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HomeMy WebLinkAbout0031 MAIN STREET (COTUIT) - Health 31-1VIain-Street Cotuit. A 009 017 �r i e r 009- 0/� c Commonwealth of Massachusetts Title 5 Official Inspection dorm la Subsurface Sewage Disposal System Form -Not for Voluntary Assessmentsr`- cnj 31 Main St. Property Address , Benjamin Canavan Owner Owner's Nam information is Co__ ✓ Ma. 02635 Jul 19 2019 required for every y page. City/Town State Zip Code Date of Inspection,_s -4 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information �1,r- 1y06� on the computer, Thomas Roux use only the tab key to move your Name of Inspector cursor-do not use the return Company Name key. 89 Mayflower Lane r� Company Address East Wareham Ma. 02538 Cityrrown State Zip Code 774-678-9066 S14531 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);I have personally inspected the sewage disposal system at theproperty address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails ";�zo I Ll__ - _" V / I 201q Inspector's Signature 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of MassarAusetts- �n Title 5 Official Insp ectiob Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 p Y rY C; >�u, 31 Main St. Property Address Benjamin Canavan Owner Owner's Name information is Cotuit Ma. 02635 Jul 19, 2019 required for every Y page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑N ❑ ND (Explain below): t5insp-doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 31 Main St. Property Address Benjamin Canavan Owner Owner's Name information is Cotuit Ma. 02635 Jul 19 2019 required for every y page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in.accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Main St. Property Address Benjamin Canavan Owner Owner's Name information is Y Cotuit Ma. 02635 Jul 19 2019 required for every , page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. k c. Other: t 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system,component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 31 Main St. Property Address Benjamin Canavan Owner Owner's Name information is Cotuit Ma. 02635 Jul 19, 2019 required for every Y page.. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged.SAS or cesspool ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Main St. Property Address Benjamin Canavan Owner Owner's Name information is Y Cotuit Ma. 02635 Jul 19 2019 required for every , page. CityrFown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to an question in Section C.5 the system is considered a significant Y Y 9 threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Wasthe facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Main St. Property Address Benjamin Canavan Owner Owner's Name information is Cotuit Ma. 02635 Jul 19, 2019 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 446 gpd Description: Number of current residents: 11 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes. ❑ No Water meter readings, if available (last 2 years usage(gpd)): Detail: The laundry is connected to the main system. Sump pump? ❑ Yes ® No Last date of occupancy: currentDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c Commonwealth of Massachusetts p Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Main St. Property Address Benjamin Canavan Owner Owner's Name information is Cotuit Ma. 02635 Jul 19 2019 required for every y page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/2 6120 1 8 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Main St. Property Address Benjamin Canavan Owner Owner's Name information is Cotuit Ma. 02635 Jul 19 2019 required for every y page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ I Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 15 years, Design plan dated 6/18/04. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 3.75' feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: +10feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Main St. Property Address Benjamin Canavan Owner Owner's Name information is Cotuit Ma. 02635 Jul 19 2019 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2.75 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: 10.51 x5.67'W x 5.6TH Sludge depth: <11, Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness <1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle " 16" 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.): The septic tank was pumped out in June 2019. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Main St. Property Address Benjamin Canavan Owner Owner's Name information is Cotuit Ma. 02635 Jul 19, 2019 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Main St. Property Address Benjamin Canavan Owner Owner's Name information is required for every Cotuit Ma. 02635 July 19 2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No solids carryover in the D-Box. t5insp.doc-rev.7/2612018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Main St. Property Address Benjamin Canavan Owner Owner's Name information is Cotuit Ma. 02635 Jul 19 2019 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): "If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: The septic tank and D-box are both working correctly. Therefore, the SAS is draining properly. Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2, 49-L ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .�, 31 Main St. Property Address Benjamin Canavan Owner Owner's Name information is Cotuit Ma. 02635 Jul 19 2019 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There was no evidence of hydraulic failure. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26&18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Main St. Property Address Benjamin Canavan Owner Owner's Name information is Cotuit Ma. 02635 Jul 19, 2019 required for every y page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Main St Property Address Benjamin Canavan Owner Owner's Name information is Cotuit Ma. 02635 July 19, 2019 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately e . I A - - _ i i �4V -4!5 3-53'2"' _3--5� �. g � 4 , I I I' t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 • Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Main St. Property Address Benjamin Canavan Owner Owner's Name information is required for every Cotuit Ma. 02635 July 19, 2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: +11, 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: 6/18/04 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: From the design plan on file. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 31 Main St. Property Address Benjamin Canavan Owner Owner's Name information is required for every Cotuit Ma. 02635 July 19, 2019 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 FRANKLIN ANALYTICAL S RVICES INC 401 DELANO MAROON,MA 02738 508-748-3156 PHONE 508-748-9713 FAX LETTER OF FULL DELEADING COMPLIANCE DATE: 8/13/10 Charles Sheehan P.O. Box 2066 Nantucket,MA 02584 Dear Mr. Sheehan: This letter is to certify that I re-inspected your property located at 31 Mam St apartment no NlAand relevant common areas, in the City or Town of Cotuds for full deleading compliance on!8/1 1/3 04, and on that date those surfaces cited in the initial inspection report of rA-nthony Jakaitis M-2929 (9/9M& were found to be in full compliance with Massachusetts General Laws, Chapter 111, Section 197, and 105 CMR 460.000: Regulations for Lead Poisoning Prevention and Control. Dust samples were taken and found to be within acceptable limits. Massachusetts law does not require the abatement or containment of all .residential lead paint. The residential premises or dwelling unit and relevant common areas shall remain in compliance only as long as there continues to be no peeling, chipping or flaking lead paint or other accessible leaded materials, as long as coverings and/or encapsulants forming an effective barrier over such paint or other leaded materials remain in place, and as long as surfaces reversed to correct lead hazards remain reversed and securely in place. The law grants you a 30=day maintenance period to repair deteriorated lead paint or detached coverings over such paint, and to clean up, during which time this Letter remains valid. The reverse side of this letter indicates the authorized person(s) who performed deleading on the property and a general summary of the methods used. A complete reinspection report is attached to this letter, which specifies how and on what date each surface was brought into compliance.Do not lose these documents. The bt of my) owledge, the cost of the legally required deleading is$10,050.00. J m •:. Sincerely, Eav, � O �, 2171 DPH License Number F- C Private LFVC Pagel of 2 Rev 8/08 �Y ADDRESS 31 Main St Cotuit,MA Inspection and Deleading History Initial inspection done on: 9/9/09 by A.Jakaitis License#2929 Reoccupancy reinspection, if needed, done on: by License# Final Deleading reinspection done on: 7/13/10 by Amy Franklin License#2171 Deleading Contractor: John Lyons License#: 1912 Deleading methods: Scraping Demolition Power sanding Caustics Heat gun Replacement Covering Liquid encapsulation Other diuping Work was done in the following rooms: porch Work was done on the following types of components: windows Start Date:7/4/10 Finish Date: 7/31/10 Cost: $98.00 Lead-safe renovator: License#: Moderate risk owner/agent: Charles Sheehan Authorization#: 11133-OM Deleading Methods: Replacement Making intact(interior) Dippping Making intact(exterior) Covering Liquid encapsulation Work was done in the following rooms: All Rooms Work was done on the following types of components: Windows,Jambs,Doors, Start Date: 11/10/09 Finish Date:7/31/10 Cost: $10,050.00(Doesn't Include Owner's Labor) Low-risk owner/agent: Authorization#: Deleading methods: Covering Liquid encapsulation Capping baseboards Replacement(ONLY doors,cabinet doors,shutters,shelves not affixed,drawers,windows on binges) Work was done in the following rooms: Work was done on the following types of components: Start Date: Finish Date: Cost: (Doesn't Include Owner's Labor) Should you have any questions about this letter, call the Department of Public Health at 1-800-532-9571. Private LFDC Page 2 of 2 Rev 8/09 r �� � s � r f { . . .- _ �a, -� _ - - i �.- � «- s � ,. �,. _ �, �,� ..O ��n� _ 4 '�tiy.a. � f .� \ �' �� �r COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sign., re Item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ' �/ Addressee so that we can return the card to you. B. Received by(Printed Name) C. ate f Deli ery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1?. Yes 1. Article Addressed to: YES,enter delivery address below: O Charles Sheehan, T t � TO Box 2066 6�q�, 1Zi Nantucket,'MA 0258 I� 3�Service Type ' I S LGeRifled Mall ❑Express Mall " ,.�. (b]Registered ❑Insured Mail C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7008 116d i 0000 i0iii 0560 y (Transfer from service lab PS Form 3811,February 2004 Domestic Return Receipt 102595-02-MA540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISP�^ Pe ms o.G-10 ZQ C ° Sender: Please print your name, address,(an ZIP+4 i-61his Town of Barnstable E I Health Division \Q 200 Main Street o "' 1 Hyannis, MA 02601 4 I I I. pFTHE r Town of Barnstable R-egulatory Services BA ASS.M = Thomas F. Geiler,Director / MA 9 SS 0Q $AIFoMA�A`0 Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 026011-6 Office: 508-862-4644 Fax: 508-790-6304 August 26, 2009 Charles Sheehan PO Box ocoo Nantucket, MA 02584 A lead paint determination was conducted at the home you own at 31 Main Street Cotuit, MA. This determination found lead paint in violation of the Lead Law, Massachusetts General Laws, chapter 111, section 197, and the Massachusetts Department of Public Health's (DPH's) Lead Poisoning Prevention and Control Regulations, 105 Code of Massachusetts Regulations (CMR) 460.000. The law requires owners of homes or apartments built before 1978 to have lead paint violations deleaded for full compliance or brought under interim control when a child under six years old lives there. A private risk assessor has to do a risk assessment and give you a lead inspection/risk assessment report before you can go aheaf with interim control. A private lead inspector has to do a comprehensive lead inspection and jive you a lead inspection report before you can go ahead with deleading for full compliance. If you already have a Letter,of Compliance for this property, please complete the last page of the Order to Correct and send it to me within 14 days. The Order that comes with this letter has important information telling you: . • what you have to do • what deadlines to meet • what documents you have to send to this agency • who can do the necessary work • what the penalties are for not meeting the Order's requirements • what your options are if the property has been previously deleaded. Please call me at this office at (508) 862-4646 as soon as possible to discuss this Order and how to meet it. The following.information explains the deleading process,if the property has not been deleaded previously. - Hiring a Lead Inspector To help you take the first step—getting a full inspection or risk assessment—a list.of lead inspectors is enclosed. We recommend that you check references and make sure that the inspector is still licensed. You can check on the license by calling the state Department of Public Health's Childhood Lead Poisoning Prevention Program(CLPPP) before hiring an inspector. To get a list of risk assessors for interim control, call CLPPP's central office at 1-800-532-9571. You can also get other helpful materials from CLPPP, including brochures explaining the BOH Cover Revised 1-05 Page 1 of 3 choices of full compliance deleading and.interim control. Again, you can get these by calling CLPPP at the number above or by checking our website at www.state.ma.us/dph/clppp. Requirements for Doing Deleading Work High-risk deleading: If you need to or choose to have high-risk deleading work done, such as having lead paint stripped or scraped, you have to hire a deleading contractor. A list of deleading contractors is also enclosed. Just as in the case of inspectors, we recommend you check references and make sure that the deleader is still licensed. You can check on the license.by calling the state Division of Occupational Safety (DOS) at 1-800-425-0004. Moderate-risk deleading: Before you or your agent can do moderate-risk deleading work, such as removing windows and woodwork,you have to take a course, pass it and get an authorization number from CLPPP. These courses are given by a number of groups and organizations at various places, times and prices. For a list of approved moderate risk training providers, call CLPPP at 1-800-532-9571 or check our website (address above). Remember that you still have to meet the deadlines in the Order. If a course for owners to do moderate-risk deleading is not available at a convenient time or place for you to meet the deadlines of this Order, you won't be able to do moderate-risk deleading work yourself. You then have to use other methods to delead, or hire a licensed lead-safe renovation contractor. To get a list of these contractors, or to check their licenses, call DOS at 1-800-425-0004. Low-risk deleading: Before you or your agent can do only low-risk deleading work; such as covering surfaces, you have to read the CLPPP low-risk booklet; take a self--corrected exam that you send in to CLPPP, and get an authorization number from CLPPP. If you want to encapsulate, you must first have a full lead inspection done on the property and then contact CLPPP to go over your inspection report and discuss surfaces that may be good for encapsulation. If encapsulation is a suitable option, you have to read CLPPP's encapsulation booklet,take a self- corrected exam that you send in to CLPPP, and get an authorization number from CLPPP. To get a free copy of the low-risk booklet, or the encapsulation training handbook, call CLPPP at l- 800-532-9571. Interim control work: If you or your agent will be doing other work for interim control, such as structural repairs and cleaning of leaded dust, you have to take safety steps and clean up in the way described in the CLPPP booklet for interim control.To get a copy of this interim control booklet, call CLPPP at the above number. Deleading work has to be carefully done to.be safe. To protect the people who live in the home or apartment, you have to keep them out of the home or apartment,or area being worked on, in these ways: • All people and pets have to be temporarily moved from the home or apartment for the whole time that high- or moderate-risk deleading work is taking place inside the home or apartment. You have to provide the residents with a reasonable alternative place to live for this period. People and pets who have been temporarily moved from their home or apartment can only come back after a licensed private lead inspector or licensed private risk assessor says it is safe for them to return. The inspector or risk assessor does this after reinspecting the home, including taking dust samples to assure that lead dust levels meet approved standards. This reinspection will be done at least three hours after deleading work is all done. BOH Cover Revised 1-05 Page 2 of 3 r • People and pets have to stay out of the work area while you or your agent does most low-risk deleading work or structural repairs or cleaning of lead dust. They also have to stay out of the work area while there's any deleading work in common areas outside the home or apartment, as long as they have another regular way (not a fire escape) to go in and out of the building. In these cases, people and pets can use the area once the work is done in the area and cleaned. up. • People and pets have to stay out of the home or apartment for the workday while you or your agent apply encap'sulants with an airless sprayer. They also have to stay out for the day during deleading in common areas when they do not have.another regular way (not a fire escape) to'go in and out of the building. When people and.pets are out of their home or apartment for the day, it means they can come back to the home or apartment after cleanup at the end of the workday, and don't have to be out overnight. All work for deleading and interim control has to be neatly and properly done, in a professional way, and the home or apartment has to be returned to a condition that meets the requirements of the State Sanitary Code. Deleaded surfaces cannot be repainted until after they have passed reinspection by a licensed private lead inspector or risk assessor. You have to give written notice about common area lead paint violations to all other residents of the building. "Notice to Tenants bf Lead Paint Hazards" is enclosed for that purpose. You also have to send a copy of the lead inspection report or lead inspection/risk assessment report and any reinspection reports to all mortgagees and lienholders of record. If your property has been previously deleaded, you may be eligible for a 30-d4y maintenance period. Please fill out the last page of the Order to Correct and return it to me within 14 days to take advantage of this option. If you have questions about the Department of Public Health's Lead Poisoning Prevention and Control Regulations, you can ask me, or call the CLPPP central office (1-800-532-9571 or 617- 284-8400). If you have questions about the Division of Occupational Safety's (DOS) Deleading Regulations, call the DOS central office (1-800-425-0004 or 617-727-7047). Remember to refer to the attached Order for more information about what you have to do. PER O R F TH BOARD OF HEALTH r Th mas A. McKean, R.S., CHO Director of Public Health Town of Barnstable BOH Cover Revised 1-05 Page 3 of 3 °p1HE r Town of Barnstable Regulatory Services • r BAMSTABLE. * Thomas F.Geiler,Director 9a MASS. �a 39.& Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601, Office: 508-862-4644 Fax: 508-790-6304 August 26, 2009 Charles Sheehan PO Box 2066 Nantucket, MA 02584 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The-property owned by you located at 31 Main Street, Cotuit, MA was inspected on August 25, 2009 by Timothy O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a.complaint. Be advised that certain portions of this residential property to be in violation of the State Sanitary Code, 105 Code of Massachusetts Regulations (CMR) 410.750(J). This violation also constitutes a violation of the Lead Law, Massachusetts General Laws (MGL), chapter 111, section 197, and the Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. If you already have a Letter of Compliance, please look to the last page of this Order and fill out the. appropriate information. Conditions exist in this residence that may endanger and/or materially impair the health of the occupants of these premises. DECLARATION OF EMERGENCY The Director of the Massachusetts Department of Public Health Childhood Lead Poisoning Prevention Program declares that the presence of this violation of the Lead Law and the Regulations for Lead Poisoning Prevention and Control constitutes.an emergency pursuant to the Lead Law, MGL chapter 111, section 198 and within the meaning of the Sanitary Code, 105 CMR 400.200(B). CORRECTION OF LEAD VIOLATIONS) The Lead Law, MGL c. 111, §§189A-199B, and the Department of Public Health's Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000, require the owner of a residential premises or dwelling unit built before.1978 in which a child under the age of six lives have lead BOH OTC Revised 1105 Page 1 of 8 paint violations either abated or contained (referred to as "deleading") for full compliance or brought under interim control. The steps that you.must follow are in the "Order" section. The Lead Law, the Department of Labor and Workforce Development's Deleading Regulations, 454 CMR 22.00, as well as the Regulations for Lead Poisoning Prevention and Control require that residential deleading work be done by authorized people. The type of authorization will determine the method of deleading that can be done. There are three levels of deleading: High Risk Deleading Only licensed Deleaders can do high risk deleading activities. These activities include scraping, stripping, demolition, and making large amounts of loose paint intact. If this type of work is done on the interior of a unit, then the occupants must be temporarily relocated until the work is complete and has passed a reoccupancy reinspection. Moderate Risk Deleadinu Moderate risk authorized owners/agents and licensed lead safe renovators can do moderate (and low risk) deleadin g. These activities include removal and replacement of building components such as windows, and making a small amount of loose paint intact. If this type of work is done on the interior of a unit, then the occupants must be temporarily relocated until the work is complete and has passed a reoccupancy reinspection. Owners interested in becoming trained and authorized to do moderate risk deleading should contact CLPPP for more information. Low Risk Deleadin Low risk authorized owners and agents can do some minor deleading activities such as covering surfaces with approved coverings and encapsulating approved surfaces.- Owners interested in becoming trained and authorized to do low risk deleading should contact CLPPP for more information. These rules on who is authorized to perform what kind of deleading work apply whether the work is being done for full compliance or for interim control. An owner or owner's agent may also make structural repairs, as defined in 105 CMR 460.020, and clean leaded dust, as may be required for interim control. ORDER You are hereby ordered to remedy all violations of MGL c. 111, §197 and 105 CMR 460.000, as identified by a licensed private lead inspector. If you wish to pursue interim control, you must remedy all urgent lead hazards identified by a licensed private risk assessor. Whether you pursue full compliance or interim control, you must correct the relevant violations in accordance with the following schedule: Within sixty (60) days of your receipt of this.Order, you must provide proof of the following: 1. A complete analysis of the property for lead hazards. Proof consists of one of the following: BOH OTC Revised 1/05 Page 2 of 8 • A comprehensive initial lead inspection report done by a licensed private lead inspector. The inspector must inspect the interior of the unit and the common areas of the unit, including the exterior. • A comprehensive initial lead inspection and risk assessment done by a licensed private inspector who is also licensed as a risk assessor.This is only necessary if you have decided to pursue the option of Interim Control. For more information-on the Interim Control program, please contact CLPPP. • For previously deleaded properties, a post compliance assessment determination done by a CLPPP code enforcement inspector. If you have a previously complied property and failed to return the last page of this order within 14 days, then you may no longer be eligible for a maintenance period; however, you must still have the assessment done. Only a CLPPP code enforcement inspector can do this assessment. 2. An established deleading plan for who will be deleading and when the work will be done. Proof consists of at least one of the following: • A contract with a licensed deleader, licensed lead-safe renovator, or low risk authorized agent. To check on the license for deleaders and lead safe renovators, contact the Division of Occupational Safety at (617) 727-7047. To check on the authorization for low risk agents, such as vinyl siders or carpet layers, contact CLPPP at IP Y 800-532-9571. • If you or your agent will be doing the work,a copy of the authorization letter-and a completed "Documentation of Training to be an Authorized Owner/Agent And Intention to Comply with the Order to Correct" form verifying that all work will be done within required timelines (see 90 day and 120 day requirements). This form is included in this package. Contracts with licensed/authorized people as well as an authorized owner or agent's completed"Documentation of Training to be an Authorized Owner/Agent And Intention to Comply with the Order to Correct"must also specify that the unit will meet acceptable lead dust levels under 105 CMR 460.170, as determined by the licensed lead inspector or risk assessor's dust wipe sampling. Should any of the dust samples fail to meet acceptable standards, the last authorized person who performed high- or moderate-risk work will be required to reclean the entire unit until all dust samples meet acceptable levels. If a low or moderate risk authorized person.did the deleading and dust samples fail three times, a licensed deleader will be required to reclean the entire unit until all dust samples meet acceptable levels. Within ninety (90) days of your receipt of this Order you must provide r Y p proof that the following work was completed and reinspected (including passing dust wipes if required): 1. All high and moderate risk deleading on the interior of the unit must be done and must have passed reinspection, including dust wipes. BOH OTC Revised 1/05 Page 3 of 8 Please note that if high or moderate risk activities will be done on the interior,then encapsulation cannot be done until after all of this high and moderate risk work has been reinspected and passed dust wipes. 2. Removal and replacement of doors, if chosen as the method of deleading, must be done and have passed reinspection. 3. Loose surfaces in the interior of the unit must have been made intact by the appropriately authorized person, been covered, or otherwise deleaded and reinspected. This includes loose surfaces being prepared for encapsulation (but DO NOT encapsulate these surfaces until after a successful reoccupancy reinspection). Making paint intact on the interior of a unit requires dust wipes at the reinspection. There-cannot be any loose paint in the unit by the ninetieth day. 4. For those owners pursuing the Interim Control option, rules 1- 3 still apply; however only "urgent" lead hazards are required to be corrected. In addition, all required safeguards and structural repairs relevant to the interior of the unit must be complete and have passed reinspection and dust wipes, if required. Proof of this work consists of a copy of a reinspection report from a licensed lead inspector or risk assessor and copies of passing dust wipe results,if dust`wipes were required. Copies of these documents must be provided to this agency by the 90th day. Within one hundred and twenty(120) days of your receipt of this Order, you must provide proof that the following work was `completed and reinspected (including passing dust wipes if required): 1. Any low risk activities on the interior of the unit that were not done by the 901h day deadline must be complete. This includes encapsulation of interior surfaces that were previously made intact. 2. All required deleading in the interior common areas and on the exterior is done and has been -reinspected, including passing dust wipes if they were required. 3. For those owners pursuing the Interim Control option, all of the "urgent" lead hazards must be corrected on the interior, common areas; and the exterior. Also, all required safeguards and structural repairs,relevant to the interior common areas and the exterior must be complete and have passed reinspection:For Interim Control, a final set of dust wipes is required to be taken at the final reinspection. Proof of this work consists of a copy of a reinspection report from a licensed lead inspector or risk assessor, copies of passing dust wipe results, and a copy of a compliance document. Copies of these documents must be provided to this agency by the 120th day. PROSECUTION AND CIVIL PUNITIVE DAMAGES Failure to comply with any of the deadlines set out above will require this agency to initiate criminal or civil proceedings against you within seven (7) business days. Compliance with this Order will be determined by this agency's receipt of the appropriate documents within the BOH OTC Revised 1/05 Page 4 of 8 specified deadlines. Documents should be sent to my attention at 200 Main Street Hyannis, MA 02601. Inspection documents required by the 60th day deadline. One of the following- ❑ Initial Lead Inspection report by a licensed.private lead inspector; ❑ Inspection report and risk assessment report by a licensed private risk assessor; ❑ Post Compliance Assessment Determination done by a CLPPP code enforcement inspector. Deleading documents required by the 60th day deadline. At least one of the following, although there may be a combination of documents: ❑ A contract with a licensed deleader, licensed lead-safe renovator, or low risk authorized agent; ❑ A copy of an owner/agent authorization letter from CLPPP and a completed"Documentation of Training to be an Authorized Owner/Agent And Intention to Comply with the Order to Correct;„ ❑ If you or your agent will only be doing structural repairs and lead-dust cleaning for interim. control, a signed written statement attesting that this work will be completed in accordance with the required timelines. Documents required by the 90th day deadline: ❑ A Letter of Lead Paint(Re)occupancy (Re)inspection Certification issued by a licensed lead inspector or risk assessor, in cases where high- or moderate-risk deleading work occurred, requiring occupants to be relocated from the unit for the duration of the work; ❑ Copies of results of all dust samples taken by the licensed lead inspector or risk assessor,and copies of all reinspection report(s) issued by a licensed lead inspector or licensed risk assessor; Documents required by the 120th day deadline. Only one of the following: ❑ A Letter of FullDeleading Compliance issued by a licensed private lead inspector. ❑ A Letter of Interim Control issued by a licensed private risk assessor. o For previously deleaded properties, a Certification of Restored Compliance (an addendum to the original letter of compliance) issued by a CLPPP code enforcement inspector. A copy of the deleading notification(s) must be sent to this agency at least ten (10) days before the start of any deleading, no matter who is performing the work, and whether it is for full compliance or interim control. BOH OTC Revised 1/05 Page 5 of 8 r The law provides penalties of up to $500 for each day of noncompliance. In addition, you may become liable for civil punitive damages equal to three times any actual damages for failure to comply with this order if a child becomes poisoned. CORRECTION OF VIOLATION BY CODE ENFORCEMENT AGENCY If within the time periods stipulated above this residential property is not brought into full compliance or interim control, this agency may contract with an authorized person or authorized persons to correct the violation(s) and obtain a Letter of Full Deleading Compliance'or a Letter of Interim Control, and bill the owner, or initiate court action to reimburse itself. RIGHT TO A HEARING You may request a hearing pursuant to 105 CMR 460.900 of the Regulations for Lead Poisoning Prevention and Control, in conjunction with the procedures of 105 CMR 400.200(B), the Sanitary Code provision for hearings in emergency public health matters. As already noted,the aforementioned violation constitutes an emergency. (See "Declaration of Emergency" section.) As such, you may request a hearing only if you have complied with this Order. The hearing will be provided within ten days of your request. This agency shall issue a written decision within seven days after the hearing. ' FEDERAL REGULATIONS Some federal financial assistance programs require additional environmental investigation. If you are planning on or have applied for a federal loan program, please contact me as soon as possible in order to discuss further requirements. Please have the name of the loan program and the local agency administering the program when you call. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an,order shall constitute a separate violation. Should you have any quLen garding the above violations, please contact the Town Health Division and ask to speae inspector who performed the inspection. ER O ER _THE OF HEALTH i CHO Director of Public Health Town of Barnstable BOH OTC Revised 1/05 Page 6 of 8 r If your property already has a letter of compliance, you must fill out this form and return it to me within 14 days. Please include copies of ALL your lead- related paper work for this address. I will review the paper work for this address and contact you to schedule a post compliance assessment determination. Upon this review and a site visit, you may be eligible for a 30-day maintenance period, during which you maybe able to fix the. hazards yourself and your letter of compliance remains valid. Failure to return this form to me within 14 days may disqualify you from this option, requiring you to follow all of the rules and timelines outlined in this Order To Correct Violations. Only a CLPPP code enforcement inspector can do the required inspection work for previously complied properties. The inspection and reinspection services are provided for free. Please complete and return this form immediately in order to take full advantage of this 30-day maintenance period. Please print clearly: NAME: DATE: ADDRESS: ZIP CODE TELEPHONE NUMBER: (__) ADDRESS OF THE PROPERTY CITED: ZIP CODE: OCCUPANT(S)NAME: OCCUPANT'S TELEPHONE NUMBER: (_j Please check off which documents you have attached to this form: ❑ Lead Inspection Report ❑ Risk Assessment Report ❑ Letter of Full Initial Inspection Compliance ❑ Letter of Abatement Compliance ❑ Letter of Full Deleading Compliance ❑ Letter of Interim Control ❑ Certificate of Maintained Compliance BOH OTC Revised 1/05 Page 7 of 8 r ❑ Certificate of Restored Compliance. Other: This %s an imporrant. notice_ p'1 --m-.havc.xt translatcd. Este e urn aviE.so imporrante. Que ra ;anda-lei mduzir- Este es un aviso mport m Sir se mandarl traduczr . -DAB` Uk MOT BAN, THONG CAQ QUAN TRON.G XIN VUI LONG CHO DTCH_1`.AI THONG, 0 A' ci e.sc imp ,rrant. 'Veurllez faire traduire. Ls r u n IIPOZOXH, AYTO EINAJ MMANT IKO nAPA :Ah 0, 14IETA PA TE Questo e un 'avviso importance. Si pregadi farlo tradurre: BOH OTC Revised 1/05 Page 8 of 8 T N FORM 30 C&W HOBBS&WARRENIM THE COMMONWEALTH OF MASSACHUSETTS BOARD FHEA H CIT / OWN W DEPARTMENT II V ADDRESS TELEP ONE Address Occupant— Floor Apartment o. No. of Occupant No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming unit No.St• ries_ Name and address wner� 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: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceilin : 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 Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom(1). Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub.- Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n.- General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES PE J FtY." INSPECTOR TITLE 1 DATE O "� �o .M TIME P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 1 f' 410.750: Conditions Deemed.,to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger.or materially impair the health or safety, and well-being of the occupants or the public..Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1). Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The 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 occupanf upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. --sue,.,;f;•,.-_c^Y.;i"v,.r,- �,-+.,...m.......vr.,nr,,,,r'*,-,y.R"...i.;.°i�.`�".�yu+,,.f.r.. o +....s,.,w......-...r=„' M THE COMMONWEALTH OF MASSACHUSETTS FORM 30 C&W HOBRS 8 WARREN BOARD OF HEAL" H CITY/TOWN W E// DEPARTMENT ADDRESS 3 � �� (�-�• TELEP ONE Address '�/` _ Occupan i►1 �f/VV '___' p 1 `Floor Apartment No. No. of Occupants No. of Habitable19ooms No.Sleeping Rooms No.dwelling or rooming unit No.Staries Name and address o weer /� 0 O / Remarks Reg. Vio. YARD Out Bld s.: Fences: , Garbage and Rubbish OA 15 X Containers: r 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: Dam ness)4 Stairs:-'3'Q Li rh*tin 1 r *I STRUCTURE INT. Hall,-Stairway: n e C Obst'n.: " r ., t ,� -t J ilk A r Hall, Floor,Wall,Ceiling: � Hall Lighting: Cl a }+ Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair w-,.j I'-- —r- TYPE: Stacks, Flues,Vents: " PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: # H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 `'' Bedroom 3 Bedroom 4 Hot Water Facil. 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 f a OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND f PENALTIES OF PE J AY." INSPECTOR t TITLE DATE ' TIME t . t.MV i/' t�.J P.M. E A.M.- .: ... THE NEXT SCHEDULED REINSPECTION r' t.::t`�s' "¢ " ' '^ P.M. Al 1 N 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 r impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a{period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The 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. i .a %Citizen Web Request Page 1 of 2 f' S 83. ant fr ., Citizen Request Management - Irate al Use y, FT, Request ID: 26821 Created: 8/24/2009 3:48:34 PM Status: Assigned To Staff Assigned To: O'Connell, Timothy Health Office l Chapter II : Housing Anonymous: No Category: Substandard E.C. Date: 9/8/2009 Created By: Wadlington, Ellen Citations: Health Office Time Worked: 0 Response Time: 0 rs Requestor Details: _..............._..._............_........._.._.....-.._._._...----...------------_.__..__...._.._._.. Email: ................ ................... ............__........_......................._...._.._..__...._._.._...._.__.........._...__._._........_.-._.._..___.....__.---........__........._......--- Request Location: 31 MAIN STREET(COTUIT) Cotuit, Ma 02635 Parcel Number: �p: 009 Block: 017 Lot: 000 _...._._...._._....._...._...._....._.....__.......__....._..._................................_..__....._......................._.........._...._.............._.............._................_.........__...............---........................---- Request: Has a nine (9) month old baby. With the age of house afraid there is lead pain in the house. Request Work History: Internal Note History: System entry on 8/24/2009 3:48:34 PM: Assigned to Cabot, Jaime System entry on 8/24/2009 3:51:32 PM: Assigned to O'Connell,Timothy http://issgl2/intemalwrs/WRequestPn'nt.aspx?ID=26821 8/25/2009 oFIHE r Town of Barnstable Regulatory Services * BARNSfABLE, * Thomas F.Geiler,Director y MASS. 1639'M Public Health Division ArED A'S A Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 26, 2009 Charles Sheehan PO Box 2066 Nantucket, MA 02584 A lead paint determination was conducted at the home you own at 31 Main Street Cotuit, MA. This determination found lead paint in violation of the Lead Law, Massachusetts General Laws, chapter 111, section 197, and the Massachusetts Department of Public Health's (DPH's) Lead Poisoning Prevention and Control Regulations, 105 Code of Massachusetts Regulations (CMR) 460.000. The law requires owners of homes or apartments built before 1978 to have lead paint . violations deleaded for full compliance or brought under interim control when a child under six years old lives there. A private risk assessor has to do a risk assessment and give you a lead inspection/risk assessment report before you can go ahead with interim control. A private lead inspector has to do a comprehensive lead inspection and give you a lead inspection report before you can go ahead with deleading for full compliance. If you already have a Letter of Compliance for this property, please complete the last page of the Order to Correct and send it to me within 14 days. The Order that comes with this letter has important information telling you: • what you have to do • what deadlines to meet • what documents you have to send to this agency • who can do the necessary work • what the penalties are for not meeting the Order's requirements • what your options are if the property has been previously deleaded. Please call me at this office at (508) 862-4646 as soon as possible to discuss this Order and how to meet it. The following information explains the deleading process, if the property has not been deleaded previously. Hiring a Lead Inspector To help you take the first step—getting a full inspection or risk assessment-a list of lead inspectors is enclosed. We recommend that you check references and make sure that the inspector is still licensed. You can check on the license by calling the state Department of Public Health's Childhood Lead Poisoning Prevention Program(CLPPP)before hiring an inspector. To get a list of risk assessors for interim control, call CLPPP's central office at 1-800-532-9571. You can also get other helpful materials from CLPPP, including brochures explaining the BOH Cover Revised 1-05 Page 1 of 3 f • choices of full compliance deleading and interim control. Again, you can get these by calling CLPPP at the number above or by checking our website at www.state.ma.us/dph/clppp. Requirements for Doing Deleading Work High-risk deleading: If you need to or choose to have high-risk deleading work done, such as having lead paint stripped or scraped,you have to hire a deleading contractor. A list of deleading contractors is also enclosed. Just as in the case of inspectors,we recommend you check references and make sure that the deleader is still licensed. You can check on the license by calling the state Division of Occupational Safety (DOS) at 1-800-425-0004. Moderate-risk deleading: Before you or your agent can do moderate-risk deleading work, such as removing windows and woodwork, you have to take a course,pass it and get an authorization number from CLPPP. These courses are given by a number of groups and organizations at various places, times and prices. For a list of approved moderate risk training providers, call CLPPP at 1-800-532-9571 or check our website (address above). Remember that you still have to meet the deadlines in the Order. If a course for owners to do moderate-risk deleading is not available at a convenient time or place for you to meet the deadlines of this Order, you won't be able to do moderate-risk deleading work yourself. You then have to use other methods to delead, or hire a licensed lead-safe renovation contractor.To get a list of these contractors, or to check their licenses, call DOS at 1-800-425-0004. Low-risk deleading: Before you or your agent can do only low-risk deleading work, such as covering surfaces, you have to read the CLPPP low-risk booklet, take a self-corrected exam that you send in to CLPPP, and get an authorization number from CLPPP. If you want to encapsulate, you must first have a full lead inspection done on the property and then contact CLPPP to go over your inspection report and discuss surfaces that maybe good for encapsulation..If encapsulation is a suitable option, you have to read CLPPP's encapsulation booklet,take a self- corrected exam that you send in to CLPPP, and get an authorization number from CLPPP. To get a free copy of the low-risk booklet, or the encapsulation training handbook, call CLPPP at 1- 800-532-9571. Interim control work: If you or your agent will be doing other work for interim control, such as structural repairs and cleaning of leaded dust, you have to take safety steps and clean up in the way described in the CLPPP booklet for interim control. To get a copy of this interim control booklet, call CLPPP at the above number. Deleading work has to be carefully done to be safe. To protect the people who live in the home or apartment, you have to keep them out of the home or apartment, or area being worked on, in these ways: • All people and pets have to be temporarily moved from the home or apartment for the whole time that high- or moderate-risk deleading work is taking place inside the home or apartment. You have to provide the residents with a reasonable alternative place to live for this period. People and pets who have been temporarily moved from their home or apartment can only come back after a licensed private lead inspector or licensed private risk assessor says it is safe for them to return. The inspector or risk assessor does this after reinspecting the home, including taking dust samples to assure that lead dust levels meet approved standards. This reinspection will be done at least three hours after deleading work is all done. B0H Cover Revised 1-05 Page 2 of 3 f • People and pets have to stay out of the work area while you or your agent does most low-risk deleading work or structural repairs or cleaning of lead dust. They also have to stay out of the work area while there's any deleading work in common areas outside the home or apartment, as long as they have another regular way (not a fire escape) to go in and out of the building. In these cases, people and pets can use.the area once the work is done in the area and cleaned up. • People and pets have to stay out of the home or apartment for the workday while you or your agent apply encapsulants with an airless sprayer. They also have to stay out for the day during deleading in common areas when they do not have another regular way(not a fire escape) to go in and out of the building. When people and pets are out of their home or apartment for the day, it means they can come back to the home or apartment after cleanup at the end of the workday, and don't have to be out overnight. All work for deleading and interim control has to be neatly and properly done, in a professional way, and the home or apartment has to be returned to a condition that meets the requirements of the State Sanitary Code. Deleaded surfaces cannot be repainted until after they have passed reinspection by a licensed private lead inspector or risk assessor. You have to give written notice about common area lead paint violations to all other residents of the building. "Notice to Tenants of Lead Paint Hazards" is enclosed for that purpose. You also have to send a copy of the lead inspection report or lead inspection/risk assessment report and any reinspection reports to all mortgagees and lienholders of record. If your property has been previously deleaded, you may be eligible for a 30-day maintenance period. Please fill out the last page of the Order to Correct and return it to me within 14 days to take advantage of this option. If you have questions about the Department of Public Health's Lead Poisoning Prevention'and Control Regulations,you can ask me, or call the CLPPP central office (1-800-532-9571 or 617- 284-8400). If you have questions about the Division of Occupational Safety's (DOS) Deleading Regulations, call the DOS central office (1-800-425-0004 or 617-727-7047). Remember to refer to the attached Order for more information about what you have to do. PER O R F TH BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable BOH Cover Revised 1-05 Page 3 of 3 I Town of Barnstable Regulatory Services RARNSTABLe, Thomas F.Geiler,Director 9 MASS. 1639. public Health Division ArFD PAA'�A Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 26, 2009 Charles Sheehan PO Box 2066 Nantucket, MA 02584 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The-property owned by you located at 31 Main Street, Cotuit,MA was inspected on August 25, 2009 by Timothy O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint. Be advised that certain portions of this residential property to be in violation of the State Sanitary Code;:105 Code of Massachusetts Regulations (CMR)410.750(J). This violation also constitutes a:violation of the Lead Law,Massachusetts General Laws (MGL),chapter 111, section 197, and the ' Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000.If you already have a Letter of Compliance, please look to the last page of this Order and fill out the appropriate information. Conditions exist in this residence that may endanger and/or materially impair the health of the occupants of these premises. DECLARATION OF EMERGENCY The Director of the Massachusetts Department of Public Health Childhood Lead Poisoning Prevention Program declares that the presence of this violation of the Lead Law and the Regulations for Lead Poisoning Prevention and Control constitutes an emergency pursuant to the Lead Law,MGL chapter 111, section 198 and within the meaning of the Sanitary Code, 105 CMR 400.200(B). CORRECTION OF LEAD VIOLATIONS) The Lead Law,MGL c. 111, §§189A-199B, and the Department of Public Health's Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000, require the owner of a residential premises or dwelling unit built before 1978 in which a child under the age of six lives have lead BOH OTC Revised 1/05 Pagel of 8 r paint violations either abated or contained(referred to as "deleading") for full compliance or brought under interim control. The steps that you must follow are in the "Order" section. The Lead Law, the Department of Labor and Workforce Development's Deleading Regulations, 454 CMR 22.00, as well as the Regulations for Lead Poisoning Prevention and Control require that residential deleading work be done by authorized people. The type of authorization will determine the method of deleading that can be done. There are three levels of deleading: High Risk Deleading Only licensed Deleaders can do high risk deleading activities. These activities include scraping, stripping, demolition, and making large amounts of loose paint intact. If this type of work is done on the interior of a unit, then the occupants must be temporarily relocated until the work is complete and has passed a reoccupancy reinspection. Moderate Risk Deleading Moderate risk authorized owners/agents and licensed lead safe renovators can do moderate (and low risk) deleading. These activities include removal and replacement of building components such as windows, and making a small amount of loose paint intact. If this type of work is done on the interior of a unit, then the occupants must be temporarily relocated until the work is complete and has passed a reoccupancy reinspection. Owners interested in becoming trained and authorized to do moderate risk deleading should contact CLPPP for more information. Low Risk Deleading Low risk authorized owners and agents can do some minor deleading activities such-as covering surfaces with approved coverings and encapsulating approved surfaces. Owners interested in becoming trained and authorized to do low risk deleading should contact CLPPP for more information. These rules on who is authorized to perform what kind of deleading work apply whether the work is being done for full compliance or for interim control. An owner or owner's agent may also make structural repairs, as defined in 105 CMR 460.020, and clean leaded dust, as may be required for interim control. ORDER You are hereby ordered to remedy all violations of MGL c. l 11, §197 and 105 CMR 460.000, as identified by a licensed private lead inspector. If you wish to pursue interim control,you must remedy all urgent lead hazards identified by a licensed private risk assessor. Whether you pursue full compliance or interim control, you must correct the relevant violations in accordance with the following schedule: Within sixty (60) days of your receipt of this Order, you must provide proof of the following: 1. A complete analysis of the property for lead hazards. Proof consists of one of the following: BOH OTC Revised 1/05 Page 2 of 8 i • A comprehensive initial lead inspection report done by a licensed private lead inspector. The inspector must inspect the interior of the unit and the common areas of the unit, including the exterior. • A comprehensive initial lead inspection and risk assessment done by a licensed private inspector who is also licensed as a risk assessor. This is only necessary if you have decided to pursue the option of Interim Control. For more information on the Interim Control program, please contact CLPPP. • For previously deleaded properties, a post compliance assessment determination done b p p p p y a CLPPP code enforcement inspector. If you have a previously complied property and failed to return the last page of this Order within 14 days, then you may no longer be eligible for a maintenance period; however, you must still have the assessment done. Only a CLPPP code enforcement inspector can do this assessment. 2. An established deleading plan for who will be deleading and when the work will be done. Proof consists of at least one of the following: • A contract with a licensed deleader, licensed lead-safe renovator, or low risk authorized agent. To check on the license for deleaders and lead safe renovators, contact the Division of Occupational Safety at(617) 727-7047. To check on the authorization for low risk agents, such as vinyl siders or carpet layers, contact CLPPP at 800-532-9571. • If you or your agent will be doing the work, a copy of the authorization letter and a completed"Documentation of Training to be an Authorized Owner/Agent And Intention to Comply with the Order to Correct" form verifying that all work will be done within required timelines (see 90 day and 120 day requirements): This form is included in this package. Contracts with licensed/authorized people as well as an authorized owner or agent's completed"Documentation of Training to be an Authorized Owner/Agent And Intention to Comply with the Order to Correct"must also specify that the unit will meet acceptable lead dust levels under 105 CMR 460.170, as determined by the licensed lead inspector or risk assessor's dust wipe sampling. Should any of the dust samples fail to meet acceptable standards, the last authorized person who performed high- or moderate-risk work will be required to reclean the entire unit until all dust samples meet acceptable levels. If a low or moderate risk authorized person did the deleading and dust samples fail three times, a licensed deleader will be required to reclean the entire unit until all dust samples meet acceptable levels. Within ninety (90) days of your receipt of this Order, you must provide proof that the following work was completed and reinspected (including passing dust wipes if required): 1. All high and moderate risk deleading on the interior of the unit must be done and must have passed reinspection, including dust wipes. BOH OTC Revised 1/05 Page 3 of 8 I Please note that if high or moderate risk activities will be done on the interior, then encapsulation cannot be done until after all of this high and moderate risk work has been reinspected and passed dust wipes. 2. Removal and replacement of doors, if chosen as the method of deleading, must be done and have passed reinspection. 3. Loose surfaces in the interior of the unit must have been made intact by the appropriately authorized person, been covered, or otherwise deleaded and reinspected. This includes loose surfaces being prepared for encapsulation (but DO NOT encapsulate these surfaces until after a successful reoccupancy reinspection). Making paint intact on the interior of a unit requires dust wipes at the reinspection. There cannot be any loose paint in the unit by the ninetieth day. 4. For those owners pursuing the Interim Control.option, rules 1- 3 still apply; however only "urgent" lead hazards are required to be corrected. In addition, all required safeguards and structural repairs relevant to the interior of the unit must be complete and have passed reinspection and dust wipes, if required. Proof of this work consists of a copy of a reinspection report from a licensed lead inspector or risk assessor and copies of passing dust wipe results, if dust^wipes were required Copies of these documents must be provided to this agency by the 90th day. Within one hundred and twenty (120) days of your receipt of this Order, you must provide proof that the following work was completed and reinspected (including passing dust wipes if required): 1. Any low risk activities on the interior of the unit that were not done by the 90th day deadline must be complete. This includes encapsulation of interior surfaces that were.previously made intact. 2. All required deleading in the interior common areas and on the exterior is done and has been reinspected, including passing dust wipes if they were required. 3. For those owners pursuing the Interim Control option, all of the "urgent" lead hazards must be corrected on the interior, common areas, and the exterior. Also, all required;safeguards and structural repairs relevant to the interior common areas and the exterior must be complete and have passed reinspection. For Interim Control, a final set of dust wipes is required to be taken at the final reinspection. Proof of this work consists of a copy of a reinspection report from a licensed lead inspector or risk assessor, copies of passing dust wipe results, and a copy of a compliance document. Copies of these documents must be provided to this agency by the 120th day. PROSECUTION AND CIVIL PUNITIVE DAMAGES Failure to comply with any of the deadlines set out above will require this agency to initiate criminal or civil proceedings against you within seven(7)business days. Compliance with this Order will be determined by this agency's receipt of the appropriate documents within the BOH OTC Revised 1/05 Page 4 of 8 specified deadlines. Documents should be sent to my attention at 200 Main Street Hyannis,MA 02601. Inspection documents required by the 60th day deadline. One of the following: ❑ Initial Lead Inspection report by a licensed private lead inspector; ❑ Inspection report and risk assessment report by a licensed private risk assessor; ❑ Post Compliance Assessment Determination done by a CLPPP code enforcement inspector. Deleading documents required by the 60th day deadline. At least one of the following, although there may be a combination of documents: ❑ A contract with a licensed deleader, licensed lead-safe renovator, or low risk authorized agent; ❑ A copy of an owner/agent authorization letter from CLPPP and a completed "Documentation of Training to be an Authorized Owner/Agent And Intention to Comply with the Order to Correct;" o If you or your agent will only be doing structural repairs and lead-dust cleaning for interim control, a signed written statement attesting that this work will be completed in accordance with the required timelines. Documents required by the 90th day deadline: ❑ A Letter of Lead Paint (Re)occupancy (Re)inspection Certification issued by a licensed lead inspector or risk assessor, in cases where high or moderate-risk deleading work occurred, requiring occupants to be relocated from the unit for the duration of the work; ❑ Copies of results of all dust samples taken by the licensed lead inspector or risk assessor, and copies of all reinspection report(s) issued by a licensed lead inspector or licensed risk assessor; Documents required by the 120th day deadline. Only one of the following: ❑ A Letter of Full Deleading Compliance issued by a licensed private lead inspector. ❑ A Letter of Interim Control issued by a licensed private risk assessor. ❑ For previously deleaded properties, a Certification of Restored Compliance (an addendum to the original letter of compliance) issued by a CLPPP code enforcement inspector. A copy of the deleading notification(s) must be sent to this agency at least ten (10) days before the start of any deleading,no matter who is performing the work, and whether it is for full compliance or interim control. BOH OTC Revised 1/05 Page 5 of 8 I The law provides penalties of up to $500 for each day of noncompliance. In addition,you may become liable for civil punitive damages equal to three times any actual damages for failure to comply with this order if a child becomes poisoned. CORRECTION OF VIOLATION BY CODE ENFORCEMENT AGENCY If within the time periods stipulated above this residential property is not brought into full compliance or interim control, this agency may contract with an authorized person or authorized persons to correct the violation(s) and obtain a Letter of Full Deleading Compliance or a Letter of Interim Control, and bill the owner, or initiate court action to reimburse itself RIGHT TO A HEARING You may request a hearing pursuant to 105 CMR 460.900 of the Regulations for Lead Poisoning Prevention and Control, in conjunction with the procedures of 105 CMR 400.200(B), the Sanitary Code provision for hearings in emergency public health matters. As already noted, the aforementioned violation constitutes an emergency. (See"Declaration of Emergency" section.) As such, you may request a hearing only if you have complied with this Order. The hearing will be provided within ten days of your request. This agency shall issue a written decision within seven days after the hearing. ' FEDERAL REGULATIONS Some federal financial assistance programs require additional environmental investigation. If you are planning on or have applied for a federal loan program,please contact me as soon as possible in order to discuss further requirements. Please have the name of the loan program and the local agency administering the program when you call. 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. a ze , S., garding the above violations,please contact the Town Health inspector who performed the inspection. OF HEALTH Director of Public Health Town of Barnstable BOH OTC Revised 1/05 Page 6 of 8 l I If your property already has a letter of compliance, you must fill out this form and return it to me within 14 days. Please include copies of ALL your lead- related paper work for this address. I will review the paper work for this address and contact you to schedule a post compliance assessment determination. Upon this review and a site visit, you may be eligible for a 30-day maintenance period, during which you may be able to fix the hazards yourself and your letter of compliance remains valid. Failure to return this form to me within 14 days may disqualify you from this option, requiring you to follow all of the rules and timelines outlined in this Order To Correct Violations. Only a CLPPP code enforcement inspector can do the required inspection work for previously complied properties. The inspection and reinspection services are provided for free. Please complete and return this form immediately in order to take full advantage of this 30-day maintenance period. Please print clearly: NAME: DATE: . ADDRESS: ZIP CODE TELEPHONE NUMBER: ( ) ADDRESS OF THE PROPERTY CITED: ZIP CODE: OCCUPANT(S)NAME: OCCUPANT'S TELEPHONE NUMBER: O Please check off which documents you have attached to this form: ❑ Lead Inspection Report ❑ Risk Assessment Report ❑ Letter of Full Initial Inspection Compliance ❑ Letter of Abatement Compliance ❑ Letter of Full Deleading Compliance ❑ Letter of Interim Control ❑ Certificate of Maintained Compliance BOH OTC Revised 1/05 Page 7 of 8 ❑ Certificate of Restored Compliance Other: This is an impormnt notice. Pi se.have -ir. Translated. Este e um aviso irnpor-can.te. Queim manda-lo mduzir_ Este es un aviso importmte. Sirvase mandarl.o r ducir. -DAY LA MOT BAN THONG CAC? Q 3AN TRONG X N VUI LONG CHO DICH LAI `MONG CAO A"Y� ci esr important. Vcuiilez fa ire traduire. * -_"f J)�2 4 L * T.* soNV4* NW1�5w Mjils IIITim t is S , , TIP02OXH, 1 1 1 O EINAI Y-HMC NTIKO. TIA AKAAt1 1! ETA4)A (" ITE Questo e un "avviso importante. Si pregadi farlo tradurre. BOH OTC Revised I/05 Page 8 of 8 UMass �� - Dartmouth LEAD ABATEMENT FINANCING PROGRAM November 3, 2009 To Whom It May Concern, This letter is to confirm that Mr. Charles.Sheehan, the owner of property at 31 Main Street, Cotuit, Massachusetts, has submitted an application for financial assistance to the UMass Dartmouth Lead Abatement Financing Program, to help pay for lead paint abatement at 31 Main Street, Cotuit, Massachusetts. Mr. Sheehan's application for financial assistance is currently being processed by UMass Dartmouth. Mr. Sheehan is making a good faith effort to identify ways to pay for deleading at 31 Main Street, Cotuit, Massachusetts. Sincerely, Carmen Maiocco Program Director tjLj ; Lead Abatement Financing Program ■ www.umassd.edu University of Massachusetts Dartmouth ■ 4 Park Place ■ New Bedford ■ MA 02740 Ph: 508.993.4918 ■ Fax: 508.99,7.2173 ' Department of Public Health Childhood Lead Poisoning Prevention Program i Deleading Notification Please complete all sections of this form clearly.Incomplete or illegible forms will be returned. � P M aq 0C/ Lead Paint Insp ector pector``AA"Q9qQTa_ License# Inspection<,Date Property Owner Property Owner's Address 31 M R , t`1. � - � �}- Zip Code 0.),fQr Authorized person performing work: aka r ES l 1 1 : p p P g Q r �i�l Lic#/Auth.# �j M Address of authorized person �j� . M P} j N) !i, a C:My k T Zip Code 6a- ( Telephone Number(pg�) g L(l,, ( h`-5 Z Address where the work will be done: Building Name(if an Floor ' Street Address_ e �:�1 1N -. Apt No. City '.gq Lj Zip Code D2.:W The property is a multi-family- single family. Deleadine Method(s): o Making paint intact(high risk) G✓Making paint intact(moderate ❑ Applying vinyl siding on exterior ❑ Demolition risk) 0/Component removal (low risk ❑ Scraping ❑ Liquid encapsulant components) cif -omponent removal/replacement Covering ❑ Other: V Dippmig ❑ Capping baseboards The work will begin on) 1/4/hand will finish by4A 1 /&The work will be done in the ✓am✓m or + weekends. In Case of Emergency Contact C , , Daytime Phone Evening Phone i The Property Owner must complete and sign the following information:: , I certify that only authorized persons who have complied with the training requirements of the Massachusetts Lead Poisoning Prevention and.Control Regulations, 105 CMR 460.000,will conduct deleading work.I further certify'thatthe authorized person(s)will not exceed the scope of his/her authority and will be performing only those activities indicated above.All of the information contained in this document is true and correct to the best in ledge and belief. Date!jo U- t Signed _ The following peopletagencies must be notified ten days before beginning work: I. Occupants of the dwelling unit 2. All other occupants of the residential premises,if any work will be done in the common areas 3. Childhood Lead Poisoning Prevention Program,DPH Fax(781)774-6700 MWRHO 5 Randolph Street, Canton,MA 02021 4. Asbestos and Lead Program, DOS 19 Stanford St, 1s`Floor,Boston,MA 02114 Fax(617) 626-6965 50 Local Board of Health/Code Enforcement Agency IW If the home is on the State Register of Historic Places,call the MA Historical Commission at(617)727-8470. TOWN OF BARNSTABLE /�, LOCATIO SEWAGE #266 I V� VILLAGE ASSESSOR'S MAR & LOT — INSTALLER'S NAME&PHONE NOR I: SEAA1Z 3&MITY� 0 LEACHING FACILITY: (typ� ��=� (size) 50" x 2—' 2 NO. OF BEDROOMS BUILDER OR OWNS PERMITDATE: �. COMPLIANCE DATE: ( b Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Z Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) )VA. Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) MA Feet Furnished by R,3 6eJ e/-A-CQ ee A (%6u 5-MA,C--770kf 4 t 6 4 4:3 0 NO. E COMMONWEALTH OF MASSACHUSETTS i FEE Oro BOARD OF HEALTH APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair (---Upgrade ( ) Abandon`( ) - ❑Complete System ❑Individual Components .3/ Loca MR� 9/CAI'on OwnLs6�/ Map/Pare!# Address Lot# ��.lephon # b eu�/a c 9 cc S c-c� vrJ J o C�i '�i�n I er's Name igner's Name dress Address 44!a+99 1_3B5 )Z3L/ Telephone# Telephone# Type of Building: IS/ Lot Size /00 Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building s/�j /�No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) gpd Calculated design flow XCIO gpd Design flow provided V51&gpd Plan: Date -/ ��/ Number of sh ets Z Revisioq Date Title m vo J / -� � / iork Description of Soil(s) b�-� D-bs• A/V �A ��- /)/e41— Soil Evaluator Form No. Name of Soil Evaluator �ate of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS '5E'� The undersigned agrees to install the above, iv ual Sewa osal ystem in accordance with the provisions of TITLE 5 and further es not to ace the sys m,o 'rahb a Certi to Complies ce has been issued by the Board of Health. Signed ate SPA V V /fR FORM 1 - APPLICATION FOR DSCP 86 APPROVED FORM 5/96 r ,,,.. _ � ---' 1 _:f'�,;.,'f �t >�,��•� •-- ��' l l' 1, - . No. tt THE COMMONWEALTH OF MASSACHUSETTS Fee BOARD OF HEALTH OF APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair (4rUpgrade ( ) Abandon ( ) - ❑Complete System ❑Individual Components 3`/ Jilin/ SJ' ng/b,".f Location Ownera e Map/Par I# Address � . T. feu!/�c'9u�' bS -(� . yfJ �Ayotlr �>»y In6aller's Name tsig ner's Name �,sa pia h or4Ja y / Za I d 40r4e �- -*.;„ i w ress Address Telephone# Telephone# Type of Building: Lot Size /0,P /f , Sq.feet ' Dwelling—No.of Bedrooms _ Garbage Grinder ( ) Other—Type of Building No.of persons -' Showers ( ),'"'Cafeteria ( ) ' Other,fixtures, Design AFlow(min.required) gpd Calculated'desi n flow ey0 gpd Design flow provided '/u&gpd l_ Plan: Date'"'�-16" Number of sh_qets 1 Revision Date Title b4tiu .kg ,t�/sD/emu /. tLr��u2 G / /�lo/vjr� Sl" C.�i�yi/ Ike,,.. Description of Soil(s) ' 'Soil Evaluator Form No. Name of Soil Evaluator hri`®ate of Evaluation'"& c/ DESCRIPTION OF REPAIRS OR ALTERATIONS 1� ' l ,$Ir -a! r The undersigned,agrees to install the above described Individual S wage,15 osaI System in accordance with the provisions of TITLE 5 and further agrees not to p ace the sys m`in operation until I a Certifi�6'te d Complia&e has been issued by the Board of Health. J Signed � '� Date i � ,.a •% ` .,,.•Inspec ' ]YS J �' fi . � . r?f FORM 1 - APPLICATION FOR DSCP �R-DERAPPI�G VED FORM 5/96 -- ————� No. 24 \ �, THE COMMONWEALTH OF MASSACHUSETTS,- FEE ti DrIl irP_s-to-� b2-- BOARD OF HEALTH-- ' CERTIFICATE OF COMPLIANCE r Description of Work: ❑ Individual Component(s) ❑Complete System The undersi ned hereby certify that the Sew. e Disposal System;Constructed( ),Repaired�,Upgraded( ),Abandoned b ( ) y 1 (>✓ (J/J I at 31 f t�L a l yi 5--f" �` u.t + t has been installed in accordance with the o isions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application NoAA� 1K Approved Design Flow W® (gpd) Installer R . �. d, C. be a /J 1 Designer: _Pkt t 0 ST�` 'C Inspector n,,` - 9`�Date t The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No y —Z THE COMMONWEALTH OF MASSACHUSETTS FEE 60 2Akm"OARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair (,,) f Upgrade ( ) Abandon ( ) an individual sewage disposal system at 31 VVt to V" ,y as described in the application for Disposal System Construction Permit No. �Tr�.{�J `7 dated v Provided: Construction shall bye completed within three years of the date of this loca conditions must be met. Date A I 1 Board of Health �Jl t FORM 2 - DSCP`. DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBSB WARREN TM PUBLISHERS- BOSTON Town of Barnstable Regulatory Services Thomas F. Geiler,Director ib39' Public Health Division '°IEDMA�� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 664. Designer: �1�/ � G(�G� �� Installer: f Address: Address: o2V4 On _2/- PJV)0 6 as issued a permit to install a . (date) (instal r) septic system aVnj-jobased on a design drawn by (address) d signer) certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the s 'c system)but in accordance with State &Local Regulations. Plan revision or ce as-built by designer to follow. (Installer's Signature) �. . SPAT* Pionat Eta (Desi is Si afore) (Affix Desi p Here) PLEASE RETURN TO BARNSTABLE-PUBLIC�HEALTH DIVISION. CERTIFICATE OF COMPLIANCE. WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Desiper Certification Form TOWN OF BARNSTABLE 26 LOCATIO SEWAGE # C ASSESSOR'S & LOT j VILLAGE _ INSTALLER'S NAME&PHONE NO�° SEPTIC TA K CAPACITY_ P LEACHING FACILITY:, 041 rcn size ix 22 NO.OF BEDROiN BUILDER OR OTT ' PERMIT COMPLIANCE DATE: Separation Distance Between the: r Z� Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Alk Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist N.A Feet within 300 feet of leaching facility) Furnished by R-'3 0e J t Z�'CQ a- A O-eV—Sc"i�C 2O•<<- — Ho BI 6 3_53,z„ k -4�11 -lOq' -7 A S ?` A.M.Wilson Associates Inc. FAX NUMBER ( 508 ) 420 - 9795 �C FACSIMILE TRANSMITTAL SHEET TO: ` FROM: 't0 10 P.A—,U"i.: I �a7lL C,�LLS�RC COMPANY: DATE: t3PC2-elf s 7 c FAX NUMBER: TOTAL NO.dF PAVES INCLUDING COVER: Z ❑ URGENT AFOR REVIEW ❑ PLEASE COMMENT ❑ PLEASE REPLY NOTES/COMMENTS: 67 31 Ike A C� C 77 StTc. fks f,�cLC `c�1c��2� 3 �r� S .F& 05W A 5 Pt '3t ���� D-/2 1 c� ice© s&-S c9 1 Tl-C &5 i i ✓h�'�i 6—Ft Ar t i a+ -310 0 4,4-2- i 0QA , IF COMPLETE DOCUMENTATION IS NOT RECEIVED, PLEASE CONTACT US AT(508)420-9792 �(C 20 Rascally Rabbit Rd. Unit 3 508 420-9792 Marstons Mills, MA 02648 cno non n170c CL CL DEN DINING'ROOM BEDROOM BEDROOM BATH CL KITCHEN SITTING ROOM CL CL BATH FOYER �W7/D UNFINISHED LV LIVING ROOM ATTIC BEDROOM: SUMMER KITCHEN first Floor Scale:1"= 11, Second Floor 0 5 10' Existing Floor Plan 3 Rain Street -� A. k Wilson'Associates Inc. COtUIt MA Date: June 17, 2004 20 Rascally Rabbit Road,Marston .Mile,NA M-420-9792 � y JUN-23-2004 14:36 A.M.WILSON ASSOCIATES 5084209795 P.01 0001 A.M.Wilson Associates Inc. FAX NUMBER ( 508 ) 420 - 9795 �k tiiP9 "�®l.Oq FACSIMILE TRANSMITTAL SHEET TO: \ FROM: �Ou �A ✓11[OEfI-itl D 1 CL'7l[.6 LJ[�_Sdu COMPANY: DATE: V—/ PAX NUMECR: TOTAL NO.dF PAC?Lq INCLUDING COVSR: ❑URGENT FOR REVIEW ❑ PLEASE COMMENT ❑ PLEASE REPLY - N OTFS/COMMENTS: -4 - dd-A-r q �.. i (-7 Ak rF C,c ma'scam=_ 4�! t V lA s t_c:1 Cyr. e:'--s T GD Qc_ _ Scram A S au 1,jcL� 5� c�t �eF- fir:' 3 ��ks►-1 s dAd `i�-f �.+�t� T-t�o ICE au C:-7— '1 a IF COWLETE DOCUMENTATION IS NOT RECEIVED, PLEASE CONTACT US AT(508)420-9792 20 Rascally Rabbit Rd. Unit 3 508 420-9792 Marstons Mills, MA 02648 cno non n7n< JUN-23-2004 14:36 A.M.WILSON ASSOCIATES 5084209795 P.03 �A 'loQ • A.M.Wilson Associates Inc. LETTER OF TRANSMITTAL, TO: DATE: FILE NO.: RE: We are sending you the following item(s): Copies Date Description _ COMMENTS: 1 A ( 7 n 17 S r/V C's Please do not hesitate to call US With any questions. If enclosures are not as noted, kindly notify US at once. Signed: 20 Rascally Rabbit Rd, Unit 3 508 420-9792 Marstons Mills,MA 0264R vt,ojo30 - a�-� COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Govemor Commiss' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ^ 8 PART A CERTIFICATION Property Address: 31 MAIN ST. COTUIT Name of Owner n/a l Address of Owner: Charles Sheehanr� 8 ry99 Date of Inspection: 1/26/99 Name of Inspector:(Please Print)John Graci _� N I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: John Graci Title V Septic Inspection 7s r Mailing Address: P.O.Box 2119 TeaTicket,Ma.02636 Telephone Number: (608)564-6813 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: _ Passes X Conditionally Pa ses _ Needs Further val ation By the Local Approving Authority _ Fails q� Inspector's Signature: j '/' Date:1/26/99 The System Inspector shall submit 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 and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM CONDITIONALLY PASSES INSPECTION.THE SYSTEM CONSISTS OF ONE SYSTEM WHICH IS TWO CESSPOOLS,ONE 515' CESSPOOL FUNCTIONING AS A SEPTIC TANK,CONNECTED TO A 616'PIT.THIS SYSTEM PASSES,THE PIT HAS NOT HAD MORE THAN 2'OF WATER IN IT.THE SECOND SYSTEM CONSISTS OF A SINGLE CESSPOOL,WHICH IS IN HYDRAULIC FAILURE.THE LIQUID LEVEL IS FULL OVER THE PIPE. WHAT IS PIPED INTO SYSTEM TWO MUST BE REPIPED TO SYSTEM ONE TO PASS TITLE V REQUIREMENTS. i� revised 9/2/98 Page 1 of 11 r a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 31 MAIN ST.COTUIT Owner: n/a Date of Inspection:1/25199 INSPECTION SUMMARY: Check A, B, C, o/D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: , n/a B. SYSTEM CONDITIONALLY PASSES: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. NQ 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). brokenpipe(s)are replaced _ P obstruction is removed distribution box is levelled or replaced NI2 The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _ broken pipe(s)are replaced obstruction is removed revised 9/2198 Page 2 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 31 MAIN ST.COTUIT Owner: n/a Date of Inspection:1/25/99 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nla-(approximation not valid). 3) OTHER nta revised 9/2/98 Page 3 of 11 L f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 31 MAIN ST.COTUIT Owner: n/a Date of Inspection:1/26/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: X 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 X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped nfa. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, 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 X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 31 MAIN ST.COTUIT Owner: n/a Date of Inspection:1/25199 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste Flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 S S CIO O SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION N M F R PART C SYSTEM INFORMATION Property Address: 31 MAIN ST.COTUIT Owner: n/a Date of Inspection:1/26/99 FLOW CONDITIONS RESIDENTIAL: Design flow: .g.p.d./bedroom ��3o c3 Number of bedrooms(design): 3 Number of bedrooms(actual):nLa Total DESIGN flow: 3 Cy6's Number of current residents:2 Garbage grinder(yes or no):MQ Laundry(separate system)(yes or no): MQ If yes,separate inspection required Laundry system inspected(yes or no):M Seasonal use(yes or no):JM Water meter readings,if available(last two year's usage(gpd): n& Sump Pump(yes or no): MQ Last date of occupancy: n& COMMERCIAL/INDUSTRIAL Type of establishment: n& Design flow: n&gpd(Based on 15.203) Basis of design flow: n& Grease trap present:(yes or no):AQ Industrial Waste Holding Tank present:(yes or no): Na Non-sanitary waste discharged to the Title 5 system:(yes or no):MQ Water meter readings.if available:n& Last date of occupancy: n& OTHER: (Describe) nLa Last date of occupancy: n& GENERAL INFORMATION PUMPING RECORDS and source of information: System was last pumped in Dec.98 System pumped as part of inspection:(yes or no):MQ If yes,volume pumped nta_ gallons Reason for pumping: nLa TYPE OF SYSTEM X Septic tank/distribution boxisoil absorption system X Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: n& APPROXIMATE AGE of all components,date installed(if known)and source of information: System is 35+years old. Sewage odors detected when arriving at the site:(yes or no): MQ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 MAIN ST.COTUIT Owner: n/a Date of Inspection:1/25/99 BUILDING SEWER: (Locate on site plan) Depth below grade: V Material of construction:_ cast iron _40 PVC X other(explain) Distance from private water supply well or suction line: TOWN Diameter: nta Comments: (condition of joints,venting,evidence of leakage,etc.) nLa SEPTIC TANK: X (locate on site plan) Depth below grade: I EVI F Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) nLa If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NQ nta Dimensions: 5'X5'BLOCK CESSPOOL Sludge depth: Z Distance from top of sludge to bottom of outlet tee or baffle: 3z Scum thickness: Distance from top of scum to top of outlet tee or baffle:_6" Distance from bottom of scum to bottom of outlet tee or baffle: 1L How dimensions were determined: MEASURED 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.) MAIN CESSPOOL AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING YSTEM EVERY YEAR GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) DIA Dimensions: nta Scum thickness: n& Distance from top of scum to top of outlet tee or baffle:jVa Distance from bottom of scum to bottom of outlet tee or baffle nLa Date of last pumping: nta 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.) n(a revised 9/2/98 Page 7 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 MAIN ST.COTUIT Owner: n/a Date of Inspection:1/26/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n& Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) nLa Dimensions: n/a Capacity: nta gallons Design flow: nLa gallons/day Alarm present: NQ Alarm level:-n&- Alarm in working order:Yes_No_: NQ Date of previous pumping: n& Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nta DISTRIBUTION BOX: _ (locate on site plan) Depth of liquid level above outlet invert:nta Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) ElLa PUMP CHAMBER: NO (locate on site plan) Pumps in working order:(Yes or No): NQ Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) nLa revised 9/2198 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 MAIN ST.COTUIT Owner: n/a Date of Inspection:1/26/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: nLa Type: leaching pits,number: Wa leaching chambers,number: -nia leaching galleries,number: jiLa leaching trenches,number,length: nLa leaching fields,number,dimensions: Wa overflow cesspool,number: 6'X6'BLOCK CESSPOOL Alternative system: Wa Name of Technology: jVA Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY PIT HAD 2'IN IT AT THE TIME OF THE INSPECTION HAS NOT HAD MORE T CESSPOOLS: X (locate on site plan) Number and configuration: ORE Depth-top of liquid to inlet invert: OVER Depth of solids layer: nLa Depth of scum layer. nla Dimensions of cesspool: Wa Materials of construction: R1 OCK Indication of groundwater: nLa inflow(cesspool must be pumped as part of inspection)nLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) CESSPOOL IS PAST THE EFFECTIVE DEPTH OF LEACHING,CESSPOOL WAS FULL OVER PIPE AND IN HYDRAULIC FAILURE PRIVY: _ (locate on site plan) Materials of construction:Wa Dimensions:nLa Depth of solids: Wa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) WA revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 MAIN ST.COTUIT Owner: n/a Date of Inspection:1/25/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 MAIN ST.COTUIT Owner: n/a Date of Inspection:1/25/99 NRCS Report name: Wa Soil Type: n& Typical depth to groundwater: nLa USGS Date website visited: Wa Observation Wells checked: NQ Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record X Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS revised 9/2/98 Page 11 of 11 TOWN OF BARNSTABLE LGCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. i SEPTIC TANK CAPACTTXS< C:Q�SjQ©a� LEACHING FACILITY: (ty` ) �'XC� US52m¢size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: C ATE Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) „�— Feet Furnished by u Y 1 .. {. Y 4� 5 f• i ' r+ e .y Z 903 499 074 ,US PostaaService 'Receipt for Certified Mail No Insurance Coverage Provided. Do not Usefor Intemational Mail See reverse Sent to 77, er` Frost 99 e, e Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee U) Return Receipt Showing to Whom&Date Delivered Return Receipt Showing to Whom, Date,&Addressee's Address 0 TOTAL Postage&Fees $ 77 COPostmark or Date 0 LL a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return 0 address leaving the receipt attached, and present the article at a post office service y window or hand it to your rural carrier(no extra charge). m V 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the, Q) cc I return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address � on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of articib n RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. , M 5. Enter fees for the services requested in the appropriate spaces on the front of this t receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. to C� 6. Save this receipt and present it if you make an inquiry. 102595-97-B-OJ45 4 d f s , oFINETp Town of Barnstable O� �sene[.s, Department of Health, Safety, and Environmental Services 9� ' ,.�' Public Health Division A'ED�AP�A P.O. Box 534, Hyannis MA 02601 Office: 508-8624644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health November 10,, 1998 Mr. Steven Agoston P.O. Box 1770 Cotuit, MA 02635 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V:- MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE, AND 105 CMR 410.00 STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR , HUMAN HABITATION. The property owned by you located at 31 Main Street, Santuit, listed as Parcel 017 on Assessor's Map 009 was inspected on October 27, 1998, by Jerome Dunning, Health Inspector for the Town of Barnstable, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code II -Minimum Standards of Fitness for Human Habitation was observed: REGULATION 310 CMR 15.02 (207) AND 105 CMR 410.300• Overflowing sewage onto the ground. This violation is a serious public health hazard. 1) You are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four(24) hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. 3) You are further directed to contact and hire a licensed Disposal Works Installer within seven (7) days of receipt of this letter in order to repair this system or connect to town sewer. You may request a hearing before the Board of Health if written petition requesting same is received within seven (7) days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER Oy THE BOARD OF HEALTH <70A62;��_ TTIUffias A. McKean Director of Public Health r Health Complaints 13-Nov-98 Time: 11:00:00 AM Date: 10/27/98 Complaint Number: 1605 Referred To: JEROME DUNNING Taken By: LS Complaint Type: TITLE V SEWAGE Article X Detail: Business Name: Number: 31 Street: MAIN STREET Village: COTUIT Assessors Map_Parcel: Complaint Description: SEWAGE BACKING UP INTO 2 BATHROOMS AND INTO KITCHEN SINK SINCE END OF SEPTEMBER. IT IS COMING UP FROM GROUND ALSO. RENTER CANNOT GET A HOLD OF OWNER OF PROPERTY AND SHE HAS NO WHERE TO GO. Actions Taken/Results: Investigation Date: Investigation Time: PAR ] 'Real Estate System - General Property Inquiry] Help [ ] Parcel Id: 009 017- - Account No: 2302 Parent: Location: 31 MAIN ST SANTUIT Neighborhood: 06AB Fire Dist: CT Devel Lot: Lot Size: 5.00 Acres Current Own: AGOSTON, STEVEN J State Class: 101 PO BOX 1770 No. Bldgs: 1 Area: 2166 Year Added: COTUIT MA 2635 Deed Date: 020192 Reference: 7867/271 January 1st: AGOSTON, STEVEN J Deed MMDD: 0292 Deed Ref: 7867/271 Comments: Values: Land: 98200 Buildings: 64000 Extra Features: Road System: 31 Index: 951 (MAIN STREET (COTUIT) ) Frntg: 180 Index: ( ) Frntg: Control Info: Last Auto Upd: 050695 Status: C Last TACS Update: 010693 Land Reviewed By: Date: 0000 B1dgs Reviewed By: Date: 0000 Tax Title: Account: Taken: Account Status: Hold Status: Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name Parcel Number [009] [018] [ ] [ ] [ ] .21. J,{..e.. 4 , Ze, F r 1 4l j Health Complaints 12-Nov-98 Time: 11:00:00 AM Date: 10/27/98 Complaint Number: 1605 Referred To: JEROME DUNNING Taken By: LS Complaint Type: TITLE V SEWAGE Article X Detail: Business Name: Number: 31 Street: MAIN STREET Village: COTUIT Assessors Map_Parcel: Complaint Description: SEWAGE BACKING UP INTO 2 BATHROOMS AND INTO KITCHEN SINK SINCE END OF SEPTEMBER. IT IS COMING UP FROM GROUND ALSO. RENTER CANNOT GET A HOLD OF OWNER OF PROPERTY AND SHE HAS NO WHERE TO GO. Actions Taken/Results: Investigation Date: Investigation Time: 1 3 SENDER: I also wish to receive the � ■Complete items 1 and/or 2 for additional services. Z ■Complete items 3,4a,and 4b. following services(for an 4) ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. ai ■Attach this forth to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address 2 ;! permit. d y ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery fA ■The Return Receipt will show to whom the article was delivered and the date a C delivered. Consult postmaster for fee. 0 v 3.Arti ddressed to: 4a.Article Number d E 4b.Service Type ❑ Registered 4V Certified 7- l`7��- ' ❑ Express Mail ❑ Insured S c 0-Return Receipt for Merchandise [I COD /� o �' a 7.Date of Deliveb w zJ f . /f3 9p 0 p 5.Received By:(Print Name) Addressee's Address(Only if requested and fee is paid) F 6.Sig=redress a orAg t' C�$ 0 rn PS Form 3811,Te-cember 1994 t( *102595-97-B-0179 Domestic Return Receipt UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 C Print your name, address, and ZIP Code in this box O PublIC H8311h Division , 'down of Bamstabie P0.Box 534 if{ I,11111114„ ���lii1����1�1�,�11,�{:►1<<Il+ri�J��l�ll BETHEL ANIMAL CLINIC STEVEN J. AGOSTON, O.D., D.V.M. 43 Dr.Duggan Road Bethel, New York 12720 (914)583-4117 12,of Ke (I 1 L ev,,iolleJ' io A� I re— r v�tnr` �� kc Vl S e q �k/ c I mollc�^ � s a �( �e.��n Se ased p 1��j-4 tiera We- 40 w1 foe Ow~{,J/s ('�✓1 s e�� Is( vl C�✓� 5 Lead,inspection J Risk Assessment Report Panther Lead Painnnspections page Of�� 969 Washington Street . Braintree,MA 02184 781-849-7313 Address Al L- 31 Main St s City Zrp Code r Cow Owner Name: Charles'Sheehm Hof P.M MS in Unrt, L ftloOwner Address: PO BOX 2066 G T YPIK FamRy Contact Information: NWW--et hAA 0' " ON Famlyr #Unb— Client Name Of different from owned: C�Om6s�n_ 4 Client Address: my care onw. i Key- LeadCdwm Key., D—dew PC d COMM: C Cowered Cqped SCR , d laundry in Bait? Ybs or .V8 Ba�osrd 11COV C p R Find in Baselrls�n.7 Yes or VR Voryl Rep. 1MR Mew RePL WMdM A�lam REP Teams Me lam: MA MA e i . PreAar MRep REV Reversed {�$ �,1�e OftO No Coaft �ipt+!!�t R� r Rd'L k�tt ® Stern Frame Reid Xo Tile Tile fteft WMFSW t Does ro#ExM Modd,RNM aft d 1462 DC Dropped Ceft rio7illr 1Notes. ter#-PiS iS the krM kMirQ sd "f - 7— 111 1 . C b ----------------- • 1 I • ° II . I I I I 1 • ' . , I, ° 1 e - , ; ; -- -- -- - c } - - - - - ---'--J---=---�-- --_--- --J---=---�-- --1--- J - /1`,• • Q - - -- ___t__J___t___C__ __1___C__J___1___l__ - • 1 , 1 r-- --r---r--r--r--- .--i---a--r--' p 1 1 1 1 1 I ( ) t kern 'A meet.tel Stert er Pb.(least)equal to or greater than 1.0 MWCM2 with x-ra fluorescence or positive with Na2S is Dangerous. XRF Calibration Recorded in Log Book `� ✓ -Ched ofif.when complete Address verified through USPS. ✓. -Check off when co Research on Lead-Related Historyfor Address ✓ _mplete -Check off when compete Inspector Name Anthony Jakaids Lic#M jW Signature Date SM09 LYRA rev 1UQS r L 4 4 l . E , } ADDRESS: 3I Main St.,Cotuit,MA 02635 Page 2 ofm INSPECTION HISTORY INTERIM CONTROL Imination y inspector ;.,J�r Rom`n wessment N RA N�: .Lf�# MDead Hazards? U , [NJ 6nspttor Nam Mthomr Inin�rrru�si an y —�LW ff 2W Dust TakenRim P RA Mmm LWOgo90 N m — F Amessment LeW Hazards? une vsual Portion mp initial of w/Partial roan Lice 1��pection f� P RA Nand~ =— Y . , N ft" Dead Hazards? Addendum addax Dust Tam for Risk RA Nattte: Lk to Initialr Y .Lise Asst N S�rtabrre PUT Lead Hazards? _ V and Portion of ReWWccfim for RA.Name: Lice, Addendum as Fun huedra Connol Y bigr�lge; .� 8 F Lew Hazards? re Dust Tdwwfor Rrsk P RAMaw: Lk As f Reins Walk T>wugL for Ed/Conadtation kmpectw f+e: use F Sisttabtte Risk Assessment EINSPECTION HISTORY Reartifcedon R y R L Name: .Lice VdSua]Portion ofPN Reoec.R ' IF hmpector Name: Lice Uraw Pb_Imo? i Mgnahn Dust Taken for RA p RA Name: Lim Visual Portion of Rerxati6r�iioa - Reocc:R 'or, P kope�r Names Li � F e F POST COMPLIANCE ASSESSMEN'1'DETERMINATIONS DustTaken PCAD Reocc. ht oNme: Lick— ' .L , JINY Lad Hzad Dust Taken for p Room on htt pes 0r Name:• Full Davection F Acing ffi PCAD Siq>mtune yy hater Name: UA— Duet Takes for Lead HazvW. L_J Reocc.R ' ' n phmpectw ate:— F WSW Portion of PCAD Rei ction: 8 to Name: Lid Ysual Portion of f Final R ' on P hmpector Natlm' UCAL— F ft�re ' Drat T�for P Nam: PCAD Reins eon Visual Portion of F Final R ' 'on r .Lk# y I. I f [Fq rtature i Dust Takeo for Dust Taken for Final PCAD P hmpector NemC;_ Lis# Rein o Reoec p 67aptOr '� .Ling F T. . . l+ �g>tatute ADDRESS: 31 Main St,Cohik MA. 02635 Page 3 of REOCCUPANCY CERTIFICATE HISTORY COMPLIANCE HISTORY(CONT.) Certificate of Cei of 6tspector Name• _ Nattle: -Ll� limoe only after �911a1;IrE b-Hio Nod Risk. No Worms No Dust #roans nge work=7 Dug Certificate of certificate of !lame' .LRcMxW 6mpe* N=W .Lei - only an& Higd/Mod Risk Sigttahtre DW wipes and aath 9 rooms rote People Certificate of �tg Name: .lkk Certificate of S Maintained 6mpecor Name: :Ud cc Only after Il ORAnd Risk No Wo&-No Dot (#rooms rube Work=7 Dist COMPLIANCE HISTORY Certificate of. LAZer of Fall Initial Rrskarted ;aace tnepedor Name: Lir# c . No prior history/ Sbguwe No of UD Dust wipes and au* e Letter ofinuxim OTHER HISTORY:WAIVERS/UD control bmpecwftm- AXffovW CAMP Waiver No prior Comp. SCgltab�pe1 1 , 1 1 F.V - - ins in 1 yr. Attach to Comp Docs Rme tification-of Ihterim Control Name: _Lk APpmad CLPPP Waiver hopeftf NBttte: .Lid Expims2yrsfmm original Interim S�aadtR Attadr to comp ' Control Does Letter of Full r DdeWing UD/DES Visrat- iance '(` hopeor Name: .ua Dust wipes if No No LOC Issued F Re=. Stgt�uie I Ceatifrcate of - UD./DES Dag Maims 6mpeclor tmnte: -!k$ Tamhance P kNoWork=No DustNO LOC Lssaedork=7 Dust UD/DES 6M Certificate of — Taken storeC e ce Ittspet:bor Name: ,L&� F -L� No LW LvmW m Dist wipes and ash.. UD/DES Final + le - } No LW WuW EXPLANATION OF LEAD INSPECTION/ 4 of E�REPORT FORM COLUMNS This Page Provides general information needed to understand the assessor before lead' with the irmspector/risic dart to do o assessment -However, speAk any work on your home You should SIDE Refers to A,B,C,or D side of the building or room_See the diagram bwTdmg or room is the side'facing the street that gives the on cover sheet The"A"side of the brit • Keeping your back to this P�PY c(usually,it is the&unt of the �• �iII street,from the"A'side move clockwise to the"B"side on your the:"C" side opposite You,and the"D"side to the right Numbering is from Left to right. LOCATION/ Refs to the building - LURFACE example,th n�f s)being�:Some surfaces malt be�up ofmore than one part.For p "Baseboard-may refer to four separate Pieces of wood(one on each walla but is stiff considered one since. LEAD The actual lead remit.Each surface tested must have a result recorded in "Lead"cohmm_ A number shows that the surface was tested with an XRF analyzer_A numbi(or average,nuimber)equal to tit greater than l.0 mg/cm is a danngerous level of lead.- • "Paste or"areg"shows that the surface was tested with level of lead. sodium sulfide."Pars"means that there is a dangerous. l � . • /A"tnearts that the inspector was not able to test the surface.Unless the owner can get a sample to test the inspector must assume the surface.contains lead and require it to be deleaded,if . ' 'WT"or"BW means that a metal surface was not tested and only needs to be intact,even if it is a lewd surface. However,metal handrails,metal window sills,and metal railing caps,need to be deleaded if they tit equal to or greater than 1.0 mg/cmZ,or is marked"N/A." • For key to abbreviations lice"COS","VB","VR"or-MR,-NC',"Tile=, `DC",sce, per the cover , s When a component box is slashes nerd there are test results above and blow the diagonal.line,the result on the "bottom"rePresents.results below S&and the"W result iaftnes the test,result above5 R TYPE OF Not all lead Y i ELAZA� paint motet be deleaded:'ClDis column tells ou IF a�WHY a surface need deleac�rg.The deleading i smndards below may not apply for Interim Controls_Speak to your risk assessor for more inf�on: ° "M/1"circled means that the surface is a Moveable/impacted surface and mast be deleaded in its entirety: a "SF"circled indicates anal there is a storm frame present which requites the blind stop and exterior sill be deleaded as interior moveable/imp surfaces. i "AIW circled mews that the surer is-accessible mouthable"and must be deleaded tea a miniairbra of fare fled high;four inches in from the edge or comer.. "L"circled.isms that the surface is loose and must;at minimum be remade intacL • If more than one choice is circled,the rules for deleading may edge dew�:w method of deleading you choose.Speak to the for more infortnadon.. "N/A"means the tospector was unable to determine if the surface was a lead hazard.The person doing the deleading must check this surface and follow all the rules for deleading,speak to the inspector for more information. . m If nothing is circled M'the cola=4 then it is likely the surface does not iced deleading_speak to the ius r for mom information• Remember,this does not mean the entire surface is lead free;it just docs not require deleading in its current condition. 1 - URC HAZ? This column is only completed during a risk assessment.NA.risk assessment is an evaluation of a home's suitability for Interim Control. Only a licensed risk assessor can do a risk assessment,not all inspectors are r asseacom If"Y"is circled,dace this surface is considered an"thgent lead Hazer&and some type ofdeleadmg work is required to qualify for Interim ConftL iG DATE , The date tth_e liceaased risk scse%r determines the surfice meets the standards for laiw6m Control. IC METH The deleading method or strucuual repair done to qualify the surface for Interim Control..Refer to the deleading, codes key on the cover page. DELEAD The date that the lead inspector reinspects the:surface and find that it has been successfully brought back into DATE compliance. DELEAD The method-used m bring a surface into full complianw-Refer to codes in the Key on the cover Page ofthe PGAD I - _ _ EXCLUDED The amount of loose paint on a surface as cured b the lead ins J y inspector."N/A"means that the inspector was not SURFACES able to measure the loose paint,but has deterrumed it is more than the cut-off for moderate risk g intact. t�IlZA Ems.� h , The Commonwealth of Massachusetts Executive Office of Health and Human Services .r Department of Public Health Center for Environmental Health Childhood Lead Poison ingPrevention Program MITT ROMNEY 250 Washington Street, 7t" floor GOVERNOR Boston, MA 02108 KERRY HEALEY LIEUTENANT GOVERNOR 800-532-9571 RONALD PRESTON SECRETARY CHRISTINE C. FERGUSON COMMISSIONER Documentation of Training to be an Authorized Owner/Agent And Intention to Comply with the Order to Correct Please complete this form and mail it to the code inspector enforcing the case. His or her address is included in the Order to Correct. I, f �� , the owner, or I, the (print owner's name) owner's agent (fill in one), (print agent's name) do attest to the fact that I have complied with the owner/agent delea ding training prerequisites of 105 CMR 460.000, the Lead Poisoning Prevention Regulations, and passed an exam to qualify for and perform specific abatement and containment work. I further attest to the fact that I will complete the abatement and containment work that I will perform in compliance with 105 CMR 460.000,the Lead Poisoning Prevention Regulations, and within the deadlines stipulated in the Order to Correct Violation(s). Finally, I attest that I will not exceed the scope of my low-risk authorization moderate risk authorization (circle appropriate level of authorization). Signature of Owner or Agent Authorization Number (Address of unit where work will be performed) Name of Code Enforcement Lead Inspector: I Nib V rz l Doc of Training 1-05 Page 1 of 1 Executive Office of Health and Human Services Department of Public Health ' Center for Environmental Health Childhood Lead Poisoning Prevention Program MITT ROMNEY 250 Washington Street,7�!floor GOVEIZNOR KERRY HEALIYY Boston-, MA 02108 URMff&ff GOVERNOR 800-532-9571 RONALD PRESTON. SECPEfARY CHRISTINE C.FERG JSON COMMISSIONER Documentation of Trainine to be an Authorized Owner/Agent And Intention to Comply with the Order to Correct Please complete this form and mail it to the code inspector enforcing the case.His or her address is included in the Order to Correct. I, ud-k-(&2 6exe ztn ,the owner,or 1,the (print owner's name) . owner's agent (fill in one), (print agent's name) do attest to the fact that I have complied with the owner/agent deleading training prerequisites of 105 CMR 460.000,the Lead Poisoning Prevention Regulations,and passed an exam to qualify for and perform specific abatement and containment work.I further attest to the fact that I will complete the abatement and containment work that I will perform in compliance with 105 CMR 460.000,the Lead Poisoning Prevention Regulations,and within the deadlines stipulated in the 'Order to Correct Violation(s).Finally,I attest that I will not exceed the scope of my low-risk authorization/moderate risk authorization (circle appropriate level of authorization). Signature of Owner or Agent Authorization Number (Addres's of unit where work will_be performed) Name of Code Enforcement Lead Inspector: ib 0 Doc of Training 1-05 Page,I of I - J L At Ony Jakaitis M 2929 Inspector(Print) lic# 919009 PageG_UI D Wan Date ArMony Jakaitis R 292.9 ' Risk Assessor(Wirt) Uc# Signah►re at Address o Proert : 31 Main St De Apt - city Cobtk ROOM# SIDE LOCATION/ LEAD TYPE OF URG IC IC DE DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD DATE METH DATE METH SURFACE HAZARD . DATE MATH DATE METH A I3 Weis O 3 AMt L WA Y. SM G. AM AMP L WA Y Lar Walls AIM L WA Y B m Apra Z AIM L WA Y A B AM WA Y F A B Ch&Rag C Win C AIM L WA .Y AIM L WA Y D Header Stop .vo 'AIM' L WA Y A Radiates AIM L WA Y f [rttStrips ©:. Mlll ABM L WA Y Ftaor - AIM L WA Y Vd Wm int Sash . MUI AIM L NIA Y AIM L WA Y 2 SAI SF Q WA Y A r AN L WA Y 3 6J WA Y Part�d ` CD Dam Casing .2 AIM L WA . Y 4 Sri Stop SF<&NIA Y 12 Doorlantb 031 AIM t WA Y WinExtSash Y 34 AIM L NIA Y 1,"i�atdt3arSO p.S APO L WA Y A B Door WA Y ' D Door Caserg ® AIM L WA Y B ` AM! i NIA Y 12 Doarlamb IJ.Z AN WA Y C m AJMI L NIA Y D Hater Stop I AAA AIM L WA Y 3 4 ThrEsheld Q. AIM L WA Y Ird sly ,d MIA AN L-NIA Y tArzia A B Door AAN L WA Y " 1 Ird C D Dw Cam AN L WA Y Sash are L WA Y Ext sm e( SF NIA Y 12 DoorJan AMIL WA Y 3 PmtBead A Y 3 4 Threshold AA;A t WA Y 4 Bind Stop SF G NIA Y AB Door AIM L WA Y st Ed Sash KUWA Y C Q [," Cog A1M L WA Y A wbwow Stll MIA AIM L WA Y 12 DorJamb AIM L NIA Y B wmApmn 3 AIM L NIA Y 34 rnreshotd, AIM L WA Y C.win Casing AN L WA Y A cbw Dom Qj Header Stop ?M AN L WA Y, B Ci Casing AIM L NIA Y b t Sys. Affl AN A L WA Y C Cat Jatrb AIM L WA Y 1 Wm IM Sad, MA AffA L NIA Y D ck)w fth AA1d L WA Y 2 Exiariarsin 2- SF CLIWA Y Cl Basaboard AIM t WA Y 3 part 8eaa WA Y 1 Closet Pole AAA L WA Y 4 B SF NIA Y 2 AIM NIA Y ExtSash a. . A Y r 3 a Ssspparls AIM L NIA Y B 1 irk AM'L NIA Y 4 cbsetFbor AMt L WA Y D M AIM L NIA Y Ck>sd m9 AN L,NIA Y AB F m Abm 5' AIM L MBA Y NTS/STRUCTURAL DEFECTS: AIM L NIA ' Y Y AIM L WA Y AIM L NIA Y UD C_ can ip O a SIDE LOCATION MEASURE:L(0 SE PAINT iC SID LOCATIONM!£aSURE LOOSE PAINT IC A {MORE THAN 288 SO1 Ito) DATES I�THDD (MORE THAN 288 SO.IN.) DATE METHOD J U/M RepRoom,Mg Anthony Jatca•Ids M�29 _ 1 Z OI� Inspector(print) Lic# �.1( Anthony Jahaft R 2929 Date Risk Assessor(print) L�# Address of P_ oerty ro " 31 Main St Date HALLWAY: cny Cotuit SIDE LOCATION/ LEAD TYPE OF URA IC' IC DELEAb DELEAD SIDE LOCATION/ LEAD TypE OF URG IC IC Dt:LEAD DELEAD SURFACE HAZARD DATE METH DATE METH SURFACE HAZARD DATE METH DATE METH A a Up Ward .Z AIM L WA Y A Cb�t Door" A a N/el� AIM L WA Y AIM!WA Y B a Ca" AIM L WA Y A e Baseboabs G• AIM L WA Y C •� AIM L WA Y A B Chair Rao AIM L WA Y D Iow walls. AIM L WA Y CD Rad�abr- .I AIM L WA Y CI Baseboard AIM L WA Y Fbor AIM L WA Y ' 9 AM L WA Y 1 Closet Pole AIM L WA Y 2 Cbmshe8 AIM L WA Y A Dow LWA Y 3 a S qmm AIM L WA Y CD 3 AIM L WA Y 4 aosatRoor AIM L WA Y 12 Door Jamb L WA v Cbs�Cedag AIM L WA Y 34 TIVemm Z. AIM L WA Y A B Door .A Windo�r Sl MII AIM L NIA Y .� WA Y B Vlfn Apron A AN L WA Y Doorcasing AN L WA Y C Caft AlM L WA Y 12 Door Jamb 21 AIM L WA Y D t adarStap MR AIM L WA IY 34 ThresdhMW 4. AM L WA Y lat Sbps MJI AIM L WA Y AB Dw AIM L NIA Y 1 in bfl Sash MY AIM L WA Y Drmr Casigq 3 AIM L WA Y 2 Exta �2 DaorJamb - " �rSB . ' iMli SF LWA Y 3 AIM!WA Y 3 tart Bead Mfl L WA Y 34 Threshold Q Al M L WA Y 4BOW Stop !M SF L WA Y A B Door AAA L WA Y Win Ext Sash MA L WA Y CQ Door AIM L WA Y A Sf9 AIM ! WA Y 1 Door Jamb !� AN WA Y $ WMAW J .A/M L WA Y 3 4 Threshold Q AN L WA Y C' win AIM l N/A Y.. A 8 Door Aft L NIA Y D Headar Stop R91i Ati►t L WA Y C DODODrC",, AM L WA Y trdSto� tNli AIM L WA Y AIM L WA Y 1 win hrt Sam' W AN.L WA Y AIM L WA Y 2 Exf WSin III SF L WA Y A j AIM L WA Y 3 Pa:t er ad Lin L NIA Y 8 2 A#A L NIA Y4 BlindStop Mn SF LWA Y C AIM L WA Y VmExtSash FM L WA Y 14 Q. AIM L WA Y AB D etAb=5 ttrlJl. AIM L WA Y CI B�eboard q. AIM L WA Y ae p IWI AIM L WA Y. 1 closet rye AIM L WA Y P S j AIM-L WAI v 2 cbw Sheu !WA Y COMRIENTSI STRUCTURAL DEFECTS- 3 Ci Support q•� O L WA Y 4 laosd Ftoa Q AIM L WA Y Cbset Cetlirg d. AIM L WAI Y EXCI t DED SURFACE Surfaces listed in Ifiese boxes can be made intact only by a licensed deieader. r LOCATION MEASURE_LOOSE PAINT IC lC LOCATION MEASURE:LOOSE PAINT IC IC {MORE THAN 288 SO-Bd.) DATE METHOD (MORE THAN 288 SO.IN.) DATE MTHOO IJIRA Replfall,IIJI?R i go/g,utooacbll YM a ROM 31V0 Nwu 3mm amm 31Va ` tNl'OS OR N*U 3HOW1 01 01 lWd 3SOO1:gHMM NOUV00l 3 CODS 01 01 INN 3SO01!3unSV3W NOI1V0O1 3CUS -iopeapp pasum e 6 Pews a w N uea swo M u1 p saa A I VIN 1 NYtl A lvm 1 my A ]VIN l MV A VIN 1 WN - :s103d3a lvaru0nuls I s1N3WWo0 A vm l VIN S e*09V uUN 0 V A YM l WIV sulllaJ pmo A tlM 1 MV elm Go A YM 1 MV mold pRo y A vm 1 Wlv d a v A YM 1 WIV WoddnS 10 £ A VM 1'Z 4SeS IX3 UMA A VIN 1 WN 1184S l9g3 Z A VM dS d01S m b A JVM 1 WIV el0d mm' A VM PeaBAed A YIN 1 WIV Wafie 609810 A tl :is ') FSMJW3 Z A YM I Wlt/ t seem IN43 Q A VM 1 WIV UN 4SeS lul w.M A VIN 1 WV 9wer lam Q A VIN l WIV YW i� sits iW A Y/N 1 WIV e!seo 10 9 A, tlM l WIV UW 'C' 01 dWS APBOH Q A IVIN l NV mu lam y A IVIN 1 lwv E•5 &M w,AA . A I vM 1 WIY P104sw41 y£ A vm 1 WIv VO wady wAA 9 A vm 1 W!V gwer jooa Z 1 A V/N 1 Wro UW Z'0 MS OPwM A VIN 1 M &moj000 Q Q A YM '"F WS P3 w A vM 1 WIV 9 b� A VM9 dS do1S PWE, b A VM 1 Plo4MU b£ A vmm Pe%M £ A YM 1 Qwer=a Z ( A vm i3 is Z wsmwpWP3 r A VIN 1 Bum J000 Q bl A YIN 1 MV UW 4SeS jul tQm - A YIN 1 NV j:0 looa 9 y A lvm 1 M UW a S ft P4 A VIN 1 NV -Z'tj PIo4M41 V£ A' IVIN 1 VW UW 'D ft H 'Q A vm l�w �'9 aWerjoo0 Z A YM1 w )' tom.3 A VMIVW 9 �� QO A tlM l Wltl Z• D 0mdyw.AA 9 A VM l WIH Z'(� A vM 1 WM YW D &S M A VM 1 t' PI04sai Vi C A VMAl. WSlxd u'1N A VM l Qwer1000 Z l A VIN dS dMS WM q A VIN l WIV j' Bwse310 a Hy A VINt1� PeaB ved £ A VIN T000 A VMS dS n WSJOPW3 Z A vm l WItl 6,mool A YM l WIV UW UeBSWImM A VM 1 WIV A VIN 1 WV IM Sd(4S Sul A YIN 1 WN JOM.Pea e8 v A YM l WIV uw h' d03S J pm Q A VM 1 WIV 0ea AND 8.v j A tlM l WIV n ! w0 tw 0 sS A vm i Wlv spaeogeselg e v J< vm 1 my •9 00*w,M 9 A YIN 1 WIV seem m(n e v A VIN 1 WIV WN, TO MS MOPuUN A YM l WIv 0 sgeM do s v HIM 31VO H13W 31tl0 e.ZVH OaVZVH 30V48M H13W 31v0 Himm 31val H avvm 30vdans OV3130 avm3a 01 oi Jan d0 3dA1 Ot/3l MOIlV00l 301S Ov3130 av3130 01 01 Jan j0 3dA1 OV31 MOUY001 301S s —#Wooa 3!�WoJ l v Is ulew 66�JO VV a1e0 au,yeurxs #�!1 (wad)mssassy�Im RM H glilqer Auo4wv r alea auq¢u615 on (luud)mwadsul /�m Ta68d 600VGM fm w tiler AuotpuV Anthony Jakaids M 2929 9mm Pages OtT Inspector(print) Lic# Date Anthony Jakaids R 2929 Risk Assessor(print) Lic# Signature Date Address of ProaertY: 31 Main St Apt City Coto CONTINUATION OF ROOM( ) SIDE LOCATIOW LEAD TYPE OF URG IC IC D DELEAD SIDEJ LOCATION/ LEAD TYPE OF URG IC IC DEL J1D DELEAD SURFACE HAZARD DATE METH DATE METH SURFACE HAZARD DATE METH DATE METH odow Sill 3 W AIM L WA Y A Window Sit W AIM L WA Y B Win Apron 0.1 AIM L WA Y Win Apron AIM L WA Y C Wen Casing 0.1 AIM L WAI Y C Win Ca ft G.L AIM L WA Y D Header stop G.1 Mlt AW, L WAI Y I D HeaderSnp M8 AAM L WA Y nt stops 0 .2.w AIM L WA Y IM stops Mn AIM L WA Y 04 Win Int Sash 6-3 W AIM L WA Y Win nt Sash W AIM L WA Y Exterior Sid ( WA Y EAWW SN 7j. SF 4Q.1 WA Y Part Bead WA Y Prot Bead (JI WA Y Baw Stop f SF A Y Blind Slop SF W WA Y Wn Ext Sash WA Y Win Ext Sash AG U WA Y Window'Swill L Mll AN L WA Y A W6�ow S® AIM L WA Y B Wn Apron AIM L WA Y B Apron AIM L WA Y C Win Casing 1 AIM L WA Y C Win Cadrg AIM L WA Y D Headerstop G.i M11 AIM L WA Y D HeadsrStop Mll AIM L WA Y hd St)pa C, W AIM L WA Y trd Stops MI AN L WA Y S win Int sash 4 Mn AIM L WA Y Wen Innt Sash . Mli AIM L WA Y Exterior Sip .( SF OWA Y Exteft SB MI SF L WA Y Part Bead WA Y Part Bead W L WA Y Blind Step � SF�WA Y Bnd Stnp Mn SF L WA Y Nfun Ext Sash 114 WA Y W'n Ext Sash L WA Y A Window SO Q1. AIML WA Y A SB W AIM L WA Y B n Apron O. AIM L WA Y B n Apron AIM L WA Y C Win Casing 6.11 AIM L WA Y C Wn Casing A/M L WA Y D Hea�Stop V MR AN L WA Y D Header Slop MR AN L WA Y hostnps p hM AIM L WA Y nt�s MD AN L WA Y 6 Winn nt Sash 6 . MA AIM L WA Y wn nt Sm h MII AN L WA Y Exterior SM (. SF N/A Y Exterior Ss W SF L WA Y Part Bead WA Y Part Bead MA L WA Y Bfnd Stay A Y Blind Stop M!i SF L WA Y Wn Ext Sash 1.; a WA Y JWM Ext Sash IM11 L WA Y C( 14 L WA Y s•4 L WA Y Cos. LWA Y WLWA Y s.► S g WA Y q. L WA Y AIM L WA Y ? •r► L WA Y WA Y t `"i"1 L WA Y COMMENTSI STRUCTURAL DEFECTS: COMMENTS I STRUCTURAL DEFECTS: EXCLUDED SURFACES:Surfaces fisted in these boxes rarl be made intact only by a licensed deteader. SID LOCATION I MEASURE:LOOSE PAINT -. IC IC SID LOCATION MEASURE:LOOSE PAINT IC IC MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD UIRA ReplkoomCom(W),8108 Anthony Jakaitis M 2929 9f9lM Page—q Of 0 Inspector(print) Lic# 4,03106 Date Anthony Jakaitis R 2929 Ric Assessor(print) Lic# Signatune Date Address of 31 Main St Apt City COW ROOM# SIDE LOC LEAD TYPE OF URe IC IC DELEAD DELEAD SIDEJ LOCATIOW LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD DATE METH DATE METH SURFACE HAZARD DATE METH DATE METH A B Up Walls 7 l WA Y �, mdorr SN O. Mfl AIM L WA Y A B LOW Walls 3 AIM L WA Y B Wm Apron AIM L WA Y A B thai AIM L WA Y C Win Casing AIM L WA Y A B AIM L WA Y D Hemmer Stop 4.31W AIM L WA Y Radiator ( AIM L WA Y Int Stops v. MI AIM L WA Y Floor AIM L WA Y 1 Win Int Sash Cx 2 w AIM L WA Y CeTmg AIM L WA Y 2 Exteror SR Y SF A Y Door A/M L WA Y 3 Part Bad (V WA Y C D Door Casing Q.2. AIM L WA Y 4 Band Stop Mil SF L WA Y 12 Doorjamb 4.1 AIM L WA Y Wm Ext Sam WWA Y 3 4 iThrmeshm O.I AN L WA Y Window SIG Mll AN L WA Y A B Door Q AIM L WA Y B m Apron AIM L WA Y tV Door Casing 4.1 AIM L WA Y C Wm Casing AIM L WA Y 2 Doorjamb .3 AIM L WA Y. D Hader stop Mn AIM L WA Y 3 4 Threshold -3 AAN L WA Y Int Stops ri Mg AN L WA Y A B Door L WA Y 1 Int Sash G. Mil AIM L WA Y Q Door Casing O. AIM L WA Y Exterior SDI I(. SF A Y 1 Door Jamb v. AIM L WA Y 3 Part Bead A Y 3 4 Threshold AN L WA Y 4 Blind Stop MR SF L WA Y A B Door WA Y Wm Ext Sam Q QI WA Y tb Door Casing Q. AIM L WA Y A Window sm MR AIM L WA Y 12 Jamb G. AIM L WA Y Wm Apron .Z AIM L WA Y 4 ThreshoW 6. 1 AIM L WA Y C Wm Casing ( AN L WA Y A Closet Door QA Y D Hader Stop A.( Mll AJM L WA Y B Cl Casing 0.1 AIM WA Y IntStops 01. Mil AIM L WA Y ©Closet Jamb U• AIM L WA Y <b Wm In;Sash 4.3 MA AIM L WA Y D Closet Wald Q AIM L WA Y 2 Exterior SM Z-7 Q SF Qj WA Y Cl Baseboard AIM L WA Y 3 Part Bad IQ WA Y 1 ClosetPole AN L WA Y 4 Brmd Stop SF WA Y 2 Closet Shelf AIM L WA Y Wm Ext Saar WA Y 3 Cl Supports AIM L WA Y A B Fkeplaoe AIM L WA Y 4 Closet Floor Q. AIM L WA Y D Mantle AIM L WA Y Closet Ce ft AIM L WA Y A BD Wm Above S AIM L WA Y COMMENTS I STRUCTURAL DEFECTS: Moldlo AIM L WA Y # o AIM L WA Y coe- AIM L WA Y AIM L WA Y L in Uiese bomes can male intact Only y a Ioen r. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SQ.IN.) DATE METHOD (MORE THAN 288 SO,IN.) DATE METHOD LYRA RepRoom,8/08 Anthony Jakaitis M 2929 9191m Page =,�J Inspector(print) LIC Date Anthony Jakaibs R 2929 Risk Assessor(print) uc# Signature Date Address of Properly: 31 Main St APL City Cotuit MF ! Ambo.tw 3 Co w�_ SIDE LOCATION/ LEAD TYPE OF URG IC IC DE DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD DATE METH DATE METH SURFACE HAZARD DATE METH DATE METH A B Up Wails AN L WA Y A Closet Door L WA Y A e Low Wails AIM L WA Y B CI Cog AMA L WA Y A e Baseboard AIM L WA Y C c0 setJamb .Z AIM L WA Y LCD Chair Raj AIM L WA Y Closet Welk AIM L WA Y Radiator AIM L WA Y CI Baseboard AIM L WA Y Floor AIM L WA Y 1 ClosetPoke AIM L WA Y Wing AIM L WA Y Closet AN L WA Y A B Door qt ZZNIA Y 3 Cl Supports 4 AIM L WA Y se-t j Casing .1 AIM L WA Y 4 ClosetFloor A/M L WA Y 1 Door Jamb 6 .2 AIM L WA Y Cbw cebv AIM L WA Y 3 4 Threshow AIM L WA Y A Wmdow So .3 MR AIM L WA Y A B Door .14 WA Y Win Apron IN AIM L WA Y r Cw4 6• AIM L WA Y C Win Cwft (/Z ARM L WA Y Door Jamb 5.3 AIM L WA Y D Header Stop Mn AIM L WA Y 3 4 Threshold 6.2 AIM L WA Y ld Stops MR AIM L WA Y A B Door WA Y 1 Win Ird Sash MII AN L WA Y 4 Dow Casing Ci. AMA L WA Y <5 Exte;SB A SF QJWA Y 12 Door Jamb .1 ARML WA Y 3 Part Bead A Y reshold AIM L WA Y 4 BUW Star SF 4CPA Y A B Door AIM L WA Y n Ext Sash A QJ WA Y C D Door Casing A/M L WA Y A Window SM AIM L WAI Y 12 Door Jamb AIM L WA Y B WhApron AIM L WAI Y 3 4 Threstrold AMA L WA Y C Wm CasN AMA L WA Y A B Door AIM L WA Y D HeadtSlDp MR AMA L WA Y C D Door Ca" AIM L WA Y Ird Stops Lin AIM L WA Y Door Jamb A/M L WA Y 1 Wm lrt Sash MR AMA L WA Y AMA L WA Y 2 Bbrior sip MR SF L WA Y A Closet Door L N/A Y 3 Part Bead MR L WA Y B G Casim Q. AIM L WA Y 4 Bfnd stop Mn SF L WA Y C Closet Jamb Cl•Z AN L WA Y Win E6d Sash Mn L WA Y 46 Closet Wald 6. AIM L WA Y A p Wm Above 5 MR AMA L WA Y CI Baseboard AIM L WA Y Au Ceft hUl AIM L WA Y V3 Closet Pole AIM L WA Y W A/M L WA Y 2 Closet Shen AMA L N/A Y COMMENt'S/STRUCTURAL DEFECTS: 3 CI Supports 3 AIM L WA Y Z 4 Closet Floor A/M L WA Y Closet Ceit s A/M L WA Y L ED RF CE :Suffams Isted in ftse boxes Can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD MORE THAN 288 SQ.IN.) DATE METHOD LURA RepHA 8/08 I Anthony Jakalds M 2929 919 M Page ll of Inspector(print) LIc# Date Anthony Jakalds R 2929 Risk Assessor(print) UC# Signature Date Address of Property: 31 Main St Apt. Gty Cotuit ROOM# qL SIDEJLOCATION/ LEAD TYPE OF URG_ IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD DATE METH DATE METH SURFACE HAZARD DATE METH DATE METH A a UP Wald ,%) AflN L WA Y A window Sig 0.2.Mn AIM L WA Y A B LOW Walls 2. AIM L WA Y ® Win Apron AIM L WA Y A B Baseboards AIM L WA Y C Win Cwft . I AMA L WA Y A B Chao Rail 4 . AIM L WA Y D Hearer Stop O.ZJW AIM L WA Y A a Radiator Q.3 AMA L N/A Y Int Slops 0.3 MII AIM L WA Y Floor 4 .3 AIM L WA Y © Wm Int Sash O Mfl AIM L WA Y Cel" L2 AnOUNIA Y 2 Extsriorsio CW MA SF L WA Y Door Q.2 AN L N/A Y 3 Part Bead Cwj bin L WA Y C Q Door Casing d. AIM L WA Y -�v 4 BTand Stop MR SF L WA Y 1 Door Jamb IQ L WA Y q &4@,t Wm F.xt Sash 0.2 M/I L WA Y 3 4 restm AN L N/A Y A Widow SN Q. MM AIM L WA Y B Door C).I AIM L WA Y Aprmn . 1 AIM L WA Y C D Door Casing AIM L WA Y C Won Casing 4.1 AIM L WA Y 16 - Jamb (1. AIM L WA Y D Headers op a . NVI AIM L WA Y 34 ThreMrold G. AIM L WA Y hd Stogy MR AIM L WA Y AB Door AMA L WA Y 1 Win Int Sash v. W AIM L WA Y Door Casing 2 AIM L WA Y C3 Ext�iorSN 0e MA SF L WA Y 1 2 Doorjamb Z AIM L WA Y 3 Part Bead OPe mA L WA Y 3 4 Threshold AIM L WA Y 4 Blind Stop . Mll SF L WA Y ArBI Door Q AAA L WA Y n Ext Sash 0.2.MII L WA Y A Door Casing 3 AN L WA Y A windowsill Q.Z MA AIM L WA Y 12 Doorjamb 2 AIM L WA Y B WnApron V. AIM L WA Y 3 4 Threshnow AIM L WA Y Win Casing u ?� AIM L WA Y A Clow Door 0.1 AN L WA Y D Header Stop 02 MA AIM L WA Y B Cl Casing 0. AIM L WA Y Int stops tt.1 W AIM L WA Y C Closet Jamb 0.11 AIM L WA Y Win Int Sash W AIM L WA Y Closet Walls AMA L WA Y 2 EKWWSM MA SF L WA Y CI Baseboard L>4 AIM L WA Y 3 Part Bead MA L WA Y 1 Closet Pole AIM L WA Y 4 lew Stop Mil SF L WA Y 2 Closet SW AIM L WA Y Win Ext Sash *.3 M4 L WA Y 3 Cl Suppods AMA L WA Y B Replace J AIM L WA Y P4C oset Floor AMA L WA Y D Mande AIM L WA Y lot CerTmg AMA L N/A Y VMar Above 5 AMA L N/A Y NTS I STRUCTURAL DEFECTS: _, Calling VWdlrq AMA L WA Y AIM L WA Y AMA L N/A Y AMA L WA Y mVIese boxes can m e intact only by a licensed de eader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SQ,IN.) DATE METHOD LIRA RepRoom,8108 f 80/8`uwblIda1I VN/I'I 00" 3IVG ('NI'OS 8BZ NVRL 9MOV4 GOH13W 31VG ('NI'OS 88Z NWU 3HOVY) 01 01 1NlVd 3S001:3HnSV31N N0LLV001 MISI Of 01 1NIVd 35001 aunsV3W NOLLVO01 301S posueql e Aq Al uopqtq opw aqueo se)(oq esm togamoxg A I VM l WN A NM 1 WN ' A V/N l Y#V A NM l WN kmm 6wm € M33j301VafllOfl s I S1N3WW00 A VM 1 WN S avw wm o O A VM 1 WN 6wJ.w0 PRO ev A VIN l WN altaeNl a A VM 1 WN JOOU P RO V A VM i MV a A WN l WIN gmftS 10 £ A VM l UW 4S lx3 wAA A VM 1 WN UwIS lesul0 Z A VM l IS UW da}S Pupa b A IVMIM I I alad basal0 A V/N 1 UW Pella Ued £ I A IVIN 1 WIV t I Pwaqma la A V/N l 3S UW N AW3 Z A VM 1 WN 511eM Pqo Q A VM 1 WN UW 4SeS aul wAA l A V/N l Y#V gWef te" a A VM 1 WIN UW 'A edWSlul A VIN l WIV &M013 e A V/N 1 WIN UW _j dogs ApeoN A VM l WN A J000 les010 y A IVIN 1 WIV UIM Q A V/N l WN PlaUsanu b£ A VM 1 WN Z W*wAn a A VM l WN gWef jwG Z A VM l WN UW IS .M y A VM l WN �e0jao0 a o A VM 1 UW 7 WS P3 WA A VM l WN m00 GO A VM l B UW d(4S PUBS y A V/N l Wro P104mu t,£ A VM l UW rto Peaaued A VM 1 WN gwerjooG Z I A NM i dS IMI M) MSMM3 A VM 1 WIV jwa a s A WN 3 WN UW 1- 0Fq P4 w.M A V/N l WN J000 e y A VM l WN UW Z:f� dMS M A VM l WIV PIa45w41 q£ A VM 1 WN UW 'p +anH Q A VM 1 WN �uef ma0 ZA VM l WN 1 ' 3 uyM A VM l WN NsBo ma a s A V/N 1 WN ) '0 uaadV 14 M a A V/N l WN Ma By A VM l WN UW IDS MPwAA y A VM l WN PiDtPW41 y£ A VM 1 UW "p 4SSS 3x3 wAA A NM l WN gWef=a Z L A VM 1 dS UW da9S PuHS V A VM W l V 0 jooa Q O A V/N 1 IN /iA Peaa ued £ A VM-1WN M0 a y A NM 1 A UW M2 NSJOPOIX3 �► A NM l WN 6u"O A VM l WN IN 'p 4e8S Sul wAA A NM l WN Jaald A VM l WN UW edtS WI A VM 1 WN a e V A VM-1 WN UW '0 daaS l Q A NM l WN Ile A940 a v A VM l WN 4' 0 IRA {� A VM l WN MMKRMS e v A NM l WN uOWV wAA a A NM SPM;E e y A VIN l WIV UW T 0 USmOPJA y A VM DN b b wMdfl H13W 31V0 H13W 31VO aHVZVN 3OVd2JI1S RL3W 31V0 HIM RING GMVZVH 30v:fHns OV9130 OV3130 31 01 gun 30 3dAl GV31 MOlIV001 [3jais OV31M GVM30 of 01 92U1 J0 3dAl GV31 INOIIVOO1 WSJ ploo 43 -AV 3S URN W d JD N V am eu4eu6!S #M Ouud)mmW>lelM 6W a spiew AU04M apa -ems #31 (iupd)jopodsul O '�o 8130d 60OM 6Z6Z W abler Auowv Antttony Jakaitis M 2929 91900 P 011' Inspector(print) Lic# Date Anthony Jakaitis R 2929 Risk Assessor (print) Lid Signature Date Address of Pro er : 31 Main St Apt CRY Cotuh BATHROOM# SIDEJLOCATIOW LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URGI IC IC DELEAD DELEAD SURFACE HAZARD DATE METH DATE METH SURFACE HAZARD HAZJ DATE METH DATE METH A B Up Wags 0.3 AIM L WA Y Low Cab From AMA L WA Y A B Low Walls 0.4 AN L WA Y AB Low Cab Door AIM L WA Y A B Baseboards 0. I AIM L WA Y C D Lau Cab Walk AIM L WA Y SLa A B Chair Ran 4). AMA L WA Y Low Cab Sh AN L WA Y I.LAD CD lRaftWr AMA L WA Y 12 Supporb AMA L WA Y Floor j AIM L WA Y 34 Drawers AIM L WA Y Ceirmg AIM L WA Y A Wmdow SN Z W A/M L WA Y B Door Q L WA Y B Wm Apnon 0. AIM L WA Y C D Door Casing 0. AIM L WA Y C Wm Cam AIM L WA Y 12 Doorjamb 1, Qt L WA Y I Header Stop a. MYI AIM L WA Y 3 4 Threshold AMA L WA Y Int Sloops 0 t4 MR AMA L WA Y A B Door A AN L WA Y 1 Win Ind Sash Mlt AIM L WA Y C D Door C� A/M L WA Y 2 e tenor sm Lin SF L WA Y 12 Door Jamb AIM L WA Y 3 Part Bead �/ MII L WA Y 34 Threshold AIM L WA Y 4 Bond Stop MO SF L WA Y A Closet Door AIM L WA Y rn Ext Sash !J. AM L WA Y B CI Casing AIM L WA Y c o N►lr Above S MA AIM L NA Y C Gloat Jamb AMA L WA Y AD BD CeNngJCab . W AMA L NA Y D Closet WaAs AIM L WA Y AS c D MedicinW AMA L NA Y Cl Baseboard AIM L WA Y AD Wan 0/ M R AIM L NA Y 1 Chet pole AIM L WA Y W AMA L NA Y 2 Coset Shell AIM L WA Y Mn AIM L NA Y 3 CI Supports AIM L WA Y W AMA L NA Y 4 Ckot Fi wr AIM L WA Y MII AMA L NA Y Clot Left AMA L WA Y MII AIM L NA Y B Up Cab Frame AIM L WA Y W AIM L NA Y C D Up Cab Door AIM L WA Y MR AMA L NA Y Up Cab Wals AN L WA Y MUI AN L NA Y 12 Up Cab Stm AIM L WA Y MA AMA L NA Y 34 S qmm AIM L WA Y MA AIM L NA Y Mn A/M L WA Y W AIM L NA Y W AMA L WA Y W AIM L NA Y W AMA L WA Y IW AIM L NA Y /STRUCTURAL DEFECTS COMMENTS/STRUCTURAL DEFECTS: EXCLUDED SURFACES.Surfaces fisted in ftese boxes can be made intact only by a Downed deleader. SI LOCATION MEASURE:LOOSE PAINT IC IC LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO,IN.) DATE METHOD LURA RepBath,W08 Anthony Jakaftis M 2929 90=1Page Inspector(print) Lic# Date Anthony JWmMs R 2929 Risk Assessor(print) Lic# Soatin Date Address of 31 Main St Apt City Cotuit ROOM# SIDEJLOCATIONI LEAD TYPE OF URG IC IC DELEAD DELEAD SIDEJ LOCATION/ LEAD TYPE OF URG IC IC DELEA DELEAD SURFACE HAZARD DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH DATE METH A B L IL Up Waif Z AIM L WA Y A Window SB 0.3 W A/M L WA Y A B LOW Wang A/M L NIA Y B Win Apron (J AN L NIA Y A B Baseboards Z AIM L WA Y C Wm Casing Ck ` AIM L WA Y A B Chou Rai AIM L WA Y D Hader Stop 4.1 MO AIM L NIA Y A Radiator A/M L WA Y bd Stops 42.M 11 A/M L NIA Y Floor fj A/M L NIA Y 1 Wm hrt Sash 4.3 W AIM L N/A Y Ceft Q L AIM L WA Y 2 EderiorSio SF 4.mA Y Door AIML WA Y 3 Pert Bad 4oWA Y C D Door Ca" o AN L WA Y 4 Bumstop SF WA Y 12 Door jamb D. AIM L WA Y Wm Ext Saar Y WA Y 34 7Zlo Q AIM L WA Y A Wmdow S'N .Z Mltl AIM L WA Y Door AN L WA Y B Wmm Aprrm 6.2. AIM L WA Y C D DoorCasmg AIM L WA Y C Win Casing 6.1 AIM L WA Y 12 Doorjamb AN L WA Y HeaderSbop Q. 1 Mn AIM L WA Y 3 4 Threshold (A AIM L WA Y brt Slops b.,Z Mn AIM L WA Y A B Door AIM L WA Y 1 ft Int Sash 4. Mn A/M L WA Y C D Door Casing AIM L WA Y 2 Exmrior Sa SF Q.WA Y 12 Door jamb AIM L WA Y 3 Part Bead Al 4 WA Y 3 4 Tinshow AIM L WA Y 4 Bind Stop SF 0 WA Y AB Door AN L WA Y VYn Ext Sash WNIA Y C D Door Casng AIM L NIA Y A wwdow SB Mill AIM L WA Y 12 Doorjamb A/M L WA Y B Win Apron AIM L WA Y 3 4 Threshold AN L WA Y C Wm Cam J AIM L WA Y Closet Door AN L WA Y D Hader Slap MO AIM L WA Y B Cl Casing L WA Y IntStops Mdl AIM L WA Y C CbW Jamb 0• AIM L WA Y 1 Win IM Sash Mn AIM L WA Y D Closet Wads (I. AIM L WA Y 2 Exterior Sill W SF L WA Y Cl Baseboard 9.1 A/M L WA Y 3 Pat Bad MII L WA Y 1 Closet Pole 6• AIM L WA Y 4 BhW Stop W SF L WA Y 2 Closet sw AIM L WA Y f ft Ext Sash Mn L WA Y 3 CI Supports AIM L WA Y AB Ftrpkm AIM L WA Y 4 Closet Floor AIM L WA Y C D Mantle AIM L WA Y Closet Ceiling �i A/M L WA Y 5 AIM L WA Y A s u Above COMMENTS/STRUCTURAL DEFECTS: Cebg AIM L WA Y t AN L WA Y AIM L WA Y AIM L WA Y Is m ftse boxes can be made inW only by a bcensW SIDE LOCATION MEASURE:LOOSE PAINT IC IO SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD MORE THAN 288 SO.IN.) DATE METHOD LURA RepRoom,8/08 Anthony Jakadis M 2929 919I2009 P�6 0 Inspector(print) Lie# Si Date Anthony Jakaitis R 2929 Risk Assessor(print) tic# Signature Date Address of Property: 31 Main St ApL City Cotuit CONTINUATION OF ROOM SIDE LOCATION/ LEAD TYPE OF URG IC IC DE DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEADLOCATION/SURFACE HAZARD DATE METH DATE METH SURFACE HAZARD DATE METH DATE METH A B Door AIM L WA Y Low Cab Fram 3 AIM L WA Y C D Door Casing AIM L WA Y B Low Cab Door AIM L WA Y Door Jamb AIM L WA Y CD Low Cab Walk AIM L WA Y Threshold AIM L WA Y N Low Cab ShM AIM L WA Y AB Door AIM L WA Y Supports AIM L WA Y C D Door Casing A/M L WA Y Drawers6.2 AIM L WA Y Door Jamb AIM L WA Y A Wmdow Sin MA AIM L WA Y Threshold AIM L WA Y B Wm Apron AIM L WA Y A B Door AIM L WA Y C Wm Casing AIM L WA Y C D Door Casing A/M L WA Y D HeaderStop W AIM L WA Y Door Jamb AA AL WA Y IrdStops Mn AIM L WA Y Threshold i AIM L WA Y mhdSash MA AIM L WA Y Closet Door AIM L WA Y Exleror SN Mn SF L WA Y A ci c" AIM L WA Y Part Bead W L WA Y B Chet Jamb AIM L WA Y BrA Stop IMA SF L WA Y C Closet Wafts AN L NIA Y ftEgSmql I JMVI L WA Y D CI Baseboard A/M L WA Y A Window Sri IMA AIM L WA Y Chet Pole AIM L WAI Y B Wm Apron AIM L WA Y Closet Shelf AIM L WA Y C Wm Caserg AIM L WA Y CI Supports AIM L WA Y D Header Stop MA AIM L WA Y CI Drawers AIM L WA Y Ird Stops Mn AIM L WA Y CI Dr Frame AIM L WA Y N Wm hd Sash MA AIM L WA Y Closet Fiw AIM L WA Y Exterior SB MA SF L WA Y Closet AM L WA Y Part Bead Mn L WA Y AB c D ShNs Above 5' AN L WA Y Blind Stop MII SF L WA Y AB CD Cab Above 5 AIM L WA Y Wm Ext Sash MA L WA Y A D Cab Above 5 AIM L WA Y B Fireplace AIM L WA Y B Up Cab Fra AIM L WA Y D Marital AIM L WA Y C D Up Cab Door A/M L WA Y B Sidelight(L) A/M L WA Y Up Cab Wars AIM L WA Y CD Sda%M(R) AIM L WA Y Up Cab ShNs .d ®L WA Y A u Wm Abate 5' AIM L WA Y Supports .9 L WA Y C D m Above S AIM L WA Y COMMENTS/STRUCTURAL DEFECTS: COMMENTS/STRUCTURAL DEFECTS: EXCLUDED SURFACES:Surfaces listed in tfhese boxes can be made intact only by a licensed deleadu. SIDE LOCATION MEASURE:LOOSE PAINT ICI IC SID LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SCt IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Anthony Jakei is M 2929 9191m Page Of�0— InspWor(print) Lic# Date Anthony Jakaitis R 2929 Risk Assessor(print) Lich Signature Date Address of ftM ty: 31 Main St Apt. city Colon KITCHEN SIDE LOCATIONI LEAD TYPE OF URG IC IC D DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH DATE METH A B Up Walls AIM L NIA Y O window SN V.3 MII AAN L NIA Y SLa A e LOW Wald 2 AIM L WA Y B win Apron p.3 AIM L NIA Y A 8 Baseboards V.I AIM L NIA Y C in Casi g .Z AIM L N/A Y SLL A 8 Chair Rag O �1 AIM L NIA Y D Header Slop .� MA AIM L NIA Y B Radwtor ,d AIM L NIA Y IntStops p 4 Mn AMI L NIA Y Floor ( ( AIM L WA Y 1 Win Int Sash (j. Mn AIM L WA Y Caging 14.30 AIM L WAI Y 2 Ex Bdw Sill GO SF CAA Y A B Door .3 Q L WA Y 3 Pan Bead 4#WA Y C D Door Casing 05 AIM L WA Y 4 Blind Stop SF WA Y 12 Door Jamb 01 AIM L WA Y win Ext Sash WA Y 34 Threshold a. A/ML WA Y A window Sill a.� Mp AN L WA Y AQ Door L WA Y B win Apron a. AIM L WA Y C D Door Casing v. L AIM L WA Y %J win Casing o. AIM L WA Y 12 Door Jamb V. AIM L WA Y D Header Stop MM AIM L WA Y 34 Threshold p AIM L WA Y /1 hd Stops v. MII AIM L WA Y A B Door AIM L WA Y W win hd Sash o.i MA AIM L WA Y od Door Casing Q._N AIM L WA Y 2 Extorlor Sin SF<,WA Y 2 Door Jamb Q.'j AIM L WA Y 3 Part Bead &UA Y 3 4 Threshold V. AIM L WA Y 4 Blind Stop 4M SF WA Y A B Door L WA Y win Ext Sash QR W WA Y Door Casing 0.1 AN L WA Y Up Cab Fran M33 AIM L WA Y 10 Door Jamb .2. AIM L WA Y 00 Up Cab Door V I AIM L WA Y 34 Thredw AIM L WA Y Up Cab Wads U.( AIM L WA Y A Closet Door AIM L WA Y 12 Up Cab Shlvs 16. AIM L WA Y B CI Casing AIM L WA Y 34 Supports 14.3 AIM L WA Y C Closet lamb AIM L WA Y Low Cab Fram QA41 AIM L WA Y D Closet Weis AIM L WA Y AS Low Cab Door 0.1 AIM L WA Y Cl Baseboard AIM L WA Y Low Cab Wells Q.3 AIM L WA Y 1 Closet Pole A1M L WA Y Low Cab SA p .31 AIM L WA Y 2 Closet Shelf AIM L WA Y 12 Supports 0.2 AIM L WA Y 3 Cl Supports AIM L WA Y 34 Drys 6. AIM L WA Y 4 Closet Floor AN L WAI Y A: Above S Mfl AN L WA Y Closet Ceifing AIM L WAI Y I I I C_ ,, 4 Mn AIM L WA Y COMMENTS/STRUCTdIRAl DEFECTS: Md AIM L WA Y W AIM L WA Y MO AIM L WA Y IL I NUI AIM L N/Al Y EXCLUDED SURFACES:Surfaces fisted in tttese boxes can be matte intact only by a licensed deleader. SlD LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SQ.IN.) DATE METHOD (MORE THAN 288 SQ.IN.) DATE METHOD LYRA RepKitchen,8/08 Anthony Jakalds M 2929 9f9 m Pa ja UJ Inspector(print) Lic# Date Anthony Jakaids R 2929 Risk Assessor(print) Lic# Signature Date Address of ProsW 31 Main St ApL City Cotuft CONTINUATION OF ROOM( M ) SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDEJ LOCATION/ LEAD TYPE OF URGI IC IC DELEAD DELEAD SURFACE HAZARD HAZ4 DATE METH DATE METH SURFACE HAZARD DATE METH DATE METH AB Door AIM L WA Y Low Cab F AIM L WA Y C D Door Casing AIM L WA Y AS Low Cab Door AIM L WA Y Door Jamb AIM L WA Y C D Low Cab WalkAIM L WA Y AIM L WA Y Low Cab AIM L WA Y AB Door AIM L WA Y Supports AIM L WA Y C D Door Casing AIM L WA Y Drawers AN L WA Y Door Jamb AIM L WA Y A WindowSN MR AIM L WA Y Threshold AIM L WA Y B Wm Apron 4. AN L N/A Y AB Door A/M L N/A Y et Casng ( AIM L WA Y C D Door Casing AIM L WA Y D Header Stop W AIM L WA Y Door Jamb AIM L N/A Y Int Slops M!1 AIM L WA Y Threshold AIM L N/A Y d Wm kd Sank MR AN L WA Y Closet Door AIM L WA Y Exterior Sr9 SF Ar WA Y A CI Casing AIM L WA Y Pert Bead WA Y B Closet Jamb A/M L WA Y Band stop SF A Y C Coset Waus AIM L WA Y m Ext Sash A Y D CI Baseboard AIM L WA Y A rtxlow SB tNl AIM L WA Y Closet Pole AIM L WA Y B Win Apron AIM L WA Y Closet Shelf AIM L WA Y C m Casing AIM L WA Y CI Supports AIM L WA Y D Heaft Snip Mfl AIM L WA Y Cl Drawers A/M L WA Y hd Stops M11 AIM L WA Y Cl Dr Frame AIM L N/A Y Wm lot Sash AN AIM L WA Y Closet Floor AIM L N/A Y Exterior St! MR SF L WA Y Closet Ceiling AIM L WA Y Part Bead Mll L WA Y AB Co ShNS Above 5 AIM L WA Y Stop W SF L WA Y AB C p Cab Above 5 AIM L WA Y Ext Sash MR L WA Y AB Co Cab Above 5' AN L WA Y S Fireplace AIM L WA Y B Up Cab Frame AIM L N/A Y D Martial AIM L WA Y CD Up Cab Door AIM L WA Y S SkI ftht(L) AIM L WA Y Up Cab Walls A/M L WA Y D ider#d(R) AIM L WA Y Up Cab Shhe A/M L WA Y A u Wm Above 5 A/M L WA Y Supports A/M L WA Y AB C p m Above A/M L WA Y COMMENTS/STRUCTURAL DEFECTS: COMMENTS/STRUCTURAL DEFECTS: EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SID LOCATION MEASURE:LOOSE PAINT IC IC S LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SQ.IN.) DATE METHOD (MORE THAN 208 SO.IN.) DATE METHOD Andtony Jakaids M B29 9I9/M Papgov Inspector(print) Lic# RjOgre Date Anthony Jakatds R 2929 Risk Assessor(print) Lic# Signature Date Address of Proaerty 31 Main St Apt City Codiit STAIRCASE Sk d; SIDEJLOCATION/ LEAD TYPE OF URD IC IC DREAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEA DELEAD SURFACE HAZARD DATE METH DATE METH SURFACE HAZARD DATE METH DATE METH A B UP Wass121.1141 AIM L WA Y A Window Sa AIM L WA Y A B Wei A/M L WA Y B WirApmn A/M L WA Y A B Baseboards U AIM L WA Y C Wm Casing J AIM L WA Y A B Chair Rail AIM L WA Y D Heger Slop W AIM L WA Y AS Co Radiator AIM L WA Y Int Stops W AIM L WA Y le Fkror v.5 A/M L WA Y 1 Nfm hrt Sash MR AIM L WA Y Ceiling V A/M L WA Y 2 Exw w Ssl W SF L WA Y WA Y 3 Part Bead w L WA Y C D Door Casag Z AIM L WA Y 4 Brmd Stop Mn SF L WA Y 12 Door Jamb AIM L WA Y Win Erd Sash IW L WA Y 3 4 mshdd a. AIM L WA Y A Window SN W AIM L WA Y A B Door WA Y B Wm Aeon AIM L WA Y Ib D Dow Casing 4 AIM L WA Y C Win Casbg AIM L WA Y 12 Dow Jamb 4).3 A/M L WA Y D Header Stop i1M1 AIM L WA Y 3 4 Thmdmw .Z AN L WA Y ird Sys Mn AIM L WA Y A B Dow 4UQUA Y 1 Win hd Saar W AIM L WA Y Clfi Do-orCaairg AN L WA Y 2 EduiwSm MR SF L WA Y 6 DowJamb ( A/M L WA Y 3 Part Bead w L WA Y 3 4 Threshold .( AIM L WAI Y 4 BW Strop IM11 SF L WA Y A B Dow WA Y Win Ext Sash W L WA Y Door Caseg A/M L WA Y " Newel Poi .L AIM L WA Y 1 Jamb j AN L WA Y Railing Cap v.t AIM L WA Y 3 4 Thremdd 3 AIM L WA Y Hand"rd V.N AAM L WA Y AB Door AIM L WA Y Balusln 4-3 AIM L WA Y CD Door CasN AIM L WA Y Lower ras AIM L WA Y DoorJamb A/M L WA Y Treads 6. A/M L WA Y Tlueshold AIM L WA Y Riam AIM L WA Y A Closet Dow AIM L WA Y Streger .f AIM L NIA Y B CI Casing AIM L WA Y Fbw Edge AIM L WA Y C Coset Jaft AIM L WA Y Fbw Casag AIM L WA Y D Cbset Walt AIM L WA Y W A/M L WA Y CI Bird A/M L WA Y /STRUCTURAL DEFECTS: 1 CloW Pole AIM L WA Y r � C-#6407: o y 2 Cbw Sarell AIM L WA Y A 4;f*w ? 4,7 3 CI Supports AIM L WA Y 4 Closet Fkwr AIM L WA Y Clow c iimg AIM L WA Y EXCLUDED SURFACES:Surfaoes lister in these boxes can be made intact only by a licensed deteader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT ICflMETHOD (MORE THAN 288 SQ.IN.) DATE METHOD (MORE THAN 288 SQ.IN.) 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A VIM l WN �moa a s A VM 4SBS IX3 WM A tlM l WN =0 8 y A VM 3S dMS Pu119 13 A VM 1 WN £' PW4mu ti£ A VM Pe88led $ A VM l WN q wiooa A tlM dS ms muAc3 A VM 1 NV 4' bLlSBJ 10� a A VIM 1 WN IM '0 tPS lui u L A VM =a 9 d A tlM l WN UW Z SAS M A VM l WN PW4MU b$ A VM l WN UW c*rf dolSimmi4 a A VIM l WN gwerjwa Z A V/N l WN W a A VM l WN 6**looa A VIM l WN TFO dtl M A 8 A IVIN 1 WN moa 8 V A tlM l WN uuu ZO NS A tlM l WN Z' PW45e141 b£ A tlM s WS113 WM A tlM l MV E gwermoa Z L A VMA>dS W4 IV do4S NO b A tlM l WN &4903 looa a A V PwG led £ A VM l =0 139 A tlM 5 A !S mua Z A V/Nl Wro )'p Btu : •:r A tlM l WN UW To gwS2ul14M rp A VM l WN I' mold A tlM l WN UW sdoiS lul A VIM 1 WN X)M.PBH B v A tlM l WN UW '(� d%S rapaH a A V/N l WN LteM�B4'J B y A tlM l WN fj •� &M u1M J A tlM 1 WN Zp wBogBm' ev A VM l WN Z 0 UO*MA 8 A tlM l WN WM Mot B y A tlM 1 WN VW£ @S MoW y A VM 1 WN 4D %BM do a y H13W 31Va RM 31Va allvzvH 33VAHM I HIM 31Va H13W 31V0 UZVH Crd ZVH 33vjHnS aV313O aV313a 01 01 roHn 1 d0 3dA1 aV31 MMVOOI 13ais amm aV3130 01 OI oHn 30 MA1 &M MOl1VOOl MIS #WOO)i pwo �l!J �dlt 3S URN L£ 10 RWV oleo BL S vfI (luud)mmV)js!M WE a ep!ew xuowv also Q #on (lam)jopWsul � d 600 A6 6ZSZ W smewr hotpuy Anthony JakAss M 2929 MAN Paget X Inspector(print) Lic# Date Anthony Jakaitis R 2929 Risk Assessor(print) Uc# Signature Dade Address of Property: 31 Main St Apt. CRY Cowit CONTINUATION OF ROOM( SIDE LOCATIOW LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIOW LEAD TYPE OF URGI IC IC DELEAD DELEAD SURFACE HAZARD DATE METH DATE METH SURFACE HAZARD KA24 DATE METH DATE I METH A B Door AIM L WA Y Low Cab Fran AIM L WA Y C D Door Casing NM L WA Y AB Law Cab Door AIM L WA Y Door Jamb AiM L WA Y C D Law Cab Walls NM L WA Y ED:oorJ:am:b AN L WA Y Low Cab AIM L WA Y AB AIM L WA Y Support AJM L WA Y C Dng AIM L WA Y Drawers NM L WA Y AN L WA Y A window Sm Q.Z M 11 AIM L WA Y AflN L WA Y B Win Apron AAN L WA Y A B Door AIM L WA Y 4E Win Casing It.f AIM L WA Y C D Door Casing NM L WA Y D Header Stop Mfl AIM L WA Y DoorJamb AIM L WA Y Intstops Mn AIM L WA Y Threshold AIM L WA Y Win lot Sash a .i� Mfl AIM L WA Y Closet Door �.Z AIM L WA Y 6 fk E derlor SN Mn SF L WA Y A CI Casing AIM L WA Y Bad V w L WA Y B Closet Jamb 40.1 AIM L WA Y BTmd Stop . IWI SF L WA Y beet Wad 0.1 AN L WA Y Win Ext Salt a Mfl L WA Y D CI Baseboard a AN L WA Y A Window SN MVI AN L WA Y Closet Pole AN L WA Y B Wm Apron AIM L WA Y Cktset Streit A/M L WA Y C Wit CNN A/M L WA Y CI Supports AIM L WA Y D Header Stop AIM L WA Y CIDmwem AIM L WA Y IntStops W AIM L WA Y Cl Dr Frame NM L WA Y Wn Mt Sash MR AIM L WA Y Closet Floor AIM L WA Y Exterior Sig MII SF L WA Y Closet CeMrg AIM L WA Y Part Bead IM L WA Y AB C p Shhrs Above 5' AIM L WA Y Band Stop Mn SF L NJAJ Y CD Cab Above 5' AIM L WA Y Wm Ext Sank MA L WA Y Al C D Cab Above 5' AIM L WA Y B Fireplace AIM L WA Y A B Up Cab Frarne AIM L WA Y C D IWO AIM L WA Y C D Up Cab Door NM L WA Y AB Sideight(L) AIM L WA Y Up Cab Waft AIM L WA Y C D Skl*ht(R) AIM L WA Y Up Cab SIM AIM L WA Y A o Wit Above 5! AIM L WA Y Support NM L WA Y AB WIn Above 5' AIM L WA Y COMMENTS/STRUCTURAL DEFECTS: COMMENTS I STRUCTURAL DEFECTS: EXCLUDED SURFACES:Surfaces listed in tltese boxes can be made intact only by a licensed deleader. SI LOCATION MEASURE:LOOSE PAINT IC IC S LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD L 80/8`UeH&V VZ AI QOH W RVa ('NI'M 99 NVHI 3MD'd WHEM 31Va ('NI'OS ON NVH13WM 01 01 1NIVd 3SO01'31nstl3W I NMlV001 301S 01 of iNIVd 39001 aanSV3W I NOIi=l MIS 'J9PBOPP PssuM a Aq f4uo Pgt4 OPW aq M SUN asalp ul pagsg SBOWS: o m 3 m A VM l VW &.g*1 sr A VM l WIV Amu lasal0 v f�••9� »+M A VM l WM Q E 333a lVlln10na1S S11d A VM l Wro p4S PRO Z A VM 1 UW �d� *� '" A VM l YWV n A VM l VW UW kMM BUM a A VM 1 WW pWaw"13 8tl A VM l WW UW S WW m e v A VM 1 WW SFM PR3 Q A VM 1 UW WS 93 MA A jym l WW "Br 0 Q A VM l IS UW dogs PM A VM l NUV Wse0 N) e A VM 1 uW P"S lwd E A VM l WW JOoa PRD A WN 1 AS UW LSMP%13 Z A VM l WW PIo4swu A VM 1 WW UW 4SeS M UIM A VM l WW Vwer j000 A VM l NW un gfts W A IVIN l M &ose0jooa Q Q A YIN l WW VW ftftSAPM, Q A VM 1 WW Ia e V A VM l WW BU1S*U)m Q A YIN l MV £ A VM l VW V Ualddl! 8 A VM 1 M 4V1erma Z A VM l MV W4 V A VIN l WIV &gsB'Jma Q Q A Vftn WS P9 IA A VM 1 WW iwa S V A vft J� dS ft PUBS b A VM I WW PI 41 £ A V ""m £ A VIN 1 WW quer j000 Z A tl dS MS�WMX3 Z A VIN l WW BU1 o ma Q Q A VM 1 VW MW 'O t[OS R4 UUN t A VM l VW �a 9 V A VM 1 VIV MW�'0 sdagg w1 A VM l NV D PIOLIMI 1 q£ A VM 1 M UW ,'n ftJBWH Q A VM 1 VW 'C) "Or ma Z� A VM l WW Kus6o W Q A VIN 1 WW Bum=a Q A VM l WW Z' MWV�M 8 A YM 1 M i'D Ma 9 V A tlM l WW UW ■S v A VM l NW WJJ A VM 1 M BUo 1 A VIN 1 WW 'i• 4LL1 A VM 1 M mu pm0 A VM l WW Z D BU1S A VM l MV sal® $ A VM A VM 1 WW �'O JIMMPW3 Z A VM 1 WW A VM l WW QPdleM A VM l MVjo A VM l WW We�a 10 A V/N 1 WW > qj A VM l WW 31eMlasat0 Q A VM 1 WW Pe A VM l WW 4LL1er A VM 1 WW spwq e a tl A VM l WW f & oo ro 9 A VM l VW Z' s11eM mOl e 'I. A YIN l WWF— V A WN l WW sueM do a tl H13Vi 31Va Hun 31Va avHl a&wH 30V3?Ins I uva Km I 31Va imlcluv H 30Vdans ' OV3l3oOV3W 01 01 Oan I 30 3dAi aV31 MMV00l l3ats aV3130aV313a 0! 1 01 ouni 3dJLL aV31 KOLLVOOI 3a1S 1:,kVMIWH 1!n;o:) 40 my 1s URN�£ JO spa oj►4eu6iS #a!l (ittud)mmwm 6MZ a $Uhler Auo4m ago sinwAs #a!1 (lupd)jopadsul �" 600TJ616 6m W $U"er An041W r AnMony Jakaf is M 2929 9/9/2009 PageAID Inspector(print) Lic# re Date Anthony Jakaitis R 2929 Risk Assessor(print) Lic# Signature Date Addrmof 31 Main St Apt City Cobirt ROOM SIDE L TIOW LEAD TYPE OF URG IC IC DELEAD SIDE LOCATIOW LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD DATE METH DATE METH SURFACE HAZARD DATE METH DATE METH A a Up Walls fJ.3 A!M L WA Y A Window SB .3 MW AIM L WA Y A B Low Walb AAN L WA Y B Wn Apron 3 AIM L WA Y A B Baseboards 4.2. AIM L WA Y n Casing .7. AIM L WA Y A a Chair Rao AIM L WA Y D Header Stop .E W AIM L WA Y Radator AAN L WA Y Int Slops MA AIM L WA Y Floor d AIM L WA Y 1 Int Sam Q. NW AIM L WA Y Ceing AIM L WA Y 2 Extw w SB SF UI. WA Y B Door QQQ WA Y 3 Part Bead (0 WA Y C D Door Casing AIM L WA Y 4 BBnd Slop SF WA Y 12 Doorjamb 3 AIM L WA Y Win Ext Sash Q WA Y 3 4 .2 AIM L WA Y A Wier sm AIM L WA Y AW Door 4M WA Y B Win Apron AIM L WA Y C D Door Casing AIM L WA Y C Win casing AIM L WA Y 12 Doorjamb AIM L WA Y D HuftSwp JW AN L WA Y 34 Threshold Z AIM L WA Y art Slops NW AIM L WA Y AB AN L WA Y 1 Win art Sash Ann AIM L WA Y C D Door Casing AIM L WA Y 2 Exteriorse MW SF L WA Y 12 Doorjamb AIM L WA Y 3 Part Bead MW L WA Y 34 Threshow AN L WA Y 4 Bond Stop 1W SF L WA Y A B Door AIM L WA Y WmBdSashl ]W L WA Y C D Door casing AN L WA Y A Window SB MAN L WA Y 12 Doorjamb AIM WA Y B WinApron AIM L WA Y 34 Tkeshow AIM L WA Y C Wn Casing ARIA L WA Y Closet Door fA tNA Y D meander Stop NW A/M L WA Y B Cl Casing q, L WA Y w Slops NW AIM L WA Y C Closet jamb O.3 AIM L WA Y 1 Win hrt Sash W AIM L WA Y D Closet Wags AIM L WA Y 2 Eftior a MA SF L WA Y Cl Baseboard 'R.1 AIM L WA Y 3 Part Bw I W L WA Y 1 Coset Pole V-foz AIM L WA Y 4 Bled Stop NWSF L WA Y 2 ClosetSho AIM L WA Y Wn Ext Sarah MAL WA Y 3 CI Support LWA Y B Fireplace AIM L WA Y 4 ClosetFloor AIM L WA Y D Mantle AIM L WA Y Closet Ceiling 6.1 AIM L WA Y c u Wn Abare 5 AIM L WA Y MMENTS/STRUCTURAL DEFECTS: � Ceiling WTq AIM L WA Y C_ C.Lefe .1 AIM L WA Y R w, AIM L WA Y AMA L WA Y m ese boxes can be made mtad only by a licensed Meader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC 'SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SQ.IN.) DATE MERiOD WE THAN 288 SO.IN.) DATE METHOD LI/RA RepRoom,8/08 I— r Anthony Jakaihs M 2929 9I912009 Page�`x Inspector(print) Uc# Date Anthony Jakaids R 2929 Risk Assessor(print) Lic# Signature Date Address of Property: 31 Main St Apt city Cotuit CONTINUATION OF ROOM( ) SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD SIDE LOCATIOW LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD DATE METH DATE METH SURFACE HAZARD DATE METH DATE METH AB Door AIM L WA Y Lan Cab From AIM L WA Y C D Door Casing AIM L WA Y (AJ3 Low Cab Door AIM L WA Y Door Jamb AIM L WA Y C D Low Cab We& 9' QA L WA Y Th►esiwtd AIM L WA Y # Lon C� �I I L WA Y AB Door AIM L WA Y S+Pport AIM L WA Y C D Door Cas(ng A/M L WA Y Drawds AIM L WA Y Door Jamb AN L WA Y A Window Sin MA AN L WA Y Threshold AN WA Y B m Apron AN L WA Y AB Door AIM L WA Y C Win Caskg AIM L WA Y C D Door Casing AIM L WA Y D Heador Stop MA AIM L WA Y Door Jamb AIM L WA Y hd Slops MA AIM L WA Y AIM L WA Y Win Int Sash Mn AIM L WA Y Closet Door AIM L WA Y Exterior Sni MA SF L WA Y A CI Casing AIM L WA Y Part Bead MA L WA Y B Closet Jamb AN L WA Y NXI Stop MA SF L WA Y C Closet Wars AIM L WA Y Win Ext Sash L WA Y D Cl Baseboard AIM L WA Y A mdow sm AN L WA Y Closet Pale AIM L WA Y B Wm Apron AAN L WA Y Closet Shell AIM L WA Y C m CaNng AIM L WA Y Cl Supports AIM L WA Y D Header Strop MA AIM L WA Y Cl Drawers AIM L WA Y Int Stops W AIM L WA Y Cl Dr Frans AAA L WA Y Win hA Sash M11 AIM L WA Y Closet Floor AIM L WA Y Exterior SN MA SF L WA Y Closet AIM L WA Y Part Bead MA L WA Y AS co ShMs Above ' AIM WA Y Brnd Strop MIA SF L WA Y AS c o Cab Above 5' AN L NIA Y n Ext Sash M fl L WA Y AS CD Cab Above 5' AIM L WA Y B Fireplace ANA L WA Y B Up Cab Frame AN L WA Y D Martel AN L WA Y C D Up Cab Door AIM L WA Y B ht(L) ANA L WA Y Up Cab Walls AIM L WA Y D Sight(R) AIM L WA Y Up Cab Sirius. ARA L WA Y C n n Above 5' AIM L WA Y Support AIM L WA Y c o n Above 5' AIM L WA Y COMMENTS/STRUCTURAL DEFECTS: COMMENTS/STRUCTURAL DEFECTS. EXCLUDED SURFACES.Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SI LOCATION MEASURE:LOOSE PAINT IC ENUHOWDI (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 Sa IN.) DATE so/8'4lefldaN vwn WHIM 31VO l'N!'OS Mg NMI 3WM OOHIM 31Va ('NI DS W NVH13aOW) OI OI INIVd 3SO01:3anSV3W NOI LV301 3QIS OI 1 OI INIVd 3SO01:3ansm I NOLLVOOI 13cus 'gyp pasuaog a 6q I O MCI apew eq uea saxoq es"u4 POR seclePg:s3OV3ans 03amom W331301Vanimus/SIN3MW m :sLoaj3a 1Vu UOnas/s1N3Wwo0 A VN I MV UW A V/N 1 NUN UW ' A VN l MV V UW A V/N I WN UW ' A VN I WN UW A V/N 1 WN UN A VN l MWV UW A V/N 1 MV SPoddnS b£ A VN I NW UW A VIN l WN sN4SQeodn Z L A VN I WN UN A V/N I WNRju eM M do A VN 1 WN UW A VM l NW =a qGo do a a A VN l MWV UW A V/N l WNes j 4eo do a A VN l WN UW aJ�� A VM l WNJ1eOle m A VN l NW UW 7 A VM l MVlasg0 >b A VN l WN UW A VIN l WIV %owns YJ £ A VN Ovy UW J64. 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HAV DATE METH DATE METH A SURFACE HAZARD HAZI DATE METH DATE METH Siding WA Y a Wing Sul AN L WA Y Comer Boards cm Y A Win Casing AIM L WA Y A Lo%wTrtm L WA Y 0 WmdowSash AIM L WA Y Upper Trim A L WA Y CeRar Wm Sill AIM L WA Y Win Above 5 L WA Y A Ce1 Win Sash AIM L WA Y Parch Above L WA Y Cel Win F AIM L WA Y Storm Door AIM L WA Y Speer Frame AIM L WA Y Door jtj QCAA Y I I I CeAar Win Sig AN L WA Y Door Casing 1.1 QQ WA Y A Cel Win Sash AIM L WA Y 2 Door ja C.,a WA Y ff CeIWmFwm AIM L WA Y 3 4 Threshold A Y Sam Frame AIM L WA Y Mckplate Z07A Y Celar Win SM AIM L WA Y Sinn Door p. AIM L WA Y A Cel win Sash AIM L WA Y Door Iffir.NIA Y 0 Cel Win Frame AN L WA Y Door Casing L9 WA Y Screen Frame AN L WA Y 1 4Z DoorJamb Zt WA Y CeRar Wm Sig AIM L WA Y 3 4 Threshold WA Y A ESaiwn Sash AAN L WA Y KidQ>tata �. A Y F AIM L WA Y Door AIM L WA Y Frame AIM L WA Y A Door Caging AIM L WA Y FomWdm Q. L WA Y 1 2 Doff Jamb AIM L WA Y A BuIldwad AIM L WA Y 3 4 Threshow AIM L WA Y Fern s AIM L WA Y Windowsill A Y Shutters AIM L WA Y At Win Casing A Y Newel post AIM L WA Y Wmdwv Sash ft AIINdj:WA Y Raging Cap AN L WA Y Window SB A Y Handrail AIM L WA Y Al Win Casing A Y A Balusters AN L WA Y Window Sash AIML WA Y Lower AIM L WA Y Windowsill AIM L WA Y Treads A M L WA Y A Win Casing At1N L WA Y Risers d AIM L WA Y Widow Sash AIM L WA Y Stringer r%. AIM L WA Y A Lamp Post L NIAJ Y I Lattice AIM L WA Y COMMENTS/STRUCTURAL DEFECTS: Drain Pipes L WA Y A Elec Conduit L WA Y 01 Fill Pipe L WA Y Orerfnang T 4— AIM L WA Y Excluded Surfaces:Surfaces fisted in this box can be made Sal Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area 11200 ppm for bare sod) SIDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREA NWASUREA4ENT RESUL REMED REMED A (MORE THAN 1440 SQ.IN.) DATE ME1H (Square Feet) (PPM) DATE METH A Ptey Area A Bare soil A Commends: A LIRA Rep.ExtA,8/08 80/8'ap(acbs vWn V Aos e�eg V earyARd y H13W 31Va (Wdd) (198A embS) HAN 31VO ('NI'OS M6 NVH13a0W) V a3W3a a3W3a iinsu D13YOWI M V3xv NOLLVOOI OI 01 LNIVd 3SOOl 3anSVmN I NOLLVOOI 13aisi oos ajeq joj wdd OOZL!ears Aeid iq wdd ook ueyl ssal eq;snW) iapegep pesueoll a/tq duo piul gnseb#sal Lx)S spew eq ueo xoq sitµ uI Pals!!swspRS:SewpnS PaPnpx3 A VIN l WIV Im,&BPMO A VN l 07L wild 1H AO A VIN 1 WPDO oel3 8 A VN I MOd U.Wa :S103d3a imionals/s1N3WWOJ A V/N 1 MV f'Uuleom A VIN 1 PDd dwel 8 A V/N l W1V JGU4S A V/N l WN YMS NOPU!M A V/N l MV sti a A V/N l iY )'1 &=3 WO f8 A VIN l WN s'PM1 A VN 10 RT msmoPu!M A VIN I MV mmicni I I I A VN I VW -Ohl 40S WWAA A VMI 1 WN Sam" 8 A V/N I WN &OM w.M 8 A V/N 1 WN PPPUeH A VN 1 WN 4'p His MOPU.AA A V/N l WM deo 6mea A V/N l MV bJ1 40S wWRM A VIN 1 WN lsod P"N A lvm 1 PW BU1Se'J UIM is A V/N 1 WN mwqs A V/N I WN ILIS MoPulM A V/N l WN SMUej A V/N l WN Photrsw41 v £ A IVIN I WN Peeing 8 A VN 1 WN 4wei'ja Z L A VN l umim .4 A VIN 1 WIV &nwo x*a 8 A VN I MV Wunn3 Umns A V/N l WN iW0 A V/N l WN OWMA ft RD 4 A VIN l WN ell A VIN l WN WS m,M n 8 A VIN l WN W4SMU ti £ A VN l WIV NS U!M IBM A V/N I WN g jooa Z L A VIN l V V a mzi Wanj A VIN 1 WN &m3 jooa 8 A VN l WN RMA ta,M Pol A A V/N l VIN is A VIN I WN Was um R'J 8 A VN l WN �u qs A V/N l WN @S UJM A V/N I WN Volqqdlm A V/N I WN am:j UBevS A VN l )'f Pio�41 v A V/N l NUV ei3 UHIA m A V/N 1 rZ gwef�a Z L A V/N l WN 4seS tqM pol 8 A I V/N 1 WN l'P 6u±se0�ooa A VN 1 VMV LIS14MMao A V/N l I" =a A V/N 1 WN A VN l WN =a UUolS A VIN 1 @0 MMA MID� A VIN l eeogV 4PJOd A VIN 1 Op I Z OBS tqM 109 8 A VN I 8OAWV LQM A VN l Fa 'L'Z IISMAJIMI A IVIN 1 uWljddn A VN I WN f 4NS eOW.M A A V/N I wP.L XkM(I 8 A ;IN 1 Le A VN(p speog A V/N l C MS .AA A VAIP �S HAN 31Va HIM 31Va OWM 33VMnS 8 H13W 31VO H13VV 31Va GUMN 33V3ans 8 aV313a aV3130 01 of Jan 30 3cbd GM NOLLVOOI pals aV3lpa aV3130 of Oi 'Jan 30 3dA1 1 NOLLV�I MIS aPIS 8 801831X3 3lrqo0 APO ldv is uleW t£ A SSWv spa emp ft P!1 (iuud) msmy W.W OWN "at fucq;ud e #on (wld)iomdsul I0 <uo 6 � Wb 80/s`,-Ax3(bw vwn d :sluewwoO b LDS suea b eauV AId y H13W 31V0 bw@ (t"d wenbS) H13(Al 31Va CNI'OS ML NVH13WW) V 03W38 jCrM38 LinSM11 mmuuflsvaw V3Nd NOUVO01 01 01 iMVd 3S001:3tInsm NOUVOOI 301S 6! S QM A Wdd OOZL/em Ap4d jo1 tudd-Oo#tiB4t ssaI a1 jon) isPeoloP Posupl a Aq duo ppui s11n21 Pal IDS apew aq ueo xoq spi u1 polsq s-,oqpnS:sGwPnS PaPnPx3 A IVIN 1 VW uWi&MPAO A IVIN 1 wild IQd 110 4 solo-Is-> A V/N I M xN3 O lY o An A VM l sadd ww0 S a :K JL H'I :S1O3d301V!inio uis/siN3VIIWOO A V/N 1 VWV M W1 A V/N i lid"n A V/N l MV isam A VIN I VWV 0,.%l 4WS MOPU!M A V/N I M spa A V/N l WN &NUJ wM A VM I vuv A VM INV Ins Mww A VM 1 WN PH Awl A lvm 1 VWV WS AAA A VM 1 V41V sages A VM 1 VW �4M A VM l WN l4WeH A VM l NV Q MS M A VM 1 VVN deO web A VM l KIV weS AA A VM I WN pod VWN A VM 1 - &M uIM! A V/N 1 VWV �4S A VM 1 HIS AAA A VM I KIV d A VM l VWV P!o4Sw41 A VM I VYIV PN WnM A VM 1 w oBrxma Z t A VM l uogepunod A lvm I KIV �4SeO0 A VM I WN M=d Moos A lvM l WN J000 A VM 1 INN MRIA UN PO A VM l VWV x A V I l M 4wS u"M. O A VM I VWMo v A VM l w IRS MMJJ A VM l WN gWePFoa Z L A IVIN 1 MV GL=d WaCS A VIN l MV lkfise3 ma 3 A IVIN I W wd MM W'J A A IVIN 1 NV lw0 A V/N I MV WS WAA WO O A IVIN I VVN Jo0 UAS A VM 1 MV NS WA AO A VM l M wom A VM 1 VO a=d MmS A VIN 1 NIN I'0 MmPwU b £ A vMfbM MA NO x A VM I VMV UO guof ma Z L A vnc>w WS WAA IeO i O A VIN l WM jM A V NS ft JV 180 A V/N I M Jwa A VM 1 VW1/ S A IVMIVW JW0 UM A VM l INN 4Z 0 amj wWJ* A A V/N I ee09V 4J0d A VM l VYIV J� 468S u. oo)j A VM 1 S UQV u!M A VM I VWV iustgMjqrJ A jVffyq WPljeddO A VM 1 KIV 4PS MW4M 4 A VM I u4►1 jawl 3 A VM 1 VWV I lkwo tqM 50 A VM SPJM JOuOO A 04 1 VVIN T HIS wPAA A WIN 1 &4pl.S H13W 31V0 ROW 31Va avHa2lVZ1M 33Vd21f1S 0 NOW 31Va H13W 31VO aaVZVH 3OVdtins OV3130 OV313a Oi Oi Hn d0 3dA1 CN31 MOUVOOI 3aIS aV313a 0 01 OI Jtiil I d0 3dA1 aV31 MOUVOOI 2j ®PIS 3 a01831X3 VW3 AIO ldV Is weW to P V spa einmu ft Pri (Lund)m 9my M 616Z H SM84LT AU04M o #on (Lund)jopadwl 10 mooed SCOZ/616 6M W s4 xeP xuowd Anthony Jakalds M 2929 9I9f2009 P4�iq 011-D Inspector(print) Lic# Date Anthony Jakaids R 2929 Risk Assessor (print) Lit# Signature Date Address of Property: 31 Main St Apt City Cotuit EXTERIOR D Side SIDE LOCATION/ LEA TYPE OF URG IC tC DELEAD DELEAD SIDEJ LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD D SURFACE HAZARD DATE METH DATE METH D SURFACE HAZARD DATE METH DATE METH Skiing !( (L)HA Y Window SM AIM L WA Y Caner Boards GNIA Y D win cam AIM L NIA Y D Lower Trap L WA Y N wnrw Sash AIM L WA Y UpperTrim A Y CearWnSid AIM L NIA Y Wet Above 5' L WA Y D cel wen Sash AIM L WA Y Porch A ve 5 L WA Y CeI 0nn AIM L WA Y Storm Door AIM L WA Y Screen F AMA L WA Y Door A/M L WA Y Cellar Win SM AMA L WA Y D Door Casting AIM L WA Y D Cel Win Sash AMA L WA Y 1 2 Doorjamb AMA L WA Y 0 Cel wM Frame AIM L WA Y 4 ThretM A/M L WA Y Screen Frame AMA L WA Y ICdate AIM L WA Y Cellar wM S� AIM L WA Y Storm Door A/M L WA Y D Cel win Sash A/M L WA Y Door AIM L WA Y Cal Win Fra AIM L WA Y D Dow cmft A/M L WA Y Screen F AIM L WA Y 1 2 Doorjamb AMA L WA Y CeIIar Wn Sig AMA L WA Y 3 4 Rkplats eshold AIM L WA Y D Cei Win Sash AN L WA Y AMA L WA Y N Cal wm Fra AMA L WA Y Darr AN L WA Y Sam Frame AIM L WA Y D Door Caft AMA L WA Y Foundation L WA Y 1 2 Doorjamb AIM L WA Y D JBuWwd ().J I AIM L WA Y 3 4 Threshold AIM L WA Y Ferroes AIM L WA Y LWindowsill OWL WA Y Shutters AMA L WA Y D wM ceft ftL WA Y Newel post AN L WA Y Wndow Sash AN L WA Y RafBrg Cap AN L WA Y Window Sid AMA L WA Y Handrd AIM L WA Y D War Caft AMA L WA Y D Baksters A/M L WA Y Window Sash AN L WA Y Lower Rant AIM L WA Y wrndowSB AMA L WA Y Treads AN L WA Y D wM Casing AIM L WA Y Risers AMA L WA Y Window Sash AIM L WA Y Stringer AMA L WA Y D Lamp Post L WAI Y Lattice AMA L WA Y COMMENTS/STRUCTURAL DEFECTS: Drain Pipes L WA Y D ElwConduk L WA Y Od Fig Pipe L WA Y Overfrarg T AMA L WA Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area/1200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREA MEASUREMENT RESUL REMED REMED A (MORE THAN 1440 SQ IN.) DATE MEIN (Square Feet) (PPM) DATE I METH A Play Area A Bare sod A Cam A L/RA RepExtD,8/08 Anthony Ja6fis M 29n 91912009 Page�—U.D Inspeaor(pdnt) UC# NVAIre Date Anthony Jakeitis R 29n Risk Assessor(print) uG# Signature Date Address of Property: 31 Main St Apt City Cotuit GARAGE SIDE LOCATION/ LEAD TYPE OF URGI IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD A I SURFACE HAZARD HAZI DATE METH DATE METH C SURFACE HAZARD HAD DATE METH DATE METH Siding Q. L WA Y Siding 03 L WA Y A Comer Boards o.2. L WA Y C Comer Boards 0..3 AIM L WA Y LawerTdm L N/A Y LowerTdm L WA Y Upper Trim L WA Y UpperTrim O.2. L WA Y Door AIM L WA Y Door AIM L WA Y A Door Casing AIM L WA Y C Door Coming [ AIM L WA Y Door Jamb AIM L WA Y Door•hrmb AIM L WA Y Threshold AIM L WA Y Threshold AIM L WA Y Window Sin AIM L IVAI Y Window Sin AIM L WA Y A wm Casing AIM L WA Y C Win Casing AIM L WA Y Win Saar AIM L WA Y )C n Ski AN L N/A Y A Foundation L WA Y C FoLamon L WA Y COMMENTS I STRUCTURAL DEFECTS: COMMENTS I STRUCTURAL DEFECTS: 4%&--W: a s- �a.t•y >NM EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDEJ LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC A (MORE THAN 1440 SQ.IN.) DATE METHOD C (MORE THAN 1440 SQ.IN.) DATE METHOD A C A C A C SIDE LOCATION/ LEAD TYPE OF URG IC IC DREAD DELEAD SIDEJ LOCATIOW LEAD TYPE OF URG IC IC ID"DELEAD B SURFACE HAZARD HAV DATE METH DATE METH D SURFACE HAZARD DATE METH DATE METH SIWN 63. L WA Y Siding OIL L WA Y B Cornier Boards G Z L WA Y D Comer Boards o 2. L WA Y LowerTran L WA Y LowerTrkn L WA Y Upper Trim d 3 L WA Y UpperTdrn 0.1 L WA Y Door AN L WA Y Door AIM L WA Y B Door Casing AIM L WA Y D Door Casing AIM L WA Y Door Jamb AMI L WA Y DoorJamb AIM L WA Y Threshold j AIM L WA Y Threshold AIM L WA Y Window Sin AN L WA Y WhWow Sin AN L WA Y B Win Casing AIM L WA Y D Win Casting dE AIM L WA Y Win Sash A/M L WA Y Wn Sash AIM L WA Y B Foundation L WAI Y D Fow ddon d. L WA Y COMMENTS/STRUCTURAL DEFECTS Law'S e•^ : OL /STRUCTURAL DEFECTS: rj 4vst &%Olt : OC► CAlI s EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC B (MORE THAN 1440 SO.IN.) DATE METHOD D (MORE THAN 1440 SQ.IN.) DATE METHOD B D B I I D B L D U/RA RepGarage,8/08 I - o pp- ® Moderate Risk Deieader Owner/Agent @091EINNOW Certification # BOSTON CHILDHOOD LEAD POISONING PREVENTION PROGRAM OFFICE OF ENVIRONMENTAL HEALTH - MODERATE RISK TRAINING CERTIFICATION. This- is to certify that Charles B: Sheehan has attended and completed the 8-hour 6derate Rich Training Course for wners'and Their Agents, offered on September 24t" 2009 at.the-Boston Public Health Commission.. Thomas Plant Charles M a , Director-of Special Projects Director, BCLPPP BOSTON PUBLIC HEALTH COMMISSION: 1010 MASSACHUSETTS AVENUE, 2ND FLOOR ♦BOSTON, MASSACHUSEM* 02118_ ? e (617) 534-5966 (v) .(617) 534-2372(FAxy* I i REMOVE & REPLACE NOTES SEPTIC TANK DETAIL 1500 GALLON INVERT ELEVATIONS: DESIGN CRITERIA: REVISIONS: NOT TO `SCALE ZONING SUMMARY LOCUS MAP. No. DESCRIPTION DATE NOTE: TANK TO BE MONOLITHIC '• DESIGN FLOW: " NOT"TO SCALE WITHIN THE AREA SHOWN, ALL UNSUITABLE MATERIAL (A & B HORIZONS 4 INVERT AT BUILDING MATCH EXISTING RF RESIDENTIAL DISTRICT SEE PLAN) TO BE REMOVED AND REPLACED WITH SOIL CONSISTING OF NOTES: 1. SEPTIC TANK SHALL BE STEEL 6. INLET TEE TO BE CAST IRON, SCHEDULE 40 PVC OR 4 BEDROOMS AT110 G.P.B. D 440 G.P.D. CLEAN GRANULAR SAND, FREE FROM ORGANIC MATTER AND DELETERIOUS REINFORCED MONOLITHIC: CONCRETE, WITH CAST-IN-PLACE CONCRETE. OUTLET TEE TO BE SUBSTANCES. 0 E. MIXTURES FILL SAND AYERS OF ONTAIDIF ER MATERIAL LARGER THREE (3) 20 MANHOLES. CENTERED UNDZABEL FILTER ER O) WITH MANHOLE EXTENSION. TEES TO BE ( ) 98.12 MIN. LOT SIZE 87,120 S.F. THENOT " REQUIRED SEPTIC TANK: SEPTIC TANK IN THAN 2 INCHES. A SIEVE ANALYSIS, USING A #4 SIEVE, SHALL BE 2. SEPTIC TANK TO WITHSTAND H-10 LOADING MIN. LOT FRONTAGE 150' AT UNLESS UNDER PAVEMENT, DRIVES, OR 7. 4" SCH 40 PVC PIPE EXTENDED TO BOTTOM OF 440 x 200% s 880 PERFORMED ON A REPRESENTA9VE SAMPLE OF THE FILL. UP TO 45% BY GAL. MIN. FRONT SETBACK 15 CONSTRUCTION,.IINOTES: WEIGHT OF THE FILL SAMPLE MAY BE RETAINED BY THE #4 SIEVE. TRAVELED WAYS WHERE BY H-20 LOADING TANK WITH 2" DIA. HOLES DRILLED WITHIN PIPE. ++ + 4 INVERT AT SEPTIC TANK OUT MIN. SIDE SETBACK 15 SIEVE ANALYSIS ALSO SHALL BE PERFORMED ON THE FRACTION OF THE SHALL APPLY. INSTALL 4"X4" SCH 40 PVC TEE ON BOTTOM (OUT) 97.87 SEPTIC TANK PROVIDED: ' 1. ALL UNDERGROUND UTILITIES SHOWN WERE FILL SAMPLE PASSING THE #4 SIEVE, SUCH ANALYSES MUST 3. ALL PIPE CONNECTIONS ,AND CONCRETE --- MIN. REAR SETBACK 15 - COMPILED ACCORDING TO AVAILABLE RECORD DEMONSTRATE THAT THE MATERIAL MEETS EACH OF THE FOLLOWING CONSTRUCTION SHALL BE WATERTIGHT. RISERS TO BE MADE USE 1500 GAL. PLANS AND ARE APPROXIMATE ONLY. WE SPECIFICATIONS: 4. MANHOLE COVERS TO BE BROUGHT TO WATERTIGHT WITH TOP ZABEL FILTER 4" INVERT AT D-BOX ; ASSUME NO RESPONSIBILITY FOR DAMAGES ( ) 97.79 SIZE OF LEACHING FACILITY REQUIRED: AS A RESULT OF INACCURATELY SHOWN OR WITHIN 6" OF FINISHED GRADE. OF TANK W/ EXTENSION 9 OMITTED UTILITIES. SEE CHAPTER 370, ACTS EFFECTIVE % THAT MUST 12" MIN,-3' MAX. SIEVE SIZE PARTICLE SIZE PASS SIEVE 5. RECOMMENDED MANUFACTURER- PEMBROKE (A100) < 2 SITE IS LOCATED WITHIN OF 1963, MASSACHUSETTS GENERAL LAWS. THE COVER ++ DESIGN PERC. RATE: MIN./ INCH RESOURCE PROTECTION APPROPRIATE PUBLIC ENGINEERING DEPARTMENT # - CONCRETE OR APPROVED EQUAL. /� /!�/� 34„ 4 INVERT AT D-BOX (OUT) 97.62 - CLASS I SOIL OVERLAY DISTRICT. 4 1.75 MM 100% // SHALL BE CONTACTED AS WELL AS DIG-SAFE # 50 0.30 MM 10% 100% 10'-6" CLASS I ELR = - Locus (PH. NUMBER 1-800-322-4844) PRIOR TO # 100 0.15 MM OX-20X ,>.. :�.�. ��.e Vic.: �: INVERTS AT LEACHING FACILITY: 440 G.P.D. / .74 GAL/S.F. 595 S.F. SITE IS LOCATED WITHIN THE START OF CONSTRUCTION. i # 200 0.075 MM OX-5% 10'-0" NORMAL WATER 12" GROUNDWATER PROTECTION 2. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE 3 + OVERLAY DISTRICT. 3. THIS SYSTEM SHALL BE INSPECTED REQUIRED 13' " LEVEL 4 INVERT AT BEGINNING SIZE bF LEACHING FACILITY PROVIDED. GRINDER, TED AS RE ED 14" (2) 2 W x 2 D x 49 L LEACHING TRENCHES BY TITLE 5 AND BARNSTABLE:BOARD OF HEALTH AfIO PRECAST SEPTIC TeNK OF LEACHING FIELD 97.59 <� � i . I7 P!II•!1 III,t,II'I i.B{ I'� � .II� GENERAL NOTES _ _ - 2(49+2+49+2)(2) = 408 S.F. N INLET TEE of 4" INVERT AT END 2 49 x 2 = 196 S.F. 4. AT ALLPOINTS OF INTERSECTION OF WATER 1. OWNER: CHARLES B. SIIEEHAN I I " 0 i ) OF LEACHING FIELD g7,32 ( TOTAL) LINES ANDISEWER LINES BOTH,,I, PIPES-SHALL BE �t 4-0 MIN. = 604 S.F. N T T CO S RUC ED OF CLASS..15 ;' R ir) O LSSUIZE PIPE .AN I 2. DEED REFERENCE: DEED BOOK. 15693 PAGE 148, BARNSTABLE COUNTY LIQUID DEPTH �- F D REGISTRY OF DEEDS. 20 4" PVC ELEVATION AT BOTTOM 604 S.F. x .74 GAL/S.F. = 446 GPD ARE TO BE PRESSURE TESTED Tp 'ASSURE WATER- 4" ) v �i FINISHED GRADE 5. PRECAST CONCRETE TA A1TIGHTNESS. A (TYP) � (SEE NOTE 7 OF FIELD 95.32 NK}} PUMP CHAMBER 3. LOCUS IS SHOWN AS PARCEL 17 ON ASSESSORS MAP 9 ON THE TOWN AND LEACHING FACILITY TO'WI7HSTAND H-10 OF BARNSTABLE ASSESSORS MAPS " '` » '-FILL . AND LOAM �� LOADING UNLESS UNDER PAVEMENT, DRIVES OR °rPa 6 CRUSHED STONE BASE�Pa 3 NO GROUNDWATER OBSERVES TOTAL LEACHING = 604 S.F. _ , ., " �. 4. THE SYSTEM IS LOCATED WITHIN FEMA MAPPED "C" ZONE (ABOVE THE �� ELEVATION 89.5 TOTAL CAPACITY = 44 A �� �l ��" ,-ter ��� �� '; �� END CAP TRAVELED WAYS WHEREIN H-20 LOADING SHALL PLAN VIEW &^I- /��y// � 0 L C C Y 6 GALLONS PER DAY 4" PERFORATED PV�� � S=o.005 , � s f „ �� APPLY. I /��//iX.J%/�C� 500 YR. FLOOD LIMIT) CROSS-SECTION VIEW T.P. # 1 6. SEPTIC TANK, PUMP CHAMBEF�'pmEiCr SHALL BE I 5. THERE ARE NO SEPTIC SYSTEMS KNOWN TO BE WITHIN 20' OF THE MANUFACTURED BY PEMBRQKE ,CONCRETE OR AN 2.0' EFFECTIVE EQUIVALENT MANUFACTURER.' PROPOSED SEPTIC SYSTEM. DEPTH 6. ELEVATIONS ARE BASED ON ASSUMED DATUM. DISTRIBUTION BOX DETAIL: DISTRIBUTION BOX COVER TO LEVEL BOTTOM 7. ALL PIPES IN THE SYSTEM SHALL 13� PVC NOT TO SCALE BE BROUGHT TO WITHIN 6" OF ��:.ii. %� , 7�i,. ��i,�����c�� SCHEDULE 40 OR PVC SDRI 21 PRESSURE PIPE, 7. NO VEGETATED WETLANDS OR'SURFACE WATERS WITHIN 100' OF 5,5" OUTLETS N O. OF OUTLETS " FINISH GRADE WITH CAST IRON ' 4ta,-O" ( SEE PLAN. PROPOSED SEPTIC SYSTEM. REMOVABLE 2" WALLS NOTES: 20 MANHOLE COVERS SET TO OR FRAME AND COVER MIN. ELEV.= 99.1 8. GROUT TO BE USED AT ALL POINTS WHERE PIPES II, ENTER OR LEAVE ALL CONCRETE STRUCTURES IN COVER MIN. 1. DIST, BOX TO WITHSTAND H-10 LOADING WITHIN 6" OF FINISH GRADE MAX, ELEV.= 101.1 PROFILE ORDER TO PROVIDE A WATERTIGHT SEAL. �+ UNLESS UNDER PAVEMENT, DRIVES OR LOAM AND NOTES / " 9. ALL SHIPLAP JOINTS IN THE,,SEPTIC ;TANK SHALL. �•:•!,.�..,Q.�.;:J. ,'1 Q�i:.Q....i 2" 4 SCH '40 PVC PIPE - , ,�.. « .. h:: �..;. .N ..,.. ., _ SHALL APPLY. WHEREIN H-20 LOADING i FIRST PIPE LENGHT TO BE 2% MTV, FINISH :GRADE SEED BE SEALED W,TH NEOPRE.ANE ;GIAS"ETh vn ASS VIAL 1, HOMEOWNER IS RESPONSIBLE FOR VERIFYING THAT ALL EXISTING T 71:19 11 1111111I�. CEMENT TO PROVIDE A WATT RT. T SEAL. • `i SET LEVEL FOR MIN. 2 HOUSE SEWERS ARE CONNECTED TO THE PROPOSED SEPTIC 1 �- 15 1 6" 3,5" INLETS 8 I 2. SLOPEPROVIDOFNPIPE EXCEEDS 0.08 FT./FT �_� `LET TEE OR BAFFLE WHERE2" MIN. ,, MIN, . •. ,,ll OF ALL SDUSTSANDEF"IIdES: A FREE SYSTEM. > 10. D §A,LL BE I � I Idlile wln r. 2. EXISTING CESSPOOLS TO BE PUMPED AND BACKFILLED WITH T ,,.. OR IN PUMPED SYSTEM. 4" PVC��`� 7//�,'GN �J%/� RESERVE CLEAN FILL. T e°a�a'� a a�a�� a a�o� ��c 3.FIRST TWO FEET OF PIPE OUT of DIST. SCH 40 4" PVC SCH 40 '� � ��y'�� � ��y'��� 9� �� U'��� 7�� " AREA 2' MIN. OF" 11. UNLESS OTHERWISE NOTED, ALL CONSTRUCTION CAP END 2-6 Typ 2-0 1/$ TO 1/2 METHODS AND MATERIALS SHAL.L.•,CONFORM TO ,"� 2" BOX TO BE LAID LEVEL SLP=1% MIN. 2'W X 49'L X 2'D TRENCH ( ) 5 OF THE STATE E BOTTOM ON LEVEL ! MATCH 97 87 �����' '�'\ 6'-0" ����' ' �� WASHED STONE AND ETOWN OF BARNSTABLEONMf NTAL CODE STABLE BASE 4. RECOMMENDED MANUFACTURER-ROTONDO EXISTING LEGEND PLAN VIEW 6" MIA. 3/4" TO OR APPROVED EQUAL 97.59 6 97.32 3/4" TO 1 1/2" DOUBLE CLEAR 2'-0" RULES AND REGULATIONS.—- 6* 1 1/2 STONE 5. ALL PIPE CONNECTIONS AND CONCRETE - 98.12 97.79 " 97.62 BOTTOM EL.= 95.32 WASHED STONE (NO FINES) (TYP.) 12. EXCAVATE ALL UNSUITABLE MATERIAL IN THE 100--- EXISTING CONTOUR CONSTRUCTION SHALL BE WATERTIGHT. 3 OUTLET LEACHING AREA AND BACKFILL WITH MATERIAL AS � PROPOSED LEACHING TRENCHES �--30 1/2" --� -.��. DIST:R BOX DESCRIBED ON PLAN. i T PROPOSED CONTOUR PRECAST CO GALLON NO GROUNDWATER ® EL.=89.5 r 13. HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO PRECAST CONCRETE CROSS SECTION VIEW 3,5" INLETS SEPTIC TANK TEST PIT # 1 OPERATE OVER THE LIMITS OF THE SEWAGE ���-- �t�( WATER SERVICE / LINE PRECAST DIST. 12' 5,5" OUTLETS MONOLITHIC TANK ,, ADJUSTED GROUNDWATER ELEV. = f70.5' (SEE DETAIL - DISPOSAL SYSTEM DURING THE COURSE OF CON- PRECAST PROFILE ) LEACHING TRENCHES A A STRUCTION OF THE SYSTEM. G GAS, `SERVICE / LINE L� eox - 19" , 14. NO MODIFICATION TO THE SEWAGE DISPOSAL I SYSTEM SHALL BE MADE,WITHOUTIPRIOR WRITTEN 6" 1 " NOT •.TO SCALE. NOT TQ SCALE APPROVAL OF THE DESIGN ENGINEER AND THE LLL--- LOCAL BOARD OF HEALTH., - oHw -- - OVERHEAD UTILITY LINE 7 1/2"�----� T >r. CROSS-SECTION TREES OR SHRUBS (TYP) KELLY, BERNARD & DEBORAH L P O BOX 2096 5' LIMIT OF UNSUITABLE COTUIT, MA 026,35 PROPOSED D-BOX ew MATERIAL EXCAVATION TP#1 PROPOSED 1,500 GAL. �: m •. EL.=100.5 SEPTIC TANK found i`�ee Linp „. 221.f0' - _ . 1UD h + 1 w" iv ---- Decid. �•. x q 41' (TO BE MPED Tree Lme � ------ ------ do BACK l LED C-A R E ti� WITH CLE N FILL) 5 E R V ------ ---- PHILLIP SPATH P.E. DATE / I p - •- ------ O Exist. Shell Driveway p _ A p PROPOSED (2) � C= _ RESERVE A -�� - - BARRETT, ✓OSEPH R & ANNE H h ----R E A ;:••,.' .. .; ,„ ' W 49'L x 2'W x 2'D "---- _.___ PO BOX 44 2 LEACHING TRENC S COTU/T, MA 02635 Benchmark Sept�9 air+ Overhead Wires _ - - / Concrete Bound Cover Fill , 11�F�yys Elev. = 100.17 Assumed Bulkhead Approx. Wat Service Loco on ��epp°� 's'9yG / N f00 12 LE 4in LOW R, nv.= A« LO � N7154'12"E ' Gorden Steps 295.99 CB/DH With Per ,/�31 " o W T • Found 1�1_ Existing � ;w 0 4 Bedroom ,y Elec. Existing �4� Dwelling v lb RALPH H. COLE P.L.S. DATE Out/et Septic / F.F. EL=103.6 Steps o o_ �} +�6 / Cover PREPARED BY: hkOy�h do BACKFILM DED I O f WITH CLEAN FILL Patio} Elec. Gas 24" ROSANO • DAMS • PATH i i al I.{ cedar � ENGINEERING /02 Steps 9 ROCKY LANE > Lot 1 Exisf. Shell Drwewoy COHASSET, MA 02025 O f j\48,5 _ �� 781-383-12 4 o i Area 108,140t Sq. Ft. 46 Deciduous 2. �- 67.5 ) 56.6 �� 28 - Or EX1!'MNG LUM TO BE REPLUMBED R°v 2.48 Acres To tx ON sTT>RLY sI> F BUILDING SURVEY SERVICES PROVIDED BY: ,p0 }\39,2 ` O �,, d 20 Rascally Rabbit Road .. C3 Q/62 O / `so.e "sb's Mar stons Mills, MA 02648 v X 9,a_ ;\ Garden 0� �� Water �( / a \ O ec Shed Gorden cp 3y Faucet / D Flagpole / .t / G� n . � o '- o -� ' � Deck A. M. Wilson Associates Inc. 14'7. rn 508 420 9792 / FAX 420 9795 f' / p a Existing I 42.1 Yao.e > r PROPOSED ;:P48 Cover S p` p0 = 4i�rti`e PROJECT TITLE: �° LEACHING c TRENCHES �, o,r QQ X6 t BE PUM D � SEWAGE DISPOSAL / OBSERVATION HOLE DATA Existing Greenhouse BA Fl D 100.5 TESTED BY: PHILIP SPATH P.E. �c WI CLE FIL �� a SYSTEM REPAIR 2 Iatr X6 .3 OBSERVATION GRID ELEV.= `- / ��OI_E #'i GW ELEV.= - WITNESSED BY: ��� o AT / \ - • \ >\54.7 DATE: 6-14-04 MOTTLING ELEV.= � CERTIFIED BY: PHILIP SPATH P.E. 31 MAIN STREET I %<63,6 ELEV. SURFACE SOIL SOIL SOIL SOIL OTHER �%� - /- .,,� 8.00 " -� C0 T U 1 1 , MA I 100.5 DEPTH HORIZON TEXTURE COLOR MOTTLING -- (� 1 4718 W / ,103 Existing Y ASSESSORS' MAP 9 PARCEL 17 septic / ;(s3.o \ `\ 0"-11" A SANDY 10YR 4/3 N FRIABLE Cover �o GROUNDWATER ss.s LOAM PREPARED FOR: ;\69s o CONTOURS BASED CHARLES B. SHEEHAN i ON 1992 GAHRETY/ J � 11"-39" B LOAMY 10YR 6/6 N FRIABLE 31 MAIN STREET do MILLER MODEL. 97.2 �o CARTE?, THOMAS J & 7ERESA A / USGS GROUNDWATER ADJUSTMENT DETAIL COARSE LOOSE a p 8 BRIER PATCH RD COTUIT, MA 02635 39"-132 SAND 2.5Y 6/4 N 5%-10% GRAVEL �j OSTER�'LLE, MA oz DATE: JUNE 18, 2004 FOR PROPOSED LEACHING TRENCHES: BASED ON TOWN G.I.S. MAPS SURFACE ELEVATION = 62'f. 89.5 GROUNDWATER IS ELEV. 32'f BASED ON 1992 GAHRETY do MILLER MODEL, OR +30' BELOW SURFACE ELEVATION. NO GROUNDWATER OBSERVED ® 132" TOP OF PERC 45" PERC RATE COMP./DESIGN: P.II.SPATH BOTTOM OF PROPOSED SAS IS f5' BELOW GRADE OR ±25' ABOVE REGIONAL GROUNDWATER. (ELEV.=89.5) HOLE CAD ELEV. 96.8' <2 MIN./INCH CHECK: P.H.SPATH / R.H.COLE ADJUSTED GROUNDWATER = ±70.5 (SEE DETAIL) 578.90' -� Scole,1"-e 20' DRAWN: J.V.B. S7134'12"Nr - _ FIELD: J.V.B. P.L.B. Sheehan Base.DWG HOLY GHOST SOCIETY OF SAN7U/T AND COTU/T / MAIN STREET 0 10 20 30 40 50 FEET RDS JOB # RIDS 511 SHEET CO7U/T, MA 026.35 Job. No. 2,1422.00 OF i T