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Home My WebLink About0118 WAGON LANE - Health 00 118.WAGON ViWZ 270-211 HYANNIS i j 1 G MQ "4° l r- -T �l� Pt�s z 4 l cc4 k� a - - � No: ( Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes JtJ�ILatIDtt fOr��IB�ID�AY p�t<Pltt � I� UttIDYC pffm .t KL� G! O 4 Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No.//8 ajmf ah 046: Owner's Name Add r d Tel.No. Assessor's Map/Parcel f�— 2 y a fill/ In taller's ame,Address,and Tel,No��$-4914 W 25 � Designer's Name,Address,and Tel.No. I rs'To /l.S' Type of Building: Dwelling No.of Bedrooms Y Lot Size sq.& Garbage Grinder( ) t Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) A& gpd Design flow provided /U4 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) ��bS�'� r�15®X k 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 Boardof Health. Sign �C G�'(� Date 6IXvl&t Application Approved by Date Zo roi Application Disapproved by Date for the following reasons Permit No. M — �jj Date Issued �j l /j.� -1-4 No. Fee ! l THE COMMONWEALTH OF MASSACHUSETTS Entered incomputir: � Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS y 01pplication for Disposal 6pstent Construction Permit - , mac, 0-9ax oh Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No./��j (,! m?q 0v1 L 1444% Owner's Name,Add re s,and Tel.No. Assessor's Map/Parcel `f"0 - ✓�. /7` r�His �v,pryr�ti� i4y/or In taller's Name,Address,and Tel.No j��-C��Q q f 3: Designer's Name,Address,and Tel.No. ' ��i-� A Type of Building: s Dwelling No.of Bedrooms y Lot Size ' sq.ft. Garbage Grinder( ) -Other a Type of Building No.of Persons ; Showers( ) Cafeteria( ) i x Other Fixtures x' Design Flow(min.required) p- __4 gpd Design flow provided gpd Plan Date Number of sheets ff Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ji/g zl e l3 2 l-),1 L1 Date last inspected: Agreement: a 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. f Signed / Date Application Approved by Date c �o Application Disapproved by Date for the following reasons t. Permit No. -20(5�� Date Issued 6�� , aj i THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(,Ope) Upgraded( ) Abandoned( )by t 1nSj�� 6/Y> at / has been constructed in accordance with the provisio s of Title 5 and the for Dis osal System Construction Permit No. Q Ij 4-ZU dated /20 17ol Installer lo /J Designer #bedrooms - Approved design flow d gpd The issuance of thi'permi shall not be construed as a guarantee that the system will unction signed. Date / Inspector t;; No.00 I Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair ) Upgrade( ) Abandon( ) System located at / A i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completedcompleted within three years of the date of this permit. Date jrn �.( Approved by f , KETkztlA Town of Barnstable Barnstable �P Inspectional Services caG j Y . BARN" LE, A 9. t639. Public Health Division ♦`� m -- "ors. 200 Main Street, .Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 9699 Tune 26, 2019 TAYLOR, MARY ANN 56 NORTH STREET HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 118 Wagon Lane, Hyannis, MA was inspected on .05/23/2019 by Chad Hathaway, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • The distribution box is rotted. You are ordered to repair or replace the septic system within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH r Zzwaean, R.S., CHO Agent of the Board of Health Q:\SEP"fIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\118 Wagon Lane Hyannis.doc Town of Barnstable w i w . • IIA.RNFrASBLE, 1639, ,�� Inspectional Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OIXER Repair deadline: I Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts fn Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 118 Wagon Lane Property Address Taylor Owner Owner's Name information is Ma 5/23/19 required for every Hyannis page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information filling out forms on the computer, Chad hathawa use only the tab Y key to move your Name of Inspector cursor-do not HPS use the return Company Name key. P.O.Box 151 4:1 Company Address Forestdale Ma 02644 City/Town State Zip Code ,av# 774 274 2581 12866 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ® Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 5/23/19 I pect& Sig ure Date The sys em inspector shall sub it a copy,.of this inspection report to the Approving Authority(Board of Health or DEP)within 30 da s o enipleting this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 / '' c Commonwealth of Massachusetts �m ,ig Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 118 Wagon Lane Property Address Taylor Owner Owner's Name information is Hyannis Ma 5/23/19 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This inspection is not a guaranteeand applies no warrantyof the described septic components in this report including but not limited to piping structual intergrity of components and life exspectancy of leaching and described components. This inspection is to describe conditions witnessed at time of inspection only. Regular tank maintenance and water conservation can prolong life of septic systems Information on care and do's and don't's can be found at town health dept or mass.gov 2) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Wagon Lane Property Address Taylor Owner Owner's Name information is Hyannis Ma 5/23/19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ® distribution box is leveled or replaced ® Y ❑ N ❑ ND (Explain below): DB3 H10 box is badly rotted and sand has started to flow in from sides. Box needs replacement ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 16 I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Wagon Lane Property Address Taylor Owner Owner's Name information is Hyannis Ma 5/23/19 required for every y page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Wagon Lane Property Address Taylor Owner Owner's Name information is Hyannis Ma 5/23/19 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes. No ❑ ® 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 '/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 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 water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence. of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u- 118 Wagon Lane Property Address Taylor Owner Owner's Name information is Hyannis Ma 5/23/19 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts. �n Title 5 Official Inspection Form 1 I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 118 Wagon Lane Property Address Taylor Owner Owner's Name information is Hyannis Ma 5/23/19 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts l� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Wagon Lane Property Address Taylor Owner Owner's Name information is Hyannis Ma 5/23/19 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: owner pumps every 2 years Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form 1I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Wagon Lane Property Address Taylor Owner Owner's Name information is Hyannis Ma 5/23/19 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1984 tank 2001 dbox and leaching Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 1.25' feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 24+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): none t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 118 Wagon Lane Property Address Taylor Owner Owner's Name information is required for every Hyannis Ma 5/23/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1000 gal H10 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8'x5' Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 19,E How were dimensions determined? tape and sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tees in place tank level is at bottom of.outlet pipe. no visable leaks or decay t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Wagon Lane Property Address Taylor Owner Owner's Name information is Hyannis Ma 5/23/19 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 i Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 c Commonwealth of Massachusetts �m ,ip Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Wagon Lane Property Address Taylor Owner Owner's Name information is Hyannis Ma 5/23/19 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Dbox needs replacement sides are caved in causing sand to wash in. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts ,w Title 5 Official Inspection Form t,P- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments </ 118 Wagon Lane Property Address Taylor Owner Owner's Name information is Hyannis Ma 5/23/19 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: probed stone in area of SAS stone is dry and clean. no port was located on SAS via asbuilt ties Type: ❑ leaching pits number: ® leaching chambers number: cultec chambers42'x11'x2' ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: f ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 118 Wagon Lane Property Address Taylor Owner Owner's Name information is Hyannis Ma 5/23/19 required for every page. Citylrown State Zip Code Date of Inspection D. System. Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): no ponding or dampness encountered 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form �= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Wagon Lane Property Address Taylor Owner Owner's Name information is Hyannis Ma 5/23/19 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 118 Wagon Lane Property Address Taylor Owner Owner's Name information is H annis Ma 5/23/19 required for every Y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14..Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 1 p �ec� O ) a 3 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M � 118 Wagon Lane Property Address Taylor Owner Owner's Name information is Hyannis Ma 5/23/19 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 26 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: town GIS mapping You must describe how you established the high ground water elevation: lot el. 45-46' low wetland in area el. 20' bottom of SAS T below grade Before filing this Inspection Report, please see Report Completeness Checklist on next page. L15msp.,doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Wagon Lane Property Address Taylor Owner Owner's Name information is Hyannis Ma 5/23119 required for every y page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included 1 s EI . WI a s a od aZ) -0ao °° 51g,"d f cr cv, AC, t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 101 as, 4 COMMONWEALTH OF AWSACHUSETTS � EXECUTIVE OFFICE OF ENVIRONMENTALgM]F ',�/�o� F A� IS TA.6LE o— DEPARTMENT OF L1MRONMZNTAL PROTECTION 20Jsr APR 21 AM 10: 39 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM FORM PART A CERTIFICATION Property Address: /d " o,., L 4 rye— Owner's Name: n v Owner's Address: Ell. hG Date of Inspection:_ ` —d 6 o S Name of Inspector.(please print)% GTr� �4Z. Company Name: o — E Mailing Address: o L—'g awr 6t�� Telephone Number: v — CERTIFICATION STATEMENT I=14 that I have personalty inspected the age disposal*stem at this address and that the information reported below is true,aocurate and complete as of the time of the mspection inspection was performed based on my training and experience in the proper fimctian and approved system inspector pursuant to on 15 Tides 310 CMR sewa1&000 n I am a DEP Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shall submit copwof this DE P)within 30 days of completing this• inspection report to the Approving Airthority(Board of Health or gpdDE or greater,the inspection.If the system is a shared system or has a design flow of 109000 DEP.The original should be sent to owner shall submit the report to the apPopsiregional ce of the authority. owner and odes sent to the buyer if applicable,and the approving Notes and Comments report only describes conditions at the time of in on d der the condition of use time.This inspection does not address how the system will perform in the fatare under the sa at that me or different conditions of use. Page 2 of 11 "t OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F PART A FORM RM / CERTIFICATION(continued) Property Address: / G, o _ " Owner: Or 60/ Date of Tnspecdon: -- —_a( _ ors 'nspection Summary: Check A^C,D or E/ALWAYS complete all of Section D A. System I have not found any information which indicates that 15.303 or in 310 CN1R 15.304 exist. any of the failure aiteria described in 310 CMR �y failure criteria not evaluated are indicated below. Comments: a System Conditionally passes: - One or more system components as described in the" Conditioual phW section need be replaced rquired.The system,upon completion of the replacement or mp vr, pp Board of or pass Answer yes,no or not determined(Yexplain. ,N,ND)in the for the roll owing statements.If not determine please S4*c tank rs metal and over 20 years old*or the unsound,exhibits substantial infiltration or ex1'iltration or tank faihne is ) �' * t tank i replaced with .complying septic tank as approved by the Board ofHSeaalttlL w�1��spection if the metal septic tank will pass inspection if it is structurally sad,not leg .if a Certificate Compliance urdicating that the tank is less than 20 years old is available. ND explain: Observation of sewage bap or break out or obstructed pipe(s)or Heal tobroken,settled or uneven d trihi ion boxtatic waterl evel System w aluss bVection if(with wibroken in the distribitition box due to or approval of Board of broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The 1 �tem required approval of Pumping ore than 4 times a year due to broken or Boated of Health): ° plpe(s).The system will broken piPe(s)are Mplaood obstruction is removed ND explain: • Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION contin ( red) Prop erty Address.u t: Owner: p Date of Inspection: — p C. Further Evaluation is Required by the Board of Health: &/Conditions exist which require further evaluation rs failing to protect public health,safety or the environni Board of Health in order to determine if the system 1- System will pass unless Board of Health determines in accordance system is not functioning in a manner which will with 310 C1iIIt 15,303(ixb)that the 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 Ve.Betated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,saf ety and environment: TU 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. ne system private waterhas a septic tank and SAS and the SAS is less thaw 100 feet but 50 feet or more from a supply well Method used to determine distance "*This system passes if the well water bacteria and volatile owalysk o�at a DEP certified laboratory,for eoliform rgamc 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 failure criteria are triggered,A copy of the aioalysis must be attached to this fonn�laded that no other 3. Other: i Page 4 of 11 r ` r t OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM f } PART A CERTIFICATION(continued) Property Address: Owner. Date of '� won: — ? os D. System Failure Criteria applicable to all systems: You must indicate"yet"or"no"to each of the following for al!inspections: Yes No ofsewage intoficiiity or system component due to overloaded or Clo — 3�uMnaW or po>�g of enlueut to the surface of the �SAS or cesspool logged SAS or cesspool fund O1's�faoe waters due to as overloaded or Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or o1 v9�nddepth in cesspool is less than 6"below invert or available vol , Pumping amre than 4 times in the last ume Less than/�day flow Miles Pumped 3'cer N_OT due to clogged or obstrucf�pip�s) Number �y portion of the SAS,Cesspool or privy is below lu ground water `G*a Posu cesspool or privy is within 100 feet of any elevation.sUPPly ��ry to a surface — �AUy""portion of a Cesspool or privy is within a Zone 1 of a public well. portion of a cesspool or privy is within 50 feet of a private water Any portion of a cesspool or privy is less than 100 feet but greater �P1Y wen. supply well with no acceptable water quality analysis, [This i stem MU 50 feet from a private water N the performed at a DEP certified laboratory,for colkform bacteria and well water analysis, indite that the well is free from pollution from that f volatile o organic impounds and nitrate nihtigeu is equal to or less than 5nitrogen and the presence ammonia are triggeredanalysis must be attached A copy of the PPm.Provided that no other failure criteria (Yes/No)The system to this form.] fw'1�.I pave determined that o�or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails,The Health to determine what will be necessary to correct the failu> m owner should Contact the Board of e. E. Large Systems: To be considered a large system the system must serve a f gpd. aalky with a design now of 10,000 gpd to 15,000 You must indicate either`yW or"ne.to'each of the following; (The following criteria apply to large systems in addit ion to the criteria above) yes no system is within 400 feet of a sucfaoe drinking water supply Khave 5is is within 200 feet of a tributary to a surface drinking water�y he Zone IT located in a nitrogen welltrve area(Interim Wellhead protection Area—1WPA)or a mapped public water "Yes"b an3'question in Section E the `Yes"in Section D above the large system has failed.The system is considered a significant ti con or answered significant threat under Section E or faded.under Section))sW upgrade or operator of any large system considered a 15.304.The system owner should contact the appropriate regime ft wi&310.-C1R Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B Q CHECKLIST Property Addresm; Owner. G 14 p �hN� r Date of Inspection: Check if the followm have been done.You most indicate es"or"no"as to each of the followin Yes o �g mforimation was provided by the owner,Oocup�,or Board of Health were any of the system components pumped out in the previous two weeks — — received normal flows in the previous two week period 2—,were largevolumes Of water been to the system rooently or as part of this ingwion as built plans of the system.obtained and examinees(1f they were not available note as N/A) Was the Facility or dwelhg inspected for signs of sewage back u Was the�' — inspected for signs of break out were all system components,. g the SAS,located on site septic tank manhoks uncoverC4 of the � °s"d and interior of the tank inspected for the condition °on' lxpct depth of sludge and depth ofscum a6WA ( °0C different firm Owner)Provided with information an the proper The size and location of the Sal Absorpdon Sys(SAS)on the site has been determined based on: Yes informatioa.For cmmPk a plan at the Board of Haft _ Determined in the field(if any of the faihme criteria related to Part is un2ccept3b1e)1310 CMR 15.302(3)(b)j C is at issue approx;matian of dish I Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR YOLUNTARY.ASSES MUMn SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION.FORM PART C SYSTEM INOORMAZION Property Addsysw �,/Gj 0 Z— 141 Owner. (r 1✓►'� O / Date of nVectiao: RESIDENTIAL FLOW.CONDMWfgS Number of bedroom deli � PQ✓ /✓1 �t� C� !-1 < Sn)� Nuuu>a�of bedr�( � nO �� /P r, DESIGN flow based aa:310(IIR-15.203(foc : 110 gpd x d,of fbedroon>Br �{�f p / 7`� Number of current residents. � q ` Does residence have a garbage grinder(yes or no): Is laundry on a sepal sewage system.(Yes or no):Laundi [if yes separate y systeminspected(yes or no): ? won mquiredl Seasonal use:(Y=or no):AV Water ,¢available(last 2 years usage(�): !goo p Pump(yes or wy/l/» — G'S Doo Last slate of occupancy: COMMERCIAL TgDUSTRIAL Type of establishment: Design flow(based on 310 C11Dt 15.203): and Basis of design now(seats/persons/sgft,etc.): Grease uP present(yes or no):— Industrial waste hoping tank p (yes or no):— Non-sanitary waste dkharged to the Title 5 system(yes or no): Last date Water to 'if available: — occupancy/use: OTHER(describe): Pumping Reeords GENERAL INFORMATION Source of information: Was stem — O�✓Ke� �3' Piped as part the inspection(yes or no).—If Yes,volume Reason for "�—How%as quantity Pumped determined? F SYSTEM ta*distribuiion box,soil absorptiou system _Single cesspool ow cesspool —Shared system no)(Iry�attach previous inspection if any) obtainedfroms,� e bOYh a copy of the cam operatr�and rn (to be _Try tank —Attach a cxupy of the DEP approval _Other(describe): rate age of all oampow9%date installed(if louown)and source n M�✓ L P of rnformation: Were sewage odors detected when arriving at the site(yes or no):�/a Page 7 of I I OFFICIAL INSPECTION FORM NOT.FOR VOLUNTARY ASSESS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM TS PART C SYSTEM/ IlWORMATION(contirn� Property Addresm G/q l7N Owner•. �'I h o -- A 6�60� Date of�spection• ��,- BUXDING SEWER(j,o W op s/ its per) Depth ow Materials of of 8r eonstrnchoaa PVC—other iron ✓q� Distance from private water supply wen,or Vie: O.. Comments(on .of joiff1k vAnfiq&Vvidmm of 1• SEPTIC TANK- , Phm) Depth below grade: material Ogr Mft`ucfime other(explain) ott�~ — �__.pObeylene Htank is metal list.age:_ Is agermad certificate) I, by a ate of Coaace(yes or no):_(attach a copy of Dimendew �x � tat bottom.of aulet tee or ba8le: d 9 Scum thicl®ess: of i� Distance from top of scam to top of Ou t tee or bait: P 7 Distance fin�m�o �„,,'et tree . How �"" Co ( e �"� yr �� ou mOO �s,inlet.and outlet tee or,baffie co to outlet" e ), ndrtron,structural integrity;liquid levels GI vy 1'� NO `J GREASET "/6Y locate'on site Plan) Depth below Material of co srrue ; (explain): concrete_metal_fi glass_potyethyjne_otbw Dimensions: Scum thickness:_ Distance from top of scam to top of Outlet tee or bye: Distance from bottom of scum to bottom of outlet tee m bad Date of last pumping Comments(ou Pig reoommen MOn$,inlet.and outlet,tee or tztft coadi6o as related to outlet invert,evidence of leakage,etc.): WtX liquid levels f Page 8 of I l OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contin,14 Property Address: Ornnw. Date of Inspection: -- p,. TIGHT or HOLDING TANK: tank must be ptunped at time of inspection)( Oft on site Plan) Depth below grade: Material of construction concrete metal fiberg>ass_pokyethylene ( plain): Dimensions: Capacity: � Design Flow fonWday Alarm present(yes or no): Alarm level: Alarm is working order(yes or no): Date of last p mg)ing Comments(condition of alarm and float switches,etc.): DETRIBUTION BOX- �(ifseat mast be oPM140ocate on site plan) Depth of liquid level above outlet invert: c- L— Comments(note if box is level and distribution to outlets leakage into or oug,of bo etc.): any evidence of solids carryover,any evil of PUMP CHAMBFft Z(Iocate on site plan) PUmps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pomp chamber,condition of pumps and app ,etc.): f - 4 pap 9oflI OFFICIAL INSPECTION FOAM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTTON.FORM PAATC ., SYSTEM INFORMATION Property Addian CA4 owner: G-,,,w Dateof hispectiew SOIL AMR""SYSTEM OA*:. on. e p1ma,awmado.xW mobvo If SAS not located opw why. -L1—leg Pft —leachinsmaimmmbeC. leadft ,lam: , overflow cesspool,amnber wam system � /01 twjmOjW Comments(ame condition of sod ems ,signs of hydraulic faihme,level of ponding damp soil,condition of /G ��oo, / H HT y ' �,�� .So iaH G � tide C&WOOM� be pamped as part fiLvection)iocate on site plan) NumberaadConfolratim. >�-oaf li�idio inlet invest: Depth of solids lay, Depth of wom f Dimensim of - Materials of cep; Indic a ion of gmundwater (es or No):. Comte Nft of soal,sites of lOd ofpondw.wnftm off,ar PWY:1/-OOCMM site plan) Matedafs cf,c Dimes Depth of Cow(Boftwnftm ofso *Ps c level aft candWw avqpISCOR,etc.): Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(conEimted) Property Address: ` "' Owner. 6— 1 Date of Iaspecbion: — ( p> SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at feast two peruncit reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the build n& 1 r .• - ,_ _ • i �S / • Page 11 of I1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C n SYSTEM INFORMATION(contimn Property Address: /d G✓� 0 t� /l/ Owner: Date of inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water L 9,Sfeet /` a 3 , Please indicate(check)all methods used to determine the ° CI� � water elevatian:� de�ga l�on record-1f chadWd,die of design plan reviewed: site(fig P�eity/observadon hots within 150 feet of SAS) Checked with lo�Board of HealHt-exp]ain:_v"1 a,�,_9 Accessed USGS mmvatmk installers-( c docum on) You tpst hojv you ega.blished the high mod.war elevation: h P 07-E7� ................... Goa 7C) 0 Ole ,d ' \`1 0 � G- �✓ = �- - UUOV �g3 �ao3 Town of Barnstable Department of Health, Safety, and Environmental Services sARNsTABL& ;. Public Health Division 1.659.p s 0� 367 Main Street,Hyannis MA 02601 Unite: 5US-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health Ms.Israel DaSilva&Lea SM September 22,2004 816 Old Strawberry Hill Road Centerville,MA 02632 NOTICE TO ABATE VIOLATIONS OF THE STATE SANITARY CODE,CHAPTER 2, 105 CMR 410.00, THE STATE ENVIRONMENTAL CODE, TITLE 5 AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 118 Wagon Lane, Hyannis, MA was inspected on September 21, 2004 at 12:05 p.m. by Thomas McKean, Health Agent for the Town of Barnstable. Also present were Thomas Perry Building Commissioner,Eric Hubler of Hyannis Fire Department, Sergeant Sweeney of the Police Department and Thomas Geiler, Director of Regulatory Services. The following violations of the State Sanitary Code, 105 CMR 410.00, 310 CMR 15.000 State Environmental Code, Title 5 and of the . Town of Barnstable Rental Ordinance,Article 51 were observed: 105 CMR 410.450: Two sleeping areas (bedrooms) with beds observed within the basement Without; adequate emergency egress provided to each of the two bedrooms. 105. CMR 410.481: Posting of Name of Owner and Article LI: The name, address'and tele'�oiie number of owner was.not posted on a twenty (20) square inch sign outside the dwelling adjacent:to'.the:: main entrance as required. 310 CMR 15.214:. There.were a total of six (6) bedrooms observed in this dwelling; including.tfie lwti- bediooms within the basement.. However, the existing septic system capacity is designed for a maximum of four(4)bedrooms total. The property is limited to four bedrooms due to it's location within a nitrogen sensitive area and due to the size of the lot. You are ordered to.remove both. bedrooms from the basement by removing entrance doors, by removing the beds,and by opening all door-way entrances(partially or fully removing walls)to each room a minimum of five feet wide within sixty(60)days of your receipt of this letter. You are also ordered to post your name,address and telephone number on a twenty(20)square inch sign outside the dwelling adjacent to the main entrance within ten (10) days of your receipt of his letter. You may request a hearing before the Board of Health if written petition requesting same is received within seven(7)days after the date the order is served. Non-compliance will result in the issuance of non-criminal ticket citations of$100.00 each. Three non- criminal ticket citations totaling$300.00 were mailed to you on September 22, 2004. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF BOARD OF HEALTH T�60ZcKean Director of Public Health Cc: Ednei Acioli, 188 Wagon Lane Hyannis 1/6/99 NOTICE: This Form Is To'Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL V WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, a• t - J -� , hereby certify that the application for disposal works construction permit signed by me dated ;�l ,concerning.the property located at (,co�v meets all of the following criteria: �- is failed system is connected to a residential dwelling only. y There are no commercial or business ses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system There.are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed here are no variances requested or needed. • he bottom of the proposed leaching facility will not be located less than five feet above the maximum adj ed groundwater table elevation..[Adjust the groundwater table using the Frimptor method when plicable] If the S.A.S.will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above.the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation (using GIS information) �, t B) G.W. Elevation ar'V +the MAX. High G.W. Adjustment .% DIFFERENCE BETWEEN A and B SIGNED : - DATE: [Please Sketch pr p ed lan of em on back]. NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. . q:health folder:cert �a �. ---� �, � Q �—. No. 1 I / ' l tS 1 Fee 5 l THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTAB'LE, MASSACHUSETTS . Z(ppYication for Migpotal bpeum Construction Permit Application for a Permit to Construct( )Repair(V41U,,_P grade( )Abandon( ) El Complete System Individual Components Location Address or Lot No. w Owner's Name,Address and Tel.No. Assessor's Map/Parcel 5 � 'v Inst s N e,Address d Tel.No. Designer's Name,Address and Tel.No. � 111\-s_ Type of Building: [I Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures t! Design Flow ! 10 gallons per day. Calculated daily flow [ gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ., S i :j=kC00 5r�.'flG Type of S.A.S. Description of Soil �/l,e-,� S�'�"►n(10 Nature of Repairs or Alterations(Answer when appl'cable) Date last inspected: Zpp. K l(X Z I Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Enviro ental Code and not to place the system in operation until a Certifi- cate of Compliance has b y is o alter --- �—¢ Signed kZk Date Application Approved by—� ,nA ,. Cc , . Date Application Disapproved for the following reasons Permit No. — / Date Issued O ur No. Fee N 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYication for IDi.5po.5al 6potem Con,5truction Permit Application for a Permit to Construct( )Repair �Upgrade( )Abandon( ) El Complete System C Jndividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel �^�� t ..1 v�'t.... Installq's Name,Address,and Tel. o. Designer's Name,Address and Tel.No. �. 'A Type of Building: / Dwelling No.of Bedrooms `f Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures r Design Flow q// Y gallons per day. Calculated daily flow C(I-If gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank jg�,--t S<< a .__l 00D SY-z l e, Type of S.A.S. -LLI r(A��:c�.', 'j K.r,(�t . Cz c Description of Soil hn e I w l/1 �' T 4 Nature of Repairs or Alterations(Answer when applicable) (.!�GR i Date last inspected: Agreement: 16 6r The undersigned agrees to ensure the construction and maintenance of the afore des cribed.on-site-sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has beets-issued-by this Bo d of e9th. �,.-�~� Signed , � .•�'"" Date 't')� Application Approved by4v o Llt.�+ �L �� Date Application Disapproved for the following reasons 1 , s rb Permit No. �7�1. I 1 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (tompliance ,�' THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded(✓- ) Abandoned( )by at r-1 fn► 1��[.�16 I IA`r< has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 20-) --121 dated Installer Designer The issuance of this permit shall of be construed as a guarantee that the syst will fu ctio as designed. (� Date Inspector am 0 No. ..l)I I Fee h THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS L � W6pogal *p5tem Co.notruction Permit Permission is hereby granted to Construct( )Repair( )'Upgrade( )Abandon( ) ti✓`� System located at 6 `i1 - \.-1., and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: Approved by Y,rn,, T_`y TOWN OF BARNSTABLE LOCATION i AQN SEWAGE # ZOU i VILLAGE S we',' A S ASSES OR'S MAP & LOT Z70-211 INSTALLER'S NAME&PHONE NO. J SEPTIC TANK CAPACITY + rl l�- LEACHING FACILITY: (type) c_� (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: 3/9/�/ COMPLIANCE DATE: ?� Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by It) �i .. m T T � i r' No......................... Fs$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH `\� ...................•--.OF.................................... .... ,pplirtttion for #irip aal Workii Tnnitrurtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System • _..................... .. �- ....- #at�i .Addre��3 W ner ' s..._, ..d.... . .... Installer V Address � U Type o uilding Size Lot_./,--?_..__ Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures ................................................................................ ............_..... -----------•- W Design Flow...../10 ._ gal .............................gallons per person er day. Total dail w.._... ...._....._............gallons. - -----•----• WSeptic Tank—Liquid capacity gallons Length---- ........ Width................ Diameter---------------- Depth................ x Disposal Trench—No.....................iWidth.................... Total Length.......... ......_. Total leaching area-------- ..._____sq. ft. Seepage Pit No----------/---_.... Diameter...-?------------ Depth below inlet.._.....'_....•._ Total leaching area...... .__sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '~ Percolation Test Results Performed by.......................................................................... Date..................... --- 4 Test Pit No. i...J- :.minutes per inch Depth of Test Pit-__-f:_.�.�^. Depth to ground water.._.t�� . GX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil ... - ~* - TW' !`� ---- -�------ .�?--�_ ------•--------------------------------•-•......••-•-- W U Nature of Repairs or Alterations—Answer when applicable.____-_......................................................................................... ......-•--------------•---------------...------------•-------------------------------------------------.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been sued by the board. health.. Signed ' ••-- .. - Date ApplicationApproved By--•-••-•••--•...........•--•-•••••-•...........•--•--••-••-••-•-•--••--.....-•-••-•--- Date Application Disapproved for the following reasons:----•--------------------------------------------------•----------...-----------------------•......•--••-••---- •-•••----•--•-•-••-•---•-•----•••-••••-••-••••-•-•••-•---••-•.....•--•••---•--•••--•---••...•-••••-•---•-•••--•••-•--•••••••••••--••----•••••---••--•••••••---••••-•---••----••......-•••-•......-•---- Date Permit No........ -�' ..t .................. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 9N� ...........O F........ ✓.7�d�i> ................,............... ........................................... _ �rrtif irtt#�e ,af �nm�fittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by................... fir.,,.-........` r r r: ......................•--------------•------.. at......................................//.-.'�........... �&V ........ .'�►`!x �:. + has been installed in accordance with the provisions of TITI_,c, 5 of The State Sanitary Code as des c ibed in the application for Disposal Works`Consstruction Permif No ' �._..! !.�_______________ dated....._._._'"__ ^ ........__...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISF T Y. :, �.----.. G DATE.................. _.... ... . �� ., l 9 S -•---•---- Inspector- --------------------------------------------•-•-------.......------. a".W;r....• .1 THE COMMONWEALTH OF MASSACHUSETTS BOAR[),,:..:.OFr�'H�ErA LTH 3d ......... T` F2! 4. gisvviial IV ks Trnnstr ion rrmit Permissionis hereby granted............. --• ••-•. ............... •• . -•••----------•••-•••••-••----•••--............................................... to Constrt ct ( r Repair ( ) an idual Sewage Dispos System atNo..47. ••••---•-••-••---•-••-...---•-•-•-- -----------------------------•---•--------•--•-----------------•-•......•--•-•-•--•--- Street G as shown on the application for Disposal Works Construction Permit Nooa'—Q-pk,Dated....... p ................................••-•--•••-��ar- o d of ff s H ea a lth""f ` -•--------- DATE_ r �j O FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 7 0/ Qi� �oy � Town of Barnstable oFtKE , .o& Department of Health, Safety, and Environmental Services BARNS .ABM : Public Health Division 367 Main Street, Hyannis MA 02601 TFD MA'S A Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public H September 28,2004 Ms.Israel DaSilva&Lea SM 816 Old Strawberry Hill Road Centerville,MA 02632 NOTICE TO ABATE VIOLATIONS OF THE STATE SANITARY CODE,CHAPTER 2, 105 CMR 410.00, THE STATE ENVIRONMENTAL CODE, TITLE 5 AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located a 6iza on Lane, yannis, MA was inspected on September 21, 2004 at 12:05 p.m. by Thomas McKean, Health Agent for the Town of Barnstable. Also present were Thomas Perry Building Commissioner, Eric Hubler of Hyannis Fire Department, Sergeant Sweeney of the Police Department and Thomas Geiler, Director of Regulatory Services. The following violations of the State Sanitary Code, 105 CMR 410.00, 310 CMR 15.000 State Environmental Code, Title 5 and of the Town of Barnstable Rental Ordinance,Article 51 were observed: 105 CMR 410.450: Two sleeping areas (bedrooms) with beds observed within the basement without adequate emergency egress provided to each of the two bedrooms. 105 CMR 410.481: Posting of Name of Owner and Article Ll: The name, address and telephone number of owner was not posted on a twenty(20)square inch sign outside the dwelling adjacent to the main entrance as required. 310 CMR 15.214: There were a total of six (6) bedrooms observed in this dwelling; including the two bedrooms within the basement. However,the existing septic system capacity is designed for a maximum of four (4) bedrooms total. The property is limited to four bedrooms due to it's location within a nitrogen sensitive area and due to the size of the lot. You are ordered to remove both bedrooms from the basement by removing entrance doors, by removing the beds,and by opening all door-way entrances(partially or fully removing walls)to each room a minimum of five feet wide within sixty(60)days of your receipt of this letter. You are also ordered to post your name,address and telephone number on a twenty(20)square inch sign outside the dwelling adjacent to the main entrance within ten (10) days of your receipt of his letter. You may request a hearing before the Board of Health if written petition requesting same is received within seven(7)days after the date the order is served. Non-compliance will result in the issuance of non-criminal ticket citations of$100.00 each. Three non- criminal ticket citations totaling $300.00 were mailed to you on September 22, 2004. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF T BOARD OF HEALTH McKean Director of Public Health Cc: Ednei Acioli, 188 Wagon Lane Hyannis -70 as /00 0 000L/ Town of Barnstable DE.tNE. o Department of Health, Safety, and Environmental Services s sARNSfABM «. Public Health Division 367 Main Street,Hyannis MA 02601 arEp��a Office: 5U2S-79U-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health September 22,2004 Ms.Israel DaSilva&Lea SM 816 Old Strawberry Hill Road - — - Centerville,MA 02632 NOTICE TO ABATE VIOLATIONS OF THE STATE SANITARY CODE,CHAPTER 2, 105 CMR 410.00, THE STATE ENVIRONMENTAL CODE, TITLE 5 AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 118 Wagon Lane, Hyannis, MA was inspected on September 21, 2004 at 12:05 p.m. by Thomas McKean, Health Agent for the Town of Barnstable. Also present were . Thomas Perry Building Commissioner, Eric Hubler of Hyannis Fire Department, Sergeant Sweeney of the Police Department and Thomas Geiler, Director of Regulatory Services. The following violations of the State Sanitary Code, 105 CMR 410.00, 310 CMR 15.000 State Environmental Code, Title 5 and of the ,. Town of Barnstable Rental Ordinance,Article 51 were observed: 105 CMR 410.450: Two sleeping areas (bedrooms) with beds observed within the basement W thouli adequate emergency egress provided to each of the two bedrooms. 105 CMR 410.481:.Posting of Name of Owner and Article Ll: The name, address and telephone number of owner was not posted on a twenty (20) square inch sign outside the dwelling adjacent to`the. main entrance as required. 310 CMR 15.214: There were a total of six (6) bedrooms observed in this dwelling; including.the 1wa bedrooms within the basement. However, the existing septic system capacity is designed for a maximum of four(4)bedrooms total. The property is limited to four bedrooms due to it's location within a nitrogen sensitive area and due to the size of the lot. You are ordered to remove both bedrooms from the basement by removing entrance doors, by removing the beds,and by opening all door-way entrances(partially or fully removing walls)to each room a minimum of five feet wide within sixty(60)days of your receipt of this letter. You are also ordered to post your name,address and telephone number on a twenty(20)square inch sign outside the dwelling adjacent to the main entrance within ten (10) days of your receipt of his letter. You may request a hearing before the Board of Health if written petition requesting same is received within seven(7)days after the date the order is served. Non-compliance will result in the issuance of non-criminal ticket citations of$100.00 each. Three non- criminal ticket citations totaling$300.00 were mailed to you on September 22, 2004. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF BOARD OF HEALTH 14 Thom .McKean Director of Public Health Cc: Ednei Acioli, 188 Wagon Lane Hyannis TOWN OF BARNSTABLE LOCATION G�at1�1�, SEWAGE # VILLAGE �a s '�s��+ S ASSESSOR'S MAP & LOT J INSTALLER'S NAME&PHONE NO. C, X�"A A4 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) t- (size) .3�S NO.OF BEDROOMS S BUILDER OR OWNER PERMITDATE: / FS .3 COMPLIANCE DATE: I/ 3 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet dge of Wetland and Leachin g Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i � � � � � , a i ' , � � I � � r � �� r - _ — -�� j1 � 0 — — d � _ A _� � �� I I - - - - - -�- LOCATION SEWAGE PERMIT NO• VILLAGE R-X3 I N S T A LLER'S NAME & ADDRESS B U I L D E R OR OWNER DATE PERMIT ISSUED na PATE COMPLIANCE ISSUED f r ri Tl G 0 7 v THE COMMONWEALTH OF MASSACAKSETTS BOARD OF HEALTH ....................... ........ ......OF...................................... ........................................... Applira#ivit for - 70iial Works Tonstrurtion Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal et System t .............. --- - oc -Addr or t No. F..._ caner ss w a --••-------' . ......... --- -------- -- •.-- •-----�'..------------------ -•---- --:....... .._ � Installer Address � _/Z Type o- uilding Size Lot_ _.k�f,F_ 5q. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------••_-•-___ _ _... _________________________' Design Flow �� ____gallons per person per day. Total daily flow------ _--.---_-----------_--gallons. W WSeptic Tank—Liquid capacity....I _._.gallons Length...e........ Width...�_�. Diameter................ Depth........... x Disposal Trench—No..................7 Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------/......... Diameter_.............. Depth below inlet.....L�_________. Total leaching area.....�d....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. L.`' Z..minutes per inch Depth of Test Pit___ Depth to ground water... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil------...6 --• 2--j- ----•-• ''``_--= ,3-.....----- --- - '-a$`-''�' ..... . � v '' "� `- l �f..... L% ! _ _ -__ 7>....................................... ..............................----......------------... ------------------------------------------------------••-•-:--------------••••-••-•-----------•---•---••••-•-••--...------•-----------------------••------••--------••--••-•-•---•------.....--•-•---- U Nature of Repairs or Alterations—Answer when applicable.___________________________________________________............................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLi: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been •ssued by the board of health. Signed............:. _.._ Date Application Approved By.......................................... •------------•--------•--- -- ................ ........................................ Date Application Disapproved for the following reasons:................................................................................................................ ---•-------------•••----...--------------...•---------•------.....---------------._..........•-----•---...-----------••_...•---------•••-•-------••-----------------------------------------•------------ Date Permit No. •------------- Issued-....................................................... =3 ' Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH %Trrfifiratr of &-impliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by---------------- -------• =----•--.....-----------------.... `.......------•----------------------•-------..._..._..........---- •.-•--- ......... Installer has been installed in accordance with the provisions of TITIZE 5 of The State Sanita - Code as described in the application for Disposal Works Construction Permit 'o.__, ?_:_.1P4?r ............... ed........ _-__ r'. .................. THE ISSUANCE OF THIS CE IFI ATE SHALL NOT BE CONAS-A GUARANTEE THAT THE SYSTEM WILL FUNCTION -S�►�I, A OILY. DATE....................••.............�......... .. . .. ...•............. Inspector.)PU!�� ...._.._...--••--...-•----•---•-----....._......_....-----._....-- r TROY WILLIAMS SEPTIC INSPECTIONS ✓� C�/��® Certified by MA Department of Environmental Protection T�WNo� 19-p08 5-1500 19 Hummel Drive y��Tyo pTr4e� N South Dennis, MA 02660 A 1 COMMONWEALTH OF MASSACHUSETTS y EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS Opy W, ;, DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON, MA 02108 617-292-5500 WILLIAM F.WELD I Governor TRUDY CORE Secretan• ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM DAVIComm issiooeS PART A CERTIFICATION n r , Property Address: f' '�T. W U t� J S G �� S /e Address of Owner: . Date of Inspection: 'r � 7 ) (If different) p Name of Inspector: T r oy W l l i a m s I am a DEP approved system inspector pursuant to Section 1S.340 of Title S(310 CMR /s.000) Company Name: _Troy Williams Septic Inspections dye,- /VIA . a/y3a Mailing Address: _ 19 Hummel Drive, South Donis, MA 02660 Telephone Number: _ ((-8-3 8 5-1 3 0 0 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: asses Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signatur Date: 7 /,y�q7 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, B, C, or D: 7A] SYST M PASSES: 1 have not found any information which indicates that the system violates any y of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components as described in the'Conditional Pass"section treed 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. (rovimed 04/3S/97) Pago i of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A oo ,, !! g CERTIFICATION (continued) w Property Address: / O c- Ot" Lh - Owner: Date of Inspection: 7/1 /g / B] SYSTEM CONDITIONALLY PASSES (continued) IV/ 19 Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution 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 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 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 (rwimed 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 1 CERTIFICATION (continued) Property Address: I W"7--`', L h Owner: 3" S I Date oiInspection: DJ SYSTEM FAILS: You must indicate ei; er '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 from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: 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. (reviaad 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 0 6J y V1 Owner: S (a- Date of Inspection: 7 / 6, 7 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. _ 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. 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) Page 4 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ) SYSTEM INFORMATION Property Address: / v_�^ `> "t o' . Owner: 5 1Q Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: 0 g.p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: b Garbage grinder (yes or no):_,8/.o Laundry connected to system (yes or no):�S Seasonal use (yes or no):VA5 Water meter readings, if available (last two (2) year usage (gpd): %b �D� �" 4 //o S Z7. // oo b t9 a Sump Pump (yes or no):-,A—/6 Last date of occupancy: be- c,S, v s ( IAJLc k ,, k S COMMERCIAUINDUSTRIAL: 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: GENERAL INFORMATION PUMPING RECORDS and source of in rmation: ) r7 1 IO.Ja» Yf i,,,G i y, ti..J [t Q 4- ,Ls G.—+-� 1, I I—V�-�k c s. �' /cc S stem p mped Ss part of inspection: (yes or no),L(/d If yes, volume pumped: gallons Reason for pumping: TYPE QF SYSTEM �/ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) /<�v (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C rr SYSTEM INFORMATION (continued) Property Address: M M M Owner: 3 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) i Depth below grade: 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: x X /606 4/lv ti Sludge depth: Distance from top o sludge to bottom of outlet tee or baffler Scum thickness: / h I A e-J- Distance from top of scum to fop of outlet tee or-baffle: Distance from bottom of scum to botto of outlet tee or Abaffle: How dimensions were determined: /mob c. �-�, 0'1 c.s-b ; I }, 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.) a h c 1 G tti^FL� e L t CJ i �G� riL U z5J t-�I--- LFJ� �v . GREASE TRAP:_1-/i9 (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 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: O �`o-�/v`` `o Owner: L? Date of Inspection: TIGHT OR HOLDING TANK: � (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.) I DISTRIBUTION BOX:_✓. (locate on site plan) Depth of liquid level above outlet invert: /LJ t Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of/leakage into or out of box, etc.) 1�-- 0o . PUMP CHAMBER: //y (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.) (revised O4/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C Property Address: SYSTEM INFORMATION (continued) ' 1� 8 yo� Lh _ Owner: V S t f Date of Inspection: ? j SOIL ABSORPTION SYSTEM (SSAS):_�_/ (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-Di, i4 La��p. L w`r y At'4*00_0--. 3 S-/�'7<_, leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note �ogdition of soil, s• s of hydraulic failure, level of ponding, condition of vegetation, etc.) a , I w o- • n 'R cA L Cam- v M ✓ (..� � u h la J r CESSPOOLS: (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.) (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / SYSTEM INFORMATION (continued) Property Address: f l (� W a C v L-% L . Owner: � J Date of Inspection: L S 7/9Iq � 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 coves into house) f,Ja+ L. .,e- T I I 11 /&60 1(o h n 56 i (zevimed 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: W o-S`��+ L L—. Owner: / Date of Inspection: S Depth to Groundwater _ Feet adjusted high groundwater 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) y Se-/'o (revised 04/25/97) Page to of 10 i cper = 4 p IDL sn n � o � p T:\ m 0 p i •p -i i n f m ,.o , a' r - o � "�� m ZU m p "0 T�_ � D p to (.�� vC. p � A ' m m m� r D o • D m o yrD z Id? o �u w sis3s o D — m r 1 m - A - p p -C p -•1 _� -C F .\ o Dv�n p w o P ' D mac` �� '' � C Wx Z N O . - co,v,� -t r z of a N °" m o m DXwmw �4111pm i -4w1► 7 R'�G � m m-C S1 A t4 Z 11 tP o _ ..a !'' ' n z i D Z V► p 6A LA - D � z r Z 11 - c N � U U Z xa fn L r ➢ D n r COprnG n � -4 m o �,, m '- p Qj m jt'x q,m Q f m10 ti �, ! 8 c U (P ➢ -Q < p do e rp NNE Z o p m Z a o� �1 u TOWN OF$ARNSTABLE LOCATION w A(�K SEWAGE # ZOU / V.E LAGE. ��/ tArvi�,a S ASSES OR'S MAP & LOT Z7l%—Z/ I INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (G��l (size) NO. OF:BEDROOMS BUILDER OR OWNER v I PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: -Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by . 1 �. —Per-Ie) fl i 0 0�; 181 - `OL Gb'3 1-7 F Town of Barnstable NE.lpw� o Department of Health, Safety, and Environmental Services MUMSTABLE Public Health Division � ' AM 039. ,m� 367 Main Street, Hyannis MA 02601 AtFO��a Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health September 22,2004 Ms.Israel DaSilva&Lea SM 816 Old Strawberry Hill Road Centerville,MA 02632 NOTICE TO ABATE VIOLATIONS OF THE STATE SANITARY CODE,CHAPTER 2, 105 CMR 410.00, THE STATE ENVIRONMENTAL CODE, TITLE 5 AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 118 Wagon Lane, Hyannis, MA was inspected on September 21, 2004 at 12:05 p.m by Thomas McKean, Health Agent for the Town of Barnstable. Also present were Thomas Perry Building Commissioner, Eric Hubler of Hyannis Fire Department, Sergeant Sweeney of the Police Department and Thomas Geiler, Director of Regulatory Services. The following violations of the State Sanitary Code, 105 CMR 410.00, 310 CMR 15.000 State Environmental Code, Title 5 and of the , Town of Barnstable Rental Ordinance,Article 51 were observed: 105 CMR 410A50: Two sleeping areas (bedrooms) with beds observed within the basement without adequate emergency egress provided to each of the two bedrooms. 105 CMR 410.481: Posting of Name of Owner and Article Ll: The name, address and tekl 00.'' . number of owner was not posted on a twenty (20) square inch sign outside the dwelling adjacent to'.the main entrance as required. 310 CMR 15.214: There were a total of six 6 bedrooms observed in this dwellin • includin the two bedrooms within the,basement.. However, the existing septic system capacity is designed for a maximum of four(4)bedrooms total. The property is limited to four bedrooms due to it's location within a nitrogen sensitive area and due to the size of the lot. You are ordered to remove both bedrooms from the basement by removing entrance doors, by removing the beds,and by opening all door-way entrances(partially or fully removing walls)to each room a minimum of five feet wide within sixty(60)days of your receipt of this letter. You are also ordered to post your name,address and telephone number on a twenty(20)square inch sign outside the dwelling adjacent to the main entrance within ten (10) days of your receipt of his letter. You may request a hearing before the Board of Health if written petition requesting same is received within seven(7)days after the date the order is served. Non-compliance will result in the issuance of non-criminal ticket citations of$100.00 each. Three non- criminal ticket citations totaling$300.00 were mailed to you on September 22,2004. Each days failure to comply with an order shall constitute a separate violation. PER ORDER OF BOARD OF HEALTH C;i� - Thom .McKean Director of Public Health Cc: Ednei Acioli, 188 Wagon Lane Hyannis , FORM W li&W=R HOBBSB WARREN"" THE COMMONWEALTH OF MASSACHUSETTS �_ BOARD OF HEALTH CITY/TOWN 4 i PtAb I I C 4Ae0 _& 0 r g EPARTTM�EJN_T.. C11t�n0 (' ADDRESS - ' Q tt``LL Yam'+,, TELEPHONE , Address j � __on _LZRAC /f/i13 Occupant Floor Apa'rf'ment No. _ _ -No.of Occupants No. of Habitable Rooms_ No.Sleeping Rooms No.dwelling or rooming units—_... No.S ones q � Name and address`of owner- gC ¢� _ ��.�ya n E �P.- __.zt r ^�.f l Load. A Z j z Remar'Ils Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: . STRUCTURE EXT. Steps,Stairs,'Porches: Dual E ress:`ano Obst'n.: r ❑ B ❑ F ❑ M Doors,Windows:. Roof Gutters, Drains: Walls: r Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : 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: Sup ly 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.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n:: Wash Basin, Shower or Tub: Infestation Rats, Mice, Roaches or Other: , Egress Dual and ObstIn: tjp Setoad Me2tAZ5, , �, ��. v�c1Q� 410 ys0 General Building Posted f, Q. 4um 6o r0NAz. h d Locks on Doors: ' 41, re S a a ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH S /1a 4�, MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE � aic�dre55 OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) PaS+rJ OA-fie lou, "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND �/0,�81 PENALTIES OF PERJURY." INSPECTOR m1 TITLE ! Ids PM DATE' ,�� 2-00 TIME _ P.M. THE TV��C-- GR€-DULR_JO=REINS'P£C N NUMbPr 0jP k=9r0M-s is. re-+tC.44 u. MgX10011a a)hnJatl¢ arsm/jc► rlo cw,R t5.2Jy, �Gr•fejc 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 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 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. o-:-^^-w"i"'sa^Af"y"'"'^- 'v.+^fRsfi��'+Wei+�v%wiWyJ+e+�*Sri."�:ii►+.wJ'w.r`."°"n ",�"�yyl'rii`w4i.�¢.*++rwfii7+-o"+.`hr:•e�Yri..=..-+: ,.,,�:.- ' t M THE COMMONWEALTH OF MASSACHUSETTS FORM 30 H&W -HOBBS&WARREN BOARD OF HEALTH CITY/TOWN W ° E��PARTMENT 0 'o ADDRESS TELEPHONE Address W-1'1pn LaAe AA�t!�_Occupant . Floor A a ent No._ `— o. of Occupants— No. of Habitable Rooms No.Sleeping Rooms_ No. dwelling or rooming units _ No.Stories oed 4e; 'm Name and address of owner C * _�: �f piald 1C AA Remarks 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 OF ❑ 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 Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Sup ly 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.: Stacks, Flues,Vents,Safeties: ..._ Kitchen Facilities Sink? r Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub.- Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: C�j (%4renn, 0 V,de So General Building Posted �. , rrnnnn!!:. ,,, . •, � ,� LocksonDoors: 4V. . N; t v -:tom,+ , a 1vho re IA� ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE.HEALTH OR SAFETY AND WELL-BEING OF THE rc? nD� OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE a �5t�-� � ,�, 02 1 AUTHORIZED INSPECTOR.(See Over) qgj r "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND ,H+ PENALTIES OF PERJURY." INSPECTOR it fY} . ( r1 TITLE I T 65 10M 4:. A.M. i. DATE -2 1 , Lri� t - TIME P.M. 1 t u v,a XM- THE NE-XT:SCH�BDU,LE;D'41EIt4SPEG:T�1� Nvrn�er i aw-5 I resr+clel Pa 'tA�V AI rY��illc�c '. a f 44 act.+0 1310 t,mol 15.21 410.750: 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 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 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, h occupant or anyone else to fire burns shock accident or other danger or impairment to health or safety. so as to expose the o p y g p y (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. iU.S. Postal Service m m !: 'CERTIFIED MAIL RECEIPT p O (DomesticOnly; . Insurance CoverageProvided) C3 O ru ru m m Postage $ .3 7 C3Certified Fee 2.30 Postmark C3 � Return Receipt Fee Here i� (Endorsement Required) 1.75 O O Restricted Delivery Fee C:7 p (Endorsement Required) ............ C3 C3 Total Postage&Fees $ 4.42 0 4 sent To Ms Israel DaSilva & Lea SM C3C3 --------------------------------'----------------------------------------------------------- N Street'Box Apt.No..N or PO " 816 Old Strawberry Hill Road ------------------------------------------------------------------------------------------ c;zysrare,zIP+aCenterville, MA 02632 PS Form 3800.April 2002 See Reverse for Inshuctiors as � S� - � � Q � �� /� �� I . ti V_ t LZ THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA n ■ ■ ■ 1• • • • .•- • •- of Barnstable ulatory Services 3 Postage $ mas F.Geiler,Director s� � M�- . 3 Certified Fee �Y" wilding Division Postma o:3Return Receipt Fee Here� 'r3r, Building Commissioner (Endorsement Required) l 3 Restricted Delivery Fee APR m 72003 ! 1 Street, Hyannis,MA 02601 3 (Endorsement Required) Total Postage&Fees $ Fax: 508-790-6230 1J Sent To v 7 j Street, .No.; l F --------------------- or PO Box No. City,State,ZIP-4 PS Form 3800, Isreal DaSilva 118 Wagon Lane o- Hyannis,MA 02601 RE: 118 Wagon Lane • . Hyannis,MA Map 270/Parcel 211 Dear Mr. DaSilva, Due to a complaint received by the Building Department,I inspected the dwelling at the above referenced property on April 17, 2003. The dwelling currently has 7 bedrooms and is only allowed to have 3 bedrooms. These bedrooms need to be eliminated by May 31, 2003 so the dwelling will be in compliance when the re-inspection is scheduled. There are 2 bedrooms in the basement that need to be eliminated immediately. I will be contacting you at the end of next week to inspect the eliminated bedrooms in the r basement. Sincerely, David Mattos Building Inspector �`� �� C--7'71,3 5-3 p-73 ,�-9 y 118 WAGON WAY HYANNIS A -1170211 o No. 4210 1/0 RFD i 0 ion+, r ter.