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HomeMy WebLinkAbout0131 MAIN STREET (COTUIT) - Health (2) .131 ,Main-Street (Cotuit) # {Cotuit (F/R ;A - 1009 `009 fit) I ,I I "I j` 1 I l� Certified Mail#7008 3230 0002 5178 0493 BIKE Tp� ti o Town of Barnstable R► IAS& Regulatory Services ArF1 3 A 0 Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 22, 2012 V aira Harik 4541 W Calle Jocobo Tuscon .AZ 85741 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 131 Main Street Cotuit, MA was inspected on August 22, 2012 by Timothy O'Connell, R.S., Health Inspectors for the Town of Barnstable.. This inspection was conducted on the basis of a complaint received at the Town of Barnstable Health Division. The following violation(s) of the State Sanitary Code were observed: 105CMR 410.552- Screens for Doors. Multiple doors along with multiple windows missing screens. 105 CMR 410.480-Locks. Window in living room not capable of being locked. Door within breeze way area not capable of being locked. 105 CMR 410.500— Owner's Responsibility to Maintain Structural Elements. Windows within bonus room missing trim. Main entrance door does not open easily. You are directed to correct the violations listed above within twenty four (24) hours by ensuring that dwelling can be secured from unlawful entry by ensuring that all windows and doors are capable of being locked. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by installing screens on all doors and windows that open to outdoors; by trimming out windows in said room; by repairing said door so that it opens easily; by registering dwelling with health division. 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. 0:\Order letters\Housing violations\Rental ordinance\131 main st 8-22-12 I 'hp PER ORDER OFT BOARD OF HEALTH T omas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Katherine Baynesmelehan Q:\Order letterMousing violations\Rental ordinance\131 main st 8-22-12 Page 1 of 1 O'Connell, Timothy From: Vaira Harik[vairaharik@msn.com] Sent: Friday, August 24, 2012 4:35 PM To: O'Connell, Timothy Subject: 131 Main Street, Cotuit Violations and Next Steps Hello Mr. O'Connell, Thank you for your time on the phone with me just now. I really do appreciate it that you called to give me a heads up with these violations instead of just letting a letter come "out of the blue" to me. I've contacted Brad Enneguess of Cape Cod Contracting (508-317-4438) in order to take care of all of the violations found as soon as possible. I do realize that "the clock starts ticking" for me once I sign for the forthcoming letter and I appreciate that. But I'm proactive and really dislike having loose ends like this out there, so I'm working to correct these deficiencies quickly. Also, I do apologize for not having a Rental Permit! I really had no idea that one was needed, but obviously that's no excuse. Respectfully yours, Vaira Harik 520-271-6314 8/28/2012 COMPLETE .N COMPLETE THIS SECTIONDELIVERY ■ Complete items 1,2,and 3.Also complete A.S` 4u item 4 if Restricted Delivery is desired. X ❑Apnt ■ Print your name and address on the reverse — ISKddressee so that we can return the card to you. ,r cel'e.by(P'nted Name) C., ate f Delivery., ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1. ❑Yes f 1. Article Addressed to: If YES,enter delivery address below: ❑No I •' �:Vaira Harik i '4 '41 W Calle Jocobo Tuscon,AZ 85741 3. Service type Certified Mail ❑Express Mail ❑00stered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes •2-A!.Icle Number :' ? £ p 3 %:: 0'8! 323i 000'2i!5178� 049 (Tranuf2r from service laben F PS Form 3811,February 2004 Domestic Return Receipt 102595-02- 1546, ! UNITED STATES POSTALR�gqt�4 xA n t.b'•2a�. .f h. .�y..�,..ww. �s .:... S It ge& aid ! � .� USPS >P.,'Z Permit No 1 'x I • Sender: Please print your name, address, and ZIP+4 in this box• I N I j N s Town of Barnstable R N8a' Health Division I 200 Main Street � I N Hyannis,MA 02601 I ( J t jj j ' j j III � �' W HOBBSBWARRENTM THE COMMONWEALTH OF MASSACHUSETTS FORM 30 CA BOARD OF—HgALTH CITY/TOWN F I PARTMENT � 'p ADDRESS c TELEPHONE Address f — Occupant!"a Floor Apartment No. No. of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units__ o.Stories Imo` Name and address of owner—---� t ��fss :2j T remark Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage I Tr Infestation Rats or other: _ �� STRUCTURE EXT. Steps,Stairs, Porches: Xl Dual Egress:and Obst n.: ❑ B ❑ F ❑ M Doors,Windows: �— Roof d Gutters, Drains: J Walls: Foundation:Chimney: Q �� BASEMENT Gen.Sanitation: Dampness: All Stairs: Li htS : STRUCTURE INT. Hall,Stairway: r Obst'n.: Hall, Floor,Wall,Ceilin : Hall Lighting: lVVI L 7 /- Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair 67 Lc' 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 REPO IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERDU INSPECTOR TITLE DATE TIME__( A.M. THE NEXT SCHEDULED REINSPECTION P.M. . t 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. 1 (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. ^.!e .- .�'"'•ivy.•.C"".�-...�.,:'Y,.,....,,ce�n--,....,...�.,,r•wwx .._.r-..••-.r..r..n++n...:.�a.v....v.N-�....v.,.w,...,.-,.,,,�,.�v'*'-n,.•.mt'......—.^n�-*rR^+•a.•+,rtV�.a,.....,r,.e,�,..-...-+-•'*•w.,..+-^,rr-+-^' ' W HOBBSS WARREN THE COMMONWEALTH OF MASSACHUSETTS FORM30 C& >• t - - BOARD OF ALTH CITY/TOWN ' ��� ♦�, /S ` DEPARTMENT ADDRESS z TELEPHONE Address 1 �! _ Occu ant r p Floor - Apartment No. No. of Occupants No.of Habitable Rooms No.Sleeping Rooms t No. dwelling or rooming units_,,AFlo.Stories ��-- Name and address of owner1 � Vio. YARD Out Bld s.: Fences: j 10 1 Garbage and Rubbish j Containers: ( ' ' n Drainalle Infestation Rats or STRUCTURE EXT. Steps,Stairs, Porches: 12jj%-� Dual Egress:and Obst'n.: . ❑ B ❑ F ❑ M Doors,Windows: / S(Do Roof V( Gutters, Drains: o' ��" jYjf�✓ "j / Walls: Foundation: Chimney: -�►, I ,Cr 11 1 f,/) L �-0 BASEMENT Gen.Sanitation: Dampness: A Stairs: STRUCTURE INT. Hall,Stairway: _ ® ,.,,.t G /0 Obst'n.: ` Hall, Floor,Wall,Ceiling: Hall.Lighting: ' -r Hall Windows: M9' - HEATING Chimneys: n �- {r{� (/ u� Central_ p Y_,❑,N E ui .,Re air,. �- TYPE: Stacks, Flues,Vents:` PLUMBING: §-u-pply 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 Wirin : j ' DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den —Living Room \ / Bedroom 1 Bedroom 2 .J t 0 / 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.: 4. 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 RJURvY. I INSPECTOR t � T TLE �+ A.M. DATE X r�yam.." TIME . L• PTM. A.M. THE NEXT SCHEDULED REINSPECTION P.M. .. _ . ..�• ram. y..- M. .,.+.r.-�e1.r y.y a.F :+ .,..��'_• : i 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 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. TOWN OF BARNSTABLE ` LOCATION � / ���� y'� SEWAGE # o `G g<7 VII.LAvE C��t�rT. ASSESSOR'S MAP & LOT 00 INSTALLER'S NAME&PHONE NO. � SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �O (size) NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: � COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) J Feet Furnished by 07 ^ 4013 B'D , 0 f No. d`U U � V Fee t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Z(pprication for Oigpozat *potent Construction Vertu Application for a Permit to Construct( . )Repair(x)Upgrade(.Se)Abandon( ) []Complete System ❑Individual Components Location Address or Lot No. -`2/ /jj�(ji✓ J'P C01&;7 Owner's Name,Address and Tel.No. Assessor's Map/Parcel a 1901 w f j Installer's Name,Address,and Tel.No. Designer's dame,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms_ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �y® gallons per day. Calculated dimly flow ��� gallons. Plan Date -�-"O�' Number of sheets Revision Date Title Size of Septic Tank /J"C' ,S31�• Type of S.A.S. ����� /-��•����� Description of Soil DESIGNING 9NGINPF-R MUST SUPERVISE Nature of Repairs or Alterations(Answer when applicable) INSTALLATION AND CERTIFY IN WRITIN THE SYSTEM AL;L;UKUA.,eiFe , Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date -D Application Disapproved for the Y0110wing reasons Permit No. D tic)) 7 Date Issued —.Z 3—U L' e No. U ) 4 Fees THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS _ �lricatiOl� for Miopooal *p$tem Con6truction Permit �. Application for a Permit to Construct( . )Repair(x)Upgrade(.%�)Abandon( ) El Complete System El Individual Components Location Address or Lot No. /3/ /�.�/w P7 C-v1sii7 Owner's Name,Address and Tel.No. Assessor's Map/Parcel O O 9 4709 Wrt cj Installer's Name,Address,and Tel.No. Designer's 'ame,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms / Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets / Revision Date Title Size of Septic Tank /s o odpz1. Type of S.A.S. -07e`40 Description of Soil" Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue 4'bg this Board of Health. Signed Date Application Approved by14N S. Date .2-.??-bLI Application Disapproved for tlie=follow-mg reasons Permit No._� �,�/ O 7 Date Issued 7 - F?3-0 L/ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(k)Upgraded-� ) Abandoned( )by at e,. p 7 G has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Do L/ r,i(,,7 dated' Installer Designer The issuance of this permit shall not be construed as a guarantee that the ystem will Anction as "esigned. Date Inspector ) A - � o No. Q k;i L1— f� 1()7 Fee I THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigogar *pgtem Cong4ruction Permit Permission is hereby granted to Construct( )Repair(�<)Upgrade)�c )Abandon( ) System located at i ?,,i t;T e oTri/r . and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: L/ Approved by \\ C ��.. I t� f TOWN OF BARNITABLE LOCATION ��� ��b''r'! ✓'� SEWAGE # VILLAGE 4-- �'�C"'T ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.' ,O' SEPTIC TANK CAPACITYf' LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: �' COMPLIANCE DATE: Separation Distance Between the: I. 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 /4c 3/ A I( & -7� 8b �3 e l 4 . q D® F I Town of Barnstable Regulatory Services Thomas F.Geller,Director i Public Health Division TRAMThomas McKean;Directar 200 Main Street,Hy na s'MA 02601 Fax: 508-790-6304 Office: 508.862-4644 I taller&DesienCrgertificadon Form Date: Installer: Designer: Address: Address: _ �_ o y J/,., LE v�Boe `J'Ei�T�c s• was issued a permit to install a On (d te) (installer) - - - - -_ septic system at_1�I � )� �_ "1�---- - basedaxra-design dr--awn y-- - (a dies} — q dated (designer) I certify that the septic system referenced was installed changes such as lateral relation f the to the design, which may include minor approved distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (Le. greater than 10' lateral relocation of the SAS or any vertical, cal.relocatioons. plan Of n revision or of the septic system)but in accordance with State&Loca1'R a certified as-built by designer to follow- A. 0 � , Art- (li�staUer's Signature) P (� i Signature) (Affix Designer's Stamp here) s PLEASE RETURN TO BARNSTABLF. PUBLIC TH DIVISION. CERTIFICATE OF COMPLIANCE WILL N D BY THE BARNSTABLE PYTBLIC�gE FORM AN SIB BUILT C ARE RECEIVE 'THANK YOU. Q:Heal&/Septic/Designer Certit'cation Form COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM'- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 131 Main Street - [RECEIVED]RECEIVED Cotuit, MA 02635 Owner's Name: Mavbell.Wrikht Owner's Address: AU G 3 0 20 0 Date of Inspection: August 27, 2001 WHEALTH pEPfi Name of Inspector: (Please Print)James M. FFord Company Name: James M. Ford . 0.09 p� Mailing Address: P.O.Box 49 t-pjL@ 9;-i 09T ION Osterville,MA 02655-0049 _ Telephone Number: (508)862-9400 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditio ally asses Needs F her valuation by the Local Approving Authority Fai Inspector's Signature: • _. Date: August 27,2001 The system inspector shall submit L of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ` ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 131 Main Street Cotuit AM Owner: Maybell Wright Date of Inspection: August 27, 2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: " 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. Answer yes,no or not determined(Y,N,ND)in the 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: 2 r 1 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) a Property Address: 131 Main Street Cotuit, AM Owner: Maybell Wright Date of Inspection: August 27, 2001 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50,feet of a surface water. Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply`or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply_well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,, for oliform 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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 , Page 4 of l l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 131 Main Street Cotuit, AM Owner: Maybell Wright Date of Inspection: August 27, 2001 D. System Failure Criteria applicable to all systems: You must indicate either`yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow the last year NOT due to clogged or obstructed i s . Number ✓ Required pumping more than 4 times m e y gg p pe( ) of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50.feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the 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.] Yes (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- 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) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION;FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE,SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 131 Main Street Cotuit, AM Owner: Maybell Wright Date of Inspection: August 27, 2001 Check if the following have been done: You must indicate`yes"or"no"as to each of the following: Yes No 6 ✓ 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? n/a Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up ✓. Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? g The size and location of the.Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 131 Main Street Cotuit. MA - Owner: Maybell Wright Date of Inspection: August 27, 2001 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Approximately 8 months ago COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Never pumped-per owner. Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool ✓ Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ; Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Unknown Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of i l OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 131 Main Street Cotuit, AM Owner: Maybell Wright Date of Inspection: August 27, 2001 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: ✓ cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: , Comments(on condition of joints,venting,evidence.of leakage,etc.): SEPTIC TANK: None (locate on site plan) Depth below grade: Material of construction: _concrete metal fiberglass,_polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): . (attach`a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): } 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 131 Main Street Cotuit, MA Owner: Maybell Wright Date of Inspection: August 27, 2001 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE•DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 131 Main Street Cotuit, MA Owner: Maybell Wright Date of Inspection: August 27, 2001 .y SOIL ABSORPTION SYSTEM(SAS): ✓` (locate on site plan,excavation not required) If SAS not located explain why: " Type _ leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: ✓ overflow cesspool,number: 2 Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): One overflow cesspool(92)was S'Wx 6'Tx 8'bottom to grade, and had 6"ofwater on the bottom. The scum line was up to the inlet pipe. The cover was 12"below grade. Kitchen waste flows to this cesspool- The other overflow cesspool 03)was 5'Wx 7'Tx 9'bottom to grade, and was dry. The scum line was up to the inlet pipe. The cesspool was under a holly tree.. Roots are growing into both cesspools. CESSPOOLS: ✓ (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 1 w/2 overflows Depth-top of liquid to inlet invert: — Depth of solids layer: 15"+ ' Depth of scum layer: — *y Dimensions of cesspool: S'Wx 2'T x S'bottom to grade z - Materials of construction: Block Indication of groundwater inflow(yes or no): No Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): The cesspool only had sludge present. The cover was to grade. Roots were growing inside the cesspool. PRIVY: None (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.): 9 t',s, Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 131 Main Street Cotuit, MA Owner: Maybell Wright Date of Inspection: August 27, 2001 Map:009 Parcel:009 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 00 feet. Locate where public water supply enters the building. r��Gk A ' A - 3� 41 1 3 ' A3- 9S- 413 a 3 .10 Page 1 I of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 131 Main Street , Cotuit, MA Owner: Maybell Wright Date of Inspection: August 27, 2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 38' feet (Adjusted High Ground Water Level is 35.4 Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the overflow cesspool to grade was approximately 9. Using the Barnstable topographic map and the Cape Cod Commission water contours map, the maps were showing approximately38'+1-to groundwater at this site. Using the Cape Cod Commission Technical Bulletin, the high groundwater adiustment for this site(MI W 29, Zone A 7101)was 2.6. ` t This report has been prepared and the system inspected and failed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,written or implied, relating to the system, the inspection and/or this report. 11 _ GSA k Gels I 9,0 " a. � AdSus 3�• � �jr0un�w��'c/ L.CVG I Z ASSESSORS MAP : DO r TEST HOLE LOGS 4D- PARCEL: - - 610��- ____ SOIL EVALUA OR :�t Y "2 .. b`2 FLOOD ZONE �D� q P,PG/GPI�L .- --- WITN E S S : `I�"p�L,� �— NOTES: b-- � �c �- / REFERENCE:Ih7,,,% .\ C7C,7l• d`- `� �- tt�� DATE:. 200 I c - - I V� (a 1 6. __ PERCOLAT ION RATE:: � 2 t-1 l , I 1) The installation shall comply with Title V and Town of Barnstable Board of 71 q Health Regulations. TH- 1 TH-2 ` I�� - � �'' 2) The installer shall verify the location of utilities, sewer inverts and septic VVV components prior to installation. �`✓'A't-t 0 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. 4) This plan is not to be utilized for property line determination nor any other purpose other than the proposed system installation. Q 3�LOCATION MAP k2 5) All septic components must meet Title V specifications. I 6) Parking shall not be constructed over H10 septic components. 7) The property is bounded by property corners and property lines as depicted. ------- 8) The property owner shall review design considerations to approve of total number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed approval of the number of bedrooms. 9) The existing cesspool septic components shall be pumped and backfilled per 00 Title V Abandonment Procedures. v O Gt7. � 10)Proposed leaching is to be within 36 inches of grade or provide venting or cut grade as permitted by the Board of Health. SEPTIC: SYSTEM DESIGN 11)System components to be 10 feet from water line. FLOW ESTIMATE —�:BEDROOMS AT GAL/DAY/BEDROOM - GAL/DAY I 4) _ SEPTIC TANK `o _ � ALGAL/DAY x 2 DAYS • �00 GAL � ti USE i M GALLON SEPTIC TANK • r N SOIL ABSORPTION SYSTEM USE• 3 to S x � Of '�- SIDE AREA: BOTTOM AREA: Z' � l'� � C.� ,`? CA ' -c> TIC SYSTEM SECTION --J 0 i ,51 ��P, �S� �t'��• C '1�1�C.. i �� ,(�(� gyp'' ���' . � �,, � 3 ,, o� � 3��n��, C� STiw 4� l�qs 101 lam, 5m�t o 160 r t yCJ GAL . SEPTIC TANK A2_L +�1-t ;' aL . �u"_ t�'i'°-DO 6 7") 1 g SITE AND SEWAGE PLAN ir-! • � �T T / l LOCATION . /� PREPARED F 0 R : 1 (3Eo0i- cS6,;�17/ C SCALE: =�0 DAV I D B . MASON RS DATE: o` z DBC ENV I RONMEOAL DESIGNS W EAST SANDWICH . MA W DATE HEALTH AGENT ( 508 ) 833- 2177