HomeMy WebLinkAbout0136 GROVE STREET - Health wd-
136 Gtov,6 Street
Uocu t
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1
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
136 Grove St.
M
Property Address
Pat Caulfield
Owner Owner's Name
information is required for Cotuit Ma. 02635 8/24/2010
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important A. General Information
When filling out
forms on the
computer,use 1. Inspector:
only the tab key
to move your Robert Paolini
cursor-do not Name of Inspector
use the return
key. Capewide Enterprises,LLC.
Company Name
r� P.O.Box 763
Company Address
Centerville Ma. 02632
City/Town State Zip Code
(508)428-4028 S14454
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
H Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
I",// &;::, 8/24/2010
Ins or r Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use. U
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sew, a Disposal System•Page 1 of 17
7
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M
136 Grove St.
Property Address
Pat Caulfield
Owner Owner's Name
information is required for Cotuit Ma. 02635 8/24/2010
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
The septic system is in proper working order at the present time.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired.The system, upon completion of the replacement or repair, as approved by w
the Board of Health,will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System
will pass inspection if the existing tank is replaced with a complying septic tank as approved by the
Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 136 Grove St.
Property Address
Pat Caulfield
Owner Owner's Name
information is required for Cotuit Ma. 02635 8/24/2010
every page.. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
1
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 136 Grove St.
Property Address
Pat Caulfield
Owner Owner's Name
information is required for Cotuit Ma. 02635 8/24/2010
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y2 day flow
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 136 Grove St.
Property Address
Pat Caulfield
Owner Owner's Name
information is required for Cotuit Ma. 02635 8/24/2010
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed i e s . Number of times pumped:
Pp ( ) P P
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
El 0 The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D.shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 136 Grove St.
Property Address
Pat Caulfield
Owner Owner's Name
information is required for Cotuit Ma. 02635 8/24/2010
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
❑ ® Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 136 Grove St.
Property Address
Pat Caulfe!d
Owner Owner's Name
information is required for Cotuit Ma. 02635 8/24/2010,
every page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: NA
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ® Yes ❑ No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 2008:18,000
g ( y g (gp ))' 2009:19,000
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: 8/24/2010
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4M 136 Grove St.
Property Address
Pat Caulfield
Owner Owner's Name
information is required for Cotuit Ma. 02635 8/24/2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was Y uantit pumped determined?
q
Reason for pumping:
R Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology.Attach a copy of the current.operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
;M 136 Grove St.
Property Address
Pat Caulfield
Owner Owner's Name
information is required for Cotuit Ma. 02635 8/24/2010
-
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 30"feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
10'+
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Joints appear tight.No evidence of Ieakage.System vented through the house vents.
Septic Tank (locate on site plan):
2'
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000gallon
Sludge depth:
2"
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
;M 136 Grove St.
Property Address
Pat Caulfield
Owner Owner's Name
information is required for Cotuit Ma. 02635 8/24/2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
30"
Scum thickness
0"
8„ �
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle 14" r
How were dimensions determined? Measured
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears
structurally sound.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
136 Grove St.
Property Address
Pat Caulfield
Owner Owner's Name
information is
required for Cotuit Ma. 02635 8/24/2010
`every page. City/Town State Zip Code Date of Inspection
D. System Information (cost.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped.at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
r Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M a 136 Grove St.
Property Address
Pat Caulfield
Owner Owner's Name
information is required for Cotuit Ma. 02635 8/24/2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert No
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
I
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°wM 136 Grove St.
Property Address
Pat Caulfield
Owner Owner's Name
information is required for Cotuit Ma. 02635 8/24/2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
. Type: r
® leaching pits number:
1
❑ 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.):
Sandy soil.No signs of hydraulic failure.Pit was dry at time of inspection.Stain line observed 32"
below invert.
Cesspools (cesspool must be pumped as part of inspection)(locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
;M 136 Grove St.
Property Address
Pat Caulfield
Owner Owner's Name
information is required for Cotuit Ma. 02635 8/24/2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
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Town of Barnstable Geographic Information System
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 136 Grove St.
Property Address
Pat Caulfield
Owner Owner's Name
information is required for Cotuit Ma. 02635 8/24/2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: Bottom of LP 10'
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health-explain:
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of
groundwater elevations.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 136 Grove St.
Property Address
Pat Caulfield
Owner Owner's Name
information is required for Cotuit Ma. 02635 8/24/2010
every page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
a
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
_
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION _ r y
(o- c�-t�5 ( l �3� out - - � _._,
Date '•�Y` eqol-e
Time: InOwner • -t r UC , U Tenant���`/h y
Address ul l Address 136
Compliance Remarks or
Regulation# Yes NO Recommendations
2. Kitchen Facilities V or
3. Bathroom Facilities
4. Water Supply V -fiu v1 Q--A-f)U
5. Hot Water Facilities % `kV
6. Heating Facilities
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17.Temporary Housing A S y 12 Tt
18. Driveway Width
19. Number of Tenants Observed 0
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Number of Bedrooms �� Number of Vehi a ax)
Number of Persons Allowed (max) 15-
Person(s) Interviewed Insp for
If Public Building such as Store or Hotel/Motel specify here
FORM 30 C&W HOBBS 8 WARREN
TM THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
DAQ tie S-rj,4, P.>Lf-
CITY/TOW N
W A
a DEPARTMENT
2—oo MA % q Sq . tk�S
ADDRESS
M 5 a �Qece 2 40(o q�
TELEP ONE
Address 1 Ne Vi 2o-/L SZ 4? u 1 T Occupant_ AN/A
Floor Apartment No. No.of Occupants /V
No. of Habitable Rooms No.Sleeping Rooms_,_
No. dwelling or rooming units No.Stori s l`
Nam�e andaddresds of owner T iC A U L I EL 0
t � l 7 1L2 L -T N Q c- o o D Q 2 6 67- Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
/ Containers:
F/ Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual E ress:and Obst'n.:
❑ B ❑ F ❑ lyl Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation: p
Chimney: 'IV fit
BASEMENT Gen.Sanitation: I
e
Dampness: b�
Stairs: a s
Lighting:
STRUCTURE INT. Hall,Stairway:
/ Obst'n.:
V Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y „r'"] N Equip. Repair
TYPE: V Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ STL/ P Waste Line:,
H.W.Tanks Safety and Vent(s)f� p
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen. Cond. Distrib. Box:
r / Gen. Basement Wiring:
V DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pantry
Den
Living Room
Bedroom(I
Bedroom 2
Bedroom 3 2NO
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 INSPE ION REPORT S SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES PERJURY."
INSPERCTOR /7- TITLE4/0141�_ fL
/ C A.
DATE ` ZOe TIME V0 P.M.
A// A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B) and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
Ls
I
lC6 ID7
COMPLETE •
■ Complete items 1,2,and 3.Also complete A.;gnature %
ftem 4 if Restricted Delivery is.desired. i(�-" Agent
■ Print your name and address on the reverse X ❑Addressee
so that we can return the cans to yop. B. Recei b (Print C. Date :) H
■ Attach this card to the.back of the mailpiece,
very
or on the front if space permits.
D. Is delivery a Tess different from item 1? es
1. Article Addressed to: ( ` ` If YES,enter delivery address below: El
No—A1 ti\I•Q} 61VT*-f-k
(�pCv�pp0 r M� o/1 ou'Z 3. Service Type
■Certified Mail O Egress Mail
❑Registered M.Return Receipt for Merchandise
.❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2: Article Number 0'816!0 0 0 0 .3=5 2 4 l 9 7 9 7'i ,(Mmms/er from service labe4 i
PS Form 3811,February 2004 . Domestic Return Receipt t02595-02-M•154o
UNITED STATES POSTA SERVICE Filet Mass
a to �e os�Pta$$�-a es P
F-F .. — _
Sender: Please pr nt your.name, address; and ZIP+4-iii.this
I Town of Barnstable
\\UHealth Division
200 Main Street
1 Hyannis,MA 02601
rJ�Z tOdtFFFll7FFl�tllt?FlFlF11!(7!l�2lF?1!!!Ft!!!/lltlFllF?F!(!!tl �%�
f�. Certified Mail#7006 0810 0000 3524 9797
°f�HE rowti Town of Barnstable
Regulatory Services
BARN5TABLE,
9 MASS. Thomas F. Geiler,Director
�p R' Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
May 1, 2007
Patrick Caulfield
77 Elliot Street
Norwood, MA 02062
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 136 Grove Street Cotuit, was inspected
on April 29, 2007 by Meredith Morgan,Health Inspector for the Town of Barnstable.
This inspection was conducted on the basis of the rental registration in accordance with
Chapter 170 of the Town of Barnstable Code.
The following violations of the Town of Barnstable Code were observed:
1& 70-10—Smoke Detectors and Carbon Monoxide Alarms. Inoperable smoke
detector in basement.
You are directed to correct the violations listed above within twenty-four (24) hours
of your receipt of this notice by repairing or replacing inoperable smoke detector in
basement.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten (10) days after the date the order is served.
Non-compliance will result in a fine of $100.00 per violation. Each day's failure to
comply with an order shall constitute a separate violation.
QAOrder letters\Housing violations\Rental ordinance\136 Grove Street.doc
Should you have any questions regarding the above violations, please contact the Town
Health Division and ask to speak with the inspector who performed the inspection.
PER ORDER OF T BOARD OF HEALTH
as A. McKean,R.S., CHO
Director of Public Health
Town of Barnstable
Cc: Meredith Morgan, Health Inspector
QAOrder letters\Housing violations\Rental ordinance\136 Grove Street.doc
FORM30 H&W HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS
BO D OF HEALTH
OTOTO N
W
DEPARTMENT
0
ADDRESS
,, � /',�, T EPHONE
70 � Od
Address �� -% C,/RI Ury� _ Occupant
Floor Apartm nt No. No.of Occup is
No.of Habitable Rooms No.Sleeping Room
No.dwelling or rooming unitsN Storie
Name and address of owneA e _/07 5V
Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vents Jr
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 FI e Vents,Safeties:
Kitchen Facilities Sink
Stove
Bathing,Toilet Facil. Vent.,-Plumb.,-San it'n.:
Wash Basin,Shower or Tub:
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Buildin_g 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 IN ECTI PORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALT RMNYV"
INSPECTOR. TITLE
/cam ` VV A.M.
DATE E P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION 40111 P.M.
Tom. .
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 410.636 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued,t comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
�pFZME rOky Town of Barnstable
Regulatory Services
9�A 6 �� Thomas F. Geiler,Director
Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
DATE: 4
NUMBER OF PAGES TO FOLLOW:
TO:
i FI
PHOnt ^ �l PHONE: (508)862-4644
42L,�2FAX PHO �( (� FAX PHONE: (508)790-6304
cc:
P0 MANOR
. c. .
NOTES/COMMENTS:
QAF'ax Form.doc
Town of Barnstable
Popp SHE Tp�y
Regulatory Services
x BARNSrA6LE, a Thomas F. Geiler,Director
MASS.159. Public Health Division
lED MAI A
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
April 30, 2007
Attn: Cotuit Fire
Health Inspector Meredith E. Morgan conducted a rental inspection in accordance with
Chapter 170 of the Town of Barnstable Code. 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):
136 Grove Street Assessors Map-Parcel: (019-031):
Smoke detector in basement not operable. Home is currently not occupied.
Meredith E. Morgan -Health Inspector
Q:\Order letters\Housing violations\Rental ordinanceUire ViolationsTIRE TEMPLATE.doc
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Parcel Detail Page 1 of 3
07
6 XX
x
Logged In As: Parcel Detail Friday, Ap
Parcel Lookup
Parcel Info
Parcel ID 019-031 JI Developer
Lot L 14 LOT 3-
-- -- - - -- ------ -- - - - - ----- - -
Location 136 GROVE STREET -� I Pri Frontage 125
Sec
Sec Road Frontage -- - _.. --- - --
Village COTUIT - -_T Fire District COTUIT
Sewer Acct Road Index F0638
Interactive
-
� . � r
- Owner Info
owner CAULFIELD, PATRICK J & Co-owner;
Streetl 77 ELLIOTT ST Street2 r _r
City NORWOOD �� State jMA Zip 02062 Country SUS
- Land Info
Acres`0.57 Y use IS gle-Fam MDr�L-011 Zoning jRF `Nghbd 0109 ==
Topography ,Level — — —I Road ,Paved
utilities Public Water,Septic,Gas -^ �I Location k _>_
- Construction Info
Building 1 of 1
Year �II Roof'`-` � Ext
Built 11988_.. _N struct,Gable/Hip JI Wall ;Wood Shingle jl
Effect i 1961 1 T Roof fAsph/F GIs/Cm
1 AC
None �l
Area --. ----- -- Cover Type pe�-- ..
Style Ranch _ Int Plastered I Bed `3 Bedrooms -
Wall - Rooms - - --- '
— --
Int - Bath -
Model Residential I Floor Ceram Clay Til Rooms 2 Full
Grade Average 1 Heat Hot Air I Total 7 Rooms
Type -- Rooms ----- --
http://issql/intranet/propdata/ParcelDetail.aspx?ID=680 4/27/2007
I
Parcel Detail Page 2 of 3
-223.
WbK I.
34
;23
Heat- Found
Stories 1 Story_ - I Oil Poured Conc. WI
J Fuel - ation eAs.
30 :BMT`
-- - 121
;z
:2u: 3
Permit History
Issue Date Purpose Permit# Amount Insp Date Comm
1/1/1988 B31580 $55,000 1/15/1989 12:00:00 AM CO 1 C
- Visit History
Date Who Purpose
3/3/2005 12:00:00 AM Paul Talbot Drive by inspection only
9/3/2002 12:00:00 AM Paul Talbot Meas/Listed
8/4/1999 12:00:00 AM Frederick Stepanis Meas/Listed
7/15/1989 12:00:00 AM ME
- Sales History
Line Sale Date Owner Book/Page Sale P
1 10/15/1982 JCAULFIELD, PATRICK J & MARY P 3590/178
Assessment History
Save# Year Building Value XF Value OB Value Land Value Total Parc(
1 2007 $182,800 $2,800 $0 $250,900
2 2006 $168,000 $2,800 $0 $247,100
3 2005 $156,500 $2,800 $0 $149,700
4 2004 $129,700 $2,800 $0 $149,700
5 2003 $115,800 $2,800 $0 $77,700
6 2002 $115,800 $2,800 $0 $77,700
7 2001 $115,800 $2,800 $0 $77,700
8 2000 $92,600 $2,800 $0 $47,200
9 1999 $91,500 $2,700 $0 $47,200
10 1998 $91,500 $2,700 $0 $47,200
11 1997 $100,900 $0 $0 $47,200
12 1996 $100,900 $0 $0 $47,200
13 1995 $100,900 $0 $0 $47,200
14 1994 $91,900 $0 $0 $53,100
http://issql/intranet/propdata/ParcelDetail.aspx?ID=680 4/27/2007
Parcel Detail Page 3 of 3
I -
15 1993 $91,900 $0 $0 $53,100
16 . "1�92 $104,400 $0 $0 $59,000
17 1991 $101,300 $0 $0 $62,900
18 1990 $101,300 $0 $0 $62,900
19 1989 $0 $0 $0 $62,900
20 1988 $0 $0 $0 $25,600
21 1987 $0 $0 $0 $25,600
22 1986 $0 $0 $0 $25,600
Photos
/ III
http://issql/intranet/propdata/ParcelDetail.aspx?ID=680 4/27/2007
TOWN OF BARNSTABLE
LOCATION I"Cj ye t�J� SEWAGE # RN 9Z
z
VILLAGE Co 7U" I- ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY 16'_�
LEACHING,FACILITY:(type) oD'-*CV ��`�1/�- (size)
NO. OF BEDROOMS . PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER 'l�lC� N )'k
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
g� t
r�
>)sL Son's
-PAR"UEL NO.-.
No.. ....Z_� P FRIM
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...---....OF......... -_----------------_-----
ApPration for Dhqpviial Works Totw4riArtion Prrutit
Application is hereby made for a Permit to Construct Repair ) an Individual Sewage Disposal
System at: �r.......6T.vir...... ... t4'7—
...... ...............................................................................................
VL ca, -A ress or Lot No.
.............................................................
. ..............
.......V . . .......................... ..........................
------------......------------------
Address
--- ----------
. .........
Installer Address
Type of Building Size Lot-Z'�,Vk I ..........Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder (
P4 Other—Type of Building ............................ No. of persons........._._......_..,..___. Showers Cafeteria (
P4Other fixtures. ......................................................................................................................................................
Design Flow................... - ------------gallons per person per day. Total daily flow:...................3 510..........gallons.
W . *...b ?.gallons Length................ Width._._..._.__._.._ Diameter.__-____._____._ Depth___.___.__..__..
1:4 Septic Tank—Liquid capacity.I
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area ........sq. ft.
Seepage Pit No............I........ Diameter-------1.72�---- Depth below inlet....&.40..... Total leaching area..U.5...sq. f t.
Z Other Distribution box Dosing tank
Percolation Test Results Performed by._A.K",V_._.±A.Y.eT............................... 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_.__._........_....-.._.
............................................................................................................................................................
0 Description of Soil-------.r. ..............;..............K......................................................................................................................
9
..... .....
U ..................................... .. ........F(;I .Alj. .........................................................................................................
.........................................................................................................-----------------------13E-SIGNMG-ENGINEE-R--MUST-,SUPERVISE
U Nature of Repairs or Alterations—Answer when applicable..-...-------------------MSTALLAT"-AND.-CERTIFYAWWRITING
..................................................................................................................................THE,, -WAS..MSTALLED..IU-STRICT
Agreement: ACCORDANCE TO PLAN.
The undersigned agrees to install the aforedescribed In ividual Sewage Disposal System in accordance with
the provisions of'THE 5 of the State Sanitary C90(5y-
�.-I undersigned further grees n-t to place the system in
operation until a Certificate of Compliance has bee i by thg board Xoeal
Sign .... .... ...... ....... .. . ..... .................. ........ ................................
C Datt
.........7/__,�
Application Approved By.........................411,. ..... .7*.............. ................. . ...
D te
Application Disapproved for the following reasons:.............................................................7�.......................................
................................................................................................................................................................................ ........................
Date
VPermit No......................................................... Issued..... ..1�7................
Fimic
THE COMMONWEALTH OF MASSACHUSETTS
=-� �BOARD OF HEALTH
------------totk)..1.�1..........OF......... .. ✓?.�1�7.I` (, ..........................
Appliration for Disposal Works Tonstrn.rtion thrmit
Application is hereby made for a Permit to Construct (�or Repair ( ) an Individual Sewage Disposal
System at
......Vi....................................iovr--------Corva"------ I ct Z
wLoca n-A dress -•----•..................................... Lot No.
C� -.
Owner Address
W
Installer Address
Q Type of Building 22 Size Lotl'�,00.0.......Sq. feet
U Dwelling—No. of Bedrooms................ ........... .....Expansion Attic ( ) Garbage Grinder ( )
p`4 Other—Type g ............... No. of persons............................ Showers ( ) — Cafeteria ( )Other—T e of Building .............
QI Other fixture ------
W Design Flow................... .. ......__••.....•..gallons per person per day. Total daily flow.................... ..........gallons.
Septic Tank—Liquid capacity. .gallons Length................ Width................ Diameter---------------- Depth----_----•-__.
W Disposal Trench—No..............•.•.... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No-----------1........ Diameter....-__1 Z....... Depth below inlet...3r--6..... Total leaching area.. .6...sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed bye- #L_ "? _ ..I���Lta�................................ Date.......0�../4 ..........
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
r;!, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------..................
P1 .....................................................-.......................................................................................................
0 Description of Soil. :....
x -------------------------------------- .t .........
. .�..1.�. ----•-•--•---••••--••-•---•....•-•-•---•••-•-•--•••••-•--•-••--•-••......_......--••••.............
U
W
UNature of Repairs or Alterations—Answer when applicable.........:...................•................................................................
..........................................=.............................................................................................................................................................
Agreement:
The ,undersigned agrees to install the aforedescribed I ividual Sewage Disposal System in accordance with
the provisions of'TTt._.� 5 of the State Sanitary C e undersigned further grees t to place the system in
operation until a Certificate of Compliance has be by th board o ealt
Sign •. ... ...... ..- =. . . .--•--•.....
-t Da
Application Approved BY c> ...............l... _.=._......... �_
te
pplication Disapproved for the following reasons:.................................................--•---......•-------------•-----------------------...•---•-...
..----•----------------------•-----...............--------^-.........----•------.•.......-•-------•-•-----•----•---••-•----••••-•---•••--•••-••-•------
-- Date
PermitNo................................................ ....... Issued.... b./-..........7................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.....................OF.......9.(. !TA.7TA.1,.?.L. 7�.............................---•-
Trrtif iratr of TI-ImpliFanre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( }
bY----------------------------------------------------------------------------------•--------------- ------------------------•-------------- - --------------------------------------------------
�.+.
nstal
at �t . ............................................ - ---------------•---•----...-------•-•----...-•--•-------------------------......----------------
has been installed in accordance with the provisions of TT ter. 5 o- The State Sanitary Co s(f� �tibed in the
application for Disposal Works Construction Permit No.._��..�r. .�r. dated_-..____�_-..!_ -�. ................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTfLIED AS A GUARA TEE THAT YH
SYSTEM WILL FUNCTI N TISFACTORY. � �
d
DATE.......................
Inspector ✓ -'� / � ,
V' 9 ' 03 THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......... ..( .( tJR.�............OF............... C`n.!: aC,t1 :� QJ
1�T0.__..S✓...L... ^K 1 G. FEE.......
Disposal Works Tono rndion Vvrrutit
Permissionis hereby granted........................................................................................................................................
to ConstruN( ) or Repai ( ),-.an Individpal sewage Disposal System
at No
Street
as shown on the application for Disposal Works Constructign-..P.4txnit NQ�__.r�.. _._ Dated.......•.._y..._.................._.
- / rd---------------------------------------------------------
oa of ea
DATE................................................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
jt.SIGNINb ENGINEER MUST SUPS IS T�J��� •
INSTALLATION AND CERTIFY IN WR � wuC�l'1
THE SYSTEM WAS INSTALLED IN STRICT
ACCOHIJANCE Ir 5 I dim /ETA O PLAN.
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i� SuR.v�Y AND THE OFF5ET5 5HOWN 5HZ)ul.T) ?q4T
13' E usE�i TD ESTX13L15N I_2:;I-r L1 N!;5.
BAXTER & NYE, INC.
Registered Land Surveyors and Civil Engineers
7 Parker Road/Osterville,Massachusetts 02655/Tel. (617)428-9131
WILLIAM C.NYE,R.L.S.-President
RICHARD A.BAXTER,R.L.S.-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering
February 24 , 1988
Town of Barnstable
Board of Health
P.O. Box 534•
Hyannis, MA 02601
RE: Lot 142BB Grove St, Cotuit
Mr. Vincent Walsh
Dear Board:
This letter is to inform you that we have inspected
the septic system for Lot 142BB. The system has been in-
stalled as per the approved plan.
Very truly yours ,
Peter Sullivan, P.E.
Baxter & Nye, Inc .
PS/fmj
cc : V. Walsh -
U
or
fvo. 297s3
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AA • , 5�,
MEMBERS OF
CAPE COD SOCIETY OF PROFESSIONAL ENGRVEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING
MASSACHUSE7TS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGRMRS