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Home My WebLink About0086 SEABROOK ROAD - Health 86 Seabrook Road, Hyannis A= �f I I, I � G III No. 157 V 7-5 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS RppliLation for Disposal 6pstpm Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon ❑Complete System ❑Individual Components Location Address or Lot No. 'IC414 56z6wk Ra Qwner's Name,Address,and Tel.No. ,�j 3- /- �Z 9`$O !�V Assessor's Map/Parcel3botr Q j� �'4cult"11`3 e1 ^ Aat Installer's Name,Address,and Tel N . ,SU-.7`?/-9.39y Designer's Name, ddress,and Tel.No. lls vXV? 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(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) ° 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 Enviro de and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He igne Date Application Approved by Date !� Application Disapproved by Date for the following reasons Permit No. ' 73 Date Issued No. /� d 77 Fee C7� A THE COMMONWEALTH�OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION '- TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4plicatioYY fDr I8tJ0saY *pstPrtt Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon ❑Complete System ❑Individual Components j Location Address or Lot No. --d(Q Smb(mk R)CA Owner's Name,Address,and Tel.No. J-13 84/- a 596 CUp�e t(- 337U r� rj(--. Assessor's Map/Parcel3U4 U32. t E��Ct n r�t S 0 .,� 'n _- r° Installer's Name,Address,and Tel.No. S?bS- r)`?/-`F j�,9 Designer's Name,Address,and Tel.No. aOi^�c,�G CryGr�S /uc�ari,517C • �� 1 s v�off 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(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) J 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 Health."----' Date ,Z/ Application Approved by Date Application Disapproved by Date for the following reasons Permit No. (�/rj �J`7- Date Issued ---------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS I O CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned" )by Ar/14-1,e 1 0 s�d *1 ✓, /,,� . at % 5;?,z4 ,/,< y J,Y ��4 rl�l!S 'has been constructed in accordance 7� with the provisions of Title 5 and the for Disposal System Construction Permit No;i5 "O?3 dated 311-5 Installer &r (,L-t� 0.r,, _lr c Designer #bedrooms Approved design flow R gpd The issuance of t is perrhit sha not be construed as a guarantee that the system wil fimc' n designed. Date I I Inspector ---------------------------------------------------------------------------- - ------------------------------------------=-=--------- No. C) Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction �Prmit "Permission is hereby granted to Construct( ) !Repair( ) Upgrade( ) Abandon(� System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mu t be c jmpleted within three years of the date of this,permit. ,-- Date � �1 Approved liy I I I UNITED STATES POSTAL SERVICE First-Class Mail I Postage&Fees Paid I USPS I Permit No.G-10 j • Sender: Please print your name,address, and ZIP+4®in this box* I Town of Barnstable Health Division 200 Main Street' Hyannis,MA 02601 I I I I I I �, 44010.,2CJ0 1Ij1fJl,�iijlf,fll�l�lillff III till 11111111111AI III 111y1f1'i'fill t � I ® Complete items 1,2, ind'3.Alsb complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent e Print your name and address on the reverse X17C ❑Addressee so that we can return the card to you.to Attach this card to the back of the mailpiece, B. Recei ed by(Prin d Name) C. Date of Delivery or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No / \l i lLl j—a + �3 TO C—( G, C i�1o'�ct."1 1 d 3. Service Type .Certified Mail® ❑Priority Mail Express, Lf 5 Z`Ld — 5 ❑Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7014 '1200� �0001 0358 5050 (Transfer from service labeq PS Form 3811,July 2013 Domestic Return Receipt LOMUMAJO �C3 .. • u-I OFFICIAL UII.� = !N � I u�i M Postage $ to ? U Certified Fee Return Receipt Fee _ Postmark O (Endorsement Required) Here Restricted Delivery Fee 4 p (Endorsement Required) �) rU Total Postage&Fees Sent To L v i Uc� O Street,Apt.IV -�------------------------- _.. ------------------- D- or PO Box No. �,-v ( 4-�O O f Ciry Stale,ZIP+4 ---'� - - ------- ---- f i , c i dln O \'� (-1 j 22Ci—IssS' i :rr rr. Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for,two years Important Reminders: I o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. n Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. n For an additional fee,a Return 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.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is 1 required. n 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,August 2006(Reverse)PSN 7530-02-000-9047 Town of.Barnstable Barnstable "e`�cft"RegulatoryServices Department V MSTAs> D "`^S& Public Health Division 639. �0 m fD N A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 5050 February 9, 2015 AMY LOI EVERETT 3370 BISHOP ST IMPORTANT NOTICE CINCINNATI, OH 45220-1858 Map & Parcel: 307- 032 DEADLINE APPROACHING According to our records your dwelling at 86 Seabrook Road, Hyannis,MA, should be connected to public sewer on or before 3/30/2015. This is a reminder that all permits need to be in place before this date to be in compliance: 1) Septic Abandonment Permits ($ 25) are issued at the Public Health Division, 200 Main Street, Hyannis. The old septic system must be either removed or filled in due to future safety concerns. This may be done by the same contractor who connects you to the sewer. ` 2) Contractors, approved to perform sewer connection work in the Town of Barnstable must obtain and file a Sewer Connection Permit with DPW-Water Pollution Control Division, 617 Bearse's Way, Hyannis contractors, please call Dave Anderson at (508) 790-6244. y t LIMITED TIME FOR SAVINGS ON GRINDER PUMP The Department of Public Works (DPW) is still offering grinder pumps at no charge, if you obtain your permits and connect to sewer promptly. (This can save you thousands of dollars, but this offer will expire.) Please note: You must pay the installation cost of the pump through your own contractor. FOR ANY QUESTIONS/ASSISTANCE: Len Gobeil at the Town Manager's Office is available to provide you with direction you may need in reference to the Stewart Creek Sewer Connections. You may contact him at 508-862-4701. Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health 1 t�T Town of Barnstable Barn Regulatory Services Department �� g ry p _ 1 � � ► •AitNSTABLB, � . MASS'39. Public Health Division i639 ♦� Fo MA'S e 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 5067 February 9, 2015 AMY LOI EVERETT 3370 BISHOP ST IMPORTANT NOTICE CINCINNATI, OH 45220 Map & Parcel: 307- 230 DEADLINE APPROACHING According to our records your dwelling at 56 Seabrook Road, Hyannis, MA, should be connected to public sewer on or before 3/30/2015. This is a reminder that all permits need to be in place before this date to be in compliance: 1) Septic Abandonment Permits ($ 25) are issued at the Public Health Division, 200 Main Street,Hyannis. The old septic system must be either removed or filled in due to future safety concerns. This may.be done by the same contractor who connects you to the sewer. 2) Contractors, approved to perform sewer connection work in the Town of Barnstable must obtain and file a Sewer Connection Permit with DPW-Water Pollution Control Division, 617 Bearse's Way, Hyannis—contractors, please call Dave Anderson at (508) 790-6244. LIMITED TIME FOR SAVINGS ON GRINDER PUMP The Department of Public Works (DPW) is still offering grinder pumps at no charge, if you obtain your permits and connect to sewer promptly. (This can save you thousands of dollars, but this offer will expire.) Please note: You must pay the installation cost of the pump through,your own contractor. FOR ANY QUESTIONS /ASSISTANCE: Len Gobeil at the Town Manager's Office is available to provide you with direction you may need in reference to the Stewart Creek Sewer Connections. You may contact him at 508-862-4701. Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health r, o TROY WILLIAMS off' �-'��-�. SEPTIC INSPECTIONS ' ' pC Certified by MA Department of Environmental Protection tow, 97 (508) 385-1300 19 Hummel Drive HFq�"FPTTAe�f South Dennis, MA 02660 � COMMONWEALTH OF IvMASSACHUSET G 9 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS COPY r DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON, MA 02108 617-292.5500 WILLIAM F.WELD TRUDY CO7iE Govcrnor Sccrctwv ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioncr PART A CERTIFICATION Property Address: 6 .Sept 4i�-�o Qct. i4ki c.K N. S Address of Owner: Date of Inspection: /o 8 l c►7 /4``4+ L /�o M•vr e ��r c L) � Troy o Williams (If different) Name of Inspector: y 14 6 .Se 4✓c V,f /�j I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 1S.000) Company Name: Troy .Williams Septic Inspections 7ay.,,o� � lt//G • Mailing Address: 19 Hummel Drive " South DpnniS , MA 02660 ' Telephone Number: ((5 0 8) 3 8 5-13 0 0S— 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. Tke 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: Date: /0�� The System Inspector shall submit a copy of this inspection report to the Approving Authority 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. INSPECTION SUMMARY: Check A, 8, C, or D: AJ SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: - BI 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. Indicate 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 conforming septic tank as approved by the Board of Health. (rw ..d 04/25/97) - P.q. 1 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: L �/o-..-w. «( •cam Date of Inspection: e] SYSTEM CONDITIONALLY PASSES (continued) W41 Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed i r r pipe(s) o due to a broken, settled or uneven distri i 'Pe but on box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) 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 pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed q FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: /v//�? , 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) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) 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 to 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 04/25/97) Pag. 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A // CERTIFICATION (continued) Property Address: b .S e Ci "6 Owner: Date of Inspection: c�w'L cA DJ SYSTEM FAILS: You must indicate ewer "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined 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 No Backup of sewage into facility or system component due to an 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 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 front 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. El LARGE SYSTEM FAILS: NII.-9 You must indicate either "Yes" or "No" as 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 owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) -A Page 1 of 10 „ P SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 6 Owner: 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. ✓ _ 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. Y _ As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. ., — 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: _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. L _ Determined in the field (if any of the failure-criteria related to Part C is at issue, approximation of distance is unacceptable) ]15.302(3)(b)] (revised 04/25/97) F Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C p SYSTEM INFORMATION Property Address: o �t�` 4,6 Owner: L �✓4Nn c cl� `�/ A Date of Inspection: RESIDENTIAL: FLOW CONDITIONS Design flow: 7 a g.p.d./bed room for S.A.S. Number of bedrooms: 3 Number of current residents: O Garbage grinder (yes or no): No Laundry connected to system (yes or no): /`,(0 bv>t s o k ip Y Seasonal use (yes or no): No Water meter readings, if available (last two (2) year usage (gpd): 4- Sump Pump (yes or no):_&/� j s Last date of occupancy: Cle.c 9G COMMERCIAUINDUSTRIAL• A1119 Type of establishment . Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no) } Non-sanitary waste discharged to the Title S system: (yes or no) Water meter readings, if available: Last date of occupancy: OTHER: (Describe) - Last date of occupancy: t GENERAL INFORMATION PUMPING RECORDS and source of information: / ��Ni � �roa �� c Lpr�.6t�` � ... �'�� f'i�•� i�-e.✓ i ti r`-o �� o.� . owr�,� System pumped as part of inspection: (yes or no) Ala If yes, volume pumped: gallons Reason for pumping: TYPE qF SYSTEM --,y`/— Septic tank/distribution,box/soil absorption;system Single cesspool fi Overflow cesspool »' Privy Shared system (yes or no)" (if yes, attach.previous inspection records, if any) VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: s //c 2 X2 5 '/k Sewage odors detected when arriving at the site: (yes or no) Nd (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: G S e- Owner: Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC_other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plan) Depth below grade: I Material of construction: ✓concrete _metal _Fiberglass _Polyethylene —Other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions:_ S X ix /moo C• �+ Sludge depth:__, o N1 Distance from top of sludge to bottom of outlet tee or baffle: A(0 S Scum thickness: Non/F_ Distance from top of scum to top of outlet tee or baffle: V* t(-V^. Distance from bottom of scum to bottom of outlet tee or baffle: wu .S ✓�., How dimensions were determined: )ara 6 Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural int/e�grity, evidence of leakage, etc.) d2LI L -s eb/ G Pt ,� � (< -e so a S I O a 7�✓ '1ti v I G� 420 Cti is _ E/T A c.�H kt. L+i`'� S I/l O - i GREASE TRAP:__,A/t/4 (locate on site plan) Depth below grade: 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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/97.) Page 6 of 10 P SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C p / SYSTEM INFORMATION (continued) Property Address: D 6 r_c �✓t+ (L . Owner: Date of Inspection: TIGHT OR HOLDING TANK: /"/4(Tank must be pumped prior to, or 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/day Alarm level: .Alarm in working order_Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: (not if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out ofbox, etc.) 0—��X c-,C. W s / �:•. c//� I-<-O'r � G►�rJ- Jt.. t�.J o r /-L . I.. S O r c/L t�/ /y u 5 h S J PUMP CHAMBER:_/� (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) F , (revised 04/25/97)a - r. Paqe 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �( c SYSTEM INFORMATION (continued) Property Address: U V cG- v K oed Owner: L Date of Inspection: t v SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: � leaching pits, number:�e- X leaching chambers, number:_ < leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure,, level of ponding, condition of vegetation etc.) / v,(1 O, G t t CerSPOOLS: -10!/,q (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 (cesspool must be pumped as part of inspection) 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.) (rwlaad 04/25/97) Paga ! of 30 p f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) . Property Address: �6 ��DZiO !_ /CF p „ Owner: U Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) -k y t—'rvh � wo•fc. L:� 5a 2� (revised 04/25/91) f' Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C c / SYSTEM INFORMATION (continued) Property Address: E' Jr i Owner: 1 6 t � r2V Date of Inspection: `v Depth to Groundwater f Feet 7' adlustcd high groundwatcr level Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers _. Use USGS Data Describe in your own words,how.you established the High Groundwater Elevation. (Must be completed) �► . d( c.i�:f cr It o�cJI J✓ s d n� c G. f (rwlud 04/2S/97)a ¢ Page r10 of 10 Permit Number: Date: Completed by77T��. l I - e_ t s HIGH GROUND-WATER LEVEL COMPUTATION Site Location: S c 4 4"•z e, k Rd Lot No. Owner: L t/�a+•,v..� ,� {y Address: Contractor: Address: Notes: STEP 1 Measure depth to water table to nearest 1/10 ft. .............................................................................. .Date 7 month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................................... ��✓l9 OB Water-level range zone ..................................................... STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to $ water level for index well ........................... ? month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A),current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) determine water-level adjustment ............................................................................................ 2' STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water levelat site (STEP 1) .....................:.....................:................................................................. 9 `r TM THE COMMONWEALTH OF MASSACHUSETTS FORM 30 �&W HOBBS 8 WARREN BOARD OF HEALTH 'r2�ta I P►IR L f- CITY/TOWN W fr.AL11 b DEPARTMENT S;T. *A _ ADDRESS 11 Z A; _ G,M Syey`0W �Sosl �� TELEPHONE Address Uto &aA &400 4- " occupant k/.ACA N1 Floor Apartment No. " No.of Occupants_l J- A No.of Habitable Rooms_;S No.Sleeping Rooms__ No. dwelling or rooming units No.Stories' Name and address of owner wt f-V�L�C�� 3 -7 V S l?• -+ C_N ' N A; 1 ON jO 4 S ZZD Remarks Reg. Vio. YARD Out Bld s.: Fences: / Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: / Roof v Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : J STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING / Chimneys: Central D/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.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: / Gen.Cond. Distrib. Box: / Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 16 Bedroom 4 Hot Water Facil. Sup.Ten., lect.: St es, ts,S feties: Kitchen Facilities Sink o 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 '"[O U S- 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 r0ERJU11Y.II INSPECTOR TITLE 1-12,41 GyW !Z S C4,ro iL DATE (1, - 17- ZoDg TIME z*?/Jo- P.M. A.M. THE NEXT SCHEDULED REINSPECTION !V ,� P.M. y 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found.to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has.the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correctio-i 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 facil ties 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 mai-itain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which preverts 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 tl-e 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 washbasir 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 41:0.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. I � LOCATION SEWAGE PERMIT NO. VILLAGE 14' �� /3 I N S T A LLER'S NAME i ADDRESS 0 U I L D E I3 OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED l �� R .� w ail � •� � �� e� N W �/, I ° � � �� THE COMMONWEALTH oF MAssAo*uSsTrs BOARD�� HEALTH ��^ ^~ ~�� " ��x�� --.--'----'---��p------------ »� �� Applir« tm� ipug«� Works Tonstrur40mn 1hrmit Application is hereby ooule for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: J Location-jLddress 4 Lot No. Installer Address Type of Building Size Lot.'-----'-'--'---'8n feet Dwelling--Nu of Dcdrooma----.... ..........................Expansion Attic ( ) Garbage Grinder ( ) ok Other—Type o6 Building ............................ No. of persons............................ Showers ( ) -- Cafeteria ( ) 04 (Jtbec fixtures —.—.------_---------_-_--------.______._._.________.________________. Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid cupucity/ftW..gallnoa Length................ Width................ Diameter................ Depth................ Disposal Trench--2Jn. .................... Width.................... Total I-cogtb---------' Total leaching area....................sq. f t. Seepage -- Diaoetec--��..^--- Depth hclmniolcL--------- Iotu leaching ur��-----'--'ml. b. �� Other I)ia�ixz600box ( ) Dosing tank ( ) ~~ Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. l................miootcyyerioo6 Depth of Test Pit.................... Depth tn ground water........................ 0�4 Test Pit No. 3................minutes per inch Depth of Test Pit.....'---'-- Depth 1oground water........................ 9 --_-.—_—._--_-_-''-_-_'---_---__-.----'---'----------'_---_'---'---'---- 0 Description cf Soil_----____.—__----_............................................................................................................................ --------`-------------------------`-------------------------'--'------------------------- | �� ----------'--------'—'------- ' U Na toreo f R pts or Ajterations—Answer when applicable. The undersigned agrees to install the uforedescribed Individual Sewage Disposal System in accordance N .."...' ............................. FEs. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................I.................O F................................... Applira#iou for Dippas al Works Tonstrurtiott ramit Application is hereby made for a Permit to Construct ( ) or Repair . ) an Individual Sewage Disposal System at: �_.cateio.,'ATZ... T� --------------------- --------------------------------------•--------...-------•-•--....-----.....-•----.......-----•--- ress or Lot No. $.�............... ___...._. ----•------------- --------------------------•-----------•---.....------ ``gyp W O ner s. nstaller Address UType of Building Size Lot____________________ __....Sq. feet Dwelling—No. of Bedrooms......... �"...........................Expansion Attic ( ) Garbage Grinder ( ) � Other—Type of Building g --------•------•------------ No. of persons____________________________ Showers ( ) — Cafeteria ( ) Other fixtures •-•-••--•--•--••------------------------• W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacit;it�...gallons, Length................ Width................ Diameter................ Depth................ Disposal Trench—No...................... Width....................Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No. Diameter Diameter____________________ Depth below inlet.................... Total leaching area_.................sq. ft. Z Other Distributfon box ( ) Dosing tank. ( ) HI Percolation Test Results Performed bY..................................-....................................... Date........................................ Test Pit No. 1________________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........................ 9 -•••----••--••----------------•••-•••--••--•------••----••-••--......-----........----------••------.........................................................O Description of Soil........................................................................................................................................................................ x U -----•----•--••-•--•---...---•-•---------•-•--------•-------•--•-•-----------••--••-•----...--•-•-•••--•----•-•-•---•-----------•-----------•-----------•-•------...--•-•------------------------------- W ........................................................................................................... V Nature of Repairs or Alterations—A swi "when applicable_ '':'pS'ef_—i' ________________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE%, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b u the I'zl~Ahealth. .c.�,,.c..�....�.. 13 Sign _�._... -----•--...---- --- ............................................. Date Application Approved By................................. .................... ----- ------------•-- -•--- - ----------•------- ................................--...... r Date Application Disapproved for the following reasons:---- ",-------------------------------------------------------------------_---_--_------.................... ---•-•-•-••------•--------------••--•-----•-----••--------•...---7-------••-•-----------•------•-•-----------------------•--------------------------=---------------------._._____---------------....... Date PermitNo.......................................................... Issued..................?n= �------•--......:---•----------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... �r �rriifiratr of f�outpfiFattrr '' THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired, ( ) bY------------------------------------------ •--•--•-----••-•--•-------•___---------------------- ---•--•-•••----------•-•----------••--•-•-•-------------••-••--------•--------------------•---- Installer at.................... ...................... .......................................................................................................................................................... has been instaried in accordance with the provisions of TITIF 5 of The State Sanitary.Code as described in the --application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUAN OF THIS CERTIFICATE SHALL NOT BE CONSTRU ® AS A GUARANTEE THAT THE SYSTEM W 'L F�`"' ON SATISFACTORY. DATE•-J f=y ../.__.._..-•----•-----------------------•-----------•---- Inspector---- --• •------------------••--••--------•---•-••---............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No. `�- ; 2 .....................:................... �.�J 1' - )----- / FEE........................ DiiiVapuf rku �oa�u#ra iou rrattit Permission is hereb to Construct ( Rep�i�r ( ) ri In� iduak5ev a e Disposal System at No.................. ......°�;�! ls! T..!C...- ! g Street 1 as shown on the appli tion r Disposal Works Construction Permit No.__..--�`_________ Date __________________________________________ ....--••-___ •-.____.... -- ;-•------•-------------------•-------•---..._-----.. DATE. _ ------------- Board of alth ---•---------- FORM 1255 A. M. SULKIN, INC., BOSTON UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Sender:, Please print your name, address, and ZIP+4 in this box • I `l i Sewer Corm-ect Public Health Division O Town of Barnstable - 200 Main Street Hyannis, MA 02601 i I I I I f .. . bELIVER I ■ Complete items 1,2,and 3.Also complete A. Si nature I item 4 if Restricted Delivery is desired. X ❑Agent s Print your name and address on the reverse q �4 ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1..Article Addressed to: D. Is delivery address different from item 17 ❑Yes i r If YES,enter delivery address below: ❑No 4Y LOI EVERETT e R -3 2113 1370 BISHOP ST CINC"ATI, OH 45220-1858 1 3. Se ''ceType 'Certified Mail ❑Express Mail G Registered ftetum Reco=o1e [so [PS ❑ Insured Mail ❑C.O.4. Restricted Delivery?(Extra Fee) ❑Yes 7012 1010 0000 2848 1032 +arm ao rr;r-eoruary zuu4- ------uomestic Return Receipt 102595-02-M-1540, Ka Pam P--M WIIR�lm 0 F I C I , ti Postage $ �PNN/S�! O Certified Fee -9 �A Postmark p 0 Return Receipt Fee tY are N O (Endorsement Required) 0) O AAg Restricted Delivery Fee �0�! C3 (Endorsement Required) r—1 O Total Postage&Fees s rq rU a AMY LOI EVERETT Cl 3370 BISHOP ST CINCINNATI, OH 45220-1858 Certified Mail Provides: o A mailing receipt c A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years 4 Important Reminders: ` o Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. o Certified Mail is not available for any class of international mail. o 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 service,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 USPSe postmark on your Certified Mail receipt is required. e 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,August 2006(Reverse)PSN 7530-02-000-9047 ------ ---- ----- ... .. J Barnstable aY Town of Barnstable � A&Amedca I Q V .�. ; Regulatory Services Department sARntSrA8M ah Public Health Division 200-Main Street,— yanriis MA-02601— --�--2DD7- Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7012-1010-0000-2848 -1032 March 28, 2013 AMY LOI EVERETT 3370 BISHOP ST IMPORTANT NOTICE CINCINNATI, OH 45220-1858 Map & Parcel: 307- 032 The Department of Public Works informed us that public sewer lines are now available in your neighborhood. According to our records, your property has a septic system. This letter directs you to connect your dwelling, at 86 Seabrook Road, Hyannis,MA, to public sewer on or before 3/30/2015. The old septic system must be either removed or filled in due to future safety concerns. This may be done by the same contractor who connects you to the sewer. Septic Abandonment Permits ($ 25) are issued at the Public Health Division, 200 Main Street, Hyannis. Failure to comply with this Board of Health Order may result in a complaint against you, in a court of law. For additional information pertaining to the sewer connection, please see the reverse side of this'page. PER ORDER OF THE BO RD OF HEALTH omas A. McKean, R.S., C.H.O. Agent of the Board of Health Cc: Barbara Childs, WPC/Roger Parsons, Town Engineering, DPW Enc. QASEWER connect\Letters Stewart Creek Sewer Connects\MAILING L.etA Sewer 2Pgs Merged 3-28-13 Yr2015.doc Public Health Division March 28, 2013 ADDITIONAL INFORMATION AND REMINDERS FROM OTHER DIVISIONS: SAVINGS AVAILABLE/GRINDER PUMP: A reminder to those of you who need a grinder pump for your connection: Department of Public Works (DPW) sent you a letter in December 2012 stating the town, for a limited time of two years, only from the receipt of the DPW letter, would provide you with the pump at no ciarge. (This can save you thousands of dollars.) Please note: You must pay the installation cost through your own contractor. Please make your contractor aware of this, if interested. Also be aware: this is a shorter deadline than the Public Health Division's deadline on the reverse side of this page. SAVINGS AVAILABLE!PERMIT FEE: The Town offers a waiver of the residential sewer connection fee of $420.00 for those properties that connect within two years of the receipt of the DPW December 20121etter. LOANS: For loan(s) available, please see the enclosed brochure, or see the town website: littp://www.town.barnstable.ma.us/cdbg (under the "CDBG Programs", see "Sewer Connection Loan Program). For loan specific questions, you may contact Kathleen Girouard, Growth Management, at 508-862-4702. CONTRACTORS: Information on Licensed Sewer Installers is available on our web site at www.town.barnstable.nia.us/PublicWorksTecli/sewerinstalIers. Contractors, approved to perform sewer connection work in the Town of Barnstable must obtain and f le a Sewer Connection Permit with DPW-Water Pollution Control Division, 617 Bearse's Way, Hyannis —contractors, please call Dave Anderson at (508) 790-6244. FOR ANY QUESTIONS /ASSISTANCE: Len Gobeil at the Town Manager's Office is available to provide you with direction you may need in reference to the Stewart Creek Sewer Connections. You may contact him at 508-862-4701. QASEWER connectTetters Stewart Creek Sewer COnnects\MAU ING LetA Sewer 2Pgs Merged 3-28-13 Yr2015.doc y F � 3 � FORM 30 C&W HOBBS&WARREN in THE COMMONWEALTH OF MASSACHUSETTS BOARD OF LTH CITY/TOWN W ` a orvv _ DEPARTMENT ADDRESS GqM yv9�� Q' TELEPHONE Address Occupant_ Qwt�W&4 Floor Apartment No. No.of Occupants No. of Habitable Rooms 5 No.Sleeping Rooms 3 No.dwelling or rooming units .Stories Name and address of owner 3 3 7 a Remarks Reg. Vio. YARD Out Bld s.: Fences: S �7LC Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: 11c ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: ` Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen ' Bathroom Pantry Den —Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: ks, Iues,Vent Safeties: Kitchen Facilities Si rove 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 INSPEC . (See Over) "THIS INSPECTION P RT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PEN A ." INSPECTOR TITLE '� t� — DATET( V- I TIME A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found-o exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation I-as 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 wits 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required Ly 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 eCectricity or gas. (D) Failure to provide the electrical fa•.-ilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sic-mess 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 anyore 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 it tl-e 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 conditiDn 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 washbasir 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 hanc rail 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 4-0.,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. FORM301 (,CH&W HOBBS&WARREN'" THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF +jEALTH CITY/TOWN DEPARTMENT ADDRESS ^M SVO o Ii TELEPHONE Address t) — Occupanttr.. r 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 A,- �. :�7 , Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish 4- i Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof t Gutters, Drains: ? Foundation: BASEMENT Gen.Sanitation: Dampness: ' Stairs: --J ? - 62/)CA A Li htin : /— ( ' Ell STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: " Hall Lighting: Hall Windows: ! .,? it HEATING Chimneys: Central ❑ Y ❑ N E` ui . Repair 7 " TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: 11110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: I� Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry ` Den II 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 ; J v fi "Sfove - Bathing' Facil. -Vent.; Plumb.';Sanit n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: r F Egress Dual and Obst'n: General I 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 INSPEC�R.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENAL-TI'ES bF P W.URY." INSPECTOR V1 TITLE t s / A.M. DATE j` _ r TIME A.M. THE NEXT SCHEDULED REINSPECTION ( P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 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 wish 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, 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.