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0018 WOLLEY ROAD - Health
R" .. _ ,Hyannis 270 170 I' ti iF I i l I. �I TOWN OF BARNSTABLE LOCATION 1< WOLLff—1 L�!S SEWAGE# VILLAGEy tf 1 ASSESSOR'S MAP&PARCEL 1Z0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY v < n LEACHING FACILITY:(type) i(size) S NO.OF BEDROOMS OWNER PERMIT DATE: 4t-1,&--16 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) N Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) N- Feet FURNISHED BY J3 T 3 361 4- 12, uJ J �2 . J3- .-,e4 3®' No. Fee$ - . THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4plication for M' sat *pstrm Construction VPrtuit Application for a Permit to 0 Repair Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. 'g Owner's Name,Address,and Tel.No.pv$-')q/,( 5-o An+oN 16 _'Sa�A s 19 Assessor's Map/Parcel v1 /7Ci ' Installer's Name,Address,and Tel. -LAC Desi er's Name,Address,and Tel.No.<528-3(_-1- 'CoYS4- co C � -!3 c SY- y S o Type of Buildin : Dwelling No.of Bedrooms Lot Size �b �- sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 U gpd Design flow provided 13 y9 gpd Plan Datea%6,AC aw c Number of sheets / 1� Revision Date ��Title 7OLs- S, �ci.r) /✓ /� Size of Septic Tank (!!.K i-60M /0664, 1 Type of S.A.S. RS ' s mo&X� Description of Soil *& 4 R 10g,4 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code a to ce the system in operation until a Certificate of Compliance has been issued by this Board of Health. S' ed Date /0/,3)1(A Application Approved by Date 11 11'b/W i/- Application Disapproved b Date for the following reasons Permit No. — 0 Date Issued No. � Fee „ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for 3 ' sal 6pstem Construction 3permit Application for a Permit to Gnstcrt@6' Repair( UPgrade( Abandon Complete System �n dividual Com_P•on,fits i Location Address or Lot No. 1$ ( li, Lt3 Owner's Name,Address,and Tel.No.5t�y-'} I ,4ri+Ur,6 V 'fU5 /S ckxt 1L-.J Assessor's Mdp/Parcel a"LO& /7G CtMNi txl.i -s i -) Installer's Name,Address,and Tel. o. *•y-5 ;k-C- Desi ner's Name,Address,and Tel.No.�vc��.�• Co rs'�r'cxhta �44. ,(�ice� �.�1t �rj nee✓'i r�t �C.ka..�n f u f !S lea CoU ` et✓ o� S" Type of Building:Dwelling No:of Bedrooms 3 Lot Size O c !} sq.ft.- Garbage Grinder( ) Other / Type of Building 5 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min:required) 330 gpd Design flow provided y/ gpd Plan Datea6" 1-20,60 Number of sheets / Revision Date Title 7 if/1-S' s4e-,P[ecr) d /" //eu /lir N�aini'S Size-of Septic Tank f-X+S¢-i /UGo _� Type of S.A.S.oZS`x(� Fs3 �h tc��c (��S-i f(ry Description of Soils 0"E4-0,0L tnI -bran 1 �CJ�.o I� �I l Y Nature of Repairs or Alterations(Answer when applicable) Date last inspected- Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in-- accordance with the provisions of Title 5 of the Environmental Code and-not to.`ace the syst in operation until a Certificate of Compliance has been issued by this Board of Health. S' ed Date /0131t(10 Application Approved by, / Date !1 16 -gv i L Application Disapproved b Date for the following reasons Permit No.��j(O •- `�4 Date Issued 11 Ill. 17-7 t(o --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS + BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On �-site Sewage Disposal system Constructed( ) Repaired(r�(L Upgraded( ) Abandoned( )by �r--WrtL `yr�S�YI� ON , 7YlG at o has been constructed in accordance with the provisions of f T Title 5 and the 'f r Disposal System Construction Permit NV�& V7 dated Installer 1 Y7t � �,�Kt,rtaL�py1 LPL Designer Mow)Cat tit1.E r nl-n/i M #bedrooms Approved design flow T gpd The i74� permit shall not be construed as a guarantee that the system will c ion as designe•. Q Date �� V` Inspector_� --------------------------------------------- ------------------------ ---------------------- No. O- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS. misposal 6pste Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at r , a and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date Approved by - 33 Town ®f Ba rnstable IwErp�yO Regulatory Services Thomas P. Geiler,Director * BMWSTABLE, ANAM 10 Public Health Division Tenr�a�°, Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: `i Sewage Permit# Zb/6` Assessor's Ma \Parcel Q-70/m g P b t Designer: f Game- �rr eh Installer: (� Address: Jay Mrti r _ f-� Address: = %� On �� � �' n �: �,9 }�. �'d�r�`� as issued a permit to install a (date) f (installer) " septic system at 6 l 1 er based on a design drawn by (a(ddress) dated ��S l ( igner) - I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateralx*ocation of the SAS or any vertical relocation of any component of the septic system):but in accordance with State &Local Regulations. Plan revision or certified as=built by designer to follow. j �H OF hi.180y 0 DANIELA. y�N (Installer's Signature) --__ �IVIL W -o No. 46502 U I (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc Town of Barnstable P# r yi),epat trnent of Health Safetp and4•TEnvrnonnaentkl Servicex. a g� �t„E ]ublieAIil Affi --Date: 367 Mam'Street,Hya-nis MA'026'10 '10 ` �.y/ Pena bate Scheduled Time— � Fee Ed' .00 PC co r Soil Suitab lio Assessment f og° &W . asposal=� Performed By: QG '�� G:n S Witnessed ..... Location Address j� p//� Owner's Name Qw A.h✓1 eAddrress f \�: Assessor'sMap/Parcel: � /.() ���. Engineer's"Name �IJDwI e NEW CONSTRUCTION REPAIR Telephone# J 0&) ' 5 Land Use 'Wjg5;5I V tt n/1,� Slopes(%) Surface-Stones Distances from: Open Water Body 0 ft Possible Wet Area O ft Drinking Water Welll _Iroj ft — P � ft Drainage Way ft Property Line ft Other SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) % Yv Sozz C'�l a; � -,�"' .:art. •, Parent material(geologic) 6 urw A`'- Depth.to Bedrock > Depth to Groundwater: Standing Water.in Hole: 1`4 Weeping.from Pit Face t i i Estimated Seasonal High Groundwater_ ."Id Used: in. De th.to=soil'mottles: in. Depth Observed standing in obs.hole: P ft Depth to weeping from side of obs.hole: in. Groundwater Adjustment Index Well# •Reading Date:_•___ Index Well level•_•_' A(IJ10factor *"` 'Adj:,Groundw,ater Level :.:.::..::::::::::::::::.:.::.::...::.::::::::::::::.:::..:..::::::::.:P.....:.::::.:::::::::::::::::.<:.::..:::.:::::.::::::.:.:::::::::::::::::::::..:.::::::::::.:::::::::..:............................ Observation Hole#' Time.at.9' r a , Time ae6" Depth of Pere �— t Start Pre-soak Time(a3 Time(9"-6") End Pre-soak Rate Min./Inch L Site"Suitability Assessment: Site'd'assed•• t' Site F.ailed;,t!»=t , Additional�TeslingNeeded(Y/N) /V •. Original: Public Health Division observation Hole Data'][O 1$e,�.Otrtple$ed'®n`Eaelt VAj� Copy: Applicant 1i, Depth from Soil Horizon SoilTexture i 3 tSoil;Color' t s' Soil Ot ier S face(in.) (USDA). (Munsell) . Mottling (Structure,Sto=Boulderes., Consistency-° #! .� r+`.'"` Depth Soil Te from Soil Horizon' xture Soil Color Soil i Other ~"a USDA (Munsell) Mottling (Structure,Stones,Boulderes. Surface(in.) ( ) + Consisten a.%Gravel) ................... Depth from Soil Horizon Soil Texture Soil Color Soil tier Siiiface(in.) (USDA) (Munsell) Mottling (Structure,Stones.. ulderes.Bo Consistengy,.%Gr el Depth from Soil Horizon Soil Texture Soil Color Soil Ot ier 'Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,°°Gravel) s5,rood�Insuramce-Igate�lVia�n: Above 500 year noodrbounda y,No Yes Within;>So0 year=boundary No Yes witli'in 1;O yearIINNW 15-tund6ry Nor. f „ z-. iDepth of aturally®ccurrine Pervious Material Does at least four feet of naturally occurring pervious matey' 1 exist in all areas observed throughout the area proposed for the soil absorption system? 1f-not,what is the depth of naturally occurring pervi s material? _Certification �ertify that on 5- _(date)I Have passed the soil evaluator examination approved by the Department of°Environniental--Ppotection_and.that the•°above analysis was performed by,me consistent•.w,ith etie required training,expertise and experience described in 310 CMR 15.017. Signature j� TOWN OF BARNSTABLE LOCATION SEWAGE # / < � VILLAGE .�,Af }aJ` ASSESSOR'S MAP & LOT 2 70.-,(70 INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY bode LEACHING FACILITY:(type) /" /wa (size) NO. OF BEDROOMS ,PRIVATE WELL O'RePlfill AWATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 7 �[ VARIANCE GRANTED: Yes No '/ e 0 e , i � NO....qj...-0_,.j50 FEB.... ©._........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Annliratiun for Bispmaf Vlorks Tonstrnrtiun ranfit Application is hereby made for a Permit to Construct ( ) or Repair (14,an Individual Sewage Disposal System at: . r .....�. 5.....�, O LL • -� - A----- ----tv- S t ------------- - ...------•------ ----- Location-Address or Lot No. . .� ..................................... .................................................................................................. Owner Address 4 Nt .......................................................... � x- .2.�... - ' - - y . Installer Addre dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms------3............... .....Expansion Attic ( ) Garbage Grinder ( ) Ak Other—T e of Building No. of persons............................ Showers — Cafeteria � Other 'fixtures -----------------------------------------------------.....---------------------------------------------------------------•----•---=--------------• W Design Flow----------- ___------------------ ---gallons per person per day. Total daily flow............................................gallons. x Septic Tank-Liquid`capacity------------gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No---------------------- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....................... Diameter.................... Depth below inlet.................... Total.leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank (: ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.............--......... W ---•------------------------------------------------------------------=--------•-•------------••---------•----------•------•------------------...-•---•----- 0 Description of Soil.............................................................................--=........................................................................................ W U ................................................................._....-•--.....----------•--------------•••---------•-----------------------------------•--------------......------•----•--•---.....---- W _ U Nature of Repairs or Alterations—Answer when ap livable !! .__`° a____d_� ___`_._.�::.. 9Y.......... . --•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State En 'ron ntal Code—T e undersigned further agrees not to place the system in operation until a Certificate of Co .,pliant as been is d b the board of health. Signed a. -------- ----- ----- ---- ... ..9. ..... Application Approved B .-. .-. PP PP y ---... . ... �1 Application Disapproved for the following rea r: e ----D--a--e q �� u ----.-.-.Id ............. .Permit No. - - ------------ No.... .1------------- ® Fizs.....3 Q....._......_ r THE COMMONWEALTWOF M-ASSACHUSET�TS BOARD OF HEALTH �- TOWN OF BARNSTABLE Appl ration for Disposal Works Ql�notrnr#iun rumit Application is hereby made for a Permit to Construct ( ) or Repair ( 1,-�an Individual Sewage Disposal System at: IND C.C.E{•---�.�•--•-_....................... . ......_ y a►� S .........................................................Location-Address or Lot No. C A2C�S C 0 S"►"i9 Owner Address l� .....C( .ti?Co_...---- kox �9`� L.v . 42W.pvT/i......._....... ----- --------------- •......---•-•.... Installer Addres Type of Building Size Lot----------------------------Sq. feet U Dwelling No. of Bedrooms-------- _._._Ex Expansion Attic.-.� g— _______._ p ( ) Garbage Grinder ( ) a Other—T e of Building No. of persons............................ Showers — Cafeteria dOther fixtures -----•------------------------------------------------•-••---•---•---------••---•-•-•...----•-•------------•---------------•--•-••-••--•---......---- W Design Flow...................._.......................gallons per person per day.*Total daily flow............................................gallons. WSeptic Tank—Liquid capacity..._........gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No.......:............. Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date......................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------- •--------------------------- -------------------------------- .------------------------ -------------------------------------------------------0 Description of Soil........................................................................................................................................................................ x U ---------------•------------------ ---------------------------------------•----------------------------------------------- W VNature of,Repairs or Alterations—Answer when ap livable..XAA4L-___/004> -TAP X. D._-.1�0� .......... Agreement: The undersigned agree's\to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State En�'ronme ial Code—Tunder'signed further agrees not to place the system in operation until a Certificate of Compliance as been issu d by the board of health. Signed - ..... -------- A lication Approved B '� PP PP y .............. .. /J ..> re .. . -�/ - Application Disapproved for the following rea s: ..........I—------ --------------------- ........----.------ -------------------..------------------------------- .. ----------------------- ---------------------------------------------- --------- -- -- ----yl_q - - ------------ --------------------- --------------- Permit No. �� - ....---'.............. Issued ---------------- - ----�te...... � re THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (1ex#tfteate of Complianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( 1.-� by----------- G1..7.6...-- Insmller at . ..�.------.W O t.�..-t�--�---- -(��---_-------- y� A --------------------- ------------ has been installed in accordance with the provisions of TITLE 5 o The St ironmental C��e s d c i d n the application for Disposal Works Construction Permit No. ........ !f /-s . -. .. .. dated ...� ./. . ... . THE ISSUANCE OF THIS CERTIFICATE SHALL.NOT BE CONS RUED AS A GUARANTEE THAT HE SYSTEM WILL FUNCTION SATISFACTORY. - ��, DATE-----------,�1............... ............... ......-------------- Inspector ..--- ........................... --------- --------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH R 150 TOWN OF BARNSTABLE I No.....J FEE....30 s. Disposal Works Tono#rnt#ion "pinmit Permission is hereby granted.....lq-7! , ..... A__K_?C©..........................••--..........-•---.......--•-•- to Construct ( ) or Repair (L.4-an Individual Sewage Disposal System at No...... Wo t,t�G_ 5�...:_.... .N.. b N N 1 S . --• -- •.. s...� �- ...-•-•-- -----•• --• Street �° '`� as shown on the application f r Disposal Works Construction er it No...I.,..... �. ._ d_._.•-t.. 2_../. Jr lL __--•-..1.. .. �._ • _ � vlBoard of He lth DATE............... --� •-•- ................................... FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS i n .� ORn1n� r O c QT, 71) COMMONWEALTH OF MASSACHUSETTS 1 1[� I EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED SEP 0 ,4 2003 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 18 Wolley Rd Hyannis �� Owner's Name: Richard Costa Owner's Address: MAP PARCE4 17 Date of Inspection: SOT y.- Name of Inspector:(please print) W i 1 1 i am E_ . Rob' nson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number: (508) 775-8776 CERTIFICATION STATEMENT I certify that 1 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 Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heanh 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 ? I Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 18 Wol ley Rd Hyannis Owner: Richarcl Costa Date of Inspection: -A Inspection S mary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sys 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. Sys m Conditionally Passes: On or more system components as described in the"Conditional Pass"section need to be replaced or repaired.Th system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,ri or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits, ubstantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is rep aced with a complying septic tank as approved by the Board of Health. •A metal septic will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the is less than 20 years old is available. ND explain: Observation o sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipes)or a to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of ealth): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system r quired pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if( tth approval of the Board of Health): broken pipe(s)are replaced obstn" m is ntm vcd rt: ND explain: Page 3 of i 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 18 Wolley Rd Mycirints Owner• Date of Inspection:.A= A 1-0 3 G 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 fail' to protect public health,safety or the environment. 1. stem will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the s stem is not functioning in a manner which will protect public health,safety.and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or,a salt marsh 2. Syste will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is unctioning in a manner that protects the public health,safety and environment: _ e 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. — Th system has a septic.tank and SAS and the SAS is within a Zone i of a public water supply. — Th system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Th system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more fronl a private ater supply well** Method used to determine distance "This stem passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the pres rice 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: Vy Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 18 Wolley Rd Hyarints Owner Rtutiard Costa Date of Inspection: 9-A-1-07 D. System Failure Criteria applicable to all systems: You must indicate`Yes"or"no"to each of the following for all inspections: Yes o 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 essP ool _ L quid depth in cesspool is less than 6"below invert or available volume is less than V2 day flow R uired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of 'mes pumped Awy y onion of the SAS,cesspool or privy is below high ground water elevation. ortion of cesspool or privy is within 100.feet of a surface water supply or tributary to a surface te supply. Any p rtion of a cesspool or privy is within a Zone I of a.public well. Any po ion of a cesspool or privy is within 50 feet of a private water supply well. Any po ion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private%z= supply ell with no acceptable water quality analysis. (This system passes if the well water analysis, perform d at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates hat the well is free from pollution from that facility and the presence of ammonia nitrogen nd nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are lrigge ed.A copy of the analysis must be attached to this form.] (Yes/No)The s -stem fails.1 have determined that one or more ofthe 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 de ermine what will be necessary to correct the failure. E: Large Systems: To be considered a lar a system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gPd• You must indicate eithe "yes"or"no"to each of the following: (The following criteria pply to large systems in addition to the criteria above) yes no _ — the system is wit in 400 feet of a surface drinking water supply the system is withi 200 feet of a tributary to a surface drinking water supply the system is locate in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public w ter supply well If you have answered"yes"to a question in Section E the system is considered a significant threat,or answered "yes"in Section D above the lar a system has fatted.The cm ner or operator of any large system considered a significant threat tinder Section or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner shoul contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 18 Wol ley Rd Hyannis Owner: Richard Costa Date of Inspection: - -® Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No� _ �t_// P mping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? _ HHas the system received normal flows in the previous two week period? � Nave large volumes of water been introduced to the system recently or as part of this inspection? -4/_ 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? -12_ Were all system components,excluding the SAS,located on site? _v_ 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? _L/ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: . Yes no/ Existing information.For example,a plan at the Board of Health. I Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 18 Wolley Rd Hyannis Owner: Richard Costa Date of Inspection: 2-r27— ct-�l FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):.3 Number of bedrooms(actual): DESIGN flow based on 310 CMR5.203(for example: 110 gpd x#of bedrooms): . G 0 Number of current residents: A A Does residence have a garbage grmder(yes or no):A-0 Is laundry on a separate sewage system(yes or no):/1-0 [if yes separate inspection required] Laundry system inspected(yes or no): J.,o Seasonal use:(yes or no):A,-U Water meter readings, if available(last 2 years usage(gpd)): 2001 tC.) 2 0 0 3 216,000 gals Sump pump(yes or no):Af�Q Last date of occupancy: -3 COM RCIAIANDUSTRIAL Type of a tablishment: Design flo N(based on 310 CMR 15.203): gpd Basis of di sign flow(seats/persons/sqft,etc.): Grease tra present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanit ry waste discharged to the Title 5 system(yes or no):_ Water m er readings,if available: Last date of occupancy/use: OTHE (describe): GENERAL INFORMATION Pumping Records Source of information: .6 Was system pumped as part ot the inspection(yes or no): /4-0 If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: 1 TY AF 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) _Tight tank Attach a copy of the DEP approval _Other(describe): Approximate age of all comp vents,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): gL O 6 Pagc 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 18 Wolley Rd Hyannis Owner: Ri r-hard Costa Date of Inspection: /r-;417-6-3 BUILDING SEWER(I ate on site plan) Depth below grade: Materials of constru ion:_cast iron _40 PVC_other(explain). Distance from priv a water supply well or suction line: Comments(on co dition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction:—concrete_metal fiberglass_polyethylene _other(explain)If tank is metal list age:_ Is age confirmed-by a Certificate of Compliance(yes or no):_(attach a copy of certificate) y Dimensions: r Sludge depth: Distance from top of sludie to bottom of outlet tee or baffle: 9$r 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-Fa fd D How were dimensions determined: 10 C e3 3j jr Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRA _(locate on site plan) Depth below gra e:F. Material of cons ction:_concrete._metal_fiberglass_polyethylene other (explain): Dimensions: Scum thickness Distance Gom p of scum.to top of outlet tee or ba(lle: Distance Gom ottom of scum to bottom of outlet tee or baffle: Date of last p ping: Comments(o pumping reconunendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to lie[invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO N FORM PART C SYSTEM INFORMATION(continued) Property Address: 18 Wolley Rd Owner: Date of Inspection: TIGHT or 11 WING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below gr de: Material of cons ction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(y s or no): Alarm level: Alarm in working order(yes or no): Date of last pum ing: Comments(con 'lion of alarm and float switches,etc.): DISTRIBUTION • V 110X. (tf present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids canyover,any evidence of leakage into or out of box,etc.): PUbIP C11ANIBE (locate on site plan) Pumps in workin order(yes or no): Alarms in wworki order(yes or no): Comments(note ondition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 18 Wolley Rd Hyannis Owner: Richard Costa Date of Inspection: C-2:7-6-1 SOIL ABSORPTION SYSTEM(SAS): `/ (locate on site plan,ezcavation'not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): G CESSPOOL (cesspool must be,pumped as part of inspect ion)(locate on site plan) Number and con guration: Depth—top of liq id to inlet invert: Depth of solids la r: Depth of scum laye Dimensions of cess ool: Materials of constru tion: Indication of ground ater inflow(yes or no): Comments(note con ition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (loc a on site plan) Materials of cons ction: Dimensions: Depth of solids: Comments(note ondition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 18. Wolley Rd Hyannis Owner: Richard Costa Date of Inspection: a..3 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. I �G 10 f Page 1 I of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 18 Wolley Rd Hyannis Owner. Richard Costa Date of Inspection:b e�— SITE EXAM Slope Surface water Check cellar Shallow wells x Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: rained from system design plans on record-If checked,date of design plan reviewed: t�3Qbserved site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe h w ou established the igh ground water elevation: ��1�1 � 0 6 � •per J d 11 . FORM30 C&W HOBBSRWARREN'" THE COMMONWEALTH OF MASSACHUSETTS BARD OF HEALTH �,J SZa g, CITY/TOW N 0 DEPARTMENT a O � \ S ADDRESS GSM 5vo•e TELEPHONE Address �-A S _ Occupant_. PE-1 e2 Floor Apartment No. No.of Occupants .9-4.e-."ao 3 No.of Habitable Rooms_- (_ No.Sleeping Rooms No.dwelling or rooming units No.Stories Name and address of owner /� �, CJ �JO(LE �W . ,4^-1A- / S Remarks Reg. Vio. YARD Out Id 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 Gutters, Drains: ' Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness; T, L,`•Ic,,o ®,- Stairs: C 4. 'a i�c Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: L�lfr�u� Hall, Floor,Wall,Ceiling: �G i Z r✓�� J� Hall Lighting: y/v vUr40- Hall Windows: HEATING Chimneys: ,.,p go /YS a 61 Central ❑ Y ❑ N Equip. Repair ig. cO 4-12-6 it TYPE: Stacks, Flues,Vents: U.em 4(ff- O`�-A PLUMBING: Su I• Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s)s ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS §IGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY ' INSPECTOR TITLE �"-s 46CC-00If- DATE •� TIME1t1 A.M. y THE NEXT SCHEDULED REINSPECTION P.M. ,,j('.. vn -t:"vYti�.yry./•"1.tbS��yY'T'�,nM�Y....'�WI}1,5�'� '�•s'�'� �'.r,,4y,�.S..r'1!`.`f'H*•S '.i '1 t 1 . . .. .. 410.750: Conditions Deemed to Endanger or Impair-Health or Safety The following conditions,when found to exist in residential premises, shall:be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which,are deemed to always have the potential to endanger or materially impair the health or safety,and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or 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 2, hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600,'410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Reg ulations.f or-Lead-Poison ing Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating,gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. FORM30 C&W Hosesa WARREN r" THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH CITY/TO W N xvVA DEPARTMENT a � ADDRESS 70/i 7D) TELEPHONE H Address Occupan CA 9. O,u Floor Apartment�p. No.of Occupant -7 7 H, Z o$ -1 1-1 io No. of Habitable Rooms -�: No.Sleeping Rooms___ No.dwelling or rooming units_—No.Stories_„_ pName and address of owner A Kjlo—sL c^ 0 &8 97 U 0 L-C Po -,y Remarks Reg. Vio. YARD Ckit Bld s.: Fences: Garbage and Rubbish Containers: fjy /0/L- S- Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, hes: Dual E res :an O. t'n.: (> 04,/Z 6 F/-O IWO Alro ❑ B ❑ F ❑ M Doors,Wi d - sfjvfl> gv®r'7 Roof Gutters, / s: Walls: G Off Foundation: &4. 11 U"/AJ J O I N g �it Fr�vT fd �Z Chimney: BASEMENT Gen.Sa ation: C1 TLC 61 f61 Dam n ss: k Stairs: Li htin STRUCTURE INT. Hall,Stair eJ 0 st'n.: \mil tJ 'oc- 'C'g.e:1 2 10 6� Hall, Floor,W elTn Hall Li tin Hall Wind s: HEATING Chimne : Central ❑ Y ❑ N Equip. R pair 5 u j TYPE: Stacks, FI Nes,VentZ`r 2/ -;rut t, f✓ !1 /(-) 2�( PLUMBING: Supply Lin . ❑ MS ❑ ST ❑ P Waste Line: 7, I/ ke—i'ZGGUcN >e1_111 J H.W.Tanks Safety and Vents A x,v"J 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), c.�.r1 D 'le.v ScG Bedroom 2 OS u c. I° Bedroom 3) () 6 y, Bedroom 4 p Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: -7'/-( Au v Stacks, Flues,Vents,Safeties: 79 -7�4 C/ Le YC Kitchen Facilities Sink 2f/ 74/2 Stove z- lau Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: e 6 �,�O.v Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: jz C)(i ov v Egress Dual and Obst'n: General Building Posted v9 L..0 % w k N rzo -co t✓ Locks on Doors: c,T(L 2jg/3 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 INSPECTOO REPORT IS SI NED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF P JURY." 71 // INSPECTOR TITLE ti Sc Doti A.M. DATE TIME �� A.M. THE NEXT SCHEDULED REINSPECTION "'r 9� P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. _ (J) .The..prese:nce-of leadbased paint on a dwelling or dwelling unit irvwiolation 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. S (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. s - (M) Any defect in asbestos material used as insulation or covering do a pipe, boiler or furnace which may result in the release,., of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410'.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. - (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. . (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating;gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure'to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. s: i v! Town of Barnstable Epp THE Tp� Regulatory Services BARNSTABLE. Thomas F. Geiler,Director' 9 r1A55. �A°pA 039. p�� Public Health Division TFb MAC Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 0ffice: 508-862-4644 Fax: 508-790-6304 December 17, 2009 Attn: Hyannis Fire Health Inspector Jaime A. Cabot conducted an inspection in response to a complaint. In accordance with the State Sanitary Code, 105 CMR 410.482, the Health Department is required to notify the Fire Department if there is a smoke detector violation, or possible smoke detector violation. The following property had possible smoke detector(and\or CO detector) violation(s): 18 W041ey Rd., Assessors Map-Parcel: (270-170) -No Carbon Monoxide (CO) detectors provided for the bedrooms on first floor. - Smoke detectors in basement not maintained. /'�;Zzl/ � s aime A. Cabot, R./S. Health Inspector (508) 862-4651 Email: Jaime.cabot@town.barnstable.ma.us QAOrder letters\Housing viol ations\Rental ordinance\\Fire ViolationsTIRE TEMPLATE.doc SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete igna item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by( ri Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery a ress different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No Antonio Santos 18 Wolley Road Hyannis, MA 02601 3. Service Type Certified Mail ❑Express Mail ❑Registered Meturn Receipt for Merchandise ❑Insured Mail LJ C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Trams Numbrfrom 006 0810 0000 3525 6207 � fTrarisfer from service label) PS Form'3811 February 2004 1 1 1 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • 700, Town 01 Barnstable Health Division 200 Main Street Hyannis,MA 02601 : 0 : '3J �THE Tp1i_ Town of Barnstable Barnstable Regulatory Services Department AFA"'IdeaCR" 1e39� Public Health Division I o 200 Main Street, Hyannis MA 02601,} 2007 Office: 508-862-4644 Q ` Thomas F.Geiler,Director FAX: 508-790-6304 /— Thomas A.McKean,CHO CERTTIFIED MAIL 1006 0810 0000 3525 6207 'M rL� June 9, 2011 Antonio Santos 18 Wolley Road Hyannis, MA 02601 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 18 Wolley Road, Hyannis, was inspected on June 8 2011 by Timothy B. O'Connell, R.S. Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received at The Town of Barnstable Health Division. The following violations of the State Sanitary Code were observed: 105 CMR 410.450- Means of Egress: No second emergency egress is provided for two bedrooms in the basement. 105 CMR 410.300 & 310 CMR 15.00—Title V. Septic system (permit#99-150) capacity is only for 3 bedrooms; 5 bedrooms observed. You are directed to correct the violations listed above within twenty four hours (24) of your receipt of this notice by removing all beds from the two bedrooms lacking proper egress and ceasing and desisting from using theses bedrooms as sleeping quarters. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by removing the 4th & 5th bedrooms by pulling permits to install five (5') foot cased openings in the doorways 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 violati . Should you have any questions regarding the above violations,please contact the own Health Division and ask to speak with the inspector who performed the inspecti ER OF ARD OF HEALTH c , R.S., CHO Director of Public Health Town of Barnstable Cc: Allen Roderick Citizen Web Request Page 1 of 3 5 Af} � Yti Logged In As: Citizen Request Management Tuesday,August 9 2011 TOWN\oconnelt Route to Users Search Requests Create Requests Request Information Request ID: 34808 Created: 6/7/2011 12:10:24 PM Status: Closed Assigned To: O'Connell,Timothy Health Office Anonymous: No Request Category: General Routine work: No Estimate: No Date scheduled: Estimated 6/21/2011 Change Estimated May June 2011 Jul Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 29 30 31 1 2 3 4 5 6 7 8 9 10111 12 13 14 15 16 17118 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 8 9 Created By: Wright,Teresa Priority: Medium Health Office Citation Numbers: Requestor Information Requestor Request Parcel Number r— Requester states he lives in the 2 Map: 12^70.�Block: 170 Lot: 000 bedroom basement apartment at this address.The bulkhead door does not Parcel Lookup have any bolts and hit him in the head.There are no windows in basement bedrooms.The owner rents out 2 bedrooms upstairs, one to an elderly woman who doesn't have a bed.this is an illegal apartment not registered. Alternate #for Allen 508- 774-7695 Email: http://issgl2/intemalwrs/V,Request.aspx?ID=34808 8/9/2011 Citizen Web Request Page 2 of 3 Track Request Progress -Request Work History: -Internal Note History: Entered on 6/9/2011 11:52:17 AM System entry on 6/7/2011 12:10:24 PM: by O'Connell,Timothy Assigned to O'Connell,Timothy On 6-8-11 went to said dwelling with RA from - — - - zoning. We were allowed access to basement area System entry on 8/9/2011 11:24:01 AM: with owner of dwelling.. We did observe two rooms being used as bedrooms. We then called occupant of Request Closed by oconnelt one of the bedrooms and he let us into bedroom. It was observed that bedrooms do not have proper egress. Furthermore, septic is only for 3 bedrooms which are already expiating on main floor. Will send order to remove beds and open door ways. Also took pictures. Entered on 8/9/2011 11:24:01 AM by O'Connell,Timothy All violations have been corrected. Basement vacant at this time. No further action required. Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) A. 'r Spell Check Spell Check; -Add document or image link: *You can also type in a folder name to see everything in the folder Current Links: Q:\O.rd...e.r lette.rs\Housin...g Violations\Rental Ordinance\18 wolley 6-9-11.doc ARemove I_ftalth\Tire O'Connell\18 wolley_\ I Remove 7 Time worked on request: 5.00 Response time: 4.00 http://issgl2/intemalwrs/WRequest.dspx?ID=34808 8/9/2011 SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES MARKED WITH MAGNETIC TAPE OR (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. 20" DIAM. WATERTIGHT 1. DATUM IS NAVD '88 �5 ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE TOP FOUND. EL. 53.5' FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS EXISTING Q� \ 2� SLOPE REQUIRED OVER SYSTEM 51 .2' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. MINIMUM .75' OF COVER OVER PRECAST -- o PRECAST H-10 NOTE: 2" MIN. WALL BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST THICKNESS REQUIRED UNITS TO BE AASHO H—�( RISERS (TYP.) PRECAST RISERS o a t. 2'0 51 .2 4"OSCH40 PVC MORTAR ALL PRECAST o ,.: PROP. TEE PIPES LEVEL 1ST 2' COMPONENTS 5. PIPE JOINTS TO BE MADE WATERTIGHT. a �ENDS (TYP.) V'S EL 48.0' 4' SIDES 48.83' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE a \*50.78' 10" EXISTING 14» �° °° _° _TEE �E10E1 I�I] 0 0°0El� —���� '°°°°°° /y o Q Q a TEE SEPTIC TANK** °°°°° °°°°°°°° 9 49.75 t ° ° ° ° WITH 310 CMR 15.000 (TITLE 5.) So b o Lo us o ° ° ° ° ° ° 12" MIN. INT. DIM °°°°°°°°°°°° '°°°°°°°° o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 '°°°°°°°° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND yo c c GAS BAFFLE ° ° ° ° ° ° MIN. SUMP 6 ° ° ° ° aoaaaaaoao'a ooaooa����� ° ° ° ° o °g° MMMMMMMM=M aaooaal7laoaa NOT TO BE USED FOR LOT LINE STAKING OR ANY I 48.28' 48.1 1' °°°°°°°° °°°°°°°° > ° ° ° ° ° ° ° ° 46.0 OTHER PURPOSE. cn � •' �' 7 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. H-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 9. COMPONENTS NOT TO BE BACKFILLED OR ��° ALL AROUND PRECAST STRUCTURES (2) UNITS REQUIRED = 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25, X 12.83, CONCEALED WITHOUT INSPECTION BY BOARD OF = \d m COMPACTION. (15.221 [21) o HEALTH AND PERMISSION OBTAINED FROM BOARD 6 OF HEALTH. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP CALLING DIGSAFE (1-888-344-7233) AND 41.0' BOTTOM TH-1 VERIFYING THE LOCATION OF ALL UNDERGROUND & NOT TO SCALE ( 14% SLOPE) ( 1 % SLOPE) NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. FOUNDATION— EXIST. SEPTIC TANK 1 p' D BOX 13 LEACHING 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 270 PARCEL 170 FACILITY SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL 12. EXISTING LEACHING FACILITY SHALL BE PUMPED UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS AND REMOVED PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE SYSTEM DESIGN. CONDITIONS IF NOT SUITABLE GARBAGE DISPOSER IS NOT ALLOWED TEST HOLE LOGS DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD ENGINEER: DANIEL E. GONSALVES, SE #13587 USE A 330 GPD DESIGN FLOW WITNESS: DAVID STANTON, RS �. SEPTIC TANK: 330 GPD (2) = 660 DATE: 10/24/16 RE-USE EXIST. 1000 GAL. SEPTIC TANK** PERC. RATE < 2 MIN/INCH LEACHING: - � CLASS I SOILS P# 15182 SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD 99.04 BOTTOM 25 x 12.83 (.74) = 237 GPD Opp4 ELEV. ELEV.51.5' 4 51 .5' DRIVE ENCF TOTAL: 472 S.F. 349 GPD USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) FILL FILL J) TH2 N SHED WITH 4' STONE AT ENDS AND 4' AT SIDES Q p 24" � OAK 33" 48.75' 30„ 49.0' O " METER TH CO 1 12" CE R PATIO W EXISTING S� DWELLING J TOP OF FNDN _j °S2 N EL. 53.5' MA APPROVED DATE BOARD OF HEALTH C C co 10" CEDAR PERC M/CS M/CS LOT 22 8022 SF W 10YR 6/6 10YR 6/6 FE �� TITLE 5 SITE PLAN BENCHMARK: USE TOP OF OF FOUNDATION AT EL. 53.5' 99.04, 24" OAK 51 18 WOLLEY ROAD 126" 41 .0' 126" 41.0' HYANNIS CAUTION: GASUNE NOT MARKED PREPARED FOR NO GROUNDWATER ENCOUNTERED AT TIME OF SURVEY BORTOLOTTI CONSTRUCTION/ SANTOS off 508-362-4541 I fax 508-362-9880 downcope.com © sti �C M����cy ,� OF All,, OCTOBER 25, 2016 DANIELA. r do wa cope engifteering, inc. 0 CIVIL � `A A civil engineers r; land Surveyors P°OFF sT�����`` ,,. ., <'`Y _ Scale: 1"= 20' 9J9 Main Street ( Rte 6A) 0' ss�o n� LNG v uRv� ti YARMOU THPOR T MA 02675 `'�_1 0 10 20 30 40 50 FEET 16-332 DATE DANIEL A. OJALA, P.E., P.L.S.