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Home My WebLink About0825 WEST MAIN STREET UNIT CAPT WINSLOW UNIT 1 - Health 825 WEST MAIN ST. HYANNIS (Oliveira + Campbell) ; i I Commonwealth of Massachusetts CK Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments' a •'r 825 West Main Street Property Address P� Sea Captains Condo's units 12-24 Owner Owners Name information is -r_r required for every Hyannis MA 02601 7/194,017 page. City/Town State Zip Code Date ofUspection 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. General Information filling out forms on the computer, ToT use only the tab 1. Inspector: key to move your cursor-do not James Ford use the return key. Name of Inspector Ford Septic Services, LLC Company Name P.O. Box 49 Company Address Osterville MA 02655 City/Town State Zip Code 508-862-9400 S12482 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes - ❑ Conditionally Passes ❑ Fails ❑ Needs Further luation by the Local Approving Authority 7/19/17 Inspe 's Signature Date The em in spec or shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. '""'This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 .L� VS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments µ, 825 West Main Street Property Address Sea Captains Condo's units 12-24 Owner Owners Name information is required for every Hyannis MA 02601. 7/19/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °, a •r 825 West Main Street Property Address Sea Captains Condo's units 12-24 Owner Owners Name information is required for every Hyannis MA 02601 7/19/2017 page. Cltyfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System.will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of.a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 West Main Street Property Address Sea Captains Condo's units 12-24 Owner Owners Name information is required for every Hyannis MA 02601 7/19/2017 page. Cltyrrown State Zip Code B. Certification (cont.) Date of Inspection 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 0 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w.. •'r 825 West Main Street Property Address Sea Captains Condo's units 12-24 Owner information is Owner s Name required for every Hyannis MA 02601 7/19/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ M Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 West Main Street Property Address Sea Captains Condo's units 12-24 Owner information is Owner s Name required for every Hyannis MA 02601 7/19/2017 page. Cltyrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms n/a 24 (design): Number of bedrooms,(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 2640 gal 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 825 West Main Street Property Address Sea Captains Condo's units 12-24 Owner Owners Name information is required for every Hyannis MA 02601 7/19/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: n/a Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? El Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: unavailable Sump pump? ❑ Yes ® No Last date of occupancy: currently Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M a 825 West Main Street Property Address Sea Captains Condo's units 12-24 Owner Owners Name information is required for every Hyannis MA 02601 7/19/2017 page. Cltylrown State Zip Code Date of Inspection D. System Information (Cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: pumped yearly Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system b system operator e Y Y Y p ator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 825 West Main Street Property Address Sea Captains Condo's units 12-24 Owner Owners Name information is required for every Hyannis MA 02601 7/19/2017 page. CltylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: stem installed -date unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 4000 gal Sludge depth: (Sins•3/13 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts a W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 West Main Street Property Address Sea Captains Condo's units 12-24 Owner information is Owners Name required for every Hyannis MA 02601 7/19/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 8 Distance from top of scum to top of outlet tee or baffle 3 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measure stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tees were present. There was no sign of Ieakage.Steel covers are to grade.Recommend pumping twice a year. Grease Trap (locate on site plan): Depth below grade: n/a feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene El 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 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments A,a 825 West Main Street Property Address Sea Captains Condo's units 12-24 Owner Owners Name information is required for every Hyannis MA 02601 Clty/Town 7/19/2017 page. State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain): N/a Dimensions: Capacity: gallons Design Flow: gallons per day 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 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 825 West Main Street Property Address Sea Captains Condo's units 12-24 Owner Owner's Name information is required for every Hyannis 02601 MA 7/19/2017 page. City/Town Sta te Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid Level above outlet invert even 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.): The D-box had speed levelers present. A steel cover was to grade. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Z Commonwealth of Massachusetts 4 m Title 5 Official Inspection Form Subsurface Sewage Disposal 9 p al System Form -Not for Voluntary Assessments . " 825 West Main Street Property Address Sea Captains Condo's units 12-24 Owner Owner's Name information is required for every Hyannis MA 02601 page. Ci ty/Town 7/19/2017 State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 6- 1000 gal. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The liquid in the pits were at all different levels. The pits were all taking flow. Steel covers were to grade. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage oisposal System•Page 13 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 West Main Street Property Address Sea Captains Condo's units 12-24 Owner Owner's Name information is required for every Hyannis MA 02601 7/19/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/a t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth ofj Massachusetts . u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `�r• 825 West Main Street Property Address. Sea Captains Condo's units 12-24 Owner Owner's Name information is required for every Hyannis MA 02601 7/19/2017 page. City/Town State ZipCode Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A l l ST-UJ C OWY Are, o rAdL 15in8•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 • Commonwealth of Massachusetts N v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 West Main Street Property Address Sea Captains Condo's units 12-24 Owner Owner's Name information is required for every Hyannis MA 02601 7/19/2 a e. Clt /T 017 P9 Y own State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 30' +/- 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: Topo and water contours map. ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: - see above Before filing this Inspection Report, please see Report Completeness Checklist on next page. !Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 • Commonwealth of Massachusetts • H t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 West Main Street k Property Address Sea Captains Condo's units 12-24 Owner information is Owner's Name required for every Hyannis Clty/Town MA 02601 7/19/2017 page. State ZipCode Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, Ci D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file ,I 15ins•3113 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 i 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 825 West Main Street Property Address Sea Captains Condominiums -units 12A-24 Owner Owner's Name information is required for every Hyannis {/ MA 02601 5/10/2016 page. City/Town State Zip Code Date of Inspection CO u Inspection results must be submitted on this form. Inspection forms may not be altered in any c�71 way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not James Ford use the return Name of Inspector key. Ford Septic Services, LLC area Company Name P.O. Box 49 Company Address Osterville MA 02655 City/Town State Zip Code 508-862-9400 S 12482 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails Needs Further Ev ation by the Local Approving Authority 5/13/16 Inspec 's Signature Date The s st m inspector shall submit a copy of this inspection report to the Approving Authority(Board of Hea or DEP)within 30 days of completing this inspection. If the system is a shared,system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 °� V-S Commonwealth of Massachusetts • W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 West Main Street Property Address Sea Captains Condominiums-units 12A-24 Owner Owners Name information is an required for every Hyannis y MA 02601 page. Clty/Town 5/10/2016 State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 West Main Street Property Address Sea Captains Condominiums-units 12A-24 Owner Owners Name information is required for every Hyannis MA 02601 5/10/2016 page. City/Town State ZipCode Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: f ❑ Cesspool or privy is within 50 fee t of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 West Main Street Property Address Sea Captains Condominiums-units 12A-24 Owner Owners Name information is required for every Hyannis MA 02601 5/10/2016 page. Cltyrrown State . Zip Code Date of Inspection . B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system A and 100 feet of a surface water supply or tributary to a surface water supply. the SAS is within ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a,•`' 825 West Main Street Property Address Sea Captains Condominiums -units 12A-24 Owner Owners Name information is required for every Hyannis MA 02601 5/10/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This asses system if the Y p well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria.indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered'a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 825 West Main Street Property Address Sea Captains Condominiums-units 12A-24 Owner Owners Name information is required for every Hyannis MA 02601 5/10/2016 page. Cltyfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate'yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms 24 24 (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 2640 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 825 West Main Street Property Address Sea Captains Condominiums -units 12A-24 Owner Owners Name information is required for every Hyannis MA 02601 5/10/2016 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? Yes El ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: unavailable Sump pump? ❑ Yes ® No Last date of occupancy: currently Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 825 West Main Street Property Address Sea Captains Condominiums-units 12A-24 Owner Owner's Name information is required for every Hyannis page. City/Town MA 02601 5/10/2016 State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: pumped yearly Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sew age a Disposal System Form Not for Voluntary Assessments 825 West Main Street Property Address Sea Captains Condominiums - units 12A-24 Owner Owner's Name information is required for every Hyannis MA 02601 page. City/Town 5/10/2016 State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: installed -original in 1974, date of newer pits unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): ' .Depth below grade: 24" feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 4000 gal. Sludge depth: 4 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 o- ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for VoluntaryAssessments sess ent s 41M p 825 We st Main Street Property Address Owner Sea Captains Condominiums -units 12A-24 information is Owner's Name required for every Hyannis MA 02601 5/10/2016 page. Cltyfrown State ZipCode Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 3 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Both covers were to rade. No sign of leakage ) Grease Trap(locate on site plan): Depth below grade: n/a feet Material of construction: ❑ concrete ❑ metal ❑fiberglass 9 El polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection i _ p on Form - Subsur face Sewa ge Disposal System Form Not for Voluntary Assessments 825 West Main Street �M Property Address Sea Captains Condominiums -units 12A-24 Owner information is Owner's Name required for every Hyannis MA 02601 5/10/2016 page. City/Town D. S State ZipCode Date of Inspection System Information (cont.) y Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or HoldingTank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass 9 El polyethylene ❑ other(explain): N/a Dimensions: Capacity: gallons Design Flow: gallons per day 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 West Main Street Property Address Owner Sea Captains Condominiums -units 12A-24 information is Owner's Name required for every Hyannis *page. city/Town Mae 02601 Zip Code Date of inspection- Distribution D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert even 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.): The D-Box was normal. speed levelers were present. 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.): N/a * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 825 West Main Street Property Address Sea Captains Condominiums - units 12A-24 Owner Owner's Name information is required for every Hyannis MA 02601 page. City/Town 5/10/2016 State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 8- 1000 gal. with 2'stone ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): All of the pits had various water levels. There were no signs of failure. All steel covers were to grade. The bottom to grade was 10.5' Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration n/a Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a° a 825 West Main Street Property Address Sea Captains Condominiums- units 12A-24 Owner Owner's Name information is required for every Hyannis MA 02601 5/10/2016 page. CltylTown State ZipCode Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/a t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 825 West Main Street Property Address Sea Captains Condominiums-units 12A-24 Owner Owner's Name information is required for every Hyannis MA 02601 5/10/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, at least two permanent reference landmarks or benchmarks. Locate all wells thin 100 feet. Lolcateo where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately AH S -0,0 COVO U A re, To Gr.4 il4p t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection F Subsurface Sewage Disposal System Form . N Form Not Volun tary tary Assessments "M 825 West Main Street Property Address Owner Sea Captains Condominiums-units 12A-24 information is Owner's Name required for every Hyannis MA 02601 page. City/Town 5/10/2016 D. System Information (cont.) State Zip Code Date of Inspection Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 25'+/- 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: Topo and water contours map. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `�M as••`'�t 825 West Main Street Property Address Sea Captains Condominiums -units 12A-24 Owner Owner's Name information is required for every Hyannis MA 02601 page. City/Town 5/10/2016 State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins r 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 s YOU WISH TO-OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME.in town(which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL,367 Main Street,Hyannis,MA 02601 (Town Hall) DATE: 0 ^? Fill in please: .rZ APPLICANT'S YOUR NAME: �J /�' � '�� ` q j BUSINESS YOUR HOME ADDRESS: �Z s y - TELEPHONE # HomeTelephone Number NAME OF NEW-13USIN��s.f��v t�'-;i4 � �f�7�+�i Q�3�L _T;iPE OF BUSINESS. ! • ' . .. ._�.��N flaveyciu.b'een.given.tiftprD�al frwi�[.the�bui(�in�j.dltiislbit'�. YES NO -� MAP PApCPL,NUIVIB> R ' . ApDR��S�3F•gLISrNkS:S '� � When starting anew business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth mits and licenses required to legally operate your business in this town. Rd.&Main Street) to make sure you have the appropriate per 1. BUILDING COMM�SIONER'S OFFICE T COMPLY WITH HOME OCCUPATION This individual ha 6n iafor of permit requirements that pertain to this type of busir1 LULLS AND REGULATIONS. FAILURE TO COMPLY MAY RESULT IN FINES. Authorized 'gna e COMMENT ; 2. BOARD OF HEALTH. This individual has b n infgr of the er it uiremen It pertain to this type of business. ev A thorized Signature** 0� MUST COMPLY WITH ALL COMMENTS: 3. CONSUMER-AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: , -� BUSINESS LOCATION: Z �✓ M�{'l� ��d / INVENTORY MAILING ADDRESS: K'' YA-1V Nt J' W1/-k 0 -" 0 f TOTAL AMOUNT: TELEPHONE NUMBER: - �� `� +�� r �Z-� CONTACT PERSON: 3 �- EMERGENCY CONTACT TELEPHONE NUMBER: d 2 0- (-(2-q MSDS ON SITE? TYPE OF BUSINESS:_ P/ l tv 7- / s y A!rr-- INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? es No 6LS _ �'!q f? 'E S NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) i I Other cleaning solvents v Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS r ' .. _', ._. '"'. -�. ..: Yrr, -, w.,vr.r�,R,,,rt,,..+tt,�rt?:twwhc �'`�.?.k..t �t, -• ,� ,Yi � .t -wk�.. 't7°4+�w'�._fE'!.`i,.N�:, Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALSON-SITE INVENTORY NAME OF BUSINESS: hL r V 12^ BUSINESS LOCATION: Z M « 4''' / INVENTORY' ' MAILING ADDRESS: Ff ((/+-7V ivf J P" 1-6 O I TOTAL AMOUNT: TELEPHONE NUMBER: Dz CONTACT PERSON: � ` N` EMERGENCY CONTACT TELEPHONE NUMBER qZ' MSDS ON SITE? TYPE OFBUSINESS: P^_711j /NCz /T3 INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waster ' P P Name of Hauler: Destination: Waste Product: Licensed? es No 0- 5 n 519 G7 (< 07 1I NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. 9 p 9 .� �. •. I LIST OF TOXIC AND HAZARDOUS MATERIALS P The Board of Health and the Public Health Division have determined that the following products exhibit toxic ? or hazardous characteristics and must be registered regardless of volume. j Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive `�• - NEW USED Cesspool cleaners Automatic transmission fluid I Disinfectants Engine and radiator flushes Road Salts(Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, *' Photochemicals (Developer) lubricants, gear oil NEW USED ( Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, k Lacquer thinners (inc. carbon tetrachloride) NEW USED I Any other products with "poison" labels Paint & varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) I �( b Spot removers & cleaning fluids (dry cleaners) ' Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT!CANARY COPY-BUSINESS 1 ` t , FORM 30 C&W HOBBSS WARREN TM THE COMMONWEALTH,OF MASSACHUSETTS BOARD OF HEALTH �jA2.w�S'La�L� CITY/TOWN a DEPARTMENT 200 M A ST. \AN t!k is , I^g ADDRESS G,,M Sveyr, TELEPHONE Address W. Mop tJ ST• Occupant_S�Ss Floor Z_ Apartment No.1_2.� No.of Occupants 1 No.of Habitable Rooms__No.Sleeping Rooms Z No. dwelling or rooming units_ No.Stories _ Name and address of owner 7[iwu kS C. Li A 446011!— �fl L.0 Q C 1s-L Qf.V 11.t,.1E 2 '52— Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ My Doors,Windows: LA Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: A Obst'n.: ' Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. u .Ten.,Gas, , lect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink / Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted `CO Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPEC ON REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES PERJURY." INSPECTOR TITLE X L 1tJ 04-- A.M. DATE 01 d TIME 'd. S` A.M. THE NEXT SCHEDULED REINSPECTION f� P.M. i 410.750: Conditions Deemed to Endanger:or Impair Heath 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 erdanger 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 qLartity;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 ease 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 ca.oacity 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. FORM30 C,W HOBBS&WARREN TM THE COMMONWEALTH.OF MASSACHUSETTS BOARD OF HEALTH �(IS L15 . CITY/TOW N o DEPARTMENT Zoo �1 4 i 4,1aT . �1 ..►N H S "A ADDRESS �M C TELEPHONE Address U� M 4► N ea'C _ Occupant—,:;�SA �; 'T1 2 A NK Floor Z Apartment No. ! 2 No. of Occupants k No. of Habitable Rooms_ ! _--No.Sleeping Rooms_ No.dwelling or rooming units No.Stories 2 Name and address of owner If[ a � G ' t_;to �. � �{L�. ?-0. G lU ( Q�V 1 l.l.� MA t>U, 522 Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: / \ Roof .•t /,e Gutters, Drains: Walls: a < Ly( �. Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: {/ Stairs: s Lighting: :,x_.$T,RUCTURE.INT= Hall,Stairway: �1 Obst'n.: A, Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING / Chimneys: Central El O/N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 110 Bedroom 2 1 , �, Bedroom 3 Bedroom 4 Hot Water Facil. Su�.Ten.,Gas70il;-Elect.: (" Stacks, Flues,Vents,Safeties: ) Kitchen Facilities' Sink " /0 Stove•---------""..... '�_ . Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted -7 o (3 Cy e,-c 0Ip Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES O vPERJURY." INSPECTOR � TITLE A.M. DATE �. 0 : TIME � Ca 1 � P.M. THE-NEXT SCHEDULED REINSPECTION P.M. .. i 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 41C.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 witnir.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, includinggarbage or trash which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. 9 9 P 9 9 Y (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 pcwdered, 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. YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FL., 367. Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. Fill in please: Date: APPLICANT'S NAME: '0R-0 6 efxe � a _ YOUR HOME ADDRESS: P,,5' `/L/ ; BUSINESS TELEPHONE # S c) HOME TELELPHONE #: /_S70 3 �� NAME OF CORPORATION: NAME OF.NEW BUSINESS f TYPE OF BUSINESS %;0V,7 � IS THIS A`HOME OCCUPATION? E NOb�- ADDRESS OF BUSINESS MAP/PARCEL NUMBER (Assessing) When starting a new business there are several things you must do to be in compliance with the rules and regulations of the Town of Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO 2nn nj. (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally ap rake you bur siness in town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual as been ' rmed of the perrnrements that pertain to this type of business. MUST COMPLY WITH ALL Cal / 14AZARDOUS MATERIALS REGULATIONS Authorized Signature"* COMMENTS: 3. CONSUMER AFFAIRS\(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature" COMMENTS: TOWN OF BARNSTABLE Date: 5 /S / 0 I9 TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: C► PE ST(461 Ff}jA17_1�1, BUSINESS LOCATION:�2� +�N/AI/� 5% /O —�1�.9��.s INVENTORY MAILING ADDRESS: 5 TOTAL AMOUNT: TELEPHONE NUMBER: _ CONTACT PERSON: 0�� E/ � EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: % AIT%ella INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) _ Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers 1 (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS • • . • ® Complete items 1,2,and 3.Also complete A. Sig ure item 4-if Restricted Delivery.is desired. X ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. R eived 6y(Printed Name) C. ate f D liv 1,0111 ® Attach this card to the back of the mailpiece, a( �I or on the front if space permits. — D. is delivery address different from item 1? ❑Y s 1. Article Addressed to: If YES,enter delivery address below: ❑No M ^ IA 3. Se e Type Certified Mail® ❑Priority Mail Express Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 0 3 5 8 7� (transfer from service label) 1113 PS Form 3811,July 2013 Domestic Return Receipt UNITED STATE R W.Il MIW--E R, ge es ° Sender: Please print your name, address, and ZIP+4®in this box* Public Health Division O� Town of Barnstable 200 Main Street Hyannis,MA 02601 - -- ij;ilill!,rl1difiltll1,iii:!ills;!=il,1I;jly!„.lilii1-OP 1!'lii UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid i USPS Permit No.G-10 I Sender:Please .. ° print your name, address, and ZIP+4 in this box • Town of Barnstable II Public Health Division 200 Main Street I Hyannis, MA 02601 I I ,i,l�lll111,l!"�'i'l1111lf�Ai��!!'!��'�''i°11'itjll,tll'1l�l,l,lf � I r � ® Complete items 1,2,and 3.Also,oOmplete A. Si ature I item 4 if;Restricted Delivery is desired. 4WL4 jAe A.4- ❑Agent I a Print your name and address on the reverse X ctom-❑Addressee so that we can return the card to you. I B. Received by(Printed Nam C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter de!very address below: ❑No I I Thomas & Cecilia Lee 26 Harbor Hills Road I Centerville,MA 02632 3. Service Type i Certified Maii ❑Express Mail - ❑Registered ❑Return Receipt for Merchandise I ❑Insured Mail ❑C.O.D. i 4. Restricted Delivery?(Extra Fee) p Yes 2. Article Number 7012 1010 0000+2850 8449 (Transfar from service label) —To PS Form 3811.February 200A Domestic Return Receipt '+02595-02-M-1540 `LI N0 � 1 1 1 -�- E� Certified Mail#7012 1010 0000 2850 8449 �oFtKE Tasti ' Town of Barnstable o� r Regulatory Services LLFtNSfABLF, 9� 6 M � Richard Scali, Director A Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 3, 2014 Thomas & Cecilia Lee 26 Harbor Hills Road Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 825 West Main Street Unit 12, Hyannis was inspected on October 29, 2014 by Timothy O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.500— Owner's Responsibility to Maintain Structural Elements.. Sliding glass door within the master bedroom does not open easily and has a 1/4 inch gap where it meets the stationary glass door. Handle to the door is broken. Holes were observed on the master bathroom wall. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by repairing walls in said bathroom and repairing or replacing said sliding glass door. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. eP -ORDER F THE BOARD OF HEALTH mas A. McKean, R.S., CHO Director of Public Health Town of Barnstable QA0rder letters\Housing violations\Rental ordinance\825 West Main Street Unit 12.doc10-29-14 „ z ' TOWN OF BARNSTABLE BOARD OF HEALTH c, ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date I r� t Time: In Out Owner ��itSL� Tenant I ^- Address t w"' '' Address Compliance .Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities zfi 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities — 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17.Temporary Housing 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) N Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here G I TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION. ' Date P® ,� ` - P Time: In Out - e r Owner rL Tenant Address D �'• 5 �I�J'� � Address •.. �— i "`"-"-" s 40 Compliance Remarks or Regulation# Yes ENO Recommendations`' 2. Kitchen Facilities 3. Bathroom Facilities ✓ : ,; `} 4. Water Supply fi '.C_ 5. Hot Water,Facilities" 6. Heating Facilities 7. Lighting and Electrical Facilities ✓ ,,,, - 8. Ventilation 100 9. Installation and Maintenance of Facilities ✓ -- <�.._ "1"0 Ciirtailmenfof Service . t 11. Space and Use T., # r. 12. Exits �" �, 00 13. Installation and Maintenance of Structural / Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal J. 17.Temporary Housing r 18. Driveway Width /� f 19. Number of Tenants Observed PART II 31. Placarding of Condemned Dwelling; Removal of..Occupants; Demolition Number of Bedroo Number of Vehicles Allowed (max) Number of Persons Allowed (max) r Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here N7 v to Complete items 1,2,and 3. A. Si r 13 Print your name and address on the reverse X ❑Agent so that we can return the card to you. ❑Addressee I o Attach this card to the back of the mailpiece, B. ecei by(Printed Na ) C. Date of Delivery or on the front if space permits. ,I 1. Article Addressed to: D. Is livery addresb different from item 1? ❑Yes ItA n — If YES,,enter-delivery address below:.. . ❑-No bS�efv,� ��-�� I'�� a'lb!55 3. Service Type ❑Priority Mail Express@ II I�Iil�l ICI IOI I II it I I I I IIII �'� II I I I I III ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted ❑Certified Mail® Delivery ,.9590 9402 1933 6123 1429 80 ❑Certified Mail Restricted Delivery ❑Return Receipt for ❑Collect on Delivery Merchandise ")Ilect on Delivery Restricted Delivery ❑Signature ConfirmationTm 9 0 3110 lured Mail 13 Signature Confirmation 7 015 1730 0 0 1; 4 9 ured Mail Restricted Delivery Restricted Delivery (over$500) PS Form 3811,July 2015 PSN 7530-02-000-9053 TO Domestic Return Receipt II, USPS TRACKING# First-Class Mail Postage&Fees Paid USPS Permit No.G-10 9590 9402 19 6123 1429 80 I I United States_ •Canrla_r P1PasP nrint.vour name.address,and ZIP+4®in-this box-* Postal Servi Os I Town of Barnstable Health Department I 200 Main Street _ _Hyannis, MA 02601 I I I � M I 1�11i�III lll'1l'I'iilill'Jill lltll"';,illi'tlllll'Jill I. 1i : _ t F C �. �e , �lj 3 f � v O� Certified Mail#7015 1730 000149.90 3110 Town of Barnstable lArsNSTADLE. '�' ... Regulatory Services Richard Scali;Director 'Public � • e. Health Division. Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 3,2018 Kerry McNamaraC/o Thomas& Cecilia Lee 26 Harbor Hills Road Centerville,MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The,property owned by you located .at 825 West.Main Street Unit 12, Hyannis was inspected-on October 29, 2014 by Timothy O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410,500—Owner's Responsibility to Maintain Structural Elements. The sliding glass.door within'the living room does not open easily and has a %4 inch gap where it meets the stationary glass door: Areas around this door are not sealed well. 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Observed rot on the outside trim boards around the sliding glass door within the living room. 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Stains on the walls were observed above the base board heating units. 105 CMR 410.351—Owner's Installation and Maintenance Responsibilities. Electrical outlet plugs-are loose or worn and due not hold plugs in as intended to. AVR let" k's - , _S+ CCkf Q:\Order letters\Housing violationsftntal ordinance\825 West Main Street Unit 12.doc 1-3-18 Certified Mail#7015 1730 0001 4990 3110 �t tti Town of Barnstable o� Regulatory Services BARN BIZ MAS& Richard Scali, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-7,90-6304 January 3, 2018 Kerry McNamaraC/o Thomas &Cecilia Lee 26 Harbor Hills Road Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. 2 West Main Street Unit 12 Hyannis was The roe owned b you located at 8 5 property riY Y Y Y inspected on October 29, 2014 by Timothy O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. The sliding glass door within the living room does not open easily and has a 1/4 inch gap where it meets the stationary glass door. Areas around this door are not sealed well. 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Observed rot on the outside trim boards around the sliding glass door within the living room. 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Stains on the walls were observed above the base board heating units. 105 CMR 410.351 —Owner's Installation and Maintenance Responsibilities. Electrical outlet plugs are loose or worn and due not hold plugs in as intended to. QAOrder letters\Housing violations\Rental ordinance\825 West Main Street Unit 12.doc 1-3-18 You are directed to correct the violations listed above within fourteen (14) days of your receipt of this notice by repairing or replacing said sliding glass door so that it excludes wind, rain and snow and is sealed around all edges; by replacing rotting trim around the exterior of the sliding glass door; by cleaning the walls above the base board heaters and by rendering the problem that is causing this staining; by replacing the electrical out lets so they work as intended. You may request uest a hearing p requesting before the Board of Health if written petition uesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PE RDER O qHIq BOARD OF HEALTH Tho- s A. McKean, S., HO Director of Public Health Town of Barnstable j Q:\Order letters\Housing violations\Rental ordinance\825 West Main Street Unit 12.doc 1-3-18 ?o oCA0�- � 5 � 1 9 TOWN OF BARNSTABLE �� BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date j— 3 ^ Time: In Out Owner I Tenant , v Address 1 Address l - 11 4 Compliance Remarks or Regulation# Yes Recommendations 2. Kitchen Facilities 01, 3. Bathroom Facilities - 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilitiesol -�- t 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here r l- s j • TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION l r Date t w Time: In A Out Owner �'` Tenant ' ~/ / " "'� /n , Address ( 3 Address Compliance Remarks or • Regulation# Yes �NO / Recommendations ,. + a i 2'Kitchen Facilities 3. Bathroom Facilities �0/' 4. Water Supply 5. Hot Water Facilities f1 6. Heating Facilities z � 1 7. Lighting and Electrical Facilities lol '` �- ^� 8. Ventilations + �, 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use E2 12. Exits 13. Installation and Maintenance of Structural ✓ ; Elements 14. Insects and Rodents � !"� It 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17.Temporary Housing r 18. Driveway Width 1/ 19. Number of Tenants Observed i PART II `< 37% Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here - 7 _ .-. Cap-A�� n� cs s 14A- alTOWN ' 3, LOCATION Has— Wf ST- MA,,' Sr SEWAGE # .ILIF—AGE NyAMI1 ASSESSOR'S MAP & LOTQyg INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY a SM n LEACHING FACILITY: (type) 0' �oXG 0"$Tf (size) /0* NO. OF BEDROOMS o1 BUILDER OR OWNER - SW Ca►� Alf PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) �O, Feet Furnished by ZeUN-✓ O�n - t,J J J OQQ O W W I 0loJ 0 �a J q A � lu v 0 0 _1 1 4 SeA Ain Co,,dos TOWN OF BARNSTABLEu1tts raA - �y _ LOCATION oZs W e-ST MAIn St SEWAGE # V�-I:LAGE$AA1%0 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 060 D GA) LEACHING FACILITY: (type) GXC P,1 S (size) AV a $I Dne— NO. OF BEDROOMS oZ BUILDER OR OWNER SeA CAp10A►n- C0,1�0 ASS. PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leading facie Feet Furnished by ,1reCu--{{'Oo% rc� w s J o0 O J OG H 00 3b W J — l J .fl � o W J P CAN. Q� 0 5t,A C/J A COn4 uA►f'S -7' I o1• ', OWN OF BARNSTABLE LOCATION ?ar w• /►'AO SEWAGE # VILLAGE 14y4e /tls ASSESSOR'S MAP & LOT 03!5�0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �' (0X ' T (size) r 7 NO.OF BEDROOMS ) BUILDER OR OWNER C4 C0 C PrOP5-lk MAIJA LiNk., PERMITDATE: COMPLIAN DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and.Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachi facility) Feet Furnished Sshed by /! C 4,T1&n ro/CJ V / Q Vc j W eSW v 'B STABLE LOCATION J�A C� �4+^I CO��SEWAGE # VIL•LAGE�A/1<1I S ASSESSOR'S MAP & LO S-" INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) `�' t �� (size) NO. OF BEDROOMS BUILDER OR OWNER .S" 5-= 4 a"f �os PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by � g a 3 13 3$ S y 3g ya S -3 �0 Fc4101 93 No....................APPROVED ..... .................... Bauble onservation Departff,488tCOMMONWEALTH OF MASSACHUSETTS bBIPAR® OF HEALTH Signed Dater N OF BARNSTABLE Appliration for Db3p<t ml Wi or1w C omarnrtinn Pamit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ......... •_. - Location-Address �+ p �,.� 72e q q U/ u ✓..... C.. G �(J �mod- /�'��. p 4j Lot No � ��/��. �.... owner ddress � Installer Address Type of Building Size Lot............................Sq. feet ... Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ____________________________ W Design Flow.......................... .. ..............gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid cap �t'�i gallons Length---------------- Width---------------- Diameter--- ------------ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------1`/....... Diameter-----ZV------- Depth below inlet....... __...... Total'leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date....._................................... 14 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 -------------------------------------------------------------------•--•-•-----..._...--•--•--------...........•....•...----..........._..--••-----------....- 0 Description of Soil........................................................................................................................................................................ x U ....•---•--•----•----••.....................•--••••••-••--•--•--••-----•-••--••. ---•--._.._..._...---•---------------•---•-••-•-----•-•--••------------•----•---•--••----•-•-••-•--...•------....••.._. M •--------------------------------------------------------------------------------------•----------•----------------------------------------------------f------------7-------------------------------•-- U Nature of Repairs or Alterations—Answer when applicable._-__,4D?�_-_------- .- .....0 ......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Complian as een issu by t ard-of health. Signed ... `° /.. ............. I.... ...- Dare Daw Application Approved By .............. J J...10.. . A /e.-..I..a-.-�� Application Disapproved for the following reasons: ............... . ................. ..........:..................... ..... ....................... ....... .................................. ......................... ................. .-- ..........-.................................... ................................------- ................................... Date Permit No. ........... ..3-- -- 1-4................ Issued ............................................. ....................... Dare 73 -�<6 No................»-••••• FEs.............................. .- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TON OF BARNSTABLE Applirn#ion for Biripwi tl 3inrk.6 Tomitrnrtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System at: t , C ..........�/—./�--1 V V 1 1'✓tom. I ....I ._�� .�. /V��J ................................................. ........... ............ .�...............___..._._._ .......................................... . ..... Location-Address of No ................ �-.� V/ ! �tJ,v"`: �, riV f� Lot No. a /VD 11J7 `I /eb G 1Ji T -•-••»............... ..•---•--......----•-•----............-••---......• ------------............. •• .........._.. ress W rG c_1 ?7 C.E;��sTiGuc_'� �J �� t.�!/► c�`/ i Dndd Installer Address U 'type of Building Size Lot............................Sq. feet �-. Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d Other fixtures ................................ Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid cape:-> gallons Length________________ Width---------------- Diameter................ Depth................ x Disposal Trench--No. .................... Width..................... 'Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....__./.y...... Diameter------f(J-------- Depth below inlet....... ...... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......-.................................................................. Date...................................... Test Pit No. I................minutes per inch Depth of Test Pit------_............. Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit----_............... Depth to ground water........................ a ...---•---••-------....-•--------•------•---•--....-----•-•--------•----••-.......•---••••......•................•-•-•-••••-•...........-••••--•••••••....... ODescription of Soil........................................................................................................................................................................ U ........................ w U Nature of Repairs or Alterations—Answer when applicable.-._.. A-00---_---_--.:-- ......... .�c:�........ ..... ......'--==5--------------- ------........`...._�/ ter!........ ---------`'f............ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the•-board of health. r �'- Signed / - -------------------------- --------- ............. ..... 1 / 3-- - Application Approved By ------------- -- - � ..�..�.�..... /t 1... -..- j q� J ------------------------------------ ..... r� Date Application Disapproved for the following seasons: ..... .... . .... . ............................................................................... ... -- . . . -- ...................... .......... .... . ...................................................................................... ............ .... ................................. Dare PermitNo. ............q... ....- .-.1 �' ............. Issued .........--............... ...................-- Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C11e>r#ifirate of Cgomp ianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ...........................................................1... .. ... ..........------------.....---- - -- - Imrallcr at ......... .......C.�::...�! �....1/J�2�1 � �` ............ �szS_f.�/1`7�1/�.1.... S i / r sruL S __................................. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..-----------.9.. ..... dated ...................._. .................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----................. 1.._r... .... ..__...._. _...... Inspector ................... / THE COMMONWEALTH OF MASSACHUSETTS �! 6 35` BOARD OF HEALTH TOWN OF BARNSTABLE No..... FEE........................ Dispaual Warkii Tomitrudivit f rrnti# Permission is hereby granted............. 5_. �--:-��!..u? .._.._._._.C- ......._.......... <o:�) to Construct ( _) or Repair ( ) an Individual Sewage Disposal System at No................ — f �1 .� 1. ,�c . .Y��----.. ............................. .......1--ST ....... ------ Street q,, as shown on the application for Disposal Works Construction Permit No.lr-�_ � -__ Dated............. ............................. r DATE...................... ` . =�._� ------- ----------------- Board of Health -)- /� / -� -- FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS