HomeMy WebLinkAbout1081 MAIN STREET (COTUIT) UNIT #A - Health _ 1081 Main Street, Cotuit =r
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The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Department of Public Health
State Laboratory Institute
WIWAM F.WELD 305 South Street
GOVERNOR Boston, MA 02130-3597 Childhood Lead Poisoning
AUEUTENANT GOVERNOR I 617-522-3700 800-532- Program
800-532-9571
GERALD WHITSURN _
SECRETARY
.DAVID H. MULLIGAN ��
CMMISSIONER
DATE` 8/9/ g
Alice Edgar 14
9
1081 Main St.
Cotuit, MA
Dear Ms Edgar
A lead paint determinationwas made of the property owned by you,at 1081 Main St
Cotuit f by Jane Crowley
of the Qhildhood Lead Poisoning Prevention Program on 8/8/96 This determination
revealed the presence of lead paint in violation of Massachusetts General Laws, Chapter 111, section
197.
Please contact this office at (508)362-2511 x371 as soon as possible to discuss your
responsibilities in this case, and the material enclosed.
The Massachusetts Department of Public Health (DPH)'s Lead Poisoning Prevention Regulations
require that you provide to this office, within sixty (60) days of your receipt of this letter, a contract
with a licensed deleader, signed by both you and the deleader, to abate and/or contain all lead
violations existing in the dwelling unit, including interior and exterior common areas. You must
provide the deleading contractor with a complete inspection report from a licensed private lead
inspector, including an assessment for encapsulation if desired. Also, if you or your agent is planning
to do any low-risk abatement and containment work, within sixty (60) days of your receipt of this
letter you must provide this office with a signed and completed Childhood Lead Poisoning Prevention
Program (CLPPP) form entitled, "Documentation of Training to Perform Owner/Agent Low-Risk
Abatement and Containment and Deadlines By Which Owner/Agent Low-Risk Work Will Be
Completed."
The contract with the licensed deleader must specify, and if you or your agent will be perfornung low-
risk work, then you or your agent will attest in the CLPPP owner/agent form described above, that
the deleading will be completed by the deadlines described in this paragraph. All violations on the
interior and interior common areas must be deleaded within ninety (90) days from your receipt of this
letter. However, you have one hundred and twenty (120) days from your receipt of this letter to
complete the following: any low-risk deleading work you or your agent perform, as long as all dust-
generating abatement and containment work, including surface preparation, required to be done by
a licensed deleader has been completed, and any doors that were removed have been replaced, within
ninety (90) days; application of encapsulants by Level II deleaders, as long as all dust-generating
abatement or containment work, including surface preparation, has been completed within ninety (90)
days; and installation of replacement windows, as long as you can document that new windows have
been ordered within ninety (90) days. All exterior violations must be deleaded within one hundred
and twenty(120) days. The contract must also specify that the unit will meet acceptable dust levels,
as determined by the sampling done by the licensed private lead inspector, and that the deleader will
be required to reclean the unit if necessary until it meets acceptable standards for dust.
This Department is required by law to file a case against you in court if it has not received the
required documents by the sixty-first(61 st) day, or if the timelines for interior and exterior.deleading
compliance are not adhered to as documented by a private lead inspector. In a criminal case, you may
be fined by the court up to $500 for each day of non-compliance.
Under the law, only deleading contractors licensed by the Department of Labor and Industries (DLI)
may engage in the removal, covering or replacement of known lead hazards, with the exception of
certain low-risk abatement and containment work that may be performed by an owner or owner's
agent without a deleader's license. Before such an owner or owner's agent may perform low-risk
abatement and containment work, he or she must read the Childhood Lead Poisoning Prevention
Program (CLPPP)'s educational booklet, view the CLPPP encapsulation video, and take a self-
corrected exam that must be submitted to CLPPP. I have enclosed a copy of the booklet, "Low-Risk
Deleading Work by Homeowners and Their Agents." To receive a free copy of the encapsulation
video, call the CLPPP Central Office at 1-800-532-9571.
I have also enclosed the booklet, "Deciding Whether to Encapsulate." If after reading it you decide
you would like to have an assessment for encapsulation performed, you must hire a licensed private
lead inspector to perform this assessment. Results of the assessment shall be recorded on the initial
"Lead Inspection/Surface Assessment form" and a copy should be sent to me. I have enclosed a copy
of a list of licensed private lead inspectors. Only those surfaces approved by the licensed inspector
will be eligible for encapsulation, no matter who actually applies the encapsulant -- a licensed Level
II deleader or you or your agent.
At least 10 business days before any,deleading work begins, the deleader must provide written
notification to DLL all residential occupants, the Board of Health and CLPPP. It is your
responsibility, as the owner of the premises, to make sure the contractor sends the completed forms
to all parties. If you or your agent will be performing low-risk abatement and containment work, you
are responsible for providing the written notice of deleading to DLI, the residential occupants, the
local board of health and CLPPP, and for also writing on the form which low-risk abatement and
containment activities you or your agent will be performing.
All occupants and pets must be out of the dwelling unit for the entire time that interior deleading
work performed by the licensed deleader is in progress. Occupants and pets may remain in the unit
while you or your agent perform low-risk abatement and containment work, as long as they stay out
d pets must be out of the unit entirely of the work area. Also, occupants an p Y while you or your agent
apply coverings to a surface with peeling, chipping or cracking lead paint or plaster. Occupants and
v been out of the unit may not return until a licensed private lead inspector approves
pets who have y
reoccupancy by conducting an on-site reinspection of the unit, including taking dust samples to assure
that lead dust levels meet approved standards. This reinspection will be done at least 25 hours after
deleading work is done: the inspector must wait at least one hour after the deleader performs a final
clean-up, and the deleader must wait at least 24 hours after the completion of deleading work to
perform that final clean-up. Deleaded surfaces are not to be repainted until the inspector performs the
reinspection and gives approval.
All work is to be done m a workmanlike manner, and the dwelling must be returned to a condition
that meets the requirements of Chapter H of the State Sanitary Code. Scraped surfaces must be
feathered and made smooth by the deleader prior to repainting. (Repaint only after reinspection).
Deleaded windows and doors must have all panes of glass intact and must be weathertight.
You are required to send a copy of the inspection report and the enclosed order to all mortgagees and
lienholders of record.
Questions regarding Department.of Labor and Industries regulations should be addressed to the DLI
office (617)727-1932. Questions regarding the Department of Public Health regulations should be
addressed to the CLPPP central office (800) 532-9571 or to me.
Sincerely,
spector
MDPH/CLPPP
7#
C:\W P30\L FAD t 99S\G ENERAL\C O V PL D.W P6
Ba BARNSTABLE COUNTY
DEPARTMENT OF HEALTH AND THE ENVIRONMENT
- SUPERIOR COURT HOUSE
O _ t-. POST OFFICE BOX 427
v M BARNSTABLE, MASSACHUSETTS 02630
• • Phone: (508)362-2511 Ext. 330
q 5 S Public Health Administration 333
Environmental Health 383
Water Quality Analysis 337
FAX (508)362-41 a6
TOO(508)362-5885
DATE: 8/9/96
ORDER TO CORRECT VIOLATION(S)
Alice Edgar
1981 Main St.
Cotuit, MA
Owner or agent of the property located at 1081 Main St. Cotuit MA
Be advised that an agent of the Director of the Childhood Lead Poisoning Prevention Program has
determined certain portions of the aforementioned residential property to be in violation of the
following:Massachusetts General Laws(MGL), Chapter 111, Section 197; the Regulations for Lead
Poisoning Prevention and Control, 105 Code of Massachusetts Regulations (CMR) 460.000 and the
State Sanitary Code.
Conditions exist in this residence which may endanger and/or materially impair the health of the
occupants of these premises.
DECLARATION OF EMERGENCY
The Director of the Childhood Lead Poisoning Prevention Program declares that the presence of the
aforementioned 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, Chapter 1, 105 CMR 400.200 (B). .
CORRECTION OF LEAD VIOLATION(S)
The Lead Law, MGL c. 111, ss. 189A-199B, and the Department of Public Health's Regulations for
Lead Poisoning Prevention and Control, 105 CMR 460.000, require that residential premises or
dwelling units.built before 1978 have lead paint violations either abated and contained for full
compliance or brought under interim control when a child under the age of six lives in the residential
premises or dwelling unit. If you are interested in interim control, .then you must hire a licensed
private risk assessor to perform a risk assessment and issue a "Lead Inspection/Risk Assessment
Report" before you proceed. If you are interested in deleading for full compliance, then you must hire
i
a licensed private lead inspector to perform a lead inspection and issue a,"Lead Inspection/Surface
Assessment Report" before you proceed.
The Lead Law, the Department of Labor and Industries'Deleading Regulations, 454 CUR 22.00, as
well as the Regulations for.Lead Poisoning Prevention and Control require that any high-risk
residential lead abatement and containment activities, including making loose paint, plaster or putty
intact,be performed by licensed deleading contractors—whether in the context of achieving Interim
Control or Full Compliance. An owner or owner's agent, after meeting the training requirements of
105 CTMR 460.175, may perform certain low-risk abatement and containment activities in accordance
with these regulations without a deleader's license—again,whether in the context of achieving Interim
Control or Full Compliance. These specific low-risk abatement and containment activities are the
following: applying encapsulants; applying such coverings as carpet, vinyl, aluminum, plywood,
plexiglass, and acrylic, to surfaces, including siding of exterior surfaces; removing doors, cabinet
doors and shutters; and capping baseboards. In addition,an owner or owner's agent may perform
structural repairs, as defined in 105 CMR 460.020, and cleaning of leaded dust, as may be required
for interim control, except that the final clean-up required after the completion of high-risk abatement
and containment work by a licensed deleader must be performed by a licensed deleader.
ORDER
You are hereby ordered to remedy all violations of MGL c. 111, s. 197 and 105 CMR 460.000, as
identified by a licensed private lead inspector or, if you wish to pursue interim control, by a licensed
private risk assessor. Whether you remedy said violations through full deleading compliance or
interim control, you must do so in accordance with the following schedule:
Within sixty(60) days of your receipt of this Order, you must provide to this agency a copy
of a signed contract with a licensed deleader, if any high-risk abatement and containment
work, including making leaded paint, putty or plaster intact, is required. If you or your agent
is doing owner/agent low-risk abatement and containment and/or interim control work, you
must also provide within sixty (60) days a signed and completed CLPPP form entitled
"Documentation of Training to Perform Owner/Agent Low-Risk Abatement and Containment
and Deadlines by Which Owner/Agent Low-Risk Work and/or Interim Control Work Will Be
Completed." The contract must specify, and if you or your agent will be performing low-risk
abatement and containment work or interim control work, then you or your agent will attest
in the CLPPP form described above, that the work will be completed according to the
following schedule:
(a) Violations of the interior of the dwelling unit and interior common areas must
be abated or contained for full compliance, or as required for interim control,
within ninety (90) days of your receipt of this Order. However, you have a
total of one hundred and twenty (120) days from receiving the Order to
complete the following activities:
(i) any low-risk abatement and containment work you or your
agent perform, as long as all dust-generating abatement or
containment work, including surface preparation, required to
be done by a licensed deleader, has been completed, and any
doors removed have been replaced, within ninety (90) days of
your receipt of this Order;
f
r
(H) application of encapsulants by a licensed Level H deleader, as
long as all dust-generating abatement or containment work,
including surface preparation required to be done by a licensed
deleader, has been completed within ninety (90) days of your
receipt of this Order;
(iii) installation of replacement windows, as long as you can
demonstrate that new windows have been ordered within
ninety(90) days of your receipt of this Order.
(b) Violations on the exterior of the residential premises and exterior common
areas must be abated and/or contained for full compliance or as required for
interim control, within one hundred and twenty (120) days of your receipt of
this Order.
Any contract with a deleading contractor must also specify that the unit will meet acceptable
lead dust levels, as determined by the results of sampling done by the licensed private lead
inspector or risk assessor at the time of the reoccupancy reinspection, if one is necessary.
Should any of the dust samples fail to meet_acceptable standards, the contractor will be
required to reclean the entire unit until all dust samples meet acceptable levels. In interim
control cases in winch no reoccupancy reinspection is necessary and no deleading contractor
involved because no high-risk abatement and containment activities, including making leaded
paint, plaster or putty intact, were necessary,.then you or your agent who performed required
work will be responsible for cleaning the unit to meet acceptable dust levels. In these cases,
dust levels will be determined by the results of sampling done by the licensed private risk
assessor at the time of the risk assessment reinspection. Any room or interior area in which
one or more surfaces does not meet acceptable dust levels must be recleaned by you or your
agent in its entirety.
You must comply with all of the deadlines stipulated above, and with all applicable sections of 105
CMR 460.000. Compliance with this Order will be determined by this agency's receipt of the
appropriate documentation within the specified deadlines. The documentation consists of the
following:
a) if any high-risk abatement and containment work is necessary, including making lead-
painted surfaces intact, a copy of a signed and dated deleading contract with a
licensed deleader;
b) if you or your agent will be doing low-risk deleading work or such other work as may
be required for.interim control, such as structural repairs and lead-dust cleaning, a
completed and signed copy of the CLPPP form "Documentation of Training to
Perform Owner/Agent Low-Risk Abatement and Containment and Deadlines by
Which Owner/Agent Low-Risk Work and/or Interim Control Work Will be
Completed";
c) a Letter of Lead Paint (Re)occupancy (Re)inspection Certification issued by a
licensed private lead inspector or risk assessor, in cases in which high-risk abatement
and containment work, such as making loose lead paint, plaster or putty intact, is
necessary,thus requiring occupants to be relocated from the unit for the duration of
the work;
d) copies of results of all dust samples taken by the licensed private lead inspector or risk
assessor;
e) a Letter of Full Deleading Compliance issued by a licensed private lead inspector or
a Letter of Interim Control issued by a licensed private risk assessor.
In addition, a copy of the deleading notification must be received by this agency at least ten (10)
business days prior to any commencement of deleading, whether performed by a deleader or you or
your agent, and whether in the context of full compliance or interim control.
PENALTIES
Judicial proceedings will be initiated against you within seven business days of.your failure to comply
with any of the above deadlines. 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.
CORRECTION OF VIOLATION BY CODE ENFORCEMENT AGENCY
If within the time periods stipulated above the aforementioned residential property is not brought into
full compliance or interim control, this agency may contract with a licensed deleader 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.
ector Director
Massachusetts Department of Public Health
Childhood Lead Poisoning Prevention Program
(DPH/CLPPP)
C:1W PSQULEAD 19951GENERAL\ZEN ER1L.1`OTCPLDEP.
LOCATION I SOURCE I Pb
1 . Child ' s bedroom. n ( Window parting 'ObS O�
every S 71 bead/exterior sill area
bedroomeO°� Window sill s� I h� T.
2 . Child ' s i
3 . Living room I Window parting bead/exterior sill area
4 . Kitchen Window parting
I
bead/exterior sill area
Cccs� .�� K � � i o, d
Interior ,p oor' laking paint
6 . Exterior Flaking paint UPP Cr �'9 /� I /o.0
I QX f 2r-i o r S', // ,ao-r un -
7 . Exterior ( Cellar window units I06,5 L(5 3_ _
S . I Exterior I Window sills below 5 ' ( %-.Q-
9 . Exterior ( Main entry door or door
casing
10 . I Interior ( Outside corner of baseboard
11. I Kitchen or Bat groom I Chair rail
12 . I Bathroom ( Window sill
13 . I Exterior IThreshhold
of-
14 . Interior hallway S -tread
(common area) u)•
15 . Interior hallway Balusters I
(common area)
16 . Interior hallway ( Door casing
common area) I
17 . I Porch ( Stair tread or riser
18 . Porch Railing cap .
19 . I Porch Balusters
20 . Porch Support columns
(<6" diameter or scruare,
21. Porch ( Staircase stringer
22 . Exterior Bulkhead I
23 . Garage/Outbuilding ( Door casing or jamb
n OSCi'ee`Ls Opip e r h q// 'rtct ou 's
1
I24 , Interior
Closet door or baseboard
(uncapped)
25 . Interior Cabinet door, shelf, or
I I wall
26 . ( ( I I
27 .
28 .
29 .
30 .
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 P •�
Y rY
f -
j
1081 Main Street
Property Address
1081 Main st. LLC r
Owner Owner's Na e i
information is y
required for every Cotult Ma 8/19/19
page. City/Town State Zip Code Date of Inspection
. ry
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:
filling
out forms
A. Inspector Information 61 *-1, ire L
filling out forms
on the computer,
use only the tab Chad hathaway
key to move your Name of Inspector
'cursor-do not H PS
use the return Company Name
key.
P.O.Box 151
rab Company Address
Forestdale Ma 02644
Cityf'rown State Zip Code
774 274 2581 12866
Telephone Number License Number
• k
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 16.000); I have personally inspected the sewage disposal system at the property 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
8/191/9
Inspector's Sign re Date
The system inspector shall submi copy of is inspection report to the Approving Authority(Board
of Health or DEP)within 30 day of comp)- Ing this inspection. If the system has a design flow of
10,000 gpd or greater, the ins ector 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
I
Commonwealth of Massachusetts
! Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
. 1081 Main Street
Property Address
1081 Main st. LLC
Owner Owner's Name
information is Cotuit Ma 8/19/19
required for every
page. City/Town 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:
® 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:
This inspection is not a guaranteeand applies no warrantyof the described septic components in this
report including but not limited to piping structual intergrity of components and life exspectancy of
leaching and described components. This inspection is to describe conditions witnessed at time of
inspection only. Regular tank maintenance and water conservation'can prolong life of septic-systems
Information on care and do's and don't's can be found at town health dept or mass.gov
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
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form •
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
.. 1081 Main Street
Property Address
1081 Main st. LLC .
Owner Owner's Name
information is Cotuit r Ma 8/19/19
required for every '
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 El 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
Commonwealth of Massachusetts '
Title 5 Official Inspection Form _ n.
Subsurface Sewage Disposal System Form-Not for,Vol untary*Assessments '
1 1081 Main Street
Property Address
1081 Main st. LLC r'
.Owner Owner's Name a ._
information is `
required for every Cotuit Ma 8/19/19
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: x
❑ 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 Zone1•of a public water
supply.
❑,The system has a septic tank and iSAS and the SAS is within 5G feet of a private water
supply well. t
❑ 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.
c. Other: t m
�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
1081 Main Street
Property Address
1081 Main st. LLC
Owner Owner's Name
information is Cotuit Ma 8/19/19
required for every
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
R
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 Y2 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.
❑ Z. 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 II of a public water supply well
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18
7
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
u 1081 Main Street
Property Address
1081 Main st. LLC
Owner Owners Name
information is Cotuit Ma 8/19/19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary(cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
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 a//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?
Y p
❑ ® 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?
Z ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
- ,lp Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1081 Main Street
Property Address
1081 Main st. LLC
Owner Owner's Name
information is Cotuit Ma 8/19/19
required for every
.page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions: ,
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 min.
Description:.
Number of current residents: 0
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:
0
Sump pump? ❑ Yes ® No
Last date of occupancy: unknown
Date
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1081 Main Street
Property Address
P
1081 Main st. LLC
Owner Owner's Name
information is Cotuit Ma 8/19/19
required for every
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:,
Type of Establishment: E
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: unknown
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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
r
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
....... „/ 1081 Main Street
Property Address
1081 Main st. LLC
Owner Owner's Name '
information is Cotuit Ma 8/19/19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.) .
4. Type of System:
® Septic tank, distribution box, soil absorption system'.'
ystem.
❑ Single cesspool
❑ Overflow cesspool `
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach'a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the 1/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:
tank and DBox 2018 leach pit unknown
' Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 1
• feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: 10'
feet'
Comments (on condition of joints, venting, evidence of leakage, etc.):
new plumbing and piping throughout building
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
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
h a
Y 1081 Main Street
Property Address
1081 Main st. LLC
Owner Owner's Name
information is Cotuit Ma 8/19/19
required for every
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: _ •5
feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
H10 1500 gal tank with tess. no solids in tank house unused since tank was installled
r
If tank is metal, list age: years
Is age confirmed by a Certificate'of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
r
0
Dimensions:
Sludge depth: 0
Distance from top of sludgeto bottom-of outlet tee or baffle 0. r
Scum thickness •0
Distance from top of scum to top.of outlet tee or baffle 0 '
Distance from`bottom of scum to bottom of outlet tee or baffle 0
How were dimensions determined? 0
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
no solids in tank full of water. tees in place tank new
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
VY 1081 Main Street
Property Address
1081 Main st. LLC
Owner Owner's Name
information is Cotuit Ma 8/19/19
required for every
page. Cityrown 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
r� ,lp Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1081 Main Street
Property Address
1081 Main st. LLC
Owner Owner's Name s
information is Cotuit Ma 8/19/19
required for every
page. Cityrrown 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.):
D133 H10 in new condition with riser
t5insp.doc•rev.7/26/2018 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 - No for Voluntary
g p y t o o untary Assessments
1081 Main Street
Property Address
1081 Main st. LLC
Owner Owner's Name
information is Cotuit Ma 8/19/19
required for every
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:
Type:
1
® leaching pits number: 1 6'x6'
❑ leaching chambers number:
❑ leaching galleries: number:
❑ leaching trenches number, length:
❑ 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
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1081 Main Street
Property Address
1081 Main St. LLC °
Owner Owner's Name
information is Cotuit Ma 8119/19
required for every
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.):
Pit opened dry and clean no sidewall staining to indicate past 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1081 Main Street
Property Address
1081 Main St. LLC
Owner Owner's Name
information is
required for every Cotuit Ma 8/19/19
page. Cityrrown '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.):
a
t5insp.doc"rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System"Page 15 of 18
• Commonwealth of Massachusetts
1 Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1081 Main Street
Property Address,
1081 Main St. LLC
Owner Owner's Name
information is Cotuit Ma 8/19/19
required for every
page. CityTrown 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:
r
® hand-sketch in the area below
❑ drawing attached separately'
O
Al t
• }
- 33 '
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
J 1081 Main Street
Property Address
1081 Main st. LLC '
Owner Owner's Name
information is Cotuit Ma 8/19/19
required for every
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: 34'feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
® Accessed USGS database-explain:
town GIS mapping
You must describe how you established the high ground water elevation:
lot el. 38 in area of septic low wetlands on abutters property el.4.5 bottom of leaching 9' below
grade at el. 25' per GIS mapping
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc-rev.7Y26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form' -
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments_
1081 Main Street
Property Address
1081 Main st. LLC
Owner Owner's Name
information is Cotuit Ma 8/19/19
required for every
page. City/Town 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
TOWN OF BARNSTABLE c
4
LOCATION v
VILLAGE lam' ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY d 6 6
LEACHING FACILITYAtype) L It, 11 (size)
NO. OF BEDROOMS PR4-i*5Ett OR PUBLIC WATER
BOOR OWNER'
r
DATE PERMIT ISSUED: J ��
DATE COMPLIANCE ISSUED• f /
VARIANCE GRANTED: - No `
5�
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TC OF........... -v�-rYi -......
Apphratiun for Uiipuiitt1 30urku Tunitrurtiun runfit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at � ���,�, �
....:..........._ ._,� °.....:*0 .. .......•---• ................ -----••-------•--------------•-••-•------•--------•-----•---------------------•-------•-----------
i press or Lot No.
.. !.. .........................• --...........--•••-•--••-••--...------....... ...............................................
er Address
ner
W •----------------•---------
...-------
........
...._ ............. ..... ...................................... ------.........._....._._...._..
� Installer Address Q yt f,�
Type of Building Size Lot.,/�.................Sq. feet
U Dwelling-ONo. of Bedrooms...... ..................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
aOther fixtures ...................................................... .
W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons.
WSeptic Tank—Liquid capacity]Q O.Pgallons Length................ Width................ Diameter.....---.---.... Depth................
x Disposal Trench—No. .................... Width................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No........I........... Diameter.-6............... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. I................minutes per inch Depth of Test Pit.--................. Depth to ground water.....................--.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.---....................
Description of Soil..... .. ..• -•--•................................
..............•••-.......
V ---••-••-------•----•-•-----•-••••--•-••---------------••-•-----.....•--------•--••-•----......•----------••-----------•-----•----•--•----------•-•---•...--••--•---...............---....-•----•...•••.
W •---•-----•--------------------------•--•------•---•---------------•----•--•••••-•--•-•-•---•---------......y� --- . --------•---•. .............................
VNature,of epairs or Alterations—Answer when applicable-.l --------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System,in accordance with
the provisions of TITIZ4 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed. ..
° Date
Application Approved By......... r`-r``. ...... `�..Cd,n yc................. ....... 2 - 5e
J Date
Application Disapproved for the following reasons:..............................................................................................................
........--•---------•--•-•--------•-----•----•--------------------•-------------•-----.......-------••-----•-••----------.....--••-•---------•---••--------------•-------------------------•---•----•--•
Date
Permit No........ ..
�f`�.--•�-✓�----------------•------. Issued.... . --.............................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF............ ........ . ..... .....................................
firation for Utoposal Works Tonstrurtion 1hrmit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at;
........ .................... ..................................................................................................
r ocatio dress or Lot No.
..
....... ......................................
.............. ..................----------- ------ - ----------—----*"*",-*.............. iress
n- - -------*..........------------- ....................I..........................Ky...............................
............7
Installer Address
Type of Building Size Lot..,L--i...00.0.....Sq. feet
U Dwelling-ONo. of Bedrooms...... ..................................Expansion Attic Garbage Grinder (
Other—Type of Building ............................ No. of persons............................ Showers Cafeteria (
04 Other fixtures -----------------------------------------------------------------------------------------------------
�< ----------------------------
Design Flow........................:...................gallons per person per day. Total daily flow......... .............*'*-**...."---gallons.
Septic Tank—Liquid capacity d.i�L2gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No.....................3Width.................... Total Length.................... Total leaching area ...................sq. ft.
Seepage Pit No........I........... Diameter...6.............. Depth below inlet.................... Total leaching area.................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit................._.. Depth to ground water....................
Test Pit No. 2................minutes per inch Depth of Test Pit............__..._.. Depth to ground water........................
04 1 4---------.............. ....................................................................................................................
0 Description of Soil.....&................... ........................I...............................................................................................................
---------------- ---------*.......**..........".......
-----------*....... ---------------"......*--------------*.........*--------------*....... ..........
....................................................................................................... .:� s:�...�..� ..1.6. .. .............................
Answer when applicable_ ;'.................................... ......................
U N ....
.:� re�,ofepairs or Alterations
.......... .. .... �t- .......................................................................................................................
S..r...... ..... .........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System,in accordance with
the provisions of T I'LIS 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
�y "y
Signed. .... .......................................I.................................. ..........................
Date
Application Approved By...........l)------. ...... ............................ ............
Date
Application Disapproved for the following reasons:...........................................................................................................
.......................................................................................................................................................................................................
Date
Permit No.........5ir ZL=..91-5.................. lssued.......L--...�..........5�................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......... ...........OF.......... ..t....................................
THIS IS TO CE (Urfifiratp of Toutphaurr
RTIFY That the Individual Sewage Disposal System constructed or Repaired
Iby................ ....... .................................................................................................................
Installer
at.................... -------------------- ...................................................................................o..........
has been installed in a�6ordance wiM the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......_._ ....... dated..............
..............................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......................... 11............................ Inspector............ ....................................................
ti
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........OF................ ..............................
Disposal Works TanstrWian Permit
Permission is hereby granted.............at'._ .....................................................................................
to Construct or Repair (�) an Individual,Sewage Disposal System
4..r - -.__!�.Z............r,- --—— ---------------------------------------------
at No...................LV.."t,-----...... ............i� ........4
"��'j ol Street
as shown on the application for Disposal Works Construction Permit No.... Dated..........................................
............................. . ..............................
DATE------------- ZM...62.................................. Board of Hel�th
FORM 1255 A. M. SULKIN, INC.. BOSTON
C�'`'�
� 0�7
Health Complaints
26-Mar-99
Time: 9:53:03 AM Date: 3/26/99 Complaint Number: 1774
Referred To: DONNA MIORANDI Taken By: LS
Type:Complaint T e: CHAPTER II HOUSING
p
Article X Detail:
Business Name:
Number: 1081C Street: MAIN STREET
Village: COTUIT Assessors Map_Parcel:
Complaint Description: SHE HAS HAD NO HEAT SINCE TUESDAY.
IT IS A 3 BEDROOM SINGLE FAMILY
RENTAL HOUSE. THE PROPANE HEATER
AND METER
SAID
SHE HAS TO GET IN TOUCH WITH THE
HEATING PEOPLE AND IT IS HER
PROBLEM. SHE SAYS IT'S NOT. A CHILD
RESIDES IN HOUSE ON WEEKENDS. SHE
WOULD LIKE AN INSPECTOR OUT TO
VERIFY IT BEFORE THE WEEKEND.
Actions Taken/Results:
Investigation Date: Investigation Time:
CCU-/ Cl- h 2. f e c-A h., S �^�"-�
Gv.e,� 1.,-a4 V-k_t t 6,, . //c) .AVd 9���.�r� `fz� 1 c cvYPA'l d
� 1 �
Health Complaints
26-Mar-99
Time: 1:00:00 PM Date: 3/26/99 Complaint Number: 1776
Referred To: GLEN HARRINGTON Taken By: DONNA MIORANDI
Complaint Type: CHAPTER II HOUSING
Article X Detail:
Business Name:
Number: 1081 C Street: Main Street
Village: COTUIT Assessors Map_Parcel:
Complaint Description: Landlord lives on the same r'
property, 428-6581. His tenant has no heat
since Tuesday . Seems to be a conflict
between landlord and plumber, Tom Jones,
775-1129. Tenant has propane heating
system. Has lived there since February 1999
and pays$850/month for rent.
Actions Taken/Results:
Investigation Date: Investigation Time:
03
1
OWN ] 31 TOWN OF BARNSTABLE REAL ESTATE PARCELS ] Help [ ]
BY OWNER NAME ] Action I]
Owner Name Parcel Number Location
[EDGAR, ALICE E TR [034] [059] [ ] [ ] [1077 MAIN ST ]
[EDGAR, ALICE E TR [034] [014] [ ] [ ] [1081 MAIN ST COT ]
[EDGAR, ALICE E TR ] [034] [012] [ ] [ ] [OFF MAIN ST COT ]
[EDGEHILL, DAVID R & ] [031] [014] [ ] [ ] [ASA MEIGS RD MM ]
[EDMONDS, GEORGE P ] [070] [013] [ ] [ ] [165 SEAPUIT RIVER RD ]
[EDMONDS, GEORGE P JR ] [070] [012] [ ] [ ] [147 SEAPUIT RIVER RD ]
[EDMONDS, WILLIAM R & MARY C ] [056] [038] [ ] [ ] [135 COTUIT BAY DR ]
[EDMONSTON, LEON JR J ] [306] [087] [ ] [ ] [330 OAK NECK RD ]
[EDMUNDS, DALE C & ] [018] [066] [ ] [ ] [1207 MAIN ST COT ]
[EDSON, JAMES B & ] [119] [028] [002] [ ] [38 WATERFIELD RD ]
[EDSON, LINDA & MEDEIROS, M ] [022] [020] [ ] [ ] [MAIN ST COTUIT ]
[EDWARD E LESLIE TR ] [308] [036] [ ] [ ] [270 NORTH ST HYANNIS ]
[EDWARD, IRVING & MARY ] [328] [102] [ ] [ ] [139 RIDGEWOOD AVE HY ]
[EDWARDS, ARTHUR H & GAI L C ] [14 9] [0 2 6] [ ] [ ] [9 5 2 OLD FALMOUTH RD ]
[EDWARDS, BRUCE E ] [269] [093] [ ] [ ] [383 PITCHERS WAY ]
Cancel [ ]
Press XMT for more data
Next Screen [OWN ] Action [I]
Owner Name [EDWARDS, CHARLES P ]
Road Index [ ] Road Name [ ]
Parcel Number [ ] [ ] [ ] [ ] [ ]
PAR ] Real Estate System - General Property Inquiry] Help [ ]
Parcel Id: 034 014- - Account No: 19759 Parent :
Location: 1081 MAIN ST COT Neighborhood: 04AA Fire Dist : CT
Devel Lot : UNNUMB Lot Size : .46 Acres
Current Own: EDGAR, ALICE E TR State Class : 101
P 0 BOX 372 No. Bldgs : 1 Area: 1952
Year Added:
COTUIT MA 2635
Deed Date : 020195 Reference : 9567/019
January 1st : EDGAR, ALICE E TR Deed MMDD: 0295 Deed Ref : 9567/019
Comments :
Values : Land: 101800 Buildings : 67600 Extra Features :
Road System: 1081 Index: 951 (MAIN STREET (COTUIT) ) Frntg: 100
Index: ( ) Frntg:
Control Info: Last Auto Upd: 060196 Status : C Last TACS Update : 052996
Land Reviewed By: Date : 0000 Bldgs Reviewed By: Date : 0000
Tax Title : Account: Taken: Account Status : Hold Status :
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Parcel Number [034] [015] [ ] [ ] [ ]
FORM30 HAW HOsesa WARREN'M THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY'//TOWN
DEPARTMENT
a pc 6"ail 16 '7 /(Aa_,,_ 3 4--
` ADDRESS
°�,y SVey`eW .
/ TELEPHONE
Address ! ,� �� C /O a;A^S� rON4 r~ Occupant_6C__ 4'^ck1R *o, tm_
Floor Apartment No. G No.of Occupants
-
No.of Habitable Rooms �5 No.Sleeping Rooms 3
No.dwelling or rooming units= No.stories
Name and address of owner
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,Ceiling:
Hall Lighting:
Hall Windows.-
HEATING Chimneys: ''e_Gnov-e 4,y" c/ hr)61k 066. .,f C 2p
Central ❑ Y ❑ N Equip. Repair ✓'e-S 0-%Si 1410aikf did kt0_+Vje, + 1 DC
TYPE: Stacks, Flues,Vents: �` " cekC, V6 kza Sv J L
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.: Lc'
❑ 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, lec
Stacks, Flues,Vents,Safeties:
Kitchen Facilities Sink
Stove -C,2^ ("CG
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 /49 -0S4-1f .f'i" w
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
PENALTI F PERJU "
INSPECTO l ,P TITLE �h 'e—
V
DATE A- ` TIME
v �recee f Dd��// / ,f A.M.
THE NEXT SCHEDULED REINSPECTION Sf'QY P.M.
`���+ �� _ .. _ a��r,'. L.. t�,�: ryi:, ' T��_{�. f,,��'`i"� 1�"„r�T'�xi�'Cr.'?A-.^:'t,' �;';�'�...•r;.r�'ti�' Y`-'��' 'r!1 �_'���,y,ier;r4''
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall.within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns,shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
FORM30 H&W Hoesss WARREN'M THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY/TO N
F
"- DEPARTMENT
0
ADDRESS _
TELEPHONE
Address �� (Tl C 41�-rt Occupant_x `-'� Z^. e,
Floor Apartment C.- No.of Occupants '�--
No.of Habitable Rooms No.Sleeping Rooms 3_
No. dwelling or rooming units No.Stories_
Name and address of owner .rd9a-, i ctg Ti-, Y- Go-k_941��
Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N E ui . Repair (v e-$T *)4ed, le-C{j4e d f-44rdlw
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 Fusin ,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 Buildin Posted nswck
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 ®t''y�2i°�t�ec��
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE 0-31\ �
AUTHORIZED INSPECTOR.(See Over) ,
"THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OF PERJURY
INSPECTOR R TITLE Ike—
r A
DATE TIME 41 6
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
V s y„ ,.,'y '7+T"�' ' 'fir rJG`j-:z'4'�f.CEt.a�:'h,r ,�y,ns';�'1 AV_V_r! +'f.'-,r J
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600,410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of Ieadbased 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.
FORM30 CRw Hoeess WARREN r" THE COMMONWEALTH OF`MASSACHUSETTS
^ BOARD OF :HEALTH
CITY,//TTOOW_N /
DEPARTMENT
ADDRESS: F6 2 ,/ �/M �T�7 TELEPHONE
Address Occupant
Floor Apartmepf+No. No.,of Occupar�
No. of-Habitable Rooms No.Sleeping Rooms }
No.dwelling or rooming units rio. Stories —
Name and address of owner 5 r , t``5 r.y S La h jo��v1
Remarks Reg. Vio.
YARD Out Bid s.: Fences:
- Garbage and.Rubbish
Containers:
Drainage
Infestation Rats or other:
1
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress.and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:..
Roof
-Gutters, Drains:
Wails:
Foundation:
Chimne
BASEMENT Gen.Sanitation: .
Dampness: -
Stairs:
Lighting:
STRUCTURE INT. Hall,Stairway
Obst'n.:
Hall,Floor,Wall,Ceilin
Hall Lighting:
Hall Windows: r s
HEATING Chimne s: /''"' !° d
Central ❑ Y ❑ N Equip. Repair c' 4,1k^ J'w"0`1-w+i-+eU., lek 4.-R I*cyt i Cjq
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 Wirih .
DWELLING UNIT
Ventil. L tn' . Outlets Walls Ceils. Wind. ` Doors Floors 'Locks
Kitchen
Bathroom
Pantry
Den
Living Room
Bedroom. 1
Bedroom 2'
�_:., r
_ 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 BuildingPosted °�` / "/ `�
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 l`►
OCCUPANT AS DETERMINED BY 105CMR ,410.750 OF THE CODE OR THE
AUTHORIZED=INSPECTOR.(See Over
iTHIS INSPECTION REPORT.IS.SIGNED'AND CERTIFIED UNDER THE PAINS AND �'
PENALTI OF PERJUR ." C ' toe
Q l
INSPECTOR" V TITLE L �' ' L
�f
3 �r tom/ rA.M.
DATE / ./ _,TIME: ( :.`:r. _ M•
+' � ,' Ar , xaFh# A.M.
THE NEXT SCHEDULED REINSPECTION' P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises,shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall.within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B) and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105.CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
Judith A. FitzGerald P.C.
Certified Public Accountant
c+� p m !
5 Main Street a C FEB-55''9 ,; I _ ,•
Cotuit, MA 02635 -% 05 F`°
�1
Board of 1 Health '
Town of Barnstable
4 367 Main Street
Hyannis , MA 02601
Illl.[[[[III III 11111:[[!!l111.1.{!111111.1 ![il!'C!II!!1!!,II!!III
j
/�
�, f
��
i�
i
k
�' 1
Judith A. FitzGerald, P.C.
Certified Public Accountant
5 Main Street
Cotuit, MA 02635
(508) 428-7737
February 5, 1997
Board of Health
367 Main Street
Hyannis, MA 02601
Re: Alice Edgar
To Whom It May Concern:
This letter is regarding Alice Edgar's property at 1081 Main
Street, Cotuit. We wanted you to be informed that she has
applied for a Home Improvement and Energy Loan with Homeside
Lending, Boston, MA for the deleading of her house at the above
mentioned address.
Sincerely,
Patricia A. Reed