Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0081 RUDDER ROAD - Health
Udder. 81 Mg; R"., HYANNIS A=247.-184 _ 3-0 TO V-1 M, 0 F B, S T AB LE 04� `�D I C, o V ^'AJ. j 7r� TT( t SIN -ri- x QY �J 111111 .l 1 75;9 a ti v U �?Jv _ ���� n 111111 �k 1/KJ' 1 .J ti --i yz kA 77 y 3ra���. pro s e-(D -�wow 04 N w V r -- o �T`> 0 k� I � . r I `y y �r f gT I-A fv) LJ-T; 3-z- C, Toe ............ so to z w _ a - a � � �.._......... C . _ C/ w. v C, �� 70 �_ / LA -JA 0- Olt 44 - a� SUIT-] 1 A - k"Ac b TIVIF loci . TV l Zj o-' 1- j 2� C� 1 1-7 J+ I 1-J it s ti _ },n�dvXar� A S � nn � h Sri V ° J 5 , Li gvzP �G�;(1L oc>fi ��S�Ui��U� 3 Farr si zQ ("'" � Dcr C �+ L COMMONWEALTH OF MASSACHUSETTS ExECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: l 1U —tXi Owner's Name: (z tiC, F Owner's Address: Date of Inspection: Name of inspector:(please print) Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 �R J _Centerville. MA i�; Tele hone Number:p t5081 775-877 C) - cn CERTIFICATION STATEMENT i~ I certify that I have personally inspected the sewage disposal system at this address and that the inform lion re orted r-+ below is true,accurate and complete as of the time of the inspection.The inspection was performed b d on my training and experience in the proper function and maintenance of on site sewage disposal systems.1 a th a DEP approved system inspector pursuant to Se tion 15340 of Title 5(310 C11IR 15.000). The system: asses Conditionally Passes Needs F valuation by the Local Approving Authority' Faits Inspector's Signature: Date: a� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Neatihvt DEP)within 30 days of completing this inspection.if the system is a shared system or has a design flow of I 0,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments "`This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 inspection Form 6/15/2000 page l f`/ Page 2ofII . OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A U CERTIFICATION(continued) Property Address• ©A C✓�` �C Owner: r. Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sys asses: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiitration or tank failure is imminent System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to-broken or obstructed pipes)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to bn*m or obstnxted pipc(s).The system wi11 pass inspection if(with approval of the Board of Health): broken pipes)are replaced obstruction is ramovod ND explain:plate: Page 3 of I I OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address- Owner: Date of Inspection: C. Further Evaluation is Required by the Board of Health: /V A . Conditions exist which require fiuther evaluation by the Board of Health in order to determine if the system ' is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the _ system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Healtk(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 I of a public water supply. x _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well** Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 pprr,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 ' 9 Page 4 of It OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Properly Address: es— Owner: Date of Inspection: 3 L + D. System Failure Criteria applicable to all systems: You must indicate"Yes"or"no"to each of the following for all inspections: Yes N _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6'below invert or available volume is less than%day flow _ 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. J Any portion of a cesspool or privy is within a Zone I of a public well. _ V 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 front a private A-z= supply well with no acceptable water quality analysis.(This system passes if the well water analysis, performed at a DEP certified laboratory,for cotiform bacteria and volatile organic compounds indicates that the well is free-from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: t� To be considered a large sy tem the system must serves facility with a design flow-of 10,000 gpd to 15,000 hpd- You must indicate either`yes"or"no"to each of the following: (ilie following criteria apply to large systems in addition to the criteria above) 4 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—1WPA)or a mapped Zone 11 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 owrier or operator of wry 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. P 4 Page S of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of Inspection: Check if the following have been done.You must indicate`des"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? i/ 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 th/e 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, Yes/no _ Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)) S Page 6 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: ' Cl y"i 1 Owner: �7` lY! t . Date of Inspection: '3 !3 a 7- FLOW CONDITIONS RESIDENTIAL 1. ' . 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): 3 3�1- y.K" Number of current residents: 9�- Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no): (if yes separate inspection required) Laundry system inspected(yes or no):�iq Seasonal use:(yes or no):^A-*� Water meter readings,if available(last 2 years usage(gpd)): - 1, c. Sump pump(yes or no):_� _ ����Zb` Last date of occupancy: COMM ERCIAIANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(ieats/persons/sgft,etc.): Grease trap present(yes or no):— Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: . OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as panto,f the inspection(yes or no): nrJ 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 k —Overflow cesspool —Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Altemative technology.Attach a copy of the curreat operation and maintenance contract(to be obtained from system owner) —Tight tank Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): /%A�' 6 1'agc 7 rJ I i OFFICIAL 1NSI'EC'rION FORM—NO.1- FOR VOLUNTARY ASSLSSNIEN7'S SUBSURFACE SEWAGE DISPOSAL SYSTEM INS►'ECI'ION FOR AI PAwr C SYSI'It;11I INFORMATION(continued) Properly Address: (�Lf , O►tncr. .1v�� Date of lrtspcctlon: BUILDING SEWEII(locate un site plan) Depth below grade: = j 4 ' + Maletials of construction:`cast iron _,,,/40 1'vC_u1hcr(explain): %V Distance front private alet supply well Of suction lute:_ Coll"lllents(oil condition of juints,venling,evidence of leakage,cic.): SEPTIC TANK: `!(locate on site plan) Depth below grade: Matcrialofeor►structivn: ✓cuitcic►c -metal fiberglass polycalylcnc __uthcr(cxplain) _ —' If tank is metal lisl age._ ccrtiftcatc) !s age cunfirrned by a Certificate of Compliance ()-es ur nu):=(attach a copy of Dinunsions: 15U6 Sludge depth: T. " Distancc from lull of sludge to buuum of outlet ice or bailie: -3•S` Scum thickness: 1 Distance from top of scum to lull of uullct ice or baflic: 7 .� ` Distancc Gorn butium of scum to buuun►of uutict tcc or IT._itic---/a" I(o%v wcic dimensions determined: dr of geb* -0. +��s„�z.•-�t Cumn►enls lull pumping reconunrndatiuns,ititet acid outlet tee ur baffle conditiu�,sttuctwal inkpily, liquid levcl% as related to outlet utvcrt,evidence of leakage,etc.): A,0 lt Gr4�� _cam �(df� die NIA GIIEASETRA11:_(locate un site plan) Dcld below grade:_ Matcrial ofconstructiuu:___ cuncrctc nicial tbcrglass_polycthylct►c__outer (explain): _ —" Dinicttsions: Scum thickness: Distance from top of scull,►u lull of outfct tcc of bailie:_ Distance front bottuut of scum to botlunt oroullcr tcc of balilc: Date of last pumping: Cununents(on pumping recuuunendaliuns,ir►let and uullet ice or baffle cundith::t,sltucttnal in1cpIty.liquid lever, ' as rclalcd to outlet invert,ct-idcltcc of Icakarc,cic.): 7 )'age 8 of i 1 e OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSL•:SSAIENTS SUUSUIVACE SLIVAGL DISPOSAL SYS7'LNI INSt'LC'1'ION F01ol PART C SY"'Lt11 INFORMATION(cuntinucd) rroperly Address:,Rt C �t1t�i S Owner: D"It of luspectlou: 3� TIGHT or 11OLDING TANK:,v (tank must be ,un►,cJ , 1 I at tune of insl,cction)(lucatc un site plan) Depth below grade; hlatetial of construction:__concrete_metal_fibctglass_j,blyethylene_olhel(explain): Dimensions: Capacity: alluns Design Flow. gallunslday Alarm prescni(ycs or no): Alarm level: Alarm in svurkin order DaIc of last pumping: 6 ()-cs of no):— Cununents(condition of alann and float SNvitches, DISTRIBUTION UO\: , ,( I resent rnusl be opcncdj(locate on site plan) Depth of liquid Revel above outicl invert: L3 r t COrllmer,lS(no le if box is level and distributive to outlets equal,an}'evidence of solids ca,ryovcr,any evidence of leakage into or out of bux,tic.). Q— niok o� — C.r ,, .. 4 c� ". ^-� '� [�cLc - we..�� /t.mil/ c PUMP CRRAMBLK: "��Ioccalc oit site plan) ,t ) Pumps in working order(ycs or nu): Alanns in working order(yes or no): Cunrnlenls(note condition of ptrntp chamber,tundilivn of pumps and appullelian(es, etc.): L Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 Owner: G Vt tn,L',i ► ! -i Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number. leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): /� f s'v�� `(�-� ._ Airs t.Ji� �t;L7z-iTa,., N�3 51C.1 cJL !'�iSF- ��1�•'�' 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): jV PRIVY: 6ocate 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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION"FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 0 T)3NAr e\1 Date of Inspection: 1 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feel Locate where public water supply enters the building. p A-a : 0 � 3 0 -(3 y �.3 13_-3 5 AS -y - yy Ap' 10 Pagt: 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: [ Owner. Date of Inspection: 3 4A V SITE EXAM Slope Surface water Check cellar Shallow wells - Estimated depth to ground water 5 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-if checked,date of design plan reviewed: Observed site(abutting propertylobservation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: (� R . I it r tHE) Town of Barnstable Regulatory Services BARNSrABLE ; Thomas F. Geiler,Director 1639. A�0� Public Health .Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/coPY of this report; this Division does not warranty the functionality of the septic system in the future not does this Division agree with any technical observation s and interpretations' contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. y � F MASSACHUSETTS ° COMMONWEALTH O EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS CTION TAL PROTECTION ENVIRONMENT OF ENVI ;. DEPARTMENT TITLE 5 S E , NOT FOR OFFICIAL INS UNTARY ASSESSMENTS PECTION FORM— r ' SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION W-A 3 MA 02601 3s i . Property Address: 81 RUDDER RD BARNSTABLE, Owner's Name: TROUT Owner's Address: 81 RUDDER RD BARNSTABLE,MA 02601 I Date of Inspection: 1/4/02 RECEIVED u JOHN GRACI � Name of Inspector: (please print) SEPTIC INSPECTIONS Company Name: 10 700Z j P.O.BOX 2119 TEATICKET,MA.02536 t � { Mailing Address: iii [3ARPiSTABLETelephone Number: 508-564=6813 FAX 508-564-7270 LTH DEFT. ji ' ....max a}F{yn• i CERTIFICATION STATEMENT T was performed based on my training and �rt= personally inspected the sewage disposal system at this.address and that the information reported be ow is = w, I certify that I have pets Y system lk true,accurate and comp lete as of the time of the inspection.The rose disposal systems.I am a DEP approvedY r ,. the proper function and maintenance of on site sewage The system: + experience in p P �+:' inspector pursuant to Section 15.340pof Title 5(310 CMR 15. � ) �� �� - X Passes 4 Conditionally P ses Approving Authority — the Local App g � Needs Furth valuation by i — _ Fails i Date: 1/4/02 „ , Inspector's Signature: withut + rovin Authority(Board of Health or DEP) I of this inspection report to the App g d or greater,the The system inspector shall submit copy e appropriate regional office of the DEP.The original should be F of coin leting this inspection. If the system is a sharedi system or has a design flow of 10,000 gp ��� • 30 days P i inspector and the system owner shall.submit the report if a licable;and the approving authority. s sent to the system owner and copies sent to the buy PP a 1 T' r a sk'd. I+ 4 MAC Notes and Comments TION.RECOMMEND PUFMPING EVERY TWO YEARS TO PROLONG THE SYSTEM PASSES TITLE V INSPEC I SYSTEM'S USEFUL LIFE. of inspection and under the conditions of use o dittos e.use`s i . ****This report only describes conditions at the time p inspection doe s not address how the system will perform in the future under the same or different c s � t Page 2 of 11 # c � OFFICIAL INSPECTION FORM—NOT FOR•VOLUNTARY ASSESSMENTSf SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM � . PART A CERTIFICATION (continued) , . Property Address: 81 RUDDER RD BARNSTABLE,MA 02601 Owner: TROUT Date of Inspection: 1/4/02 } Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D yt x A. System Passes: . X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: ""' SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE* � ru SYSTEM'S USEFUL LIFE. " A ' B. System Conditional) Passes _ One or more system components as describedfin the"Conditional Pass"section need to be replaced or repaired.The system,4 upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) inihe for the following statements. If"not determined"please explain 1 � 't n/a The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits s'= 4 substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced CPC 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 �Y that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed,. "or unenven distribution box. System will pass inspection if(with approval of Board of pipe(s)or due to a broken,settled � ;. Health): ' _ broken pipe(s)are replaced ' _ obstruction is removed _ distribution box is leveled or replaced t : ND explain: n/a r l i�4. n/a 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): Via, t _} broken pipe(s)are replaced �w It, j. _obstruction is removedY' 4 ND explain: n/a NNW .Y•. x a �� rs, Page 3 of I 1 OFFICIAL INSPECTION FORM-NOT FOR�.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM "� e" � fif PART A , , f CERTIFICATION(continued) A Property Address: 81 RUDDER RD BARNSTABLE,MA 02601 Owner: TROUT Date of Inspection: 1/4/02 t C. Further Evaluation is Required_by.the Board of Health: ± ` 1., x R 3 _ Conditions exist which require furthei;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: ;I _ Cesspool or privy is within 50 feet.of a surface waterx _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh ] *� and Public Water that th plier,if any)determines e 2. .System will fail unless the Board of Health( P system is functioning in a manner that protects the public health,safety and environment: _ The s stem has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water °3� N Y p _, supply or tributary to a surface water supply. y _ The system has a septic tafik and SAS-and the SAS is within a Zone 1 of a public water supply. Y P _ 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 of d SAS and the SAS is less than 100 feet but 50 feet or more from a private water 4 ; supply well**.Method used to'determine distance n/a ry . { ** system asses if the wellYwater analysis,performed at a DEP certified laboratory,for coliform bacteria and ' This y p volatile organic compounds indicates'ihat the well is free from pollution from that facility and the presence of ammonia i is equal to or less than 5 m,proided that no other failure criteria are triggered.A copy .. nitrogen and nitrate nitrogen q PP _ „r r; of the analysis must be attached to this form.' i W _ 3. Other: *; n/a : V. ��k s Orr 1 ' Page 4 of I I ra r . OFFICIAL INSPECTION FORM—NOT FORWOLUNTARY ASSESSMENTS r, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A . CERTIFICATION(continued) Property Address: 81 RUDDER RD BARNSTABLE,MA 02601 ` Owner: TROUTt Date of Inspection: 1/4/02 ` D. System Failure Criteria applicable to all systems: F You must indicate"yes"or"no"p o each of the following for all-inspections: � r� • Yes No X Backup of sewage into facility or system component due to overloaded or clogge AS or cesspool X Discharge or ponding of effluent to the surface of the ground,or surface waters a to an overloaded or clogged SAS or cesspool ' _ X Static liquid level in the,distribution box above outlet invert dueto an ove aded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volu is less than '/2 day flow " ui X Required pumping more than 4 times in the last year NOT due'to olo ed or obstructed pipe(s).Number of times pumped nLa. ; _ X Any portion of the SAS,cesspool or privy is below high ground ater elevation. X Any portion of cesspool or'pi ivy is within 100 feet of a surfac :water supply or tributary to a surface water supply 1 X Any portion of a,cesspool o'rl privy is within a Zone 1 of a p lic well ' _ X Any portion of a cesspool or privy is within 50 feet of a ivate;water supply well. d T X Any portion of a cesspool or privy is less than 100 fee ut greater than 50 feet from a private water supply well with ; no acceptable water quality analysis. [This syste asses if the well water analysis,performed at a DEP " certified laboratory,for coliform bacteria an volatile or compounds indicates that the well is free s' from pollution from that facility and the p sence of ammonia nitrogen and nitrate nitrogen is equal to or° ,�`� , less than 5 ppm,provided that no other lure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system faiL�.I have dete ined that one or more of the above failure criteria exist as described in 310 CMR 15,303,therefore the system fails.The,sy em owner should contact the Board of Health to determine what will be `„ u necessary to correct the failure. a • '6 �Y G fE��. E. Large Systems: To be considered a large system th 'system inust serve a facility with a design now of 10,000 gpd to 15,000 gpd. r 1 I You must indicate either"yes"or" o"to each of the following: (The following criteria apply to I' ge sy'ste'ms in addition to the criteria above)" y � t yes noY: X the system is withi 00 feet of a surface drinking water supply X the system is wi in 200 feet of a tributary to a surface drinkingtwater supply of X the system is cated in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)bra mapped ; Zone II o a public water supply well `a If you ve answered"yes"to any question in Section E the system is considered a significant threat,or answered'Y "yes"in Sectio D above the large system lias failed.The owner or operator of any large system considered a significant threat,;Yl� under Sectio or failed under Section)`'shall upgrade the system in accordance with 310 CM R 15.304. I'hc system owner,.,. p!� Y "i should contact the appropriate regional office of the Department. ' i` I , Page 5 of I I 4f- k zw OFFICIAL INSPECTION FORM—NOT FORYOLUNTARY ASSESSMENTS ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B R 4 t F CHECKLIST,, g` Property Address: 81 RUDDER RD BARNSTABLE,MA 02601 { s Owner: TROUT 4 's • Date of Inspection: 1/4/02 i xa t Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No s * � k. X _ Pumping information was provided by the owner,occupant,or;Board of Health X Were any of the system components pumped out in the previous two weeks? s X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? r , al Y +Were as built plans of the system obtained and examined?(If they were not available note as N/A) � ' L' { r . 7 �i for signs of sewage back u inspected P r dwelling ins g s facility o g X _ Was the fa y g p X _ Was the site inspected for signs of break out? k X _ Were all system components,excluding the SAS, located on site?. ' X _ 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? ': rt 'v X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? x F The size and location of the Soil`Absorption System(SAS)on the site has been determined based on: f,# : i Yes no X _ Existing information.For example,a plan at the Board of Health—, T s I X _ Determined in the field(if any of the failure criteria related to Part.C is at issue approximation of distance is M1' unacceptable)[310 CMR 15.302(3)(b)] E dW" a 1 ass ; � ISI Tye �x f. r � Page 6 of 11 ` OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS x. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' �e tig} PART C SYSTEM INFORMATION k Property Address: 81 RUDDER RD BARNSTABLE,MA 02601 Owner: TROUT 1 ' Date of Inspection: 1/4/02 FLOW CONDITIONS RESIDENTIAL ` Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents:0 o� Does residence have a garbage grinder(yes or no):NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] -a Laundry system inspected(yes or no): NO �'J4�jYt Seasonal use: (yes or no): NO l Water meter readings, if available(last 2 years usage(gpd)): n/a3r ;; Sump pump(yes or no): NO Last date of occupancy: n/a � , +t r. COMMERCIAL/INDUSTRIAL u Type of establishment: n/a a Design flow(based on 310 CMR-;15.203): n/agpd � Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO . Industrial waste holding tank present(yes or no): NO r� �t Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a ' OTHER(describe): n/a GENERAL INFORMATION' Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a '{ ), Reason for pumping: n/a " TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system Single cesspool } } _Overflow cesspool . _Privy _Shared system(yes or no)(if yes;attach previous inspection records, if any) t l _Innovative/Alternative technology:Attach a copy of the current operation and maintenance contract(to be obtained from V. 1 P1 i system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a � b"' Approximate age of all co''�'onents,date installed(if known)and source of information: ,t. Were sewage odors detected when arriving at the site(yes or no): NO i fi f: j h;, �u;5 4 A _ �f, , Page 7 of 11 '; l 1� OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS F . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) f s�. Property Address: 81 RUDDER RD BARNSTABLE,MA 02601 � Owner: TROUT r LA Date of Inspection: 1/4/02 itkt�, BUILDING SEWER(locate on site plan) ] tom, 1 Depth below grade:30" ' Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/at t Comments(on condition of joints,venting,evidence of leakage,etc.): 2 TOWN WATER ;. 1 SEPTIC TANK: X(locate on site plan) � . M .�1' yl Depth below grade: 24" Material of construction: Xconcrete_metal_fiberglass polyethylene other(explain)n/a ' If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) f.¢ I +� ' Yr•,A�1' ;t� I AF Dimensions: 1500G L 101 611 H 51 6I I W 5.811111 ��,;�, �,�, Sludge depth: 1" ' Distance from to a to bottom of outlet tee or baffle: ' P of sludge 33" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 18" * ; How were dimensions determined: MEASUREDs� `` r baffle condition,structural integrity, liquid levels as related- Comments(on pumping recommendations, inlet and outlet tee o ' to outlet invert,evidence.of leakage,etc.): f SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY.SOUND AND FUNCTIONING PROPERLY '' . RECOMMEND PUMPING EVERY'TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. . & 1 GREASE TRAP:_(locate on site plan) i444aatii • p. �„t Depth below grade: n/aau Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a ' - ' Scum thickness: n/a '' �1' -I 1 Distance from top of scum to top of outlet tee or baffle: n/a +b Distance from bottom of scum to bottom of outlet tee or baffle: n/a � ' Date of last pumping: n/a or baffle condition,structural integrity, liquid levels as related Comments(on pumping recommendations,inlet and outlet tee 7 to outlet invert,evidence of leakage,etc.);' n/a F ILI Page 8 of 11s r U, OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Evil Mw: SUBS PART C ' ;3; SYSTEM INFORMATION(continued) ,£ Property Address: 81 RUDDER RD'BARNSTABLE MA 02601 Owner: TROUT � Date of Inspection: 1/4/02 s� I TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction: concrete metal fiberglass_polyethylene—other(explain): n/a Dimensions: n/a ' Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level:N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/aN4 DISTRIBUTION BOX: X(if present,must be opened)(locate on site plan) ' t. a a Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPEt Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into , Y� y or out of box,etc.): s D-BOX IS STRUCTURALLY SOUND. ' PUMP CHAMBER:_(locate on site plan) 4 Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO f Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): All n/a vYFY J i r R4, 'P Page 9 of 1 I { r nx OFFICIAL INSPECTION FORM—NOT FOR•VOLUNTARY ASSESSMENTS F - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C : SYSTEM INFORMATION(continued) * ; Property Address: 81 RUDDER RD BARNSTABLE,MA 02601 Owner: TROUT ._s Date of Inspection: 1/4/02 'y SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: x n/a k .. Type Qr p ' n/a leaching pits, number: n/a n/a leaching chambers, number: n/a 4,v.. n/a leaching galleries, number.. 0 � . n/a leaching trenches, number, length: n/a 1 leaching fields, number: 3 CULTEC 330 K X( overflow cesspool, number: n/a n/a ,innovative/alternative system, � r n/a ,Type/name of technology: n/a v , ;. t 1 Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) TO BE FUNCTIONING PROPERLY.DID NOT EXPOSE:NO INSPECTION COVER RAISED. APPEARS , RECOMMEND RAISING COVER. BOTTOM IS AT 5'. A ; CESSPOOLS: (cesspool must be pumped as part of inspection)(locate.on site plan) Number and configuration: n/a � Depth top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a * . ' Materials of construction: n/a j .. Indication of groundwater inflow(yes or no): NO A, , Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a x PRIVY: (locate on site plan) , 1 � Materials of construction: n/a ' T j a . Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): fi n/a s Page 10of11 OFFICIAL INSPECTION FORM—NOT FOR4VOLUNTARY ASSESSMENTS ; r� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C � t SYSTEM INFORMATION(continued) ' ' Property Address: 81 RUDDER RD BARNSTABLE,MA 02601 Owner: TROUT : Date of Inspection: 1/4/02 1 ? SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal'system including ties to at least two permanent reference landmarks or benchmarks., , E Locate all wells within 100 feet. Locate where public water supply enters the building. t a w /yam J �� F f: } 1' cx C * yYy by ► AR R� 6 , ;. L 2 �ESN }`� " cq�S 1 { W U r � " Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR'!VOLUNTARY ASSESSMENTS M SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMaw PART C SYSTEM INFORMATION(continued) £; Property Address: 81 RUDDER RD BARNSTABLE,MA 02601 r Owner: TROUT 'L Date of Inspection: 1/4/02 SITE EXAM k f _Slope `. �. _Surface water t� E _Check cellar Shallow wells Estimated depth to ground water 10+feet y Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) ��, NO Checked with local Board of Health-explain: n/a Y NO Checked with local excavators, installers-(attach documentation) r� YES Accessed USGS database-explain: n/an You must describe how you established the high ground water elevation: DETERMINED BY HAND AUGER AND USGS MAPS AND CHARTS. 10+FT. 41 t t s } �t � v 'yI-kxsx*ter CL^yt. v ..StPx' .943.•r: it Town of Barnstable Regulatory Services sAMSrnsL = Thomas F. Geiler, Director y suss. $ i639. Public Health Division Thomas McKean,Director 367 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Mr. Dennis Trout Ms. Ann Fredricks P.O. Box 673 81 Rudder Rd. Hyannis, MA 02601 Hyannis,MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 81 Rudder Rd,Hyannis MA. 02601 was inspected on December 6, 2001 by Edward Barry,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: 410.500 Floor covering in the bathroom, in front of tub and perimeter of the toilet has black stains. The window pane in the rear door is cracked in two locations, a board is missing form the side rear deck,the north side of the steps to the deck are loose and unstable,the fence is loose and is held in the vertical position with a string,wallpaper partially removed in the sewing room and south bedroom,the tenant claims there is excessive dampness in and under the carpeting of the master bedroom. You are directed to correct the violations ABOVE within TWO WEEKS of receipt of this notice. You may request a hearing if written petition requesting it 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 BOARD OF HEALTH Tho• as cKean Jr of Pudic Health Q:/health/wpfiles/nuic#1 i Health Complaints 06-Dec-01 Time: 9:15:00 AM Date: 12/6/01 Complaint Number: 3190 Referred To: EDWARD BARRY Taken By: EDWARD BARRY Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 81 Street: RUDDER RD. Village: HYANNIS Assessors Map-Parcel: Complaint Description: EXCESSIVE MILLDEW IN HOUSE. CLAIMS THIS IS AFFECTING HER HEALTH Actions Taken/Results: EFB ON SITE.TENANT ANN FREDRICKS WAS HOME. SHE SHOWED ME THE BLACK DISCOLORATION ON THE PLASTIC FLOOR COVERING ALONG THE BASE OF THE TUB AND AROUND THE TOILET. OTHER VIOLATIONS WERE ONE WINDOW PANE IN REAR DOOR CRACKED IN TWO PLACES,RERA DECK BOARD MISSING NO RAIL AND NORTH SIDE STEP LOOSE AND UNSTABLE, DEBRI IN REAR YARD(OLD SHUTTERS,OLD WINDOW FRAME,OLD BARBECUE STAND,MISC PIECES OF OLD WOOD ,METAL AND PLASTIC AND ETC) REAR WOODEN FENCE LOOSLY HELD BY STRING. WALLPAPER PARTIALLY REMOVED IN SEWING ROOM AND SOUTH BEDROOM. TENANT CLAIMS THAT THERE IS DAMPNESS UNDERNEATH THE CARPET IN HER BEDROOM SHE SAID THE WINDOW WELL FILLED UP WITH WATER AND OVERFLOWED ON TO THE CARPET 9 J.F ' Health Complaints 06-Dec-01 Investigation Date: 12/6/01 Investigation Time: 11:15:00 AM 2 • � �K sty `a'� � - �. • - fir..'^ t. a 0 Postage $ r„ Er Ln Certified Fee C� Park Return Receipt Fee 4` Mere M (Endorsement Required) .0 r-q Restricted Delivery Fee � (Endorsement Required) C 9 O Total Postage&Fees `O Se �'�-WO -Tr -A-------------------------- S. L.No.,.or P x�lo. ------- - ------(0- ------ C3 Ci Sate,ZIP+4 ,mix, Certified Mail Provides: . io A mailing receipt o A unique identifier for your mailpiece o A signature upon delivery io A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. o Certified Mail is not available for any class of international mail. io NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. . o For an addit onal fee,aR'eturn Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endors ,mailpiece 'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. LZ o For an%additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". n If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,May 2000(Reverse) 102595-99-M-2087 f COMPLETESENPER: COMPLETE THIS SECTION • ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Received by(Please Pr' Clearly) to of Delivery item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. Signatur e ■ Attach this card to the back of the mailpiece, ent or on the front if space permits. �JX�X Addressee D. Is delivery address different from R m 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No ®. 1botK 1 3. Servic e 0 ertified Mail ❑ E ss Mail ❑ Registered "eturn Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number(Copy from service label) i. i i i 1 f Ill 1# I li i'. PS Form 3811,July 1999 Domestic Return Receipt 102595.00-M-0952 UNITED STATES POSTAL SE7.15E� Mq """" _- First--Class Mail"`a Postage&Fees Paid LISPS -P.ermit-No�G40- -• • Sender: Please print yo"ame, address, and ZIP+4 in this box • Public Health Division Town of Barnstable PUBL534 RETURNiBO0SENDER 10 12/28/01 NO FORWARD ORDER ON FILE UNABLE TO FORWARD RETURN TO SENDER U ll�llll11111/lllJlllllli711�1 fill III Ili 1111111111 A Ill 11 Ill 111l j Town of Barnstable Regulatory Services BARMSrABM = Thomas F. Geiler,Director 9 MASS. 1639. Public Health Division ArED N1p't A Thomas McKean,Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Mr. Dennis Trout Ms. Ann Fredricks P.O. Box 673 81 Rudder Rd. Middleboro, MA 02601 Hyannis,MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II,MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 81 Rudder Rd,Hyannis MA. 02601 was inspected on December 6, 2001 by Edward Barry,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: 410.500 Floor covering in the bathroom,in front of tub and perimeter of the toilet has black stains. The window pane in the rear door is cracked in two locations, a board is missing form the side rear deck,the north side of the steps to the deck are loose and unstable,the fence is loose and is held in the vertical position with a string,wallpaper partially removed in the sewing room and south bedroom, the tenant claims there is excessive dampness in and under the carpeting of the master bedroom. You are directed to correct the violations ABOVE within TWO WEEKS of receipt of this notice. You may request a hearing if written petition requesting it 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 1 Q:/health/wpfiles/nuic#1 TOWN OF BARNSTABLE y LOCATION SEWAGE # R8 -(?,y VILLAGE ����n ASSESSOR'S MAP & LOT A 1 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1,5b® G LEACHING FACILITY: (type) C-!1 ec 3 3 os —3 (size) 46 NO.OF BEDROOMS BUILDER OR OWNER PERMrrDATE: 1,nr-A Ci 8 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by A� vs, a f, Er- p Postage Ir \\\\ Ln Certified Fee C9 Postmar Return Receipt Fee M (Endorsement Required) � Restricted Delivery Fee H C3 (Endorsement Required) p Total Postage&Fees $ _M Sent-------Nw T __ ,� Str , pt. or P x No. O 0 = - ----•--------------- -----------•----------------------- t3 City, t te,ZIP+4 I� 02191 :.. ..1 6 Certified Mail Provides: o A mailing receipt • A unique identifier for your mailpiece o A signature upon delivery o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. e Certified Mail is not available for any class of international mail. • NO INSURANCE COVERAGE IS PROVIDED with Certified Mail., For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt serwce,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece 'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. io For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry., PS Form 3800,May 2000(Reverse) 102595-99-M-2087 Town of Barnstable Regulatory Services BARMSTABM Thomas F. Geiler,Director % MAN. 039. Public Health Division ArEp�,tA Thomas McKean,Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Mr. Dennis Trout Ms. Ann Fredricks P.O. Box 673 81 Rudder Rd. Middleboro, MA 02601 Hyannis,MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II,MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at-�&1 Rudder'Rd,Hyannis MA:02601 was inspected on December 6, 2001 by Edward Barry,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: 410.500 Floor covering in the bathroom,in front of tub and perimeter of the toilet has black stains. The window pane in the rear door is cracked in two locations, a board is missing form the side rear deck,the north side of the steps to the deck are loose and unstable,the fence is loose and is held in the vertical position with a string,wallpaper partially removed in the sewing room and south bedroom,the tenant claims there is excessive dampness in and under the carpeting of the master bedroom. You are directed to correct the violations ABOVE within TWO WEEKS of receipt of this notice. You may request a hearing if written petition requesting it 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 Q:/health/wpfiles/nuic#1 i 4 A No. \ Fee c 7 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: e ` Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS - —Zipprication for �Digozar 6pelem Conotruction Permit Application for a Permit to Construct( )Repair(Y')Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. , Owner's Name,Address and Tel.No. ICts•Ol�Cf'Z� TAB+e_( mkka,7 Assessor'sM /Pacel S�Ta oco_N L) Ann( 7 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable)Tn.5.7A// /.5'60 QA) 711h, 0-b oX. - 3 C,1Tec 330: v 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 issss ed by this oard/of;�[Ie lthSigned�tr '/�i1 Date�"� Application Approved by Date 3 � S= 9 x( Application Disapproved for theWflowiriglasons Permit No. Date Issued 2 a316 << _ d8 r `, .3j � r yy , Cc,17:c 36 TOWN OF BARNSTABLE LOCATION = I SEWAGE # Rs -(164 VILLAGE_ a ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. F^(SEPTIC TANK CAPACITY 16 00 Gnr( LEACHING FACILITY: (type) Cy/ cC 3 3 as —3 (size) NO. OF BEDROOMS BUILDER OR OWNER_ --3>An, PERMTTDATE: F-n r,1 <<i COMPLIANCE DATE: -7 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ` 3 4 �.� t► ¢. ; No. (J Fee c r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓� Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Migpogal *p Aem Cottgtrurttou Permit j Application for a Permit to Construct( )Repair(k")"Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 81 'Rv p C 2�4 Owner's Name,Address and Tel.No. \0,u�� Assessor's Ma /Parcel N (��1 g `2, O.ac Q1 �oL 0?��7 /8y , a��'' > �;sni,; �tn, 7>/- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedroom's-3 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 '11eet, %Re�vision`Date Title -4 Size of Septic Tank Type of S.A.S. + i Description of Soil f Nature of Repairs or Alterations(Answer when applicable) 50Sr,, 1 W 1Soo G j //1�i h, .>7-h L)X, 3 C u 17Tc 33o f 3 oz //� ' Spa.) e '' s�Vpl! Date last inspected: t 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 issF/ d by this oard of/Health. na r Signed ,11 7 Application Approved by 1`7 Dae � S= 1 Y Application Disapproved for the lowin easons :, Permit No. t- Date Issued J --- _- -- ._ =---_ — - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance - THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( P jUpgraded( ) Abandoned( )by 1)1), T at 81 /'?,0 0<'./?o has been constructed in accordance with the provisions of Title 5 And the for Disposal System Construction Permit No. ,: e dated t Installer '1i6trr.1 T1"' — 62a4of i Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date p p1 Inspector No. Ll Fee L- C) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ligoaf *pgtem Construction Permit Permission is hereby granted to Construct( )Repair(�Upgrade( )Abandon( ) System located at R1 /P"O,) . po 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: / d) Approved by k .Z 0 t-. N 10/9197 NOTICE: This Form Is To Be Used For.the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) hereby certify that the application for disposal works ,.,,,�.� rS S fJ ,concerning the construction permit signed by me dated ��tit t meets all of the property located At following criteria: • There are no wetlands located within 100 feet of the proposed leaching fhcility e There are no private wells within 150 feet of the proposed septic system e There is no increase in flow and/or change in use proposed e There are no variances requested or needed. If the proposed Leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will UW be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. ASSESSORS MAP NO' PARCEL NO' /, Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) B)Observed Groundwater Table Elevation(according to Health Division well map) rv� DATE: a 15 ,98 SIGNED: LICEN D SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system.Also irthe licensed Installer posea9e5 a certtfled plot plan, this plan should be submitted). <� q:health folder:cert t t i ta! ctr o v