HomeMy WebLinkAbout0045 SILVER LANE - Health t'
45 Silver La-ne �'C�
1
Hyannis
A= 268'd 56
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal Sy!*am Rani...Nof forVoWntaw Assoar„vents
Property Address
Owner �•G�_._...._,._�.._-..�G✓'1�i'��.
info Ow ne's Name
m�aUon is l
required for every
page. City/Town C/ gate; Zip Code Date of Indpection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
`"ng outf When
A. General Information
Bing out forms
on the computer,
use only the tab 1. Inspector.
key move you e.,
cursor-do not G er 0 S l
use the return Nam of Inspector
- i EG11
Cony Narne
0
Company Address ,--��
City/Town J'a� o�q 0 ' 90 State �0 f ck Zip Code
Telephone tuber ' License Number
Bo Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 1 a.000). The system:
Passes ❑ Conditionally Passes ❑ Fails
0 Needs Further Evaluation by the Local Approving Authority
la10-112116
Inspecto s Signature We
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
tSns•3113 Tftle5official Inspection Form Sutsurface Sewage Disposef Sytem•Page 1of17
4
Commonwealth of Massachusetts
19 Title 5 Official Inspection Form
Subsurface Sewage:Disp saI System Form -Not for Voluntary Assessments
. - s sl�ve� L,
Property Address --
Ow ner O v nees Kbrrle
information is /�J
required for every (�c,�►vlff / A 9
page. aty/Town State Zip Code Date of Indpection
Be Certification (cunt.)
Inspection Summary: Check A,B,C,D or E/alwayscomplete all of Section D
A) :71
asses:
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:
CI One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes "no"or"not determined"(Y,.N, ND) for the following statements. If"not
determined,'please ex0ain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating t# at the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
a
t5ns•3M 3 Title S Official lns pection F orm Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form 4 Not for Voluntary Assessments
Lts S,leer
Property Address
G�IAG�
CW ner ON ner's Name
information is
required for every Ala0011 / '/4 ()a 6 0l
page. Cityfrown 51State Zip Code Date of Ins tion
Be Ceriificabon (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
J
B) System Conditionally Passes(coat.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ NO(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO(Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ NO(Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
1&303(1)(b)that the system is not functioning in a mannerwhich 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
t9ns•3M 3 Title 5Official irr pectlon Form Subsirfae Sevrage Disposal Spl am•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Property Address
CT-C 1- �
Odv ner Ow nees Name
information is
required for every P tj A Avl f f A/4 �r 6 4�
page. s own p- State Zip Code ate of Inspection
B. certification (corn.)
2. System will fail unless the Board of Health(and Public water Supplier,if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 fleet but 50 feet or
more from a private water supply well";.
Method used to determine distance:
This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
colilbrm bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other.
u-
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No" to each of the following for all inspections:
Yes No
❑ Backup of sewage into facility or system component due to overloaded or ,
clogged SAS or cesspool
❑ Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ tatic 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
tens•3H 3 Title 5 official Inspeotion F onrt Subsurface SewMe Disposal system•Page 4 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
`tS Si lve,- L
Property Address
O,v ner Ow nett Name
inforrnation is /
required for every ! a,40 i I A14 LIJ 6 01
page. Cityf row n C14 State Zip Code Date of Wn
B. Certifica#ion (coot.)
Yes No
❑ Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ L� Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ 2 Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered A copy of the analysis
and chain of custody must be attached to this form.]
❑ e system is a cesspool serving a facility with a design flow of 2000gpd-
10,000g pd.
❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CM 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ "the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area— IWPA)or a mapped Zone II of a public water supply well
If you have answered"yes'to any question in Section E the system is considered a significant threat,
or answered "yes"in Section D above the large system has failed. The owner or operator of.any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
On. 3(13 Title 5 Official Iris pectionFomc SubwfaceSevrageDisposal System•Page 5of17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage (Disposal System Form-Not for Voluntary Assessments
r /
Property Address /
(SG✓IA.IiVJ
ON ner Ow nees Name
information is
required for every AA*AP1(f 0J 6 0/ 9- /
page. C ky/Town State _ Zip Code Date of i6spebtion
C. Checklist
Check if the following have been done. You must indicate`yes'or"no'as to each of the following:
Yes o
❑ mping information was provided by the owner, occupant, or Board of Health
❑ Were any of the system components pumped out in the previous two weeks?
❑ Has the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of
this inspection?
Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
Was the facility or dwelling inspected for signs of sewage back up?
Was the site inspected for signs of break out?
❑ Were all system components, excluding the SAS, located on site?
�❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
�❑ Was the facility owner(and occupants if different from owner)provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
Existing information. For example, a plan at the Board of Health.
❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): Number of bedrooms (actual):
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): �0
One 3M3 Tite50ffidalIspeeban Form Sutsuface Sewage DisposelSystem•PFge8of17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Y s ents
ry
`fs S,lile,—
Property Address /
Oar ner 6:cr
information is D^rner's Name
required for every P 'a✓t✓hJ / �/9 L
page. Ci r own State Zip Code Date 6f Ins lion
D. System Information
Description:
l000 Gg G�v� ,�el,4 c c-
/ Z),J
161V J-J-o-e—
Number of current residents: ---
Does residence have a garbage grinder? ❑ Yes No
Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes 0/a
information in this report.)
Laundry system inspected? ❑ Yes 0- No
Seasonal use? ❑ Yes No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
Sump pump? ❑ Yes No
Last date of occupancy: G ll,--I
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CM R 15.203):
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ms•M 3 Tine 5 Official lnspecfion Fomc Subu face Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9S Z
Property Address
QN tier ✓ ��v
information is Os oar's Name
required for every / ✓4 Off 11VI4 0o)60 / 1-r l
page. CRyfrown State Zip Code Date of nip tion
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
r•f�li� �.� -�r✓rrc o� fvts ��
Source of information: ,I/ecl
Was system pumped as part of the inspection? Yes ❑ No
/OO�o
If yes, volume pumped: gallons
Sri
How was quantity pumped determined?
i✓1
Reason for pumping: 42✓l o mc-r,
Type of stem:
Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the VA system by system operator under contract
I ❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(descri be):
t5ts-3113 Ville 5official Inspecfion F omc SubsLrface Savage Disposal symm-Page$of 17
IE
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address
Owner
information is ner's Name
required for every cl✓1ri1ll //�� u� 0� / %%b
page. W-1own State Zip Code Gate of s bon
D. System Information (cont.) P40��--
Approximate a e of all components, date installed(if known)and source of information:
' g
ah 4 /C-6L.
Were sewage odors detected when arriving at the site? ❑ Yes No
Building Sewer(locate on site plan):
Depth below grade: feet
Material of construction:
❑ cast iron 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
Depth below grade: feet
7naelconstruction:
oncrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
Sludge depth:
Ons•3f13 Title 5 official Ire pecton F am Subsurface Sewage Disposal System•No 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Fonn a Not for Voluntary Assessments
Property Address
Uv ner �,
information is ner's Name
required forevery l/ a✓►Oil 601
page. 5y-Town 7TState Zip Code Date of/inspection
D. System Information (coat.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet flee or baffle
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
S< f C / G� y,,y ?id G4 T( V14 0
1�S,02G- o—� —
/ G H 4" a o 4i o L)
rc✓t Cji T(o✓1
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5rs•3M 3 Title S Official Uupeclion Form Subsurface SevMe Disposal System•Page 10d17.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
` l
Property AddressfS SS/te,
Ow ner �e►r 'Cf v
information is Cw ner's Name
required for every q✓1 Vl l f 1�4
page. CMylrown State Zip Code Date of Ins ectlo
D. System Information (cons)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, eHdence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in worldng order: ❑ Yes ® No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
Attach;copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5rs•3H3 TJWOffidal Irspectian Form Subsurface Sava geDisposat Symm•Page 11 of 17
F•
i
Commonwealth of Massachusetts
Tithe 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address /
Ow ner rj—e;,!Ci v
inforn ation is ON rter's Name
required for every HCIA f � 0/ / 1� u
page. Citylrown State Zip Code Date of Inspebtion
D. System Information (cont.)
Distribution Sox (if present must be opened)(locate on site plan):
Depth of liquid level above outlet invert V
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Ao/
Pump Chamber(locate on site plan):
Pumps in working order. ❑ Yes ❑ No*
Alarms in working order. ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
tyre•Y13 Title5Official Irepecficn Form Subsurface Sewage Disposal System*Rage 12 cf 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address /
Oav ner Ge tr I of C/Lj
information is ;Omners Name required for every A AtJpage• own State ZO Code Date of pe n
D. System Information (cunt.)@9 D
l-
Type. 2 /�
❑ leaching pits number.
❑ leaching chambers number.
❑ leaching galleries number.
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number.
❑ innovativetaltemative system
Typetnam a of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
/ �c�
/ �/
O // D dl�i N Sa ! / C/, l�G CA Cr (A
f
� J, •�f O� �Gv�(C � �Gt��
Cesspools(cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5rsa 3M3 TideSOffcial IrepectanForm SubsWaoe SevvageDisposal System-Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
o �r �/
Property Address - /
otv rter information ON ners Name Q v
inforn is
required for every G c�1✓1 Ax //-?—//T
page. City/Town State Zip Code Date of I spec n
D. System Information (coat.)
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.):
19rs•3M3
Tttle501ffiaal4speclfatFarrrt Subsuface SexageDisposal SysEem•Page 14 of 17
Commonwealth of Massachusetts
ugTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property-Address `fS /I/.er
Oav ner ev/Gt G
n Q
information is lv er's Mn*requiredforevery / a✓�v1 I / �j G fl l 9 7
page. Aly_own State Zip Code Date of ns tion
D. system Information (cont.)
Sketch Of Sewage isposal System: Provide a view of the sewage disposal system, including ties to
at least two-PT
wo anent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where p c water supply enters the building. Check one of the boxes below:
hand-sketch in the area below
❑ drawing attached separately
�f
14
143 - 36.
t5ins•3h3 Title50fficialtrrepecdonForm SubsteaceSewageDi Disposal System
sp �5te Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Forth -Not for Voluntary Assessments
Property Addre� /
Ow ner �esr 1 Cic �j
information s Ouv ner's fume /
edforevery �N,
page
Page• CRY/lawn 60y/lown State Zip Code rate of Opecti6n
D. System Information (coat.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells /f/oVif—
Estimated depth to high ground water. /
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: gate
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
/J14 Of f i EsI /-(g/a f-
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you tablished the high groundwater elevation:
OU✓� L"(,mod �Oc a
1e /w
cza- Ile d ,4"- /�"/Clo
C4
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
tins•3M 3
Tile 50ffiaal InspactimFam SuDsrrfaee SevrageDlspordl SysOem•Pagel 16 of 17
�C-\ Commonweafth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�f s 11� ` "
Property Address
Ow rw ON ner's Name
hfom'abon is / n
page- for every Uyrfown �dl all l �a� CO
2p ode Date of pec
E. �Repport Completeness Checklist
t� Utspection Summary:A, B, C, D, or E checked
; Summary D(System Failure Criteria Applicable to All Systems)completed
;'Skete st em lnformatron—Estimated depth to high groundwater
h of Sewage Disposal System either drawn on page 15 or attached in separate Ile
On-313 TdleSOMC el trlspecOmForM Sub$Wax SeaageDisposel System-Page 17 d 17
1
r
I 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 •
c.
t 4A^ ( �ro
SENDER: COMPLETE THIS SE TIOW T'
o Complete items 1,2,and 3.Also complete A;Si,nature "
item 4 if Restricted Delivery is desired. ITV :,,.,,.'
® Print your name and address on the reverse r 'Addresse8.
I so that we can return the card to you. B.
■ R c ' y(P t ,:*C,O '
Attach this card to the back of the mailpiece, l off
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: P No
William Gerlach
PO Box 801 3. Serv' eType
Sandi ich, MA O2S6 ertified_Mail 0 Express Mail
❑Registered ❑Return Receipt for Merchandise
I _ ❑Insured Mail ❑:C.O.D,
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number 70],4 Z2CIp�'001 p358 �802 `{ (�
(fraCsfer from service label) 5
PS Form 3811`February 2004 Domestic Return Receipt 102595-02-M-1540
TfiE Tpr_
Town of`Barnstable Barnstable
Regulatory Services Department ;MUCKY
Y
* BARNSfABM s
MASS.039. Public Health Division
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 0802
December 18, 2014
William Gerlach
PO Box 801 AkQ-
Sandwich, MA 02563
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE I1—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION.
The property owned by you located at 45 Silver Lane. Hyannis was inspected
on December 12, 2014 by Timothy B. O'Connell, R.S. Health Inspector for the Town of
Barnstable. This inspection was conducted on the basis of the rental registration in
accordance with Chapter 170 of the Town of Barnstable Code.
The following violations of the State Sanitary Code were observed:
105 CMR 410.500- Owner's Responsibility to Maintain Structural Elements.
Observed multiple windows throughout dwelling unit with sever rot around trim and sill
areas.
105CMR 410.501- Weather tight Elements. Multiple areas of siding, trim, and facia
L boards are rotten and are not weather proof. Water staining within bedroom and living '
room ceilings and floor's indicated leaking roof.
You are directed to correct the violations listed above within thirty (30) days
of your receipt of this notice by replacing/repairing windows so they are weather
proof/water proof; by repairing siding, trim, facia and roof so that they are
weather and water proof.
You may request a-hearing before the Board of Health if written petition requesting same
is received within ten (10)days after the date the order is served. Non-compliance will
result in a fine of$100.00 per violation. Each day's failure to comply with an order shall
constitute a separate violation, Should you have any questions regarding the above
violations, please contact the Town Health Division.and ask to speak with the inspector
who performed the inspection.
P ORDER.OF THE BOARD OF HEALTH
as A. McKean, R.S.,ZHO -
Director of Public Health -
Town of Barnstable
A
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date ® � Time: In Out
Owner Tenant
q5v tt '
Address 1 Address
C� r '4—
Compliance Remarks or
Regulation# Yes NO Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service `1 `
11. Space and Use
12. Exits _- ..
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal ocl — -j `-( �
17. Temporary Housing
18. Driveway Width
19. Number of Tenants Observed
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Number of Bedrooms Number of Vehicles Allowed (max)
Number of Persons Allowed (max).
Person(s) Interviewed Inspector
If Public Building such as Store or Hotel/Motel specify here
TOWN OF BARNSTABLE
BOARD OF HEALTH
tt { ARTICLE 11: MINIMUM STANDARDS FOR HUMAN HABITATION
'Date 1 a + Time: In Out
Owner � X Tenant
Address Address q5o ,
Compliance Remarks or
Regulation Yes NO Recommendations
2. Kitchen Facilities
.3. Bathroom Facilities ,}
4. Water Supply- / tw
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
8.Ventilation
9. Installation and Maintenance of Facilities b
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and'Maintenance of Structural
- Elements ^ 4
14. Insects and Rodents"
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal ✓ ® -- 3.L( ��°ram '�j��
17. Temporary Housing /y
18. Driveway Width
19. Number of Tenants Observed
i
PART 11 N
� f
Ile,
t
37. Placarding of FCo m ed4Dwelling;--'—" —
Removal'of",Occupants; Demolition
Number of Bedrooms ;.
Number of Vehicles,A�Ilowed (max)
Number of Persons Allowed (max)
Person(s) Interviewed Inspectorp.
4
If Public Buildingsuch as Store or Hotel/Motels specify here #,
p fY .
I dersen' C�' Andersen Windows -Abbreviated Quote ReportProject Name: Will Gerlachws.oaogr
Quote'#: 12024 Print Date: 01/10/2015 Quote Date: 01/09/2015 id Version: 14.1
Dearer: FAIRVIEW Customer:
49 Whites Path Billing
S.Yarmouth,MA 02664 Address:
508.394.2219 Phone: Fax:
Sales Rep: Doug Contact:
Created By: Trade ID: Promotion Code:
Item Qty Item Size(Operation) Location Unit Price Ext.Price
(— 0001 2 244GW4'050(AS) $ 420.21 $ 840.42
RO Size=4'0"Wx5'0"H Unit Size=3'111/2"Wx4'11.1/2"H
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FAIRVIEW MILLWORK
- 49 WHITE 'S PATH
SOUTH' YARMOUTH, MA 02664
Phone: (508) 394-2219 Fax: (508) 394-8448
Page 1 SPECIAL ORDER TICKET Ticket# 58114307
SPECIAL NOTES Ref# 58114307 Time:13:49:27
T 188 Order Date:03./20/2015
Sal rson Doug NO.:DOUG DOUG Today's Date:01/20/2015
Sold: will Gerlach Ship:Misc . Supplies
To: 45 Silver Ln To:
Hyannis, MA 02601 John Williams '
508 . 364 . 6252
7-1538 Phone: (508) 737-1538 F:£airw
Customer No.: S015134 Job: Customer P.O. Ship via Customer Pickup
Order Ship Unit Item No. Description Price Extension
12.0 BND WCSB Bdl Wht Cedar "B" clr shingles 50.25 603.00
Re-squared and re-butted (approx 25sf)
1.0 EA DOW3 3 ' x 100' Dow Weathermate Plus Housewrap 51.00 51.00
10.0 EA 010316ST 1"x3"x16' S Dry SPF #2 & Btr Strapping 3.23 32.30
1.0 EA GR7640 16ga 1 1/4" Galv 7/16" Crown Staples . 47.85 47.85
not for use w/ACQ treated, 10000ct
1.01.0 BX TZ25OW 2501f Cortex Trim Screws w/ white Royal 99.00 99.00
pvc plugs(Includes driver bit)
2.0 EA VYCOR-4 411X 75' VYCOR DOOR&WINDOW TAPE(45639) 20.95 41.90
1.0 EA VYCOR-6 611X 75' VYCOR DOOR&WINDOW TAPE(21482) 31.95 31. 95
1.0 EA 5DSSRS-5 5lb 5d Stainless Steel ring siding nails 48.74 48.74
6.0 EA 1X8TZ 1X8X181PVC BOARD 46.95 282.70
6.0 EA 1X4TZ 1X4X181PVC BOARD 23.95 143.70
Sub: $1381 . 14
T"I able 1381. 14
Town;of Barnstable P#
Departinentof Regulatory Services
Public Health Division Date- CfMAM
a
200 Main Street,Hyannis MA 02601
Date Scheduledz Ti me �_ Fee Pd. Q U Q
Soil Suitability Assessment for Sewage Disposal
Performed By: �e�'�r �� �ti}—e-C Witnessed By:
LOCATION& GENERAL INFORMATION
Location Address s io i Vf rLckvUZ Owner's Name
1-1.t gvlr� J Address Po.
o`
Assessor's�Map/Parcel• 2(Q c� �o Engineer's Name �',i M 3 o Z
1f �£wi-Q a 'P�
NEW CONSTRUCJION j REPAIR Telephone# 50 - 7-7i 7-/)4 7 G,F
Land Use S` ���^ l Slopes(%) �� Surface Stones
Distances from: Open Water Body
ft Possible.Wet Area 144 ft Drinking Water Well ( ft
Drainage Way M0 ft Property Line I Q-Z� ft .Other` . ft
SKETCH.(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
IS'
�r
- � C7
cs�r`�L N "''
00
Parent material(geologic) Depth to Bedrock p
3c
Depth to Groundwater. Standing Water in Hole: I 0 �� Weeping from Pit F4ee 5
Estimated Seasonal High Groundwater 3
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: G"ec W 60 M V s S i c/L^ ��(
Depth Observed standing in obs.hole: w`$ in, Depth to soil mottles: in. .
Depth to weeping from side of obs.hole: I ` in, Groundwater Adjustment—
Index Well.#AL,0- Reading Date: Index Well level ' AdJ,factor AdJ droundw4terLeval,,;�P Z
PERCOLATION.TEST bate , Ttnta..
Observation
Hole# Time at 9"
Depth of Perc 2� �1�� -, A c,�t S Time at 6"
Start Pre-soak Time® - l n ` "` Time(9"-611)
7
End Pre-soak ,
Rate Min/Inch. G Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one(1)week prior to beginning.
QASEPTICIPERCFORM.DOC
DEEROBSERVATION HOLE LOG Hole#. ._
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in,) (USDA) (Munsell) Mottling (Structure;Stones;Boulders..
Consisfeadi. v1
0 3S�
1 'S � jo` �yjZ
— - t-S 1
DEEP OBSERVATION BOLE LOG Hole#
Depth,from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. .
Consistency.
o 5 L l(� c2`CIz
v -Fy Wa Y(Z3/3-
l3
DEEP OBSERVATION HOLE LOG Hole#
Depth from. Soil Horizon Soil Texture_ Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
`Consistency. fi3 . e
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,.Stones;•BoulOrs.
Flood Insurance Rate Map:
Above:5w.year-Food boundary No— Yes
'Within'SUUyear`boundary No Yes
Within 100 year flood boundary No� Yes
Depth of Naturally Oecurrine Pervious Material
Does at'least four feet of naturally occurring pervious material exist in all areas observed throughout.the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pe v�ious matorial7 ._._ ,.
Certification
I`eertify that or (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .r
the requited g,.expertise and ex erience described in 310 C1vIIt 15.017.
Signature Date ?0 ;
Q:\S•EPnC\PBRCFORM.DOC
No. �� Fee
/qP -
THE,COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLL,MASSACHUSETTS Yes
0[pplication for Mi5po5af *pgtem Construction Permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No,u,5 5,'L t/ER 1-4171e NY A�+�%5 Owner's Name,Address,and Tel.No. W e 16'4m 6e/Ci=�Ckl
J90 13oX 8o I
Assessor's Map/Parcel 2 $ 1- �R+k�1i Cl, �✓1
Installer's Name,Address,and Tel.No. C4eP 14 ; 4 "1eJ Designer's Name,Address and Tel.No. 4/ 61'ne ljj7 do,24-)
�o i3�x 7,-3 1Z cJ.c�dss -aka
C.-C�wvk k i-e Art`@
Type of Building:
Dwelling No.of Bedrooms "I Lot Size o�,���J sq. ft. Garbage Grinder ( )
Other Type of Building clo"i ti No.of Persons Showers( ) Cafeteria( )
Other Fixtures U
Design Flow(min.required) 1A gpd Design flow provided -1 S ( .B gpd
Plan Date (0 -11-IQ 05 Number of sheets Revision Date
Title kA S- S 1
Size of Septic Tank (()op G-LN. Q C66 Type of S.A.S. S(ZruO-�t'-5 7�.2.c" Art-;6
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) L� u1 LOw JAA- `q� / ,"j
Date last inspected:—cs
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.
S' ned Date — 1 � ^ l00c_
Application Approved by . Date B Y
Application Disapproved by: Date
for the following reasons
Permit No.
issued-- �=
F No. Fee
I THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _
PUBLIC HEALTH ®II�ASION - TOWN OF BARNSTABLE,MASSACHUSETTS Yes
Application for Wgpogaf �&p,5tem CCon.5truction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No.(4 5 5"L V G2 Lam e /-ly sa.,n 5 Owner's Name,Address,and Tel.No. w€`!1,.4 r,,
�j0 '50.N
Assessor's Map/Parcel "�(P ( I)(� �,(�,��CL, /yam
Installer's Name,Address,and Tel.No. C',a �,,,c4 &4.VIor,S eJ Designer's Name,Address and Tel.No. If/1461/?eef -,Z 4
�U ,3p - 7m3 (ZW. c4-ss�+ a-- A
C -,av E� M/� i�J�sY�AI�
Type of Building:
i Dwelling No.of Bedrooms Lot Size 1„�i C4Q 51 sq. ft. Garbage Grinder ( )
Other Type of Building ,k,- (�,,,,}` No.of Persons Showers( ) Cafeteria( )
x Other Fixtures
Design Flow(min.required) -{U gpd Design flow provided G*} �j , . gpd
Plan Date Number of sheets . Revision Date
Title �.l l
Size of Septic Tank 1 t`��t� G m. e-g-.\l�4 Type of S.A.S.
Description of Soil
pl✓ t�=' Sy- �y rl �-s s1o4x
Nature of Repairs or Alterations(Answer
�^when app[licable) r-,) (j�y�,�, -i �t�O CAA 'jVt,4A, \11 �p _)
Date last inspected: I neg
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.
Si ned � Date Zp�>�
Application Approved by Date B
Application Disapproved by: Date ,
` for the following reasons
Permit No. ' Date Issued !�
9►!N�e'acc..�aa.rTi. fwr a.—�..wM+.».......,i�e..s..;1�.•..y.�i:.:�il.�7F��i�'+.-+5«�.fia: - - '
THE COMMONWEALTH OF MASSACHUSETTS `�"' "�
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (�() Upgraded ( )
Abandoned( )by (?—Ao",&f Gh4-v- t � L
,&1,1N
at 45 S,L,,,t( 1.o;,A t ,yan h,� has been constructed in accordance
` � �,•�
with the provisions of Title 5 and the for Disposal System Construction Permit No. ���i--�9 q dated 1() )q PAI .
Installer C4,(t,(,ti,5j 9 40\, ,S CS Designer (DA.M—.,1,
a
#bedrooms Approved design flow t/() gpd
The issuance of this permit shall not be construed as a guarantee that the system will-function as designen,,d. ^�
Date I I ! 1)0\ Inspector (+ / / }> t r //►1��} (//j
V �� t_
_)4
----= =---=-------
�+,�,.��(►�g�+�/�'��Js�*�w�'!y�..�..�+►+y.+�t.�a►' . .:.-. '.. ,�►+ews�r!nw�r+f!r��+lt�+�+�l+erte►4f�5Sr4�r.r.nai►.�+�. �:.-►�.iii+�.
No. _ / "� q 1P
\\ Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
1=igogal �&p!tem Cott!5truction Permit
Permission is hereby granted to Construct ( ) Repair (y? Upgrade ( ) Abandon ( )
System located at %4 5 S i Lv e( L 1� , a!, ,,
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[ be completed within three years of the��at�this permi.
Date ! t C/ Approved by
11/03/2009 12:47 5084775313 ENGINEERING WORKS PAGE 01
Town of Barnstable
Regulatory Services
Thomas.F, Geller,Director
1 i Public Health Division
w►e�,
Thomas McKean,Director
200 Malta Street, Hyannis,MA 02601
Office: 508-862-4644 Fax; 508490-6304
Date: 11 3 0q Sewage Permit# Z001 Assessor's Map/Parcel
Installer&RgbLner Cyggftftn F rm
Designer: y�o�ir�4�M1�c crv�i Mrt C . Installer: (1 W�
Address: TZ- W. G-e d s-;-L 1 c, 9A Address: d X-7 t
�CTt`c-.�col�`4. V`��4' 4'ZCi�(�I ���'�✓ye� �.�, �M��
OnL�( Zoo�j C1j(�evy46 F,�c,-P r�"6vas Issued a permit to install a
(da ) (installer)
septic system at LiS i�V`Cr �.hi . 1n W r based on a design drawn by
(address)
"�c.1���3-:�C...�►,1-�c.�a � f dated �� 1�21 a�
(designer)
/ I certify that the septic system referenced above was installed substantially according to
the desir which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory,
I certify that the septic system referenced above was installed with,major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with State& Local Regulations. Plan revision or
certified as-built by designer to follow. Stripout (if required) was inspected and the soils
were found satisfactory.
H OF
PETER T.
ler's S tore) McENTEE
CIVIL CO
No.36109 C
$n�'gSignature) (Aix i� )
p O B ST PUB AC E L N BE E i
B. 99
RECEIVED BY THE
q;�AftSoc{pr,,,fldeeigoawttiflcauon foz�tl.doc
UNITED STATES.' 1 R1 S64MI e'±±:�:; i
,,,,�,,-.,< a..,.�a "�ir SS• a11a.,.,,,;:,,,.
~^ u rP3stage&t-e Qsid
;S.ta ,..€.€�.1... <'`.<;1i;'I �;.. �:.;,�� :�, „n< , „,,,��,•"�«n 11S''E�S� ;a,.,.....,.,tYM�<,•
• Sender: Please print your name, address, and ZIP+4 in this box •
Town of Barnstable
�'. 4,! Health Division
200 Main Street
Hyannis,MA 02601
I
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3.Also complete A. Signature
item 4 if Restricted Delivery is desired. ❑Al
■ Print your name and.address on the reverse XGHIddressee
so that we can return the card to you. B. Rec 'v (Printed Name) C. ate f elivery
■ Attach this card to the back of the mailpiece,
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
IN
�N /C�IC a /V� •4 C�� Express Mail
Return Receipt for Merchandise
1 . //tD/ C.O.D.
i (Extra Fee) ❑Yes
2.. Article Number 7003 168'0 `.0004; 5458t4890 U
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
I
1
t ,
Certified Mail#7003 1680 0004 5458 4890
��STati Town of Barnstable
0
' Regulatory Services
Y
• BARNSfABLE,
v� MASS. Thomas F. Geiler,Director
ATfDµA Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
July 12, 2007
William Gerlach
P.O. Box 801
Sandwich, MA 02563
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE II— MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE CODE CHAPTER 170.
The property owned by you located at 45 Silver Lane Hyannis, was inspected
on June 21, 2007 by Timothy O'Connell, Health Inspector for the Town of Barnstable.
This inspection was conducted on the basis of the rental registration in accordance with
Chapter 170 of the Town of Barnstable Code.
The following violations of the Town of Barnstable Code were observed:
170-10—Smoke Detectors and Carbon Monoxide Alarms. No carbon monoxide
alarms provided in home.
You are directed to correct the violations listed above within twenty-four (24) hours
of your receipt of this notice by installing CO alarms within ten (10') feet of
bedrooms in accordance with Mass State Fire Codes.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten (10) days after the date the order is served.
Non-compliance will result in a fine of $100.00 per violation. Each day's failure to
comply with an order shall constitute a separate violation.
QAOrder letters\Housing violations\Rental ordinance\45 Silver Lane.doc
Should you have any questions regarding the above violations, please contact the Town
Health Division and ask to speak with the inspector who performed the inspection.
PER ORDER OF TH OARD OF HEALTH
T o A. McKean, R. ., CHO
Director of Public Health
Town of Barnstable
Cc: Timothy O'Connell, Health Inspector
QAOrder letters\Housing violations\Rental ordinance\45 Silver Lane.doc
FORM30 C&w HORRs&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HE
CIT / OWN
a DE AI�TM T
c ADDRESS
50y`e
TELEPHONE
Address � ✓V"_ — Occupant ��
Floor Apartment o. No. of Occupants �--
No.of Habitable Rooms No.Sleeping Rooms
No.dwelling or rooming units--No.Storie
Name and address of owner
G marks Reg. Vio.
YARD Out Bld s.: Fences:
Garba e and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Li htin : e
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line.-
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. Lgtng. Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pantry
Den
Living Room
Bedroom 1
Bedroom. 2
Bedroom 3 Sr9
Bedroom 4 p a
F�
Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.:
$Lgirks, Flues,Ve ,Safeties:
Kitchen Facilities i k
ve
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin,Shower or Tub:
y 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 DETERM ED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECT ee Over)
"THIS INSPECTION O IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIE U Y '
INSPECTOR TITLE
( ' cc A_M..
DATE 1 — TIME P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises,shall be deemed conditions which may endanger or
impair the health;or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items whichare deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation,has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s)pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to wliom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of Ieadbased paint on a 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.
x
(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 genders 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.
�- ��`�1
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TOWN OF BARNSTABLE
LOCATION Y 57 S !&,.I r" t?r14 SEWAGE# 0 9 3 Yl
VILLAGE ASSESSOR'S MAP&PARCEL 4
IN NAME&PHONE NO. eM� a wj jj/c gcjAm
SEPTIC TANK CAPACITY /U[)Q W l a t�Y�f>Liri'4
LEACHING FACILITY:(type) rd SJ (size) Zo
NO.OF BEDROOMS
OWNER AJJ
e l
PERMIT DATE: I O / Zv0 COMPLIANCE DATE: 3 0
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
FURNISHEDBY C�rae G"L` 5�
o5v
w r
Cc, S> G h "� .yi �Tiri'p
a
�, � Y
— — : a3nssi 3:)w I1dVVo:) 31w n
� - Win,/ -t '�-7
ss�aoav �vry ry s a3o-ii
ss3baav � 3v�vn s.a3��visni�
'Orl 11V Bad 3`7vM3S NO11v0O1
o� P A
N �1
y
i
I
1
INF ,n Aditchell's
+ 90.80 v �
+ 91.00 VEGETATED WETLAND
= v a
m
9 `�`'�\ D
sty \
EXISTING LEACH PITS 9 \ ��-----_------- �, -
`� u' �,�, > WEST MAIN STREET
TO BE REMOVED OR PUMPED & FILLED `� �� "�•..,�,_ -c
W/SAND DEPENDING ON PROXIMITY TO 9�� �� \ + 92.50
PROPOSED S.A.S.(SEE NOTE 11)
I �a
Sterlin Rd
X 103.10 / I o \��`-- �� S 3839'40" -E LOCUS-
-'' 88.02' LOCUS MAP
+ 92.50 ��
x•9.9.12 996.40 NOT TO SCALE
' 47°� x -�o---�` "�" LOT 20
o /�. 131.36 98.18 � ber Ret. Wall
i To ,EL varies �
TP-1 Batf., l.=9J.0t walkout basement, EL.=92.77 + 12,445f S F.
I �� deck above Map26 GENERAL NOTES:
9i3,73 /, � 8 i deck above \ _ + 91,72
vj patio below patio below l
x /q� 4 �� p Parcel 1�� I 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
98 2 �. I BOARD OF HEALTH AND THE DESIGN ENGINEER.
'Z•P-2 i 96 5 _ ------ 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
N
\ �`� I r ' 0 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
\ LOCAL RULES AND REGULATIONS.
o �` �A \2T\�. - I EXISTING � � 05 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
�D,pv.(\ i HOUSE (#45) O O TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
STRIPOUT :o \ A"<X-,," \ \ --- J T.O.F.=101.21f 1 1 O^ DESIGN ENGINEER.
(SEE NOTE 11) ;'� c� `" ' v,-�, I ;� I I '� O� 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
o g. <S �8.7 4 t I r h
23 I I FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
S \�r\ I I I Gj ENGINEER BEFORE CONSTRUCTION CONTINUES.
O >,�\ \� ,�� �� l\ i 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
Xz 22 S {� I• 6. THE DESIGN, ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
x 9 `� JT 1{}-, 9 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
98.12 �O 9�)•22 I HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
98.22 O• ,�O X 9 26 BM • :i I
' 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
PA IEDDRIVE WAY I5W.22 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
24'99• 24� L=7598• 76'r ' I 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
5. / I AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
X 98•47 _ 7V6 j DIRECTED BY THE APPROVING AUTHORITIES.
R=52,,50 �lj, ��� OF MASS9 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
--95----- ' _ ��Q �yG THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
-aG j o PETER T. CONSTRUCTION.
INSTALL 40 MIL POLY LINER 1' OUTSIDE i g McENTEE 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
S.A.S. FROM SEPTIC TANK TO A POINT ' 94,4 CIVIL "' IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
HALF THE LENGTH OF THE S.A.S. ' 7.40 i pavement
TOP OF LINER, EL'.=97.5 96;6� of 95.47 94.73 i 35109 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
7• o �E6/ST 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
BOTTOM OF LINER, EL.=96.0 e 95,73 F S/0 �'� INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL.
ear', S/L I/ER LAND' 13• THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
EXISTING SEPTIC TANK 97.33 \\ , ij,1Q\ IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY.
LEGEND TOP OFTOTANK,REMAIN) '1"
�`"96 1 94.57 PROPOSED SEPTIC SYSTEM UPGRADE PLAN
--100-- EXISTING CONTOUR 11NV(OUT)=97.27_±(VER1FY) 96.61
x l oo.98 EXISTING SPOT GRADE 45 SILVER LANE, HYAN N I S, MA
-�H.W OVERHEAD WIRES Prepared for: Capewaide Enterprises, P.O.,"Box 763, Centerville, MA
G EXISTING GAS SERVICE BENCHMARK Engineering by: SCALE DRAWN ' JOB. No.
EXISTING WATER SERVICE Left Cor. Bott. Ste OWNER OF RECORD P.T.M.
P ;- - GERLACH, WILLIAM Engineering Works, Inc. 1"=20' '204-09 ,
TEST PIT EL.=100.19 (Assumed) P.O. BOX 801. 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
BENCHMARK SANDWICH, MA 02563 (508) 477-5313 10/12/09 P.T.M. 1 Of 2
NOTE: TO PREVENT BREAKOUT, THE PROPOSED (3) 5" DIA.OUTLETS
r! FOR A DISTANCE OF 15''NOT
AROUNDETHE 1 1�.- -• �--' 2'
PERIMETER•.OF THE S.A.S. .• •s..•,•.
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. 1 s• 12"
INSTALL RISERS & COVERS OVER INLET & INSTALL INSPECTION PORT OVER END UNIT CHARCOAL OR 15.5" i.
INSTALL RISER & WATERTIGHT CONVENTIONAL VENTg~ W2'.
OUTLET AND SET TO 6' OF FINISH GRADET.O.F. COVER SET TO 6" OF GRADEEXISTING F.G. EL.=99.Of F.G. EL.=99.Ot RIM EL.=99.Ot H-10 LOADING D-BOX
MAINTAIN 2% GRADE (MIN.) OVER S.A.S. .
' L 8' L = 8'(MAX) INSPECTION
S=1% (MIN.) ® S=1% (MIN.)" PORT
4"SCH40 PVC 4"SCH40 PVCZr
'
6"
10" 6
14" ? INVERT
EXISTING 48" LIQUID INV.=96.58 i-
LEVEL ADD INV.=97.19 PROPOSED INV.=97.02 (3 ROWS OF 8 UNITS AT 5.0'/UNIT) +1�2.4' (2 COUPLERS) = 42.4' 17.46"
GAS BAFFLE
INV.=97.27t D-BOX SOIL ABSORPTION SYSTEM (PROFILE) i14*
cy
I
EXISTING
EXISTING SEPTIC TANK ESTABLISH VEGETATIVE COVER
s.s"
BACKFILL WITH CLEAN NATIVE OR
PERC SAND TO TOP OF CHAMBERS
BREAKOUT=TOP
`c.:. '.:.:•.:::.: „ DOME END
TOP ELEV.=97.08 IN
INV. ELEV.=96.58 HEIGHT
915,
NOTES:. ^ - POST END
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BOTTOM ELEV.=96.00 C3311
INVERTS, PRIOR TO INSTALLATION. 2.83'
� NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT
2 D-BOX SHALL BE SET LEVEL AND TRUE TO 5r MIN. ABOVE BOTTOM OF TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=8.5' DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
GRADE ON A MECHANICALLY COMPACTED SIX EXISTING SUITABLE
INCH CRUSHED STONE BASE, AS SPECIFIED IN , 4640 TRUEMAN BLVD
310 CMR 15.221(2). ADJUSTED G.W., EL=91.0 = f MATERIAL HILLIARD, OHIO 43026
3) INSTALL INLET & OUTLET TEES AS REQUIRED. USE 3 ROWS OF 8-ADS Arc 36 UNITS + 2 COUPLERS PER ADVANCED DRAINAGE s.IN. Are ",36 SIDE PORT COUPLER
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE EPTIC SYSTEM PROFILE ROW WITH NO SEPARATION BETWEEN EACH ROW & NO STONE
S 63.5"
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. TYPICAL SECTION
N.T.S.
DESIGN CRITERIA 33.8"
NUMBER OF BEDROOMS: 4 BEDROOMS ^ SOIL LOG
DATE: OCTOBER 8, 2009, R
SOIL TEXTURAL CLASS: CLASS I `�O. N ( EF.# 12,726) TOP VIEW
DESIGN PERCOLATION RATE: <2 MIN/IN SOIL EVALUATOR: PETER MCENTEE PE, CSE ,_-_
WITNESS' DAVID STANTON IRS, CSE =60'
'� • END CAP END CAP
DAILY FLOW: 440 G.P.D. Elev. TP-- 1 Depth Elev.. TP-2 Depth FRONT VIEW SIDE VIEW
DESIGN FLOW: 440 G.P.D. CV ^D /' ��� 98.5 0" 98.2 0" END REAR/TOP VIEW
GARBAGE GRINDER: NO y 6' // , FILL 93 54
FILL " .16
(k`J• / / 96.0 't 30" A NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW
LEACHING AREA REQUIRED: (440) = 594.6 S.F. SPIKE 01' ' A SANDY LOAM TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
- DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
74 SE �/ P �/ S 0 R}`4 02 M 93.2 10YR 4/2 60„
95.5 36" g 4640 TRUEMAN BLVD
B HILLIARD, OHIO 43026
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY ,' Q• i� LOAMY�SAND LOAMY SAND AY'C 36 DETAIL a
O tK ( 42"/54" 10YR 5 8 ADVANCED DRANWE SYSTEMS,INC.
PROPOSED D-BOX:: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED .�� �/ Q2- ' /�1v 1OYR�5/8 PERC 91.2 /'_ 84"
p• i 94.0 54" ,. PROPOSED -SEPTIC SYSTEM UPGRADE PLAN
USE 3 ROWS OF 8-ADS Arc 36 UNITS + 2 COUPLERS PER ,� ,�, c M-c SAND
ROW WITH NO SEPARATION BETWEEN EACH ROW & NO STONE
M-C�AND 2.5Y 7/3 45 SILVER LANE, HYANNIS, MA
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) ' 2.5Y7/3 91.0 ADJ. GW=
Prepared for: Capewaide Enterprises, P.O. Box 763, Centerville, MA
(Arc36HC Units) 24 UNITS x 5.0 LF x 4.80 SF/LF = 576.0 SF S• 87.4 STG Gw- 130"
(COUPLERS) 6 COUPLERS x 1 .2' x 4.80 SF/LF 34.6 SF 87.5 132" 81.5 132^ Engineering by:. SCALE DRAWN
JOB. NO.
TOTAL AREA = 610.6 SF S•A S LAYOUT PERC;RATE <2 MIN/IN. ("B" HORIZON) Engineering Works, Inc. NTS P•T•M• 204-09
INDEX'WELL MIW-29 (ZONE ;C) 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
DESIGN FLOW PROVIDED: 0.74(610.6 S.F.) = 451.8 G.P.D. x 1 -WATEGW AVDJUSTMENT - 3E6PT 2009 (508) 477-5313 10/12/09 P.T.M. 2 Of 2