental Services IAMSrABLE, MAW. ,�� Public Health Division �ED"A0rA P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health 2 � RECORD OF VERBAL COMMUNICATION /l00 Oti, YS i s� �o�c;Eti 3' c v ell" P44 le,,2 e�/C �/�, �•yiS ._. tY'G'G�� GY-t�-.1 L„p � S'�� 0'►r ��Lt/v � 1��.,,.//.��� ��.2.�-L.�✓ G�/�1�. �..�.�✓ Lt-y. �'-e�i'�:, � lm a.�e►•,..�.aef; verbcomm.doc Health Complaints 09-Jun-97 Time: Date: 10/2/96 Complaint Number: 478 Referred To: EDWARD BARRY Taken By: DONNA MIORANDI Complaint Type: TITLE V SEWAGE Article X Detail: Business Name: Number: 20 Street: REDWOOD LANE Village: HYANNIS Assessors Map_Parcel: Complaint Description: SHE CLAIMS THERE WAS A SEPTIC SYSTEM INSTALLED TO CLOSE TO HER PROPERTY LINE. Actions Taken/Results: ED immediately went to the site on 10/2/96 and observed a worker digging two holes, one next to Mrs. Hands fence. Mr. Barry verbally ordered the worker to cease and desist the installation of a roof drain-pit next to the fence. He allowed the other roof run-off drainage pit to be installed located closer to the house. He had dug a hole and had a plastic unit to catch the roof run off from the rear roof. A 4"white pvc pipe ran from the bottom of the roof drain into the plastic unit in the ground. Reinspection in the pm showed that the 2nd hole dug was filled in and no drain was plced in the 2nd hole. On 10/8/96 at 1:30 p.m., TM spoke to the tenant named Ruth, then dug a four feet deep hole adjacent to the fence in the area that looked recently excavated to see whether a leaching pit had been installed there. There was no leaching pit or any other component in the ground at that site, only dirt and a few rocks. 1 May 28,1997 We the owners and tax payers of Redwood Lane, Redwood Lane ext.,Rustic Ave., Harrington Way and Scudder Ave.are registering a formal complaint against the owners, Kerry Elmer and Dr.Nastasia, and tenants at 20 Redwood Lane. We are requesting an examination by the Building Inspector(regarding abuse of zoning and occupancy requirements), Board of Health ( trash and other debris strewn around the yard as well as piles of tires,junk cars and unkempt property) and Housing Assistance (we believe tenant has violated its policies by taking in paying boarders). These above agencies are supported by our tax dollars and we are seeking relief of this situation. Our privacy has been invaded due to excess traffic in our residential neighborhood. We feel our property has been devalued as the upkeep of said property is unacceptable. Barnstable police have been summoned on numerout5 occasions duc to various disturbances. We are forwarding a copy of this letter to the above agencies and the owners of said property. As homeowners we refuse to allow this situation to go on any further and hope you will help us to expedite this problem. You will find below the many signatures of the homeowners in this neighborhood who are in agreement with this complaint. Health Complaints 09-Jun-97 Time: 11:27:16 AM Date: 5/27/97 Complaint Number: 815 Referred To: EDWARD BARRY Taken By: c.d. Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name: Number: 20 Street: Redwood Lane Village: HYANNIS Assessors Map_Parcel: Complaint Description: At the above location there is debris in the yard, (old tires, garbage, etc.) The debris is piled up all over the front & back of the yard. Actions Taken/Results: Investigation Date: Investigation Time: 1 U Z. 548 659 916 Receipt for Certified Mail No Insurance Covemge Provided � unarm Do not use for Intetrtational Mail PosusEEwA � (See Reverse) Sant Of t r t and No. 2 al P.O. late a o e 40 Postageco $ 3 0, Co) E Certified Fee O NSpecial Delivery Fee a r fiest�Pcted Deli4'efy Fee' I I Returnn fie'c`eipf Shbwingl to Wtiom&Date Delivered Return Receipt Showing to Whom, Date,and Addressee's Address TOTAL Postage &Fees Postmark or Date r STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). o 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address In leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). I 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return rn address of"the article,date,detach and retain the receipt,and mail the article. M T .0 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed Cd ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. C 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, ci endorse RESTRICTED DELIVERY on the front of the article. V9 0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If tl return receipt is requested,check the applicable blocks in item 1 of Form 3811. d 6. Save this receipt and present it if you make inquiry. 10S603-938-0219 "' Town of Barnstable y' Health Department 367 Main Street, Hyannis, MA 02601 Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health October 16, 1996 Kerry P. Aylmer, Trustee c/o Thomas Nastasia 62 Dunaskin Road Centerville, MA 02632 RE: 20 Redwood Lane, Hyannis Dear Mr. Aylmer: The septic system owned by you located at 20 Redwood Lane, Hyannis listed as parcel 82 on assessor's map 288, was pumped on September 5, 1996, October 2, 1996, and on October 16, 1996 according to the Water Pollution Control Division of the Town of Barnstable Department of Public Works. At this time, we are requesting your cooperation in rectifying this problem by upgrading the system to meet Title 5, the State Environmental Code. A disposal system construction permit was obtained on October 9, 1996 by Donald Perkins of Hickey Construction Company. However, to date the septic system has not been upgraded. Your cooperation would be greatly appreciated. If you should have any questions, please telephone me at (508) 790-6265. Sincerely yours, Thomas A. McKean Director of Public Health P6-C`lle°` No. g/ ' Fee .-. ! (O THE COM MONWEALTH OF MASSACHUSETTS Entered in computer: Yes j% PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS /_,�D Application for Mioaaf *pmetn Con!6tructton Permit Applicat� . Permit to Construct( VrRepair( )Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. —0 L� WUO Assessor's Map/Parcel 1 O� ,+� �t K>:�1� �'4�i—�^1E1tvs ! "Ib Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. rA 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 ?fib gallons per day. Calculated daily flow 71`0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 4 �y U Type of S.A.S. — _30"-X 4 1,1 X Z 1 TXEt'c-L4-S Description of Soil Nature of Repairs or Alterations(Answer when applicable) Ah-1 x/ ft SJ7 NC g0' Al-►,D I ru STA,L-t— I �tso S . ) -:� b- ,� 30'L X y'4j x Z. L4-ACM1N IM Date last inspected: I Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Lr Date o . _ gi j Application Disapproved for the f owin asons i Permit No.. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance i THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired ( V<pgraded( ) Abandoned( }by "\C r;E.`t �o►.�f� ✓C 170 AI at A1V ZLre 2%'DwodO k-°` has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer 0\ k1=k Cot,)S Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. Fee,5_.r]— THE COMMONWEALTH OF MASSACHUSETTS �/ PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Xluligponl *p.5tem Con!6truction Permit Permission is hereby granted to Construct( )Repair( grade( )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. Date: Z4 Approved by d SENDER: V ■Complete items 1 and/or 2 for'additional seivices. I also wish to receive the rn ■Complete items 3,4a,and 4b. following services(for an y ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. v ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address permit. y ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N I r ■The Return Receipt will show to whom the article was delivered and the date O o delivered. Consult postmaster for fee. 0 v 3.Article Addressed to: 4a.Article Number /� d E 4b.Service Type «' r ❑ Registered 0 Certified I s, � ❑ Express Mail ❑ Insured S Uj N ❑ Return Receipt for Merchandise ❑ COD 0 a7. ate Deljvery � 0 o p 5.Received By: (Print Name) Addressee's Addr ss(Only if requested W . and fee is paid) t �- g 6.Signatu e: ( dressee orA e ) 0 . XI ' `I PS Forrn 381Y, December 1994 Domestic Return Receipt ftirst Mail } UNITED STATES PoS ,L EI 7a7 Fees Paid P M , o Perm£_ G-1,0. F • Print your nan e,caddreA, and ZFP'Cod_e m=tbis-boz---"-- ® /gg� Board of Health Town of BamstablA P.O. Box 534 Hyann-s, ►l�fa:, j sachusetts 02601 I I I j 1-11££III I1,111111 H1£1£7111111£££1jj ii£li££1I111111 fill 111i III II1I1i , °— TOWN OF BARNSTABLE LOCATKON o20 9-Qw00 b Le- SEWAGE # �6 � VILLAGE 4 ►,3 to XS ASSESSOR'S MAP &LOT922�" l INSTALLER'S NAME&PHONE NO. /ff6G'y dbwsv -ni yre 8 SEPTIC TANK CAPACITY I S-n LEACHING FACILITY: (type) _"X4Nc,4 (size) 70 YY' X9 NO.OF BEDROOMS BUILDER O OVYNE PERMITDATE: COMPLIANCE DATE: ;'7-!�' Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist `r, on site or within 200 feet of leaching facility) �— Feet Edge of Wetland and Leaching Facility(If any wetlands exist U within 300 feet of le hing acility) Feet Furnished by /� 'A ,. Q� a , Q� ��� .� � CJ � a � .. GJ `, 0� �. (� ,\ �� � " ��•`"," ,��-. ' .. �� r No. 6 ' 5'13 Fee �1,s � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0[pprtcation for MtZpogar *pgtem Com5truction Vermtt Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor'sMap/Parcel o'Z8� O 1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. t-�\ricer=Lc (10A)s'1� 20 LA 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 ` gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank D Type of S.A.S. — 30'1—X I/' X Z 'B lUi`c- Description of Soil Nature of Repairs or Alterations(Answer when applicable) RUM P N— T lZ 1 A) IW 5 TD NC— a01 t Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed Date 9 )91 Application Approved by -" Date L,* s Application Disapproved for the f owin asons Permit No. f Date Issued r` No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS ZIPPYicatiou for ligpogal *pgtem Comaruction-Vermit Application for a Permit to Construct( ep�t( )Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. �O 2__awoo9 Assessor'sMap/Parcel KEY if4-L�MEK— ` uSTl=t_r 1 Installer's Name,Address,and Tel.No. ..- Designer's Name,Address and Tel.No. SA- -`l Leta r Type of Building: 'i ! Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building +No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow — gallons per day. Calculated daily flow 7$110 gallons. Plan Date Number of sheets Revision Date Title.: ; Size of Septic Tank 1 :03 ca Type of S.A.S. 20 )4 4'g,, v�'� Z-w*we S " T Description of Soil t " Nature of Repairs or Alterations(Answer when applicable) ybm O r GSddo L k L f&AQ■� , 41¢ ar t � Date last inspected: i Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage`disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system iri opeF4tion until a Certif1--.,• cate of Compliance has been issued by this Board of Health. "; Signed I Date Application Approved by Date Application Disapproved for the f(Ubwingaasons Permit No. Cam/ _ / 2 Date Issued THE COMMONVEALTH OF'MASSACHUSETTS BARNSTABLE,,M'ASSACH.US'ETTS ` "x ' certificate eo# FontYcce THIS IS TO CERTIFY, that the Qn-site Sewage Disposal System Constructed( ) Repaired( j. pgraded( ) Abandoned( )bySiE �`. �/ s at n n t o has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Jw ' Installer .A� N��—�` �� Designer, '_ ` s f The issuance of this permit shall not be construed as,a guarantee that sy till function as de�ndd Date /'� / �T..— �` Inspecto Fee —J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Digpogal *raem Congtructiou Vermit Permission is hereby granted to Construct( )Repair( V<Pgrade( )Abandon( ) System located at 9 A--Qua®�--j � 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. Date. jr) ,. 9 �/ Approved by i 'Mao P s At 11, Pa it, Mq AYR - � m �� Ft b t . � i a 1 s r ,, �.., , RE"Vow ; a 3 1 too At r a a ;. r I 1 3 two r mp&RAMB ''. ,,..•..+., a.wiwr ..... 45`I j y ENO 001, g�tf ,c 1f � ; t t t. 41 akYC� tr t " 7 t tl 6 vo K ASK. Y w 4 CERTIFICATION OF SKETCH AND APPLICATION FORA DISPOSAL WOKItS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated concerning the . property located at `moo ����6�s> �'- �� meets all of the following criteria: There are no wetlands within 300 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed There are no variances requested or needed. SIGNED : LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan or the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). Town of Barnstable Health Department 367 Main Street, Hyannis, MA 02601 161P Office 308-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health October 16, 1996 Kerry P. Aylmer, Trustee c/o Thomas Nastasia 62 Dunaskin Road Centerville, MA 02632 RE: 20 Redwood Lane, Hyannis Dear Mr. Aylmer: The septic system owned by you located at 20 Redwood Lane, Hyannis listed as parcel 82 on assessor's map 288, was pumped on September 5, 1996, October 2, 1996, and on October 16, 1996 according to the Water Pollution Control Division of the Town of Barnstable Department of Public Works. At this time, we are requesting your cooperation in rectifying this problem by upgrading the system to meet Title 5, the State Environmental Code. A disposal system construction permit was obtained on October 9, 1996 by Donald Perkins of Hickey Construction Company. However, to date the septic system has not been upgraded. Your cooperation would be greatly appreciated. If you should have any questions, please telephone me at (508) 790-6265. Sincerely yours, Thomas A. McKean Director of Public Health I oc7,4�,, as rsto Lb�.,GP,o f Tk�2 348 659.. 9Q9 r --- e-45TReceipt for Certified Mail ",No Insurance Coverage Provided o Do not use for International Mail (See Reverse) 0) s _rn t treet and No. 2to i � P.O., a and O O00 Postage M E Certified Fee O LL Special Delivery Fee CO ea t FRes;mcted LDeljv_ery FF_ee cRetu m-Rece iptdhowing to Whom&Date Delivered - Return Receipt S� irr}}yy to Date,and Ad�Ts�se��s?td TOTAL Po st-lag &Fees Postmar o rate 20 199E ASPS STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). m 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address i12 leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). R IC 2''If you do notwant this receipt postmarked,stick the gummed stub to the right of the returncl address of the article,date,detach and retain the receipt, and mail the article. a? N r 3. If you want a return receipt,write the certified mail number and your name and address on a - return receipt card;Form 3811,and attach it to the front of the article by means of the gummed ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. C 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, � endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of th4 receipt.If return receipt is requested,check the applicable blocks in item 1 of Form 3811. A 6. Save this receipt and present it if you make inquiry. 105603-9&1a-0216 1 Town of Barnstable Health Department } BMW 1 367 Main Street, Hyannis, MA 02601 t63q. Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health September 18, 1996 Thomas Nastasia 62 Dunaskin Road Centerville, MA 02632 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 20 Redwood Lane, Hyannis was inspected on September 4, 1996 by Edward Barry, 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 U were observed: 410.602: Rubbish observed on the ground behind and in front of the dwelling. 410.501: Excessive amounts of water observed on the basement floor approximately one inch deep. 410.500: The floor in front entry way warped. The floor in master bedroom sagging. 410.253: The lights in front entry way and or first floor hallway were inoperative. 410.481: The dwelling does not have posted a 20 sq. in. sign bearing the name, address, and telephone number of owner. You are directed to correct the above listed violations within seven (7) days of receipt of this notice by repairing the leak in the basement, removing the water from the basement floor, repairing the floor in the front entry way, repairing the floor in the master bedroom, removing the rubbish from the front yard, repairing the lights in the first floor hallway and front entry way, and posting the name, address and telephone number of the owner adjacent to the mailbox or the front entrance. 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: Ruth Nickerson t yo,rN�>o The -Town of Barnstable , •° .�w Health Department a } o. `Fi 367 Main Street,`Hyannis; MA 02601 Office 508-790-6265 �' -' ti ` = Thomas A. McKean FAX 50b-j7P0344 A Director of Public Health NOTICE TO ABATE VIOLATIONS OF 105 CMR 410000, STATE SANITARY CODE II, .MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by ou located ,at��.1 � � ash inspected on 91-~ y 77 ' , ' 1.99,S by, OfV-1 4,Z,1Cj f� 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: �i.}�� / 4,4����� AV a You are directed to correct these violations within twenty- four (24) hours of receipt of this notice. You are also directed to correct within days/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 Thomas A. McKean Director of Public Health �� � �. � r .f ��;,, C� ,� �, t' cJ - `� � � (� '�y1 / f [�\�\, v J ' � � ' 'l i r � `♦ .� � � .J r �f Lf. 1� VV � > � � �� �� � . � � - � � } r f � � ; � � � � pay � .., k y\ a A f 1V'�l` \\� (� , � `f j �' / ' � 'e f ��. � �� . .� _� � �a �; � .� � � t.,. ['` � � � � i J � -� � �� �. � � � � � � � � �qC'� � " �.� � � � � � ,� � � FORM3o HOBBS&WARREN,INC. THE COMMONWEALTH OF MASSACHUSETTS a,� BOARD QF HEALTH .4 4 eCITY/TOWN DEPARTMENT ' 7 �9 ADDRESS 'TELEPHONE �/� Address' e' J 14915 �f1 Ccupant-SLI fe x vD�/ Floor s Apartment N lKlo.of Occupants!5< No.of Habitable Rooms No.Sleeping Rooms :. No.dwelling or rooming units No.Stories Name and address of owner 7. . *� E f✓L/��-elf t U i. j'�� � Remarks Reg. Vlo. YARD Out Bld s.: Fences: QoMeagoaueloRubbish ey Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: 10 f Dual Egress:and Obst'n ❑ B ❑ F ❑ M Doors,Windows: 161, Roof Gutters, Drains: Walls: Foundation: _ Chimne BASEMENT Gen.Sanitation: Dampness: Stairs: r o F Li htin STRUCTURE INT. Hall,Stairway: / S Obst'n.: tljoiw Hall,Floor,Wall,Ceilin Hall Lighting:-, / Hall Windows: HEATING Chimneys: Central ❑Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P. Waste Line: H.W.Tanks Safety and Vents z ELECTRICAL Panels, Meters,Cir.:0110 ❑ 220 Fusing,Grnd.' 6v ,¢ AMP: Gen:Cond. Distrib. Box: .idS. ,P Gen. Basement Wirin : 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 jj Locks on Doors: Cf ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPA►R•THE HEALTKOR SAFETY AND WELL—BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750,,OF THE CODE OR OR THE AUTHORIZED INSPECTOR.(See Over) .i "THIS INSPECTION REPORT IS,SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF-PERJURY. INSPECTOR � t TITLE DATE "' ''� TIME P.M. P.M. 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 I s composed of these items.which are deemed to always have the potential to endanger•or materially impair they health or safety, and well-being`of the occupanta'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;4ncluded,in this listing.':-`Failure to include shall in no-way be construed as.a determination that other— violations violations may not be found to-fill within' this. categoary. 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- obiigation�of�4the person to whom the order is <; :� ., ., , issued to comply with such order. ' �._ � � _`, � ' '� � ` 1' '� � 6 - (A) -Failure to provide•a supply-of water.isufficient n quantity, pressure ' �-and temperature, both`hot and cold, to meet the ordinaiy'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 01R 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 •bi 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; (8)� Failure ,to provide a safe supply of water. _ (F) Failure to provide a toilet and maintain a sewage .system in operable coeidit on--is, by*'105 CMR 410;150(A)(ij,and-410.300. _ • ; t IG)- 'Failure to provide adequate exits,,or'the obstruction of-any exit, passageway or common area caused by,�in object,R{including garbage or trash, which prevents. egress in case of\an emergency 105 CMR 410.450 and 410.451. ;. (fl) Failure to comply with the security requirements of 105 CMR-41D.480(D). (I) Failure-to comply with any provisions of 105 CMR.410.600 through 410.602 'Aich.results_in any accumulation of garbage, rubbish, filth ,or other causes.- of-sickness .which may provide a food source or harborage- for rodents, insects for other pests or otherwise contribute to accidents jor to the creation or of disease_ . (J) "The presence-of'lead-based paint on a dwelling or dwelling-unit in ` .violation of the Massachusetts''`Depai"tment of'Public Heaith`Regualtions for e -_Lead Poisoning Prevention-and Control 105 CMR 460.000. t •(K) Roof,- foundation, or other structural defects that may expose the Occupant or anyone else-to- fire, burns, shock, accident or other dangers or. _ Ikpd 'rsleat to health •or dafety. tLj_ Failure to install electrical, plumbing, heating and gas-burning facilities iii 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 w to health or ,safety. (H),,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: , lack of a kitchen sink of sufficient_ size and capacity for washing dishes and kitchen utensils of lack 'of a stove and oven or an" 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•aey part thereof-in violation of generally accepted _ .plumbing heating,, gai-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 CMltA410.750(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'coadition within the time :so oidered,by the board . of health.: FORM30 HOBBS&WARREN,INC. THE COMMONWEALTH OF MASSACHUSETTS ?`t BOARD OF HEALTH CITY/TOWN DEPARTMENT M,4 Al �y ADDRESS ✓J 9SJ / TELEPHONE Address dRb -4d Wei ad 14's pi`1"�/3zolppccupant 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 L yJ � /✓L/ ��. fF >^ - ,T'r�s�,� f� Remarks Reg. Vim YARD Out Bld s.: Fences: Caarba-esan,&Rubbish ,��z Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n : ! 7— ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: . Dampness: Stairs: P4,5 oi 1f h 1 ` Lighting: STRUCTURE INT. Hall,Stairway: / Zs Obst'n.: Hall, Floor,Wall,Ceilin : Hall Lighting: L% Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels,!Meters.Cir.: 4 4 71z, ❑ 110 11220 Fusin ,Grnd.• 07 JL j,4 � 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 ERJURY.91 INSPECTOR TIT LE�.•e DATE "" 7 TIMEb P.M. 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 ioinimum 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. m �(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 fora period 'of 24 hours or longer. (B)'- Failure -to provide heat' as+-required'by 105 CMR`410.201 or improper 't ' venting.or•use-of.a space heater or water heater �is prohibited`by 105 CMR - 410.200(B) and 410.202. (C) Shut-off and/or failure to restore electricity or gas. M (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. (B) 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, T passageway or common area Icaused by an object, Ancluding 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 -..'vbich:results in any accumulation of garbage, rubbish, filth or other causes `of sickness which may provide a food source or harborage for .rodents, insects -:nor other pests or otherwise contribute to accidents or to the creation or -.:.spread of disease. y - (J) The presence of lead-based paint on a'dwelling or'dwelling unit in k r } `.violation of the Massachusetts Department of Public Health Regualtions for Lead Poisoning Prevention and Control 105 CMR 460.000'. ;(H) loof,'foundation, or other- structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or '_ f44foient to health -or dafety. -OL Failure to install electrical, plumbing, heating and gas-burning v - 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 fora period of five or more days following the notice to or knowledge of the owner _ of said condition or conditions: (j)— jack 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. --- - - - -.._ Q) any-defect in the-electrical, plumbing, or heating system which.makes such.system or any part. thereof in,-violation ofgenerally 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.. TOWN OF BARNSTABLE LOCATION �® �"—w®cti ��++�'r�- SEWAGE # VILLAGE�0-/A1✓Prs Deer' ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. <-- iAfC �--%4-OS;eMS- SEPTIC TANK CAPACITY ��ti STIR SS DIr c J S LEACHING FACILITY:(type) Pfp&cj4s'T T (size NO. OF BEDROOMS PRIVATE Wife OR,PART-I WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 6. a ------------ / Cl cl , r r SENDER: ti ■Complete items 1 and/or 2 for additional services. I also wish to receive the rn ■Complete items 3,4a,and 4b. following services(for an H ■Print your name and address on the reverse of this form so that we can return this extra fee): U) card to you. v ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address d permit. ry y ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N r ■The Return Receipt will show to whom the article was delivered and the date a delivered. Consult postmaster for fee. E 0 3;Article Addressed to: �. 4a.Article Number m7, 3A ,0 4cs-�a 4b.Service Type c°� ❑ Registered ® Certified.of N ❑ Express Mail [I-Insured - m c , ❑ Return R ce t for Merchandise [ICOD a 7. D,elive Ik 0 z f7 �. 5.Received By: (Print Name) 8.Addressee's Address(Only if requested W a a,and fee is paid) t 6.Sigriature' (iddrids.169 or Agent) .N i PS Form 8 , December 1994 Domestic Return Receipt (LL�t �l UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid uSPS Permit No.G-10 • Print your name, address, and ZIP Code in this box • I I Health 91146 TM d BM"s i H�BOX 534 uss 02601 Fax(0)M3344 Phone(508)79"265 I i i i 1 t � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................... Appliratiun for Disposal Works Tonutrurtiun prmit Application is hereby made fora Permit to Construct ( ) or Repair ( Lrdn Individual Sewage Disposal System at: .............. ............... • ...............----.-------- Location-Add re s .- or t No. ....---._...G! ..1/L.l7 ...... _. . .......A ................ .......•-•- - A � .--- ....._............._._..... - Owne ddress 4CAVII)k A... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms._.._3.................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria Otherfixtures ......................... ----------------------------- ----------------•------ ------.... ............. W Design Flow..............................gallons per person per day. Total daily flow.......M: _O............_......._._gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.-_-------------.-- Total leaching area....................sq. ft. 3 Seepage Pit No.....: ........... Diameter.....LO........ Depth below inlet...A4........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by......................................................................... Date........................................ .4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i, Test Pit No. 2................minutes per inch Depth of Test Pit.............. Depth to ground water-----................... 04 -----------------------------------•--------•----------..............------.....................................--------...----._.........•-•........--....-- 0 Description of Soil......................................................................................................................................................................... W V --- ---- ----------- ------------ --------------------- ------------ -------------------- -......... --------- .----------------------------------------------- .----------- -........ ------------- ---------------- •--•-•-----•-----------------------------------------------------------------------------------------------------------------------------•-------------------- t. U Nature of Repairs or Alterations—Answer when applicable.......A_Y?.V....0.Kp<......... ...........---------------------- �.' ....._....a { r 5 ......G. ::�5 }Z--.................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance hg,� n issued by the board of, he�lth. Signed..\� e .......................... _`' c� Date Application Approved By------ --------........-................. ------...�_� Date Application Disapproved for the following reasons------------------------•------------•--------------------------•-------------------------•-.....---......•--- ...------•------•------•................................•---.......-----•-•-•--------............---............------------------------------------------......................--------•-•---------•---. cy Date Permit No.......... _1._'_..3.7..(p.................... Issued..........---•-•--•-•-------- Date -No. pp 1 THE COMMONWEALTH:.O�F�MASSACHUSETTS � F `BOARD OF HEALTH f . .............." ...OF. 12. � .+ Ih ............................. _ N Appl ration for Disposal Works Tonshwtinn Frrmit Application is hereby made forfa.Permit to Construct ( ) or Repair ( t).6an Individual Sewage Disposal System at. .......... t� (Z-r1 .c'c �.G.. .................... ................i`� �, �:. --------......._._ ..... -- ... Location•Address or Lost No.' - ..............• ................. ....................................................{ c �It1�....-- .__ ne Address --••--•-•-•. ................. .............PA.. ....... 0............ a s . Installer Y ^..... Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.....:a.................................Expansion Attic ( ) Garbage Grinder a`4 Other—T e of Building No. of 'persons............................ Showers YP g -------------------•.-•----- ---....__ ..._. ( ) — Cafeteria ( ) dOther fixtures .._._... ..-----•-----------------------..:.........--•------------- •••--•-•.............. W Design Flow......... .....................gallons per person per day. Total daily flow....._:'°'-..0.......................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.....................sq. ft. 3 Seepage Pit No..._...t------------ Diameter.....k..D-1...... Depth below inlet.....Li.'.._.... Total leaching area..................sq. ft. . Z Other Distribution box ( ) Dosing tank ( ) `" Percolation Test Results Performed bY...........................................................: ........ Date........................................ Test.Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ' 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ..........•.................._•-------------------•. --------------•--••-•--•--------- Description of Soil.......:.............................................. U ......_...---•--•---•-•....... ..............•--•-••••........ ....•-•--•----..._......._..•--••--••••---••••------•-----......----•...•--• . .......-------•--......._..........•-----••------- W U Nature of Repairs or Alterations—Answer when applicable..._:_. �..a-<..... �................,_.__.. �a�!`7/'v-1. Old r� —�} .l• `P, �`�`-----.... .S.S(rr.Cx 1`,--� ...........�................. .......... f Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITiS 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasfib een issued by the board of health. 4. # ........................ ._.. . Date Application Approved BY - v.... __r .---c-��.._.. •--� �7� _ .._ Date _.Application Disapproved for.the'following reasons:............................................................. ........----••.......-•-••••-"--•-••---• , -•--------------••---•----.......•.............•.........------------------------.......................... .Date PermitNo..------. 3.7 1(p .................• Issued......................................................... THE COMMONWEALTH OF MASSACHUSETTS c w BOARD OF HEALTH w /ln" ........OF•..•... s..Q.,,A•--5NW-A_'°'C.............................. (ffrrfifiratr of TI-Implittnrr f THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by............................... 4: a z... -- 1 r• --.. ` ' .._....... •---....----•-•........ ..................:...... Installer at......................... ..vr..1!....... .......................... -•`--• "vL....................................... ~•-----•- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in'.the application for Disposal Works Construction Permit No.._...�.5'.-_.J_1..6!........ dated...................................:....__._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................. ......................... 7::. ..'.I?Z................:.......... Inspector....... �C�• ........................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (�j U J _� 4. ............Swt'JF�y.....OF .....:......... .. ................................... � r No................. F$E....t�_.•..-..1.... Disposal Works Tnnstrnrtinn Vrrntit Permission is hereby granted... L _ .. ..•.......:1''�.....��. `.[—.....`.................................................... �' to Construct ( ) or Repair Individual Sewage Disposal System . at No.................. I iZt b.... ......h:W.� �L.r.f,9(X al_.................................... ............ Street - as shown on the application for Disposal Works Construction Permit No.. ....37G?.. Dated.........:................ ................. -----•----•..................•--.................. Hoard of Health DATE....................... --------•------------••--•--•.................