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0001 ELMWOOD CIRCLE - Health
I Elttw dod Circle f� c6itat A '010-029 i �11 vt�o UPC 10230 g No�H1693 UAOfl[M tW r _ _ .�//I �o � �fti� sag- 7la� -� 20� �Jp15 : �ic�6q � v� rlL ,�- gi5-5i53 y�g- 86�2 �&�Jx S/53 J l%I�� �� �r� � �' �,� v � � I ai u)cod ccb4i� �>pc� / ono 6vvi 9 TOWN OF BARN-STABLE LOCATION / SEWAGE# VILLAGE l t� ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY JL M LEACHING FACILITY: (type)A'lm& (size) NO.OF BEDROOMS BUILDER OR OWNER 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 wetland exist within 300 feet o le ng ty Feet Furnished by 10 M 7V TOWN OF BARNSTABLE LOCATION_ i U1Q SEWAGE 94-3 86 VILLAGE ASSESSOR'S MAP & LOT0/f0, Jd�2 INSTALLER'S NAME PHONE NO. � �'la(t c x) SEPTIC TANK CAPACITY /GD6 D LEACHING FACILITY:(type) 1- Q�l. (size) /6®d NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: * DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No e c _ 32- a13 — 0 - � S'i ® -3 :—E= 3:5 ,r Page 1 of 2 Ade, Christine From: Steri-Clean [info@steri-clean.com] Sent: Sunday, February 07, 2010 3:55 PM To: Ade, Christine Subject: RE: Contact Hoard ingCleanup.com I.am not sure how I can assist you. The difficult part about hoarding, is that until the person wants help, everyone around them gets more frustrated. This is her stuff and nobody can make her get rid of it. The only way she can be forced.is when the housing you say she is under inspects her home, a landlord inspects her home, or the city/county inspects her home. Other than that she is able.to live how she wants, Cluttered or not. We get so rnany requests from people that are trying to help a loved one, and I wish I 'y could help them all. Unfortunately, we can't_just go in her house and start sorting through it all. She would:have to be on board and sign a release before we could get started, She sounds like she could use some help and the best place for her to start is in CBT or Cognitive Behavioral Therapy. This is not - traditional therapy where they sit in a room and talk for an hour.This is usually at home therapy where the person will actually go through some of the items with them and help them re-learn how to let go. They ask them to pick something up and ask them why they are keeping it then give theta the tools necessary to make the proper decision about what is truly needed and what is not. Now,gettinyo theta to agree to this is the next problem. While this is a very different disorder than say alcoholism, the problem is the same for the family members,, until the alcoholic wants help or lilts rock bottom, there is nothing . an can do. Please keep in mind that almost all hoarders are not able to make these decisions. It. is not that they are just lacy. 7Ihis is usually an abnonnality in the frontal lobe of the brain that manifests itself as hoarding typically after the onset of depression for.any reason. If they can diagnose and treat the underlying problem, many thnes t:he hoa.rdi.ng gets better is well. Each person is different though so she would need to get evaluated to see where the hoot of the problem stenis from. I knowthis is not the quick fix answer you might have been hoping for, but [have learned that no psycholog.ical.problein has an easy Fix. f world be happy to talk to you more about this if you have any other questions heel free to contact me any time. Cory.Chalmersx� Steri-Clean "Hoarder Helpers" �° , .. "Restoring Homes and Lives"rM (888) 577-7206 Ext. 111 www.Steri-Clean.com s www.Hoardin Cleanu_.com co�' t` ` -.1oardng/Piutter CL-an lip s;pc�ialist a Services: *Hoarding Remediation *Clutter Control *Biohazard Removal/Disposal (TSW#010) *Animal Waste Clean Up/Animal Hoarding *Recovery of Valuables/Sentimental items *Rolloff Bin Delivery * Window Board Up' f *Heavy Duty Cleaning/Disinfection *Recycling - E-waste/Household Hazardous Waste *Odor Removal and Control *Contract Pricing *Education and Training - Hoarding/Biohazard I } 2/8/2010 TO',,IN OF 7-.'.`:!STAr1LE ni 6 P"13: 17 1 ! lk AL ,M �• Ami PIP t� ' ..�41C ` ♦"'� '� �,,, ��'7 y� ; � its ,�! � v f r % i � 4 1 ; � ,�$ Iy��� / Off' 1 r ` � �.. t � .,. . �` '�` _ ., �� �, Miorandi, Donna Full Name: Kathy Eccleston Last Name: Eccleston First Name: Kathy Company: Dept. of Family& Children Business Address: 500 Main Street Hyannis,-MA,0260 Business: (508) 760-0237 A� Home: 1-800-792-5200r Mobile: (508) 737-2168 > The hotline number for former�DSS is 1-800-792-5200 cited above in home#. 1 Department of Children and Families - Health and Human Servi... Page 1 of 2 The Official Website of the Office of Health and Human Services(EOHHS) Mass.Gov Health and Human Services PROGRAMS&SERVICES Dome>Government>Departments and :,visions> NEWS&UPDATES Foster care ! Department of Children and Families p DCF Monthly Update-Sept/Oct .Adoption 2010 Adolescent Services FYI I Social Services Block Welcome from Commissioner Angelo McClain Grant Prc-Expenditure Report Domestic Violence and Children The Department's vision is to ensure the safety of children in a Sec.Bigby's blog::Kudos to Volunteer Case Review manner that holds the best hope of nurturing a sustained, DCF Commissioner McClain resilient network of relationships to support the child's growth Health and Medical Services y. DCF youth graduate from and development into adulthood. swnmcr;ahs program "A r -::. DCF and DPH issue reminder on INITIATIVES Child Abuse and Neglect Overview Summertimesafety tips DCF Field Management € The Department of Children and Families(DCF)is the Massachusetts state More... Restructure agency charged with the responsibility of protecting children from child i abuse and neglect.To report abuse or neglect,call the Child-at-Risk Hotline Subscribe Learn more Integrated Casework Practice Model(1CPh4) anytime of the day or night at 1-800-792-5200. -_ 1 ONLINE SERVICES Interagency Restraint and Seclusion Prevention Ways to Make a Difference at the Department of Children rmail US about roster Care or and Families Adoption Email us about the Volunteer The Department of Children and Families offers a unique opportunity for Case Review Program BH1community members to donate and/or volunteer;making a difference in a foster child's life. More DCF Success Stories fif xitly str� t1 PUBLICATIONS& REPORTS :w ...�. " i DCF Monthly Update Regulations and Policies Newsletters KEY RESOURC DCF Reports Report Child Abuse or Neglect Child-At-Risk Hotline j Child Abuse and Neglect _ epartment of Children and Families Open Meeting Notices 1-800-792-5200 Publications Department of Cliildron andFoster Care Publications Families Ombudsman i € Contact Us Statistical:Information Regional and Area Offices Directory 'I Contact information for the central office and various area offices of the Research Reports Department of Children and Families_(DCF). Aloie Office of the Child Advocate .. .. Baby Safe Haven Information and Resources I - RELATED LINKS 1-866-814-SAFE[7233] Working at Elie Department of Parental Stress Line Children and Families 1-800-632-8188 Resources for Current and Education.and Tuition Prospective Foster Parents Assistance Domestic Violence Resources _.. AdoptUSKids Massachusetts Adoption Resource Exchange(MARE) http://www.mass,.gov/?pagelD=eohhs2agencylanding&L=4&L... 10/25/2010 f 10/14/2409 09:37 5087900062 RECORDS PAGE 01 11AN: aTown ofBarn§ able m /r PoH De nt P (508) 775-0387 Adrain, (508)775-0920 Paul S. MacDonald Records: (508) 775-5466 Chief of Police Fax: (508)791] 6317 j n.is,MA 02601 www bamstablepolice.cram FAX COVER SHEET RECORDS FAX#508-790-0062 DATE: 0 Iq Q I TIME: FAX: � /C�5r - CO/& 5_ FROM: NUMBER OF PAGES INCLUDINNG COVER SHEET: NOTE/MESSAGE: This fax is intended only for the use of the individual or entity to which it is addressed,and,may contain information,which is privileged,confidential and exempt from disclosure under applicable law. If the reader of this message is not,responsible for delivering the message to the intended recipient,you are hereby notified that any copying,co i dissemination or distribution of this - communication.is strictly prohibited. If you have received this communication in error,please notify us by telephone and return the original to us at the above address via US Postal Service. -SGn*2,v the 11110 ?s afSunsti:ble, Cen,beiville,(:omit,Hyannis,Marston Mills,OsWrville,and West Barwtable 10/,14/Of009 09:37 5087900062 RECORDS PAGE 02 Barnstable Police Department Page: 1- Incident Report 10/14/2009 Incident #: 09-2559-OF Call #: 09-34227 Date/Time Reported: 10 10 2009 0944 Report Date/Time: 10/11/2009 1024 Occurred Between: 10/10/2009 0944-10/11/2009 1000 Status: No Crime Involved Reporting Officer: PTL. MARK DELANEY Approving Officer: SGT. THOMAS TWOMEY ignature: LOCATION TYPE: Residence/Home/Apt./Condo Zone: COT1 1 ELMWOOD CIR COTUIT MA 02635 1 ASSIST CITIZEN IN NEED 1 POWERS, ELIZA88TH 8 F 1P 50 NOT AVAIL 508-428-4906 1 ELMWOOD CIR COTUIT MA 02635 DOB: 001PNEONO1! EMPLOYER: SANDWICH SCHOOL DEPT. ETHNICITY: Not of Hispanic Origin RESIDENT STATUS: Resident VICTIM CONNECTED TO OFFENSE NUMBTR(S) : 1 CONTACT INFORMATION: Home Phone (Primary) 508-428-4906 2 POWBU, SASSNIA F PI 6 NOT AVAIL 1 ELMWOOD CIR COTUIT MA 02635 DOS: adowdoMa EMPLOYER: STUDENT WEST VILLAGES ETHNICITY: Not of Hispanic Origin RESIDENT STATUS: Resident VICTIM CONNECTED TO OFFENSE NUMBER(S) : 1 3 ROWzRS, CHET M W 12 NOT AVAIL 1 ELMWOOD CIR COTUIT MA 02635 DOB: ice/ EMPLOYER: BARN MIDDLE SCHOOL ETHNICITY: Not of Hispanic Origin RESIDENT STATUS: Resident VICTIM CONNECTED TO OFFENSE NUMAER(S) : 1 • • 1 DELANEY, MARK A PTLX REPORTING PARTY M 1Q 00 NOT AVAIL 508-775-0812 1200 PHINNEY'S LN HYANNIS MA 02601 DOB: NOT AVAIL EMPLOYER: BAARNSTABLE POLICE DEPT. 508-775-0812 CONTACT INFORMATION: Home Phone (Primary) 508-775-0387 Home Phone (Primary) 508-775-0812 10414/2009 09:37 5087900062 RECORDS PAGE 03 Barnstable Police Department Page: 2 Incident Report 10/14/2009 Incident #: 09-2559-OF Call #: 09-34227 ' • 2 TAXABH, CRAIG DC WITNESS M W 00 NOT AVAIL 500-775-0387 1200 PHINNEY'S LN HYANNIS MA 02601 DOB: NOT AVAIL EMPLOYER: BARNSTABLE POLICE DEPT. CONTACT INFORMATION: Home Phone (Primary) 508-775-0387 3 BLANCHARD, NANCy PTL, OTHER F 4P 00 NOT AVAIL 508-775-0387 1200 PHINNEY'S LN HYANNIS MA 02601 DOB: NOT AVAIL EMPLOYER: BARNSTABLE POLICE DEPT. 508-775-0387 4 OLSON, CHRISTOPHM J WITNESS M W 00 NOT AVAIL 509-420-2210 64 HIGH ST COTUIT MA 02635 DOB: NOT AVAIL EMPLOYER: CHIEF COTUIT FIRE DEPT. 508-428-2210 5 MIORANDI, DONNA S R.S. WITN$ss 367 MAIN ST F N 00 NOT AVAIL 508-920-3149 HYANNIS MA 02601 DOB: NOT AVAIL EMPLOYER: T.O.B. HEALTH DEPT. 508-862-4644 CONTACT INFORMATION: Hoare Phone (Primary) 509-420-3149 Home Phone 508-294-1394 work Phone (Primary) 508-862-4644 6 ROTH, ALZRRT CIO WITNESS D[ W 00 NOT AVAIL MAIN ST RTE 6A BARNSTABLE MA 02630 DOB: NOT AVAIL EMPLOYER: SCl/ SHERIFF'S DEPARTMENT 508-375-6125 CONTACT INFORMATION: Work Phone (Primary) 508-375-6125 7 BCCLESTON, 1CATHLBE WITNESS F W 00 NOT AVAIL 508-760-0237 MAIN ST HYANNIS MA 026o1 DOB: NOT AVAIL EMPLOYER: DEPT. CHILDREN & FAMILY - 508-760-0237 • 1 CD 08 PHOTS 09-2422-PR Evidence (Not Nibrs Reportable) QUANTITY: 1 VALUE: SERIAL #: NOT AVAIL DATE: 10/11/2009 OWNER: ROTH, ALBERT 10/14/2009 09:37 5087900062 RECORDS PAGE 04 Barnstable Police Department Page: 1 NARRATM FOR PTL. MARK A DELANEY Ref: 09-2559-OF Entered: 10/11/2009 W 1050 Entry ID: 122 Modified: 10/13/2009 @ 0006 Modified ID: 122 Approved: 10/13/2009 @ 0903 Approval iDs 185 On Saturday, October 10, 2009 at approximately 0944 hrs.l. (Ofc. Mark A. Delaney)was dispatched to 1 Elmwood Circle in Cotuit regarding a wellbeing check of the occupant, Elizabeth Powers. While enroute, I was further advised that a parent of one of Ms. Powers children (Chet Powers) age 12 yrs. had called stating that they were unable to get a hold of Ms. Powers via telephone and asked if the BPD would check the residence. Upon my arrival, I was initially unable to gain entry onto the property due to an 8' high enclosed & locked stockade fence, which completely encompassed the entire property at 1 Elmwood Circle. While attempting to gain entry onto the property, I was joined at the scene by Deputy Chief Craig Tamash. After some physical manipulation of the driveway gate lock, I was able to gain entry onto the property. Upon walking through the driveway gate, I observed the yard to be covered with trash & debris. As I made my way around &through the trash, I was able to make my way to the front porch area, where I observed piled up against the front door decayed & rotting bales of hay. I observed three (3) red plastic gas containers lying on top of the hay and observed a gas power lawn mower blocking the front door. I was unable to gain access to the door or even the porch itself due to numerous additional items of trash and combustible materials piled up. Unable to gain access at this location, I then walked around to the side door where 1 observed similar conditions. I observed access to the side door& stairs to be hindered and blocked with numerous items consisting of household trash & combustible materials. While standing in the side yard with DC Tamash, we were approached by a female subject who was in the company of a young female child. The subject identified herself as the home owner, Elizabeth Powers. The young child was subsequently identified as Ms. Powers'daughter, Kasenia Powers, age 6. 1 informed Ms. Powers of the nature & reason why we were there. Initially Ms. Powers was upset with us due to the fact that I had to gain access by forcing the lock on the driveway gate. I informed Ms. Powers that the (BPD) had received a call from one of her son's friends parents asking us to check on her wellbeing. I advised Ms. Powers that I had been informed that prior arrangements had been made between her and the other parent to have her(Powers) pick.her son (Chet) up that morning at 9 AM. I informed Ms. Powers when she didn't arrive to pick her son up, the parents became concerned and attempted to call her with no answer. After repeated attempts, they then called the police and asked us to check. Ms. Powers stated she must have over slept and didn't hear her phone ring. Ms. Powers went on to tell us that she wasn't feeling well and was suffering from the flu and from a recent lainjury she had sustained in an accident. While speaking with Ms. Powers, I was able to make the following observations: I observed the yard to be covered with household debris, garbage & trash and with additional items that appeared to be junk. I also observed live chickens both caged and roaming freely about the yard. Upon making these observation, I asked Ms. Powers if I could take a quick look inside her home. At first.,Ms. Powers was hesitant, but subsequently agreed to allow us a look. As I antered the home, I observed the downstairs living area to be in total disarray with accumulated clutter, trash & debris piled up on the counter surfaces and on top of all the appliances. I observed trash & debris piled (Ittering the floors and along the stairway leading up to 2nd floor area. I also observed what appeared to be laundry hanging & drying on rope which was running through the living room & kitchen area. 'I observed dirty dishes piled high in the sink and detected an overpowering smell of decaying food & garbage. Ms. Powers informed us that she wasn't the best house keeper and told us due to recent unforseen medical &financial difficulties her housekeeping duties had gotten away from her. Upon making my observations of the overall deplorable and unsafe living conditions within the 10/•14./2,009 09:37 5087900062 RECORDS PAGE 05 Barnstable Police Department Page: 2 NARRATIVE FOR PTL. MARK A DELANNY itef: 09--2559-01P tutored: 10/11/2009 0 1050 Entry ID: 122 Modified: 10/13/2009 6 0806 Modified ID: 122 Approved: 10/13/2009 Q 0903 Approval ID: 185 home the following agencies were notified and requested to respond. Cotuit Fire was requested due to the immediate fire & safety hazards observed. TOB Health Department part ent was contacted and asked to respond due to the substandard living conditions & overall health concerns within the home. Massachusetts Department of Children & Family Services were contacted and asked to respond due to the health, safety& wellbeing of Ms. Powers & her children; 12 year old (Chet Powers) and her 6 year old daughter, (Kasenia Powers). Barnstable County Sheriffs Department was requested to respond to document & photograph the scene. At approximately 1040 Cotuit Fire Chief Christopher Olson arrived and conducted an inspection of the exterior& interior of the residence. Upon conclusion of his inspection, Chief Olson determined the residence to be unsafe and in in its present condition to be uninhabitable due to several immediate fire & safety Issues. *NOTE. Refer to Chief Olson's findings & narrative. At approximately 1120 hrs. Donna Z. Miorandi, R.S. Town of Barnstable Public Health Division arrived and conducted an inspection of the residence. Upon completion of inspection, Health Inspector Miorandi also determined the residence in its present condition & state to be uninhabitable. *NOTE; Refer to TOB Health Inspector Miorandi's narrative & order. Ms. Powers was subsequently advised by both Chief Olson & Ms. Miorandi's regarding their determinations & findings regarding her residence. At approximately 1135 hrs. CIO Albert Roth from the Barnstable County Sheriff's Office arrived and was requested to photograph the conditions of the exterior& interior of 1 Elmwood Circle, Cotuit. *NOTE.Refer to CD of photos entered into BPD evidence under BPD #09-2559.6F At approximately 1150 hrs. Kathleen Eccleston from Massachusetts Department of Children & Family Services arrived on location and conducted her own inspection of the residence, which included on site interviews with Ms. Powers & her two children. After completing her investigation, Ms. Eccleston concurred with Chief Olson's & TOB Health Dept, regarding their determinations & findings that the residence in its present condition was not safe or habitable environment. Temporary arrangements were then made'to Pave Ms. Powers and both her children stay with friends, Donna & Ken Kilduff at 54 Furlong Way in Cotuit. *NOTE: Refer to DCF narrative of Kathleen Eccleston, Respectfully submitted, Ptlm. Mark A. Delaney#122 Staff Page 1 of 2 Horne Calendar Health Office Lunch Menus News&Events Stcr Sandwich Public Schools F'orestdale School Staff E-mail any faculty member by using first initial)(last name) @sandwich.k l 2.ma.us example: mvonalt@sandwich.kl2.ma.us Principal: Sharon Elliott Bellao Assistant Principal: Marilyn Smith MAIN OFFICE SPECIAL ED OFFICE HEALTH OFFICE C. Flannigan, Secretary K. Francis, Psychologist B. Recker, R.N. C. Perry, Secretary H. Lamb, Social Worker J. Chicco, R.N. B. Newell, Secretary C. MacFarland, R.N. J. Abbott, PT C. Gallagher, ESP MUSIC ART PHYSICAL EDUCATION M. Lasit, Music E. Montgomery P. Tremarche G. Machon, Inst. Music P. Eldredge L. Cahill, Adaptive P. E. TECHNOLOGY Reading Recovery LIBRARY S. Holland, ESP J. Linkkila, Reading C. Viola, Librarian S. Kern, Reading S. Murray, Math Intervention KINDERGARTEN GRADE 1 GRADE 2 S. Perdigao T. Delano E. Coughlin-Crowley M. Elliott M. Quinn C. Howell L. Silva K. Jacobsen M. Kennison M. Wood C. Skirvan r- GRADE 3 GRADE 4 GRADE 5 o J. Ahonen B. Garrity C. Anderson �� � K. Emerson S. Iadonisi S. Grise E. Powers S. Hill L. Paltrineri P� K. Slagle C. Neske K. Stapleton DE 6 GRADE 7 GRADE 8 C. Archambeault J. Kittredge A. Shea S. Bahman W. Kittredge K. Carl C. Codner M. Lehane G. McNabb J. Santoni K. Sabetta P. Trimble WORLD LANGUAGES SPECIAL EDUCATION SPEECH L. Riolo, Latin A. Abbott L. Macleod N. Colona, Spanish B. Adams S. Ryer M. Gary, Spanish S. Burns A. Ulmer, French J. Carter Literacy Staff J. Doyle Patti Leary (K-2) http://www.sandwich.k12.ma.us/forestdale/staff.htm 2/8/2010 Staff Page 2 of 2 P. Graham Donna Eident (3 - 5) K. Hart Colleen Clabault (6-8) M. Kanis N. Mark J. Smith CAFETERIA STAFF ESP's CUSTODIAL STAFF P. Byron, Supervisor K. Aiello H. Weekes, Supervisor Cynthia Smith L. Beikes N. Weekes Mary Beth Andersen E. Collins H. Lowry Susan Burbank J. Condon R. Tavares Virginia Brunelli C. CongroS. Curran Monique Varney L. Gerrity L. Husson A. Jones M. Kelley K. Kondrtowicz A. Mark L. Moore H. Murray L. Romanelli Horne Calendar Health Office Lunch Menus News&Events Sttr Send updates to forestweb This site ivm edited on 01.-26/10 http://www.sandwich.kI2.ma.us/forestdale/staff.htm 2/8/2010 w 110 CMR: DEPARTMENT OF CHILDREN AND FAMILIES 110 CMR 9.00: CASE CLOSURE Section 9.01: Introduction 9.02: Required Closings 9.03: Procedures 9.04: Closing a Supported Case 9.05: Court Approval Requirement for Closing Certain Cases 9.01: Introduction Case closing is the set of activities which leads to the termination of Department services to an individual or a family. 9.02: Required Closings Case closing shall include, but is not limited to, the following events. (1)A case must be closed when a case opened with a 51A report subsequently is not supported and the family does not wish to make a voluntary application for services. (2)A case must be closed when the child(ren) have been adopted or placed with a legal guardian and the adoptive/guardian family no longer needs Department services. Adoption or guardianship subsidy can continue to be provided, regardless of case closure. (3)A case must be closed when the social worker and client jointly agree that Department services are no longer necessary. (4)A case must be closed when a voluntary applicant for Department services withdraws the application or refuses to participate in assessment, service planning or case review. (5)A case must be closed when, after reasonable social work efforts and offers of service, a family which is the subject of a supported 51A report refuses further Department services and there are no grounds for either legal action or a new 51A report. (6)A case must be closed when a CHINS petition is dismissed and no family members are requesting or receiving Departmental services. 9.03: Procedures (1)The Social Worker And His/Her Supervisor Make The Case Closing Decision. Case closing is a clinical decision between a social worker and his/her supervisor, which decision is thereafter discussed with the client family. Case closing lakes into consideration the slated goals of the case, the individual's or family's participation in services, the reduction of risk to the child, legal issues, and the Department's responsibility to provide services. When a family which is the subject of a supported 51A report refuses further Department services, and if the social worker and/or supervisor wish to seek court-ordered custody of the children in question, then a consultation with a Department attorney shall be conducted to determine if there are grounds for legal action. The social worker documents in writing in the case record the outcome of this consultation. It legal action is not warranted and despite reasonable casework efforts, the family persists in refusing Department services, the social worker documents this in the case record and proceeds to close the case, by following the procedures set forth in 110 CMR 9.00. M 12/12/08 110 CMR: DEPARTMENT OF CHILDREN AND FAMILIES (2)A Plan Is Developed For Case Closure. The social worker and his/her supervisor determine what activities are necessary to prepare the case for closing, and complete these activities. (3)Area Director Reviews Case Closing.There shall be a review of every case closing decision by either the Area Director or his/her designee. If the Area Director or designee approves, s/he shall sign a case closing form to approve the closing. (4)The Social Worker Notifies The Family In Writing Of The Decision To Close The Case. The social worker shall notify the family in writing that the case is to be closed.An outline of the fair hearing/grievance procedures shall be attached to the letter. 9.04: Closing a Supported Case The department may close a case with a supported 51A at any time after the completion of its investigation. Commentary: It is generally but erroneously assumed that the decision to support a 51 A report after investigation automatically means that the case should be left open. However, there are some types of circumstances where"support and close"would be the decision of choice: (1) Supporting an allegation of child abuse or neglect does not necessarily mean that a child is at ongoing risk. Example: abuse that is found to have occurred by a babysitter. The child was definitely injured, by a caretaker. However, the family is in no way responsible for the injury, or for choosing an inappropriate caretaker. Also, the family is appropriate in preventing any further contact between the child and the babysitter. The incident must be supported, (as well as perhaps be reported to the District Attorney- See 110 CMR 4.50), but the Department does not need to conduct an assessment, nor to keep the case open, if there is no ongoing risk to the child. Of course, the Department's services would be offered to the child and family. (2)The second set of circumstances has to do with families that have disappeared. Example: Boston City Hospital examines a child and discovers welt marks on his back. The parents are interviewed, admit that they struck their child, and are informed that a 51A report will be filed. When the Department investigator goes out, she/he discovers that the address given does not exist. The investigator spends the rest of ten days attempting to locate the family through all other means, but is unsuccessful. There is reasonable cause to believe that the incident of abuse did occur, so the 51A must be supported. However, the Department can provide no services because the family cannot be located. Therefore, the Department does not keep the case open. 9.05: Court Approval Requirement For Closing Certain Cases When a decision is made to close any case in which the Department has court ordered custody of child(ren), the Department will not close the case until the Department seeks from the court a return of full custody to the parents, and dismissal of the case. Commentary By statute (M.G.L. c. 119, §. 26)the Department does have the option to close cases by "administrative decision"without court action. However, in the interest of consistent case work and in order to afford Department social workers maximum support in making such decisions, the Department will seek the court's approval of the decision to close the case. In these instances, a member of the Department's legal staff will file a motion to dismiss the court case. If the court approves the Department's motion, the Department will proceed to close the case. If the court declines to make any ruling on the Department's motion in light of the Department's administrative prerogative contained in M.G.L. c. 119, §26, the Department will proceed to close the case. If the court denies the Department's motion, the Department will not proceed to close the case. 12/12/08 110 CMR: DEPARTMENT OF CHILDREN AND FAMILIES REGULATORY AUTHORITY: 110 CMR 9.00: M.G.L. c. 119, §26; M.G.L. c. 119, §§51A through D. 12/12/08 D Win1L'f�ul ' m CD a Postage $ Ln Certified Fee tm 01_Postmark 6Q O Return Receipt Fee C Here p (Endorsement Required) Q 9 Restricted Delivery Fee (Endorsement Required) m vv" f'U Total Postage&Fees . M r05 Se tTo CD p �. a_ _ - �-✓_��:_L.l — O Street Apt.No., or PO Box No. G (� city,State,ZIP+4 n of l— y��1 O -2 � ,�'" :rr r�. /`/l7JJ Q) Cif Certified Mail Provides: la A mailing receipt o A unique Identifier for your mailpiece c A record of delivery kept by the Postal Service for two years Important Reminders: n Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. o Certified Mail is not available for any class of international mail. n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorsemailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery': o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS.Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 E Town of Barnstable OF THE T Regulatory Services Barnstable P Thomas F. Geiler, Director �8 $ ublic Health Division v� 16;q. �� I f ATEo Thomas McKean,,Director Zoos 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Certified Mail:7008 3230 0002 5177 8377 October 28, 2009 Ms. Elizabeth Powers rt D 1 Elmwood Circle Cua�� ,Cotuit, MA 02635 Re: Re-occupancy of dwelling located at 1 Elmwood Circle, Cotuit Dear Ms. Powers: Based on post condemnation inspections b Donna Miorandi R.S. Hea lth alth Inspector for the Town of Barnstable and Chief r'Ch istopher Olsen of the Cotuit Fire Department you and your two minor children are allowed to re-occupy your home as of the evening of October 26, 2009. However, this re-occupancy comes with conditions that must be complied.with in order to maintain your occupancy status. The conditions are as follows: 1. You must submit to this department a receipt for the work done by E.F. Winslow on October 26, 2009 for the upgrade of your hard-wired smoke detectors. 2. You must comply with the regulations of 105 CMR 410.600 relative to the storage of .garbage and rubbish as well as 105 CMR 410.750 which are conditions deemed to endanger or impair health or safety. These are regulations that you were in violation of on October 10, 2009 which resulted in your emergency condemnation. 3. Currently, there is a 15 yard dumpster on the property, which is being filled with debris from the house. You must have the dumpster removed by Friday, November 6, 2009 along with all rubbish and unnecessary clutter by that date. If you need an extension for additional rubbish to be removed you may request one from this department. 4. On October 10,1h 2009 you had several chickens and a rooster on our ro ert . You Y P_ P Y previously stated that the rooster was going to another home. You are reminded that under the Commonwealth of Massachusetts and the Town of Barnstable you must register your chickens with our animal inspector,Marybeth McKenzie, R.S., in the Barnstable Health Department. 5. You must work with Kristen Carbone, LMHC, of Family Continuity located in Hyannis, MA to develop and maintain a Family Stabilization Plan. This plan should help you and Q: Order letters/condemnations/1 Elmwood Circle, Cotuit, re-occupancy.doc your family toward a healthy and'happy environment and one that may help to sustain compliance with the Town of Barnstable Health Department. 6. You must work with your case worker, Tim Muellen, of the Department of Children and Families, to develop a service plan that will be implemented as long as your case is open with this department (DCF)r Any questions or concerns from any parties involved in this matter please feel free to contact me in this office at 508-862-4644. Sincerely, n Donna Z. Miorandi, S. Town of Barnstable Health Department Cc: Chief Christopher Olsen, Cotuit Fire Department Chief Paul MacDonald, Barnstable Police Dept.-Case#09-2559-OF Ms. Kristen Carbone,LMHC, Family Continuity Mr. Tim Muellen, Department of Children and Family Q: Order letters/condemnations/1 Elmwood Cixcle Cotuit re-occu a, _, p ncy.doc WON 2 e 10.0 �V y �� i � ___ _ ___ _- ; _ " PP/7 A An A I YL /T _n, r_-7 AS A -Ar/ tA A4 A t7 A 1CLAJ- L'.- L.-V f AA7 I w J/) I A /7 1 ",A441/9 or f I., 't Vf m co F• L N� N rI Postage $ Ln I Certified Fee C 0) D rU N Postmarld's O O ReturnReceipt Fee Here W ti p (Endorsement Required) S OOj Restricted Delivery Fee 0 (Endorsement Required) m nJ Total Postage&Fees m CEI Sent To or PO Box No. W�//�� -----------------------1g• `' 0C=___ - City,State. '4 4� Certified Mail Provides: c A mailing receipt *A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years importnt Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail& � o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain;Retum Receipt service,please complete and attach a Return Receipt(PS,Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"RestrictedDefivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. if a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530.02-000.9047 ti FtHE To Town of Barnstable ' Regulatory Services BAMSTABLE. *x` MASS. Thomas F. Geiler, Director �. i639 Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Certified Mail: 7008 3230 0002 5177 8360 October 13,2009 Ms. Elizabeth Powers 1 Elmwood Circle Cotuit, MA 02635 EMERGENCY CONDEMNATION AND ORDER TO VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L. c.l 11,sec. 127A and 127B, 105 CMR 400.000: State Sanitary Code, Chapter I: .General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter H: Minimum Standards of Fitness for Human Habitation,,Donna Z. Miorandi, R.S., Health Inspector for the Town of Barnstable, on October 10, 2009, conducted an inspection of the dwelling located at 1 Elmwood Circle, Cotuit, Massachusetts. The owner's name of this dwelling is Elizabeth Powers. Based on the results of that inspection, the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.8311 (D),the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling, which give rise to the emergency finding of unfitness and determination of immediate danger, include: 410. 750: Conditions Deemed to Endanger or Impair Health or Safety 410.750 (I) Failure to comply with any provisions of 105 CMR 410.600, 410.601, or 410.602 which results in any accumulation of garbage, rubbish, filth or other QAOrder.Letters\Condemnations\1 Elmwood Circle, Cotuit,MA.doc i L 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. The occupants, Elizabeth Powers, and two minor children ages six (6) and twelve (12) had much garbage, rubbish present in the dwelling, and a lot of clutter. Much garbage and rubbish on all the interior stairways thereby not providing for safe passage. Debris piled high on floors and furniture. This occupant has a condition known as "hoarding" and needs social and psychological assistance. 410.600: StoraLe of GarbaLle and Rubbish The occupant of any dwelling shall provide as many receptacles for the storage of garbage and rubbish as are sufficient to contain the accumulation before final collection and locate them so that no objectionable odors enter any dwelling. The occupant has caused objectionable odors both inside her dwelling and emanating to the outside. There is much debris on the exterior of this property throughout the yard. In addition there are also many chickens and chicken feathers. Inside the dwelling are two separate birdcages with cockatiels. 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. (B)Failure to provide heat as required by 105 CMR 410.200 (A). The furnace of this dwelling was shut down and thereby inoperable. (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. This dwelling has no clear passageway due to the accumulation of rubbish and trash. (1) Failure to comply with any provisions of 105 CMR 410.600, or 410.602 which results in any accumulation of garbage, 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. (1)Failure to provide a smoke detector or carbon monoxide alarm required by 105 CMR 410.482. This dwelling has oil heat and had no carbon monoxide detector and had inoperable smoke detectors. Chief Olsen was on site on *Saturday, October 10, 2009 and was taking measures to correct this matter. (0)Failure to maintain a safe handrail or protective railing for every stairway. The stairs to the cellar-had no safe handrail in this dwelling. Q:\Order Letters\Condemnations\1 Elmwood Circle,Cotuit,Mkdoc Based upon these findings any and all occupants are hereby ordered to vacate and the landlord/owner is ordered to secure the subject dwelling immediately as of receipt of this order. If any person refuses to leave a dwelling or portion thereof, which was ordered vacated she may be forcibly removed by the local Board of Health (Massachusetts General Laws C. 127B), or by local police authorities at request of the Board of Health. Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from$10-$500. Each day's failure to comply with an order shall constitute a separate violation. Once vacated this unit may not be occupied without the written approval of the Board of Health. Any person needing access to the inside of the dwelling must get permission from the Board of Health prior to entry. Note: This is an important legal document It may affect your rights PER ORDER OF HE BOARD OF HEALTH Thomas A. McKean, CHOIRS Director of Public Health Town of Barnstable Cc: Elizabeth Powers, Owner Mr. Tom_Perry, Building Commissioner Chief Christopher Olsen, Cotuit Fire Department Ruth Weil, Town Attorney Chief Paul MacDonald, Barnstable Police Chief Kathy.Eccleston,Department of Family& Children Q:\Order Letters\Condemnations\1 Elmwood Circle,Cotuit,MA.doc �I f Total Pages: 1 I ek 20939 P9 4 9 24641 1 i r �4-25-2_.O0+S a 1 1 -39u Y IIIIIInInInIIIIII�IIII0111111111111111�IIIIIVIIIIIVI�VII�l�llllllll� �j DISCHARGE OF MORTGAGE NATIONAL CITY BANK#:4489298120230919"POWERS" Barnstable,Massachusetts KNOW ALL MEN BY THESE PRESENTS that NATIONAL CITY BANK whose address is 6750 ,O MILLER ROAD,BRECKSVILLE,OH 44141 holder of a certain Mortgage,whose parties,dates and m recording information are below,does hereby acknowledge that it has received full payment and N satisfaction of the same,and in consideration thereof,does hereby cancel and discharge said Mortgage. OOriginal Mortgagor: ELIZABETH POWERS U Original Mortgagee: NATIONAL CITY BANK Date Executed: 08/22/2003 Recorded: 09/24/2003 in Book/Reel/Liber: 17692 Page/Folio: 194 as UInstrument No.:I l 1100,In the County of Barnstable,State of Massachusetts -a p QO a 2 IN WITNESSOF,the said NATIONAL CITY BANK by its authorized officer,has hereunto set its ow corporate seal. a .- NATIONAL CITY BANK On April 12th,2006 By: KEITH BRUNER,Vice-President STATE OF Ohio COUNTY OF Cuyahoga On April 12th,2006,before me,CHRISTINE DOZIER,a Notary Public in and for Cuyahoga in the State of Ohio,personally appeared KEITH BRUNER,Vice-President,personally known to me(or proved to me on the basis of satisfactory evidence)to be the person(s)whose name(s)is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity,and that by his/her/their signature on the instrument the person(s),or the entity upon behalf of which the person(s)acted,executed the instrument. WI ESS my hand and official seal, _ '!« CHRISTINEOOZIER * * NOTARY PUBLIC STATE OF OHIO 1 �� MY COMMISSION EXPIRES 5/10/09 CHRISTINE DOZIER Notary Expires:05/10/200 (This area for notarial seal) t *JES*XJES031'04/1212006 03:3077 PM*NTCC0INTCC0000000000000000115425*MABARNS*4489298120230919 MASTATE_MORT_REL**XJES031* Recording Requested By: NATIONAL CITY BANK When Recorded Return To: NATIONAL CITY BANK CONSUMER LdAN SERVICES 01-1101 PO BOX 5570 CLEVELAND,OH 44197-1201 BARNSTABLE REGISTRY OF DEEDS SEND. OMPLETE THI ECTION ■ CompletD items.I j 2,and 3.Also complete A. Si ur 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. g. Recei ed y(Pin ed e) C. Date of Delive ■ Attach this card to the back of the mailpiece, Q a d f�0 or on the front if space permits. v ry D. Is delivery address different from item 1? ❑Yes ! 1. Article Addressed to: If YES,enter delivery address below: ❑No I 1�— / 3. Service Type ZCertified Mail ❑Express Mail ❑Registered )ff Return Receipt for Merchandise I (� 3� ❑ Insured Mail ❑C.O.D. ! 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service labeq . - 7 0 0 2 10 0 0 _.0 0 0 4 _6 6:83 14 3 3 PS Form 381 1,August 2001 Domestic Return Receipt 102595-02-M-1540, I UNITED STATES POSTAL SE RV �� °� "`�"^^ First f;asks Mai ° Postage`9 F969-Paid US?S..- Permit=Nd.G-40-- j • Sender: Please priJ an e, address. Zi 44n-th�s.=box� a cryyv�i T ; rn rn lt� m F F I C I A L E m -n Postage $ rJ Certified Fee a .�.J� p� t9 N Pgstinark t3 Return Receipt Fee Q Me t3 (Endorsement Required) . 7 -5 --- i- p Restricted Delivery Fee U) O (Endorsement Required) O H Total Postage 6 Fees $ � / ru Sent To � w�� C3 -----------�--(----2------------------------------- �----------- No. Street,Apt.No. or PO Box No. ,Sae, — C 3 ---State Z�e+� --------------- ----------- :�� �� Certified Mail Provides: o A mailing receipt n A unique identifier fortour mailpTece r- . o A signature upon delivery ` o A record of delivery kept by the Postal Service for two years Important Reminders: n Certified Mail may ONLY be combined with First-Class Mail or Priority Mail 1, o Certified Mail is not available for any class of international mail. w o NO>INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. n For an additional fee,a Return Receipt may be requested to provide proof of, delivery.To obtain Return Receipt service,please complete and attach a Return- Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece `Return Receipt Requested".To receive a fee waiver for. a duplicate return receipt, a USPS postmark on your Certified Mail receipt;is' required. '- � o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". a If a postmark on the Certified Mail receipt is desired,please present the arti= cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,April 2002(Reverse) 102595-02-M-1133 J J dFt� Town of Barnstable tom ' Regulatory Services _ a � ! Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February 26, 2004 Elizabeth Powers 1 Elmwood Circle. Cotuit,MA 02635 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS,NUISANCE CONTROL REGULATION NO. 1 The property owned by you located at 1 Elmwood Circle, Cotuit., was inspected on February 25, 2004,by Donald Desmarais, RS,Health Inspector,because of a complaint. The following violations of the Town of Barnstable Board of Health Regulations, Nuisance Control Regulation No. 1 were observed: Nuisance Control Regulation No. 1, Part VU, Section 1.00: Pile of trash on the porch with numerous full trash barrels. You are directed to correct the violations within seven days of receipt of this order letter. 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. Please be advised that failure o comply with an order could result in a fine of$100.00. Each 4af comply with order shall constitute a separate violation. BO RD OF HEALTH Kea , S. Director of Public Health Town of Barnstable Q:Health/orderletters/refuse/274 South.doc Health Complaints 25-Feb-04 Time: 9:22:00 AM Date: 2/25/2004 Complaint Number: 17290 Referred To: DONALD DESMARAIS Taken By: DENISE WITTER Complaint Type: GENERAL F Article X Detail: UNSANITARY CONDITIONS Business Name: Number: 1 Street: ELMWOOD CIRCLE Village: COTUIT Assessors Map_Parcel: Complaint Description: CALLING ON BEHALF OF THE NEIGHBORHOOD. PERSON AT ADDRESS HAS TRASH ALL OVER HER FARMERS PORCH. SHE HAS A HOTTUB WITH NO ENCLOSURE. Actions Taken/Results: Investigation Date: Investigation Time: i 1 1 i 3 ti r DATE: 6/9/99 PROPERTY ADDRESS: ----------------------- 1 Elmwood Circle ------------------------ Cotuit, Ma, ------------------------ On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 1 -1000 gallon septic tank O /© 0 A 2. 2-1000 gallon leaching pits. 3. 1 -Distribution box Based on my inspection, I certify the following conditions: 4 . This is a title five septic system ( 78 code) 5. The septic system is in proper working order at the present time . 6 . Pit # 1 Waste water is 7" below pipe . 7 . Pit $ 2 Waste water is 6 ' below pipe . 8 . Pit #1 is 12" below grade . 9 . Pit #2 is 18" below grade . SIGNATURE:1 Name:__~ _ Company: Joseph_P. Macomber—& Son , Inc . Address: Box 66 -------------------- Centerville , Ma. 02632-0066 -------------------- Phone: 508-775-3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY 9 JOSEPH P. MACOMBER & SON, INC. co� JU Tanks-Cesspools-Leachflelds N 6 1999 Pumped & Installed ro"OF N Town Sewer Connections® vw P.O. Box 66 Centerville, MA 02632-0066 i ,` 775-3338 775-6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.5500 TRUDY COX $ecre'a ARGEO PAUL CELLUCCI D.wTD B. STRI,': Governor Co-_: cc, SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM PART A CERTIFICATION Property Address: 1 Elmwood Cicle Narna of Owna. Tracey Jillson Cotuiitt Address of ownw: Same D" of lnspection:�9 Q / Prt Name of 4upector: a rrt) Joseph P. Macomber Jr. 1 am a DEP approved system Inspector pursuam to Section 15.340 of Title 5 (310 CMR 15.000) CornpanyNaaw: Joseph P. Macomber & Son, Inc. Ida.MN Address: Box 66, CPntPrVi 1 1 e, Ma _ 02632-0066 T, apt—Number:5 0 8-7 7 5-3-1 R A CERTIFICATION STATEMENT I certify that I have personally Inspected the &@wage disposal system at this address and that the Information reported below is true. accurats and complete as of the time of impaction. The Inspection was performed based on my training and experience in the proper Function ano maintenance of on- it s wag@ disposal systems. The system: lasses Conditionally Passes Needs Further Evaluation By the Local Ap roving Authority Fails trsspectoe'& Signatu / r Data: The System Inspecre: all subm hit a copy of this Inspection report to the Approving Authority (Board of Health or DEP)within thirty (30) days of completing this Inspection. If the system Is a shared system or has a design flow of 10,000 gpd or greater, the inspector ano the system owner Mall submit the report to the appropriate regional office of the Department ohfnv'uonmental Protection. The original should ba sent to," system owner and copies sent to the buyer, It applicable, and the approving authority. NOTES AND CONIMENTS i I revised 9/2/98 Page I of 11 Cd P(mlod on P."lad P.psr f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1 Elmwood Circle, Cotuit Owner: Tracey Jillson Data of Inspection: 6/9/9 9 INSPECTION SUMMARY: Check A, B, C, o/ A A. SYSTEM PASSES: l� i have not found any information which Indicates that any of the failure conditions described in 310 CMR 13.303 exist. Any failure criteria not evaluated are Indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: �vr r One or more system components as described In the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate Ye0,no,or not determined(Y, N, or NO). Describe basis of determination In all Instances. If "not determined", explain why not. The septic tank Is metal, unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was Installed within twenty(20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass Inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pips(s) are replaced obstruction is removed distribution box Is levelled or replaced - The system required pumping-more thanfour-times a yeardue to broken or obstructed pipe(s). The system will-pess-- inspection If(with approval of the Board of Health): - - broken pipe(s) are'replaced obstruction is removed I I revised 9/2/98 page 2orii r SUBSURFACE SEWAGE DISPOSAL SYSTE-M 1NSPECTION FORM PART A CERTIFICATION (continued) Prw-wAddraaa: 1 Elmwood Circle, Cotuit Ovvn.r: Tracey Jillson D"01 4up.c-tlort: 6/9/9 9 C. FURTHER EVALUATION LS REQUIRED BY THE BOARD OF HEALTH: Cond)dons oxlst which require further evaluation by the Board of Health In order to detormine If the system Is failing to protoct the public health, safety and the environment. 1) SYSTE3d W11-L PASS UNLESS BOARD OF HEALTH DETERMINES INACCORDANCE WITH 310 CJ.IR 16.343 (1)(a THAT THE SYS LS NOT FUNCTIONWG W A{.TANNER WH)CKYAUPROXECT THE PUBUC HEALTH-AND SAFETY AND THE DC BORMT: Cesspool or privy Is within 60 feet of surface water Cesspool or privy Is wlWn 60 foot of a bordering vegetated watiand or a salt marsh. 2) SYSTE3d WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUSUC WATER SUPPLIER. IF ANY)DETERMINES THAT THE SYSTE3 FUNCTIONWO W A!.TANNER THAT PROTECTS THE PUBUC HEALTH AND SAFETY AND THE ENVIRONJAENf: eo The system has a &optic tank and soil absorption system(SAS)and the SAS Is within 100 foot of a surface waist supply tributary to a surface watst supply. The system has a septic tank and &oil absorption system and the SAS I& within a Zone I of a public water supply wall. The system has a &optic tank and &oil absorption&y&tsm and the SAS 1& within 60 feet of a private waist supply wall. The system has a&optic tank and toll absorption system and the SAS Is less than 100 fist but 60 foot or mots from a private water supply wall,unless a well water analysis for coUlorm bacteria and volatile organic compounds indicates tha well It flea from pollution from that facility and the pro once of-ammonia nitrogen and musts nitrogen I& ►qv&J to or Iasi than 6 ppm. Method used to determins distance- (approx)mation not valid).- 3) OTHER WWI revised 9/2/98 Page Iof11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1 Elmwood Circle, Cotuit °wear Tracey Jillson Data of Inspection:6/9/9 9 D. SYSTEM FAILS: You must Indicate either "Yes" or "No" to each of the following: _JLIZL I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination Is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ Backup o(•"Wage irrtoiacilitywr•rfatem component dueKo an overloaded orcIogged-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 distr utlon f,Lox above outlet invert due to an overloaded or clogged SAS or cesspool. t �1►i g (e — � Liquid depth inn t>vi-9eespod s less than 6" below Invert or available volume Is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy Is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is-within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the wall has been analyzed to be acceptable, attach copy of well water analysis for —coliform bacteria, volatile organic compounds, ammonia nitrogen-and nitrate nitrogen. - E. LARGE SYSTEM FAILS: You must indicate either "Yes" or 'No" to each of the following: The following criteria apply to large systems In addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No , the system is within 400 feet of a surface drinking water supply / the system•is-within 200 (eat of•$•Hibutary-io a ourfao"i;nk;"g•wate-oupplY ••• - --- the system is located In a nitrogen sensitive area(Interim Wellhead Protection Area -IWPA) or a mapped Zone ll of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4ofII i r r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST ProPanY Address: 1 Elmwood Circle, Cotuit owner: Tracey Jillson Data of Inspection: 6/9/9 9 Check if the following have been done: You must indicate either 'Yes" or 'No' as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. -None of the systemcoff-4 nts.kau&;b"n paatped+topatleast nvo•we&"arse the'rystem hasbaaasecsiuiag.ws.ul flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as pan of this Inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was Inspected for slgns of sewage back-up. The system does not receive non sanitary or Industrial waste flow. _ The site was Inspected for signs of breakout. All system components,4*cluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffle: or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System orrthe site has been determined based on: Existing information. For example, Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C Is at issue, approximation of distance is unacceptable) 115.302(3)1b)i _ The facility owner.(and.or—paots,Jf difiarerlt infor "on on thA pfoper maintan �f SubSurface Disposal Systems. revised 9/2/98 Page 5of11 l i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1 Elmwood Circle, Cotuit Owrw: Tracey Jillson Date of Inspects«,: 6/9/9 9 FLOW CONDITIONS RESIDENTIAL: Design flow: 11b g.p.d./bedro Number of bedrooms(desig ): Number of bedrooms(actual):,': Total DESIGN flow t Number of current residents: Garbage grinder(yes or no): Laundry(separate system) (q es 0r(a9):_;. If yes, separate lrtapection.required Laundry system Inspected es or no) I �(0I W08CAI)MS Seasonal use(yes or no): I _ (J �/ Water meter readings,if av liable (last two year's usage(gpd): s — 7/®+pl Sump Pump(yea or nc):7� Last data of occupancy: COMMERCIAUINDUSTRIAL: ''II Type of establishment: Ni Design flow: d ( Based on 15.203) Basis of design flow Grease trap present: (yes or no) Industrial Waste Holding Tank present:(yes or no)ATff- Non-sanitary waste discharged to the Titit9P system:(yes or no� ��((ff Water meter readings,if available: - Last date of occupancy: OTHER:(Describe). Last date of occupancy:_ GENERAL INFORMATION PUMPING RECORDS and sore inform 'on: fo UM Li 4& 6 System pumped as part of inspection: (yes or no)_ If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM iTighSeptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous Inspection records,If any) I/A Technolog at . Attach copy of up to date operation and maintenance contract t Tank ! '�L—Copy of DEP Approval Othqr PROXI AGE o �l components, date instal(ed{if known)-and a2grce.•of4aforrnation: ` Sewage odors detected when,arriving at the site'(yes or no)zw revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropoexyAll: 1 Elmwood Circle, Cotuit O wr": Dou of Irspectioru Tracey Ji llson 6/9/99 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of co truc 'on:AMcost Iron PVC that(ex p In) Distance from �Ivate water su ply well or auction Ilne Id Diameter _ _• Cmments:(condition of Joints, venting, evidence of 4"kage,-etc.) Joints appear ti SEPTIC TANK: (locate on sits plan) Depth below grade:'f Material of construction:.L/Concrste_metal_Fiberglass _Polyethylene_other(explain) It tank is metal,list age 1s.age.confirmad by Certificate of Compllancs (Yss/No) Dimensions: r i �' ,����® J�j/<.0 Sludge depth: Distance from top o s.ludgo to bottom of outlet too orbaffle: Scum thickness: �J Distance from top of scum to top of outlet tee or baffler l (f Distance from bottom of scum to bottom of utlet tee or atfle:_� How dimensions ware determined: Comments: (recommendation for pumping, condition of Inlet and outlet tees or•batfles, depth of liquid level In relation to outlet invert, suucturb�-ntegrity evidence of leakage, etc.) PumD tank Pvar�4 ;riaa cr. _ Ti;Let otit -- tees are in 1 ift snows no GREASE TRAP: " (locate on sits plan) Depth below 9rade:A1y Material o!consvuc 'o /�,�concretmstaFiberglasaaJ�Polyethylene1bther(explain) Dimensions: Scum thickness: Distancs from top of scum to top of outlet too or batflo:" Distance from bottom of ac to bottom of outlet tee or.batfle:x441 Date of last pumping: Comments: (recommendation for pumping,condition of Inlet and outlet tees or baffles, depth of liquid level In relation to outlet Invert. structural integrity evidence of leakage, etc.) Grease revised 9/2/98 Page 7orIf f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropeMAddre": 1 Elmwood CIrcle, Cotuit own": Tracey Jillson Date of Irupection: 6/9/9 9 TIGHT OR HOLDING TANK;A/,Me(Tank must be pumped prior to, or at time of, Inspection) (locate on site plan) Depth below grade: Material of constructionAt&concretwvAmetaWAFiberglas*IAPolyethyleneaother(explain) ,fA4 Dimensions: tjW Capacity: /V gallons Design flow: gallons/day Alarm present Alarm level: Alarm In working order:Yes / NoA�4 Date of previous pumping: 4,W _ Comments: (condition of Inlet tee, condition of alarm and float switches, etc.) Tight or hutdilig Lanks are nor- re DISTRIBUTION BOX:, (locate on site plan) Depth of liquid level above outlet Invert: �lJ Comments: (note-if level and distribution is equal, evidenoe of solids carryover, evidence of leakage Into or out of box, etc.) — — Distribution box has two laterals Nn ayidpnrp of enlir(c rarry aver PUMP CHAMB ER:4410— (locate on site plan) Pumps in working order:(Yes or No) AIA Alarms In working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) ump chamber is not present I revised 9/2/98 Page 8ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1 Elmwood Circle, Cotuit Own": Tracey Jillson Date of Inspectw: 6/9/9 9 �� ,,��j SOIL ABSORPTION SYSTEM(SAS):,�'0Q6�y��V X_QA "4 (locate on site plan,if possible; excavation not required,locatlon may be approximated by non intrusive methods) If not located, explain: Type: - _- — —- - - leaching pits,number: leaching chambers, number: leeching galleries,number:_ leaching trenches,number,length: leaching fields, number, dime A}fons: overflow cesspool, number- Alternative system: Name of Technology: 6 Comments: (note condition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.) Loamy sand to fine --ad -No signs of hydiattije f ii Or Gndi n nos Seils are dry . VugecdCtun is orma CESSPOOLS• (locate on site plan) Number and configuration: (l Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer; Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of Inspection) Cesspools are not rPgant Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of.vegetation, etc.) Cesspools are not nrPgant PRIVY:�i��i (locate on site plan) / Materjals of construc on: �� Dimensions: Depth o1 solids: Comments: (note condition of soil, signs of hydraulic failure, revel of ponding, condition of vegetation,etc.) Privy is not present _ revised 9/2/98 . Page 9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORA PART C SYSTEM INFOR1dAnoN (contr&,od) PT0q.nyAd&"4: 1 Elmwood Circle, Cotuit 0%wr-W. Tracey Jillson cou or V'LP.C'6�: 6/9/9 9 SKETCH OF SEWAGE OLSPOSAL SYSTEM: Includs tl&s to atlaast two psrmansnt rslsrsnca landmarks or benchmarks louts all wills wlWn 100'(Locats whits publIc w►tsr supply comas Into hours) 0 revised 9/2/98 Poll 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1 Elmwood Circle, Cotuit owner: Tracey Jillson Dots of Inspection: 6/9/9 9 NRCS Report name Soil Type_ Typical depth to groundwater USGS Data website visited Observation Walls checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 3�Feet Please Indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed.Site (Abutting propert observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps cked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used water contours map . Gahre++ty & Miller Model M revised 9/2/98 Page 11of11 r `f•IT.nT�ntTfr'.T�\fflr J.A'n1.RT'AnlTl�R1\T•I1n/R/TI"t'11T MR.IJ M1V'n'.\I1.T .��-4'n-�..�. r-..., I TOWN OFBARNSTABLE BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL .SYSTEM INSPECTION FORM - PART D •- CEwrI FiCATION �_ h-•an-�••.-::.—r..n�.rrr��rn.-n.��rr�raw�rnr..-xt.�v'w.• ww+.r-r+�+�r�vrt►+w.�.mrnr� mnn�mr+.'.mm+.'...,•,.•..-r�•r•-• _..• �-TYPL OR PRINT CI.EARLY•- P110PERTY INSPECTED STREET ADDRESS 1 .Elmwood Circle, Cotuit ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Tracey Jillson PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber- Jr. COMPANY NAME Joseph P. Macomber & Son, Inc. COMPANY ADDRESS Box 66, Centerville, Ma. 0263.2-0066 strvvi Town or City Stat. LIP COMPANY TELEPHONE (508 )775 -3338 FAX ( 508 )790 -1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that t)Ye information reported is true , accurate , and complete as of the time of ,inspection . The inspection was performed and any recommendations vegarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : —/Systeui PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined 'in 310 CMR 15 , 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* Tile inspection which I have conducted has found that the system fails to protect the }-)ublic health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . ep Inspector Signatur r Date One copy of this &6rtification must be provided to the OWNER, the BUYER ( where applioable ) and the BOARD OF iiEAL1'li: If the inspection FAILED, the owner or op rator ahall u� p pgrado ' tho ayotem Within one ,year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CMR 16 . 306 . partd • doc No.. ..33 Z . ,-o l Fa�.....(..J............... ...... _.._. THE COMMONWEALTH OF MASS ACHU ETTS + BOARD OF HEALTH ...... ---.._.OF...f3Clt,1.J..'.�✓�A0............................................. Appliratiuu -fur Dispaiial Workii Tonstrurtiuu Prrutit V/ Application is hereby'made for a Permit to Construct (P<) or Repair ( ) an Individual Sewage Disposal 10Sys ......1------------------- ----- ....--- •...0a-_C'a,:-t o' Location- d orLNo. 6ifere.a. -----------------•--•--------------•-•--•---•--•-•--- a7 r oar e J'�rW�t `' Address Installer Address Q Typ uilding �` Size Lot--- o` U---------Sq. feet U Dwellin No. of Bedrooms.................1`F'---3---------.----Expansion Attic (hp) Garbage' arbage Grinder (�� aer—Type of Building ---________________________ No. of persons-_----.-------_----------_ Showers ( ) — Cafeteria ( ) Pa Other fi_ ures ------------------------------ ---- ------------------------------ DesignW Flow-------------____0......._.............gallons per person per day. Total daily flow---- -_______.__-..__.._. .........gallons. WSeptic Tank—Liquid capacitv._/gallons Length---------------- Width................ Diameter---------------- Depth-.--.-----.-._. x Disposal Trench—No________________-.- Width-------------------- Total Length--_-_____-___--_--- Total leaching area--------------.---..sq. ft. Seepage Pit No........../----_____ Diameter....... - Depth below inlet.................... T tal leaching area..--_---._--_-_sq. ft. Z Other Distribution box (� Dosing tank ( ) Gh - ^C�-._ 9V 15 - 7 7 Percolation Test Results Performed by---------------- --------------------------------------------------------- Date--------------------------------------- a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.--------�Y_0--------- ri Test Pit No. 2________________minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ ------- - ----------------- Descrt tion of Soil---••--� f 'r r'�' = 1 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable_-------------------------------------------------------------------------..------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary 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. igne ------------- ----------•-- .--- -------------------- - ................................ Date Application Approved By.......-- ............ -• ......... --••-•-•. =......'L- ate --------------------- Date Application Disapproved for the following reasons:-•-•---•------•------------------------•--------------------_---------------------•--•-••-• .................... ..........................................-........................................--•-•--•-•--------•---------.....---.....---.......-•---------•------.---------------------------------------------- ------•---- ------------- Issued------ Date Permit No.._.._3_. -- Date No.......?..........:... Fink ..1.��................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF--- ?' ................................................ Appl ration -for Diapooat ork,s Tonmtrnrtton Vrruift Application is hereby'made for a Permit to Construct (y<) or Repair ( } an Individual Sewage Disposal Syst n at: // / Location- ddress or otf _ ��5'.. !� P" 4!/�?vIE . �a x..._.�'tic................. ......-��d?!•E'ft�r1�.. r.---•-No----.._..-- er Address Installer "' .,;y: Address p d Ty wilding `� � Size J<:of_�_d'_,,:........... ......Sq.-feet Dwellin No. of Bedrooms----------------- .. _ ---_-.__ Expansion Attic (?O) . Garbage Grinder (&a ier—T e of Building ____________________________ No. of persons............_.. -_ Showers Cafeteria _ Q Other fiWures --------------- ------------------------------------- -- --....------•---------- ----------------- ---- --- W Design Flow_____________�.? __-..gallons per person per day. Total daily flow._._ -� .........gallons. P4 Septic Tank—Liquid capacity- gallons Length---------------- Width................ Diameter-----.---------- Depth--- ------------ xDisposal Trench—No- -------------------- Width-------------------- Total Length----__--__-__..-_--. Total leaching area--------------......sq. ft. Seepage Pit No.......... ...:..... Diameter___-- �. Depth below inlet_..___:__;_:__..... TQt�al Machin ----------------sq. 1t. Z Other Distribution box ( Dosing tank ( ) lj ^r "✓ " 7 ' a Percolation Test Results Performed bY------------------------------------------------ .......................... Date---------•------------------------------ ,� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water...... 0.--_.___.. rX Test Pit No. 2----------------minutes per inch Depth of Test Pit-----................ Depth to ground water_.....----_------__-.._. �! - '>r . O z; �- Descri tion of Soil-----.. _ .. ] ��" l s a !t " - ------' - --- ------ (xj ... all ---- :r ;�>l ----------------------- :-- :rr UNature of Repairs or Alterations—Answer when applicable...---_........... ...._---.-_-. ._--- _-.--------. . . ----------------------------------------------.-.-_--.---_-__-_---------------.-----_----._--___---_--_.-__-----:---___.--..__---_--.-_--_----___--.-__-------..-_.-=:--.-----.--..--_-.-_-_--___-_-_.._. Agreement: The undersigned agrees to install the aforedescribed Individual 'Sewage Disposal System in accordance with the provisions of Article XI of the Stafe'.Sanitary.Code—The,unders further agrees not to place the system in operation until a Certificate of Compliance.has been issued by the board of health. gnecf� � e° ... ------ �------- x ---- �r��� Application Approved BY----- ---- ------------ -------- - - 1. 2P Date Application Disapproved for the following reas.'ons_------------_--------------------- _,._. rr. 4, Date PermitNo......................................................... Issued--=-------- --------- == Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........>.... ..t�s?.............OF.... f'l f //tG..........................`......:........ (9rrtifirate of f�rrut liaanrr THIS I �-'TO JERTIFA That the Individual Sewage�tDisposal System constructed 1 . or Repaired ( ) by------------------••-•Om:........ !T c. ,E at..................................................----- .............. 10---------------------------------------------------------- State has been installed.in accordance with the provisions of Art I f The Sanitary Code as described in the application for Disposal Works Construction Permit No.:__ ._...5- .-Z- ___. dated...... _ 7............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARAN EE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. ------..... 1 ......... Inspector----•-••. d THE COMMONWEALTH OF MASSACHUSETTS "BOARD OF HEALTH '... ...............O F......... ....................------------...................... No.-••-•-.`...... ilt FEE r ......... %Vivo rY'r �o�rnr i as rrinit Permission is hereby granted-----.. tom _^._-_-_ �_�`_......... .................. to Construct; (� r Re. air ( ) n Individual Sewa e Disposal System.— at No---------------h. ------- ................ ---- ----- ' Street as shown on the application for Disposal Works Construction Per _______ _4a. ted.... '. " - _-_._--_•. . a �" ..+p Board of Health DATE----- ��'5 --�-- ---------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 0 Q w woo Af A=35. 90 ,r, \ �r L07 v 2�srzvE > ( zo. 2 526917-2� i 49 / f / P2oPosGn `�� �. "5 , 00 Min/iivluA/1 .a"--ALF _, ..) ,,y 40 ` Z:>,47W 6- 22-77 .Z- C E e"r/F Y THAT -rA16 FOOA-Z�,A T/o/V /S 13E.I"G �-O r a 5140ern . IAJ _ GEORG£ , 8A,� A). 5' 7-A GE- C2 4► T`r 4 fi Z>6 co A, �. /S �/!J?" �'i 3�✓•�1_tea`' StfRV�yL .d try Z Al t TOWN OF BARNSTABLE LOCATION i ,�WOqZ SEWAGE # _3 VILLAGE {'- ASSESSOR'S MAP & LOT6/0r 432 9 INSTALLER'S NAME fa PHONE NO. � SEPTIC TANK CAPACITY j LEACHING FACILITY:(type) �.. Qom[. (size) /6®d NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER e'llew AJ L;:pi DATE PERMIT ISSUED: '• DATE COMPLIANCE ISSUED: '-��•�! VARIANCE GRANTED: Yes I R �- 6 - c _ _3.Z 13 - 0 �p No..........AppRaal, F>;a............._.............. 8t• T E COMMONWEALTH OF MASSACHUSETTS ,J- OARD OF HEAL7I-1 8r> "Da w OWN OF BARNSTABLE ApVtiratinu fnr Di-tipmial Works Tomitrnrtion rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....... Loan�on-Address -_-_•-----------------•------......or Lot No. .............. .!». ................................ •..... --........----••......................-•---•--- Owner p Address ----------•------------------------•---•-- 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 ( ) Otherfixtures -------------------------------------------------------------------------------------------------------------------------------•-------------------- W Deslgn Flow............................................G gallons Person Per day. otaai Y ow.. . .. ....................................gal Ions. WSePtic Tank—Liquid c Pacrty/ 6Ugallons Length___ Width________________ Diameter---------------- Depth................ i x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------1............ 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........................ G% Test Pit No. 2................minutes per inch Depth of Test Pit-_-_____-...___----- Depth to ground water........................ P+ --•---•--•------------------------•-•----------------------•-------•-•-------••••-•-----------.-•---....................................... ....---- .......... 0 Description of Soil........................................................................................................................................................................ x U •-•-•••-------••-•-•----•--•-----•---•----------------•-----•-------•-------------------....-••-------------------------•----------------•--------•----••-----•-----•--••-•-•-----.............----••-- W ----•-•-•--------------------------------•-------••-----------------------------....-•--------••......---....... _l U Nature of Repairs or Alterations—Answer when applicable.- �!- ..._ ��®D.. d J� T ----------- i •-------------------------------•-•----------•---•--•-••------•--••--•-----•--•-----••........•-•--•-••-•-•-•--------------------•----------•---•-....--------------•••----•----•.........--••-•---•-•-. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environ tal Code —The undersigned further agrees not to place the system in operation until a Certificate of Compli nee as een i d b the board of health. t s C Signed �� ..... 1e ------------------------ --------��J _!. Dare ApplicationApproved By .............. ' ---- ..--.................................................................. -----7-- /. ,! -"--7-Y Date Application Disapproved for the following reasons: ............................................................ .................................... ............. .. . ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- ecyy Date Permit No. ----------.1..�---- .- ...... Issued Date No................--....... FRx............................ r / THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Allp iration for Di-nVw3ai Workii Tonitrnrtion rnmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 17 Location-Address or Lot No. .................... c' o - - :-� .................................. --•---------•-•-•-----•---•-----•--•-•....•------•-•-----....---•..........-•-------.....-----•--- Owner �6 Address 5 G Installer Address UType of-Building Size Lot............................Sq. feet 'Dwelling—No. of Bedrooms---N�____________________________________Expansion Attic ( ) Garbage Grinder ( ) a �� Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a d Other fixtures .. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/fir Ugallons 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. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water--.__-..------_----_._.. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ --------------------- ----------------------------------------------------------------------- -... --•-....... •... ••------------------------- ••••••...... ....... ODescription of Soil........................................................................................................................................................................ x _ _ ---•••-------- --------- ----------------------------------------------------•-------•-------------------..... --- -- ----------------- -•----D------------•-7.... -•••--•-------•----••_.---- U Nature of Repairs or Alterations—Answer when applicable.---.'_. %_��____--.-----���-----. �--/-:---- - ----'f Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environm-ental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance as een is. ed/by the board of health. ��-77 1 Signed ...................... � .- .............. --------7-�.r:... T Dare Application Approved BY ........... -.-.-'!.../..s.:...... �.� Date Application Disapproved for the following reasons: ....................................................................................................................................... -------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ ........................................ q Date Permit No. ...........1-.�...-- 3 .�5.................. Issued Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CErtifirate of (foraylinure THYS TO CER�'IFY That the Individual Sewage Disposal System constructed ( ) or Repaired( `..`..L'.4 / wby ............. ..... . .. ... ........... ... ----------...---------------- -- - .... Insr.dler at ........ I .. ..0/ .-U/OQ.Q'...�//��I�' ��.�lJ..� r-------------_-------------......---------------------------......---------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 Uof The State Environmental Code as described in the application for Disposal Works Construction Permit No. ......! lam---. ...g....... dated ............ ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............./... '' ll....'�-�. ....... _ Inspector - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �J �> TOWN OF BARNSTABLE No.. . 6 FEE........................ �i o ttL rk TomArttion rrrntit / --0 21 `u E!G.f�!/............................................................ Permission is hereby granted......_._..�/.............. .... ..... .. . to Construct ( )or Repair (k an Individual Sewage Disposal System atNo. . ..................... Street q 2 as shown on the application for Disposal Works Construction Permit No.l...�-�1.oar.�of Health Dated.......... 7..-_1,��..".�U - I ••......•--•.....---•-•-•--- -•----•-------- - --------------------------------------- DATE............. - ---•----------••--------------••-•----�S� FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS i I _ FAMI -109 LY CONTINUITY Supporting family success in every community. KRISTEN CARBONE,LMHC HYANNIS WRAPAROUND B CARE COORDINATO��-6 / FLEXIBLE SUPPORT PROGRAM ( 60 PrrtscVeaa�cr:l\/ni HrANeis,b(A 02601 kcarbone@family www.familycontinuity.org t1508-862-0600 Ext 5153 f1508-862-0590 1'CP,Inc. L For On at AM P\[ OUR L.UES:Pamilp Communiep Advocacy 1.aade hip Change ' I I 2 I 4000710,11 FAMILY CONTINUITY Supporting family success in every community. Hyannis Department of Mental Retardation (DMR) Team Family Continuity's Intensive Flexible Family Supports (IFFS)program provides a community—based,clinical approach to services for children with disabilities and their families. The Hyannis DMR Team provides the interventions and supports to help children avoid out-of-home placements and to obtain and maintain skills to maximize functioning in the community. Once stabilization goals have been met, the Hyannis DMR team then offers transitional clinical supports to children and their families through an Aftercare Program.The Hyannis DMR Team is also a provider for DMR's State Initiative for purchased services through their Waiver Program. Specific Services Offered Behavior Modification and Management Intensive Case Management Crisis Intervention Family and Individual Therapy Social Skills Training . Referrals Families can self refer to the Aftercare Program. Families may self refer to the Waiver Program once eligibility is met through DMR or its designate. Cost Aftercare Services can be billed through most insurances. The Waiver rates are payable through a local Lead Agency DOE/DMR grant funds Contact FAMILY CONTINUITY Hyannis DMR Team 60 Perseverance Way Hyannis,MA 02601 508-862-0600 www.familycontinuity.org FAMILY CONTINUITY Supporting family success in every community. s Plymouth Counseling Services Clinic Family Continuity�s Plymouth Counseling Services Clinic offers emotional,behavioral,psychiatric or fam- ily support for a variety of issues.The Clinic offers an array of treatment modalities provided by licensed therapists who work collaboratively with clients and their support systems to achieve desired outcomes. Our therapists specialize in a variety of areas,includ- ing anger management,behavior problems,depres- sion,eating disorders,marital conflict and substance abuse issues. Specific Services Offered Individual,family and group therapy. +Psychiatric evaluations. Medication monitoring by a board-certified psychiatrist Referrals Family Continuity accepts self-referrals as well as referrals from a variety of resources,including state agencies,hospitals and other community services. Cost We accept most insurance and offer a limited sliding- fee scale.Clients are responsible for insurance co-pays and uninsured costs. Contact FAMILY CONTINUITY Plymouth Counseling Services Clinic 118 Long Pond Road,Suite 106 Plymouth,MA 02360 508.747.6762 Serving the greater Plymouth area. www.familycontinuity.org r Is (1)n- CIRCL6 Permit number-1 lebm w cownl TOWN OF BARNSTABLE .DEPARTMENT OF HEALTH, SAFETY AND ENVIRONMENTAL SERVICES HEALTH DIVISION KEEP OUT UNSAFE STRUCTURE UNINHABITABLE CONTACT HEALTH DEPARTMENT BEFORE ENTRY OR REPAIR PHONE: 508-862-4644 Address ON 001 I Health Official:Dwpi M10 # 0 0 . 0 -- P RR//URC OCN/ITIVe PRE//URR /CN/ITIVC O o PRE!!Y PRC//URe /RN/ITfVe "'i O o PRv-ss URC /CN/ITIVC O o 0 0 CNAITIVR O o � o n �� PRE//YRL �ICN/ITIVC IUI . E.F. Winslow j` B JOB INVOICE Plumbing & Heating 59890 8 Reardon Circle South Yarmouth,MA 02664 Phone 508-394-7778 CUSTOMERS ORDER NO. ATE ORDERED FAX 508-394-8256 e-mail questions@efwinslow.com ORDER TAKEN ev BILL.TO _ .DATE PROMISED D AM ADDRESS PHONE CI y Co JOB NAME AND LO—I ION i HELPER DESCRIPTION OF WOR ( F ❑CONTRACT ❑EXTRA QUANT. / DESCRIPTION OF MATERIAL USED PRICE AMOUNT J / ' �06 ca a cc 00 U HOURS LABOR MECHANICS AMOUNT @ ©g TOTAL J HELPERS @ MAT i �9 TOTAL LABOR /O 9 I hereby acknowled nat ge my sigure grants a C Ority to use Credit card numbers supplied at time of service or credit card numbers already on file. 1 I her knowledge y�satisfactory 00 le of the try escribed work. TOTAL LABOR IG E TAX ODATE COMPLETE� TOTA �C7 �7 ,93