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HomeMy WebLinkAbout0305 MARINER CIRCLE - Health 305 MARINER CIRCIfCOTUIT �I i i I i�� Commonwealth of Massachusetts 03 / � Old W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form Not for Voluntary Assessments Mo 305 Mariner Circle Property Address ND Kelly Borsatto � Owner Owner's Nam7 information is Cotuit Ma 02635 2-21-18 required for every _ — i1' page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brett Hickey use the return Name of Inspector key. B&B Excavation _ raa Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority _ 2-21-18 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 ritle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 bollo US Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °7M 305 Mariner Circle Property Address Kelly Borsatto Owner Owner's Name information is required for every Cotuit Ma 02635 2-21-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not fond 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: System was in working order at time of inspection. • 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. Check the box for 'yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ' ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 305 Mariner Circle Property Address Kelly Borsatto Owner Owner's Name information is required for every Cotuit Ma 02635 2-21-18 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): I E C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 305 Mariner Circle Property Address Kelly Borsatto Owner Owner's Name information is required for every Cotuit Ma 02635 2-21-18 page. CityFrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The syste-n 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 io 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 305 Mariner Circle Property Address Kelly Borsatto _ Owner Owner's Name information is required for every Cotuit Ma 02635 2-21-18 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should.contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 305 Mariner Circle 9M Property Address Kelly Borsatto Owner Owner's Name information is required for every Cotuit Ma 02635 2-21-18 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (Actual) 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 P 9 P Y 9 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 305 Mariner Circle Property Address Kelly Borsatto Owner Owner's Name information is required for every Cotuit Ma 02635 2-21-18 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) p ) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes D No Water meter readings, if available last 2 ears usage See below � 9 ( Y 9 (gPd))� I Detail: 2016- 306,000gallons (leaking per Water dept.) 2017- 181,000gallons Sump pump? ❑ Yes ® No Last date of occupancy: CurrentDate Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts 0 Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 305 Mariner Circle Property Address Kelly Borsatto Owner Owner's Name information is required for every Cotuit Ma 02635 2-21-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner- last or last pump is unknown Wass stem pumped as art of the inspection? y p p p p ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? Tank size Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° M 305 Mariner Circle Property Address Kelly Borsatto Owner Owner's Name information is required for every Cotuit Ma 02635 2-21-18 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1981 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1'6" feet Material of construction: El cast iron N 40 PVC other(explain): - Distance from private water supply well or suction line: Town feet Comments (on cordition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 6 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000gallons Sludge depth: 6 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 305 Mariner Circle Property Address Kelly Borsatto Owner Owner's Name information is Cotuit Ma 02635 2-21-18 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 4 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank was pumped after inspection for maintenance. Grease Trap (locate on site plan): Depth below grade: NAfeet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 305 Mariner Circle Property Address Kelly Borsatto Owner Owner's Name information is required for every Cotuit Ma 02635 2-21-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.).- Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 305 Mariner Circle Property Address Kelly Borsatto Owner Owner's Name information is required for every Cotuit Ma 02635 2-21-18 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 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.): D-box is in working order at time of inspection with liquid level equal to outlet invert. D-box did not show signs of back up. 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.): NA * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 c Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 305 Mariner Circle Property Address Kelly Borsatto Owner Owner's Name information is required for every Cotuit Ma 02635 2-21-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) Type: ® leaching pits number: 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: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching was in working order at time of inspection with no sign of hydraulic failure. Pit was dry when viewed. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 305 Mariner Circle Property Address Kelly Borsatto Owner Owner's Name information is required for every Cotuit Ma 02635 2-21-18 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 305 Mariner Circle Property Address Kelly Borsatto Owner Owner's Name information is required for every Cotuit Ma 02635 2-21-18 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately #60 JA REAR B A1-26` A2- 33` A3-41 B1-60` 82- 55'. 133-61 2 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 305 Mariner Circle Property Address Kelly Borsatto Owner Owner's Name information is required for every Cotuit Ma 02635 2-21-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No GW 144" 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: Nov 8- 1980 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plan on file with BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 305 Mariner Circle Property Address Kelly Borsatto Owner Owner's Name information is required for every Cotuit Ma 02635 2-21-18 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , . ..............O F......gA0 4k*0 .......................................... Appliratiun for Disposal Works Tonstrurtiun Fermi# Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at: ' •Address � or Lot•No. ... . .......... .... a ... ... .. ........••............ Installer Address Type of Building Size Lot....p��C?�,.t�O Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p`,, Other—Type of Building -..•..-.-'No. of persons_________ _______________ Showers ( ) — Cafeteria ( ) Otherfixtures --------- ------------------------------------------------------------------------------------------------------------------------------------------- W Design Flow.............3—,5 ...................gallons per person per day. Total dai!,flow.........Z3ZO...................gallons. WSeptic Tank—Liquid'capacity./JM..gallons Length./O..&. Width...6........ Diameter................ Depth............... x Disposal Trench—No..................... Width.................... Total Length.__......... Total leaching area.... 3 Seepage Pit No..............I_.... Diameter....... .�....... Depth below inlet..... Total leaching area. ......... ft. Z Other Distribution box (/) Dosing to ( ) Iq Percolation Test Result�} 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........................ a --------- ...... --- --.................................. .. 0 Description of Soil...... — . V ................................ ... L .... ---- ........ ................-----.....-•-•--------.................----......._.............------. w ---------------------------------.9a.—_ly .........::; -- ------------------------------------------------..................-----------.....------------------. UNature of Repairs or Alterations—Answer when applicable............................................................................................... ..--•..........................•••--........•-•----••----•-•---•--.......--•----•----•--•-------••---....----•................---•---•••.............--------...................---._................_.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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 t boar of health. sign •........................ .� . 47 alate Application Approved B Date Application Disapproved for the following reasons:........................... ................................................................................ ----•---••.................••--••••---•-•-••------•-•---....------.......-----...................--•-----.---•----------------------................................................._----------....-•--- U Date Permit No...................................................--- Issued...... .................................../ .....•-•--- Date .,7EJr/ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................., OF.......f Appliraatilan for Uiiplaiiaal Works Tonstrnr#ion Prrutit Application is hereby made for a Permit to Construct (>() or Repair ( ) an Individual Sewage Disposal System at Location Address / or Lot No. •--••�/���---_(/.•.......... .... ......_ ............................ %fib .� .11;�a.%' -GArd2�re ................._................. In ,i � Install1 .er Address U Type of Building Size Lot......;) ;;6_a�--2-..Sq. feet Dwelling—No. of Bedrooms_______________`...•.........__._...___.___.Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ..:::.:.......' ........ No. of persons.........._................. Showers ( ) — Cafeteria ( ) Otherfixtures -•-----------------------------•-•-•--•--•-----••-_-•• ----------------------------- ••••••-•--•--•-•------------.....................-•••••------ W Design Flow................ ? ..................gallons per person per day. Total daily flow.......... _,?!?__._....._.._..__..gallons. P q capacity g 1 , ••••• Depth-----e Ra Septic Tank—Liquid uid ca ac>t ..%�gallons Length ��'__.�___ Width ?.____... Diameter____.._._. W Disposal Trench—No..................... Width.................... Total Length...... /-....... Total leaching area....... __ _ _ Seepage Pit No..............."/..... Diameter....../__-__._._. Depth below inlet.._.. '........ Total leaching area......_.J__sq. ft. Z Other Distribution box ( /) Dosing tank, ( ) Percolation Test Results , Performed b 1> :!`� =-__--_-��_/'�.f_�''�%"'�-!___ Date.... '._ _:: ..'.. .... Y--••-•../ - Test Pit No. 1...J,Z,....minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 1AN Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil.......(._'_f----------------------- ------ v -------------------- ••-••-•. - ---•. ---------------------------------------------------------------------------------------- --.------------ U Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ •---•---•--------------•----•----•------------------------...--•----•----------------..............-----------------------•---•-----•--------.....---------------••-•-----------•--.....•-•••-•--••..... Agreement: ` . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with ~ .thg provisions of TIT1Z 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. Signe '.......... •............................................................. /..`./.s... �f Date Application Approved BY--------- .. . .................. =jZ ,.:,,•. Date Application Disapproved for the following reasons:............................ -••••---••••••-•-•---•-........................................................... -•---•-••-•-•---•••--•--•...•••---•..............................•-••--•••--••••-•--•--------•••---•••--•.....-•------•--•--•-----•--•••-•---•---•-•••----••--•••--•-•-••••--•••-••---••---••---•-••••••. Date r PermitNo......................................................... Issued--..................................................... ,Date 1 THE COMMONWEALTH OF MASSACHUSETTS V Y BOARD OF HEALTH f� a OF. / �� ; (,�* " .......................................... .........�..................... ............................... Tr of iratr Af Tomphaanrr THIS IS TO CERTIFY,/That tie Individual -Sewage Disposal System constructeed. (X) or Repaired ( ) , mac u() �Ct�tlr C{�t-2.(/al _`^_ by.................................. � Installer i ....................................................... ...........__.._. ._._____.___. ......_._._____________.___._____._______ Ile has been installed in accordance with the provisions of 5 of The Awe Sanitary Code as describ9 in the •- dated---- -2----/7 e....... application for Disposal Works Construction Permit N .___ ._._.�_�l�_______________ � ..___.___. THE ISSUANCE OF THIS CERTIFICATCSHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................T___1:.3_ !E(...._.............--••--•....-•--•• Inspector 6/.....-----............ ------------------------- THE COMMONWEALTH OF MASSACHUSETTS rv, BOARD OF HEALTH ....... FEE._. ...........'. Disposal Vorkp Trnni#rnrtilan rrntit � Permission is hereby granted..._../. �;_:_____,r �!, to Construct (�f) or Repair ( ) an Individual Sewage Disposal System \\ 1 j ------------••--•-••-•......... ......•......... at No..... _ Li 1.. .. 1122. :..:_--... ai; ,.� (/ r, Stree4 /+ as shown on the application for Disposal Works'Construction Permit N .......... D "d_./ _�.: ............ -•-•-•------..... -� •-••----•••......... ) Board of Health DATE......�,r2 r� ........................................ •-----••-••................ ......• fff FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS TOWN' OF BARNSTABLE BAR-W 55 Ordinance or Regulation ` WARNING NOTICE ,.IN i Name of Offender/Manager John /'Tu'rCA(tiS Address of Offender _� MV/MB Reg.# Village/State/Zip C,,o4ut+ - M 4 ®d .. Business Name a m, on is 19 -5 Business Address Signature of E forcing Officer Village/State/Zip Location of� Offense ©S pya- Lf'V.� 62/e 'zL Enforcing Dept/Division Offense. �a L ��� G .). UI.T I Facts Y"� v h&LI-e P Oh h+� 0,;t1li "Ue This will berve only as a warning. At this time no legal action has beeh tAken. � It -is `the goal of Town agencies to achieve voluntary compliance Qf Town` Ordinances, Rules and Regulations. Education efforts and warning notices, are ' attempts to'-' gain voluntary compliance. Subsequent violations will result in- appropriate legal action by the Town. (� TOWW OF BARNSTABLE BAR-W . 551 Ordinance or Regulation WARNING NOTICE r_ Name of Offender/Manager ` 0 PU".1�/ti Irli Address of Offender _ Ja5 --�F'"' L.�1 1-E MV/MB Reg.# Village/State/Zip C,,04Ut 04 Business Name OJ a m; on Business Address ignature of Erfforcing Officer Village/State/Zip Location of Offense ., a,4' 6-' all Enforcing Dept/Division Offense 1 04OU-S . Puy ff_ 6 Factstdt� This will Serve only as a warning. At this time no legal action has been taken. It is `the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town., FoRM30 Hoess&WARREN,INC.NOV.1979.1983 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i cmrrrovm DEP RTMEN 1�lk AW ADDRESS 16 TELEPHONNJE�, Address_ f �Y G� C pant `r hz egw2loc Floor Apartment No: No.of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No.Stories Name and address of owner Remarks Reg. Vim 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: 0 G 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: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks,Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Lhdna Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facll. Sup.Ten. Gas,Oil, Elect.: Stacks Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facll. Vent.,Plumb.,Sanit'n.: Wash Basin Shower or Tub: ti Infestation Rats Mice Roaches or Other: ress 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 OF PERJURY." INS R TITLE DATE TIME / j �:r :M 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 these 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 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential tolfall'withie this -category•in any given situation but may not ­'do•so in every 'case`and therefore cannot be 'included in this listing. , Failure to include shall in no way be construed as.a determination that other violations 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 the violation(s) pursuant to 410 CMR 410.830 through 410.833 nor shall it 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 requiredtby 105 OIR 410.201 or improper venting or use' f ,a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shut-off_ and/or failure to restore electricity or gas. (D) Failure to supply,the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 41b.253(A), 410.253(B) and the lighting in common 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 system in operable condition as required by 105 CMR 410.150(A)(1) and 410.300. (GI Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by an object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450 and 410.451. (H) Failure to comply with the security requirements of 105 CMR 41b.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.602 which results in any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of lead-based paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regualtions,for Lead Poisoning Prevention and Control 105 CMR 460.000. (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 dafety. (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 facilities 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 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 operable. (2) failure to provide a washbasin and a shower or bathtub as required in 105,CMR 410.150(A)(2),,,,and 4411,0.150(A)(3) and 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,• gas-fitting, 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. (N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A) through (M) shall be deemed to be "a condition 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 ordereal`by the board of health. FORM30 Hoess&WARREN,INC.NOV.1979.1993 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN DEPARTMENT, 1 w Svey`�. ADDRESS r ? TELEPHONE D3 9` 01 Address al l.�t.1r gant " t.-1� A�/66- Floor Apartment No: No.of Occupants No.of Habitable Rooms.No.Sleeping Rooms No.dwelling or rooming units No.Stories C Name and address of owner Remarks Reg. Vlo. YARD Out Bld s.: Fences: Garbage and Rubbish _(i p Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches:Dual Egress:and Obst'n.: c ❑ B ❑ F ❑ M Doors,Windows: Tj Cel l Roof ( � Gutters, Drains: Walls: keP2 _e_ P...0 C3� Foundation: Chimney: V BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vents 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 Facll. Vent.,Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats,Mice,Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR TITLE 9 aZ ABM DATE / TIME / C1 � �•M� 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 these 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 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential to 'fall•within this. category in any given situation but may not do so in every ca'se' and therefore cannot be included in this listing. Failure to include shall in no way be construed as.a determination that other violations 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 the violation(s) pursuant to 410 CMR 410.830 through 410.833 nor shall it 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) Shut-off and/or failure to restore electricity or gas. (D) Failure to supply the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253(A), 410.253(B) and the lighting in common 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 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 an object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450 and 410.451. H Failure to comply with the security requirements of 105 CMR 411).480(D). ( ) u Q P Y Y q (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.602 'w'hich results in any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of lead-based paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regualtions for Lead Poisoning Prevention and Control 105 CMR 460.000. (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 dafety. (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 facilities 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. (H) 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 operable. (2) failure to provide a washbasin and a shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3) and 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,• gas-fitting, or electrical wiring standards that do not create an immediate hazard. (a) 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. (N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A) through (M) shall be deemed to be a condition 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. FORM3o Hosss&WARREN,INC.NOV.1979.1883 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITYITOWN 0 / A DEPARTMENT ADDRESS J TELEPHONE f' IT 1 . Address Occupant Floor Apartment No: No.of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No.Stories Name and.address of owner Remarks Reg. Vlo. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: R STRUCTURE EXT. Steps,Stairs, Porches: t Jam+'1Vt C `r C tl P171 a� -A Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: / 0_. ,r Roof o r f ,gip Gutters, Drains: Walls: k..n 0 r Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: �. . Central ❑Y ❑ N Equip.Repair TYPE: Stacks,Flues,Vents: PLUMBING: Supply Line: ❑MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: ~ AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Venti1. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Livina Room Bedroom 1 Bedroom 2 Bedroom 3 t Bedroom 4 Hot Water Facil. Sup..Ten.,Gas,Oil, Elect.: Stacks,Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facll. Vent., Plumb.,Sanit'n.: Wash Basin Shower or Tub: , Infestation Rats,Mice Roaches or Other: . �C `c r Gt r U )h-� Egress Dual and Obst'n: General Building Posted HLocks 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 OF PERJURY." INSPECTOR(JL4')�( TITLE / l �} A.M. DATE' C9 �+ �! TIME I C / (R.M.� A.M. THE NEXT SCHEDULED REINSPECTION P.M. ,, y 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 these 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 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential to fall within this category in any given situation but may not do so in every case and therefore cannot be included in this listing. Failure to include shall in no way be construed as.a determination that other violations 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 the violation(s) pursuant to 410 CMR 410.830 through 410.833 nor shall it 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) . Shut-off and/or failure to restore electricity .or gas. (D) Failure to supply the electrical facilities required by 105 CMR 410.250(B), 410.251'(A), 410.253(A), 410.253(B) and the lighting in common 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 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 an object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450 and 410.451. (H) Failure to comply with the security requirements of 105 CMR 4110.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.6.02 which results in any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the'creation or spread of disease. (J) The presence of lead-based paint on a dwelling or dwelling unit in violation of the Massachusetts Department of-Public Health Regualtions for Lead Poisoning Prevention and Control 105 CMR 460.000. (R)• 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 dafety. (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 facilities 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 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-an d capacity for washing dishes and kitchen utensils or lack of a. stove and oven or any defect that renders either operable. (2) failure to provide a washbasin and a shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3) and 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,• gas-fitting, or electrical wiring standards that do not create an immediate hazard.. ( ) 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. (N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A) through (M) shall be deemed to be a condition 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. .._.........�.:..anYbR.YI1JAYdL�iM• .. ...... .... ..-... now 111 § 119 PUBLIC HEALTH PUBLIC HE k Law Review Commentaries Compliance with medical records'subpoenas. procedures or frfarming lands sh Nancy R. Rice and Steven M. Sayers (1983) 27 Boston Bar J. No. 8, p. 12. •NUISANCES Amended by St.19 Library References - 1985 Amendme Comments. General health and safety regulations n{{ emergency act,app , see paragraph inserted Creation and jurisdiction of housing courts, M.P.S. vol. 34, Stavisky and Perkins, + : see M.P.S. vol. 34, Stavisky and Perkins, § 1426. from livestock or f § 1481. Equitable relief under state sanitary code,see M.P.S. vol. 34,- Stavisky and Perkins, ' § 1377. ,• Noisome trades, s § 122. Regulations relative,to_nuisances;_examinatioin § 127`1• State The board of health shall examine into all nuisances, sources---of fi nd causes of sickness ` trial within its town, or on board of vessels within the harbor of such town, which may, in its # Said department opinion, be injurious to the public health, shall destroy, remove or prevent the same as the to be known as the case may,require, and shall make regulations for the public health and safety relative thereto ", exceeding five hun and to articles capable of containing or conveying infection or contagion or of creating dollars or up to sickness brought into or conveyed from the town or into or from any vessel. Whoever fi" « disposal of infecoi violates any such regulation shall forfeit not more than one thousand dollars. become effective an Amended by Sta992, c.23, § 16. date as may be spe health and well-b Historical and Statutory Notes department takes 1992 Legislation sentence, substituted one thousand dollars" for fitness for human St.1992,c.23,§ 16,approved April 24, 1992,and "one hundred dollars". standards for recre by§ 77 made effective upon passage,in the second family type camp gi ed, however,.that § 123. Abatement by owner ` municipal recreatio play interests and n Said board shall order the owner or occupant of any private premises, at his own expense, all people of a resi to remove any nuisance, source of filth or cause of sickness found.thereon within twenty-four municipal or non-mu hours, or within such other time as it considers reasonable, after notice; and an owner or occupant shall forfeit not more than one thousand dollars for every day during which he in the code shall be bans' shall n knowingly violates such order. In the ' ,deemed to limit the i Amended by St.1992, c.23, § 17. . .,", - opinion, may be nee( ,rules and regulationp Historical and Statutory Notes y i the code. Said code 1992 Legislation" boards of health and, St.1992,c.23,§ 17,approved April 24, 1992,and j ^, ';of housing inspection, by § 77 made effective upon passage, substituted ;for human habitation one thousand dollars"for"twenty dollars". tl t,the health or well-be: ' t:those conditions whicl s ,..:deemed to endanger § 125A. Review of order adjudging the operation of a farm to be a nuisance� 1 remises. This desi€ If, in the opinion of the board of health, a farm or the operation thereof constitutes a# ' *authorized person fe nuisance, any action taken by said board to abate or cause to be abated said nuisance under ' tnolati�ns or of ter�alh _endan er sections one hundred and twenty-two, one hundred and twenty-three and one hundred and ` appropriate. twenty-five shall, notwithstandingan otherwise a p y provisions thereof to the contrary, be subject to the,' .Alp provisions of this section; provided, however, that the odor from the normal maintenance Of' 'n. Local boards ti hea livestock or the spreading of manure upon agricultural and horticultural or farminglands or irides and regulations noise from livestock or farm equipment used in normal, generally acceptable farmin41 g length of ti S8 g said code against any vl r�� n y � • . ..:�;• r.::...ate System. � ii'_'!"'c.;l.L. 0f,]f.:j ert y Inquiry Help L...oc at1i-4nl :I0 I''i(•1RUgg GIR Ne" gL.!bgr.'har:?(:I „ I. J:l' C; 'F i r 2 BA:: ( K t.;urr y.,k'p, C)yn: ..I_iF>L..Y';_'t:J(:II-N J & I"1+-R Y A State Class: , J.o1. -" "% I'd+'1.1.1:1:J1'',IY'il.... I"IORTf: (1(:E CO I'•-lip„ B;1(:aw 1. Area` 1056 16 41. ''L`hd'L(::'i H T A R N C11 .C:�•-I-i l:'L' Year r F-1 c l d e t`I e' pailsTN L4lt( ;'_> t019 . Rf:_•`1 {'Y'i::`11r-e; -'`7 t._.. ! .0 , "-. -- Y.. � ,.:�-t i r�t, +I .:. I. _.;1. " SDI r..+i._Y, �_l la l I hl' ...., �:< 'I r-1 F t + ' F�+ i 1 t-?e:'`f�a MOW I I[::I L':I ri 0913 3 Deed I:;,r::,K 0 7 7 9 t C? i.7 .=1 '�raat� (A Land� -. _„ :`i_.� f.J'..? �':S l.,l:{ .I la.I.rlfj�l:{ % ?:v�iO Extra . I\baf_i is V 3ti.}II'lit 505 I.I-)dP.',:'g 978 (MY`lR1.NIR CIRl:l_..I_ FrOgu 116 :I:rif_LF W1if.;r`b L . J:tta::p{I Last A!..it,o Updo WWIStat6ax CYLast JACS Updates es 122994 Land Reviewed C•iV 6 �I C;:r rf..:i)t f. - _ ways ?W1.'"Ci.'1"I L fat- :"!;•: JYX Tit IN. ,Account: t, I'_tr t __' kC')'i: t_ct'C iS ( 7 WxtqS2 To", I'd e PAR Agtinn G NAM, `,F w -43n1 L CATION - SEWAGE PERMITNO. VII�LLAG . INSTA LLER'S NAME i ADDRESS BUILDER OR OWNER. 2k- DATE PERMIT ISSUED Z�—cg-e) DATE COMPLIANCE ISSUED �_.2 - � , ,,y 0 39 s7 o�.o•�. � �a�e ;,u�� C���c� ..� Fss... �. ....................... No. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H Al TH _Se -3S-1t; 1.. OF..... ................................................................ T Appliration for Uhipviial Vjarkg (futuarurtinn Prrutit Application is hereby made for a Permit to Construct X) or "�Repair ( ) an Individual Sewage Disposal System at• .Z.��-.�.- ... ...4-11 L-�"r ...A/C ...... ...-_.- ----.-... -.. ............................................................. Locatio Addr or Lot o. ...... ........ ............ .... ._.... _.... . -- ----------------.....------- �.�. .. Owne A edt�ss ... ...................................... ......•---------.-------------.--..--•---.--------------•----•--------------------.-----------.--. �- Installer Address Type of Building Size Lot.s.2 13 �1......Sq. feet Dwelling—No. of Bedrooms... :...........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ----- No. of persons......... --------------- Showers ( ) — Cafeteria ( ) 04 Other fixtures.......----•---------- ..._.....-•---•--=-------------------••----•-----------•-----•..............---------------------------------_•---- W Design Flow...............5-- ..............gallons per person Pier day. Total daily"ow.._....c9ao.......................gallons. WSeptic Tank—Liquid capacity./AeO..gallons Length. ......_.. Widfh-_�G�_. . _. Diameter................ Depth................ x Disposal Trench—No..................... Width... .............. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------/---------- Diameter...... _.------- Depth below inlet.... ....._. Total leaching area..r� Z Other Distribution box ( ) Dosing to ( ) Percolation Test Results Performed by....e.olvelz!?!? .. ..................................... Date.. ._� ._.._.._... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to grou water....-.. .-] 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....._.................. •-----•----•-----• -----------•--•-------------------------------------------•---.--... ------•------------••---•-•-•--------------•- 0 Description of Soil �. .... ®� . --------••&---(p---•-�..ce'm x �•••--. ------• . --------------- .......... :.. ......... ....---•---•-------•--------......-- W •-••----------- ------------••----••------•-----•--------•••---------------.......-----------••----------•-•--•-•-••-•-------•------------------------••----------------------•-----------------•.....-- VNature of Repairs or Alterations—Answer when applicable.................. .............................................................................. ...-.................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of L'L HE 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 t boar .of health. / S• n - ............... .............. ....-.................'-_... --J"/ - ---. to Application Approved By---` e. L..... =` == = � Date Application Disapproved for the following reasons-............................................... .................•---•----••-•-•------•-......-•--•-------......-•---•-•-•-••---••--....•--••---------•-------------------•-•---••-•--•-----•--•--•••-••-•------•---•••-----••-•-•------------••-•..•••. 'f 1n^ Date PermitNo......................................................... Issued-•••_..............----.d'.®'--......._.......... Date Y N ....... FPS... 3G............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �__ Appliration for Diapooal Works Tonotrnr#inn ramit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at; ) ........- _- _.. ............... ................................. r ... ......------•••--•••---•--••••-•--•---•- ----•---.............-------•----•--......--•-•••... Location-Address.' • or Lot No. . ........................................... .....................................••••----••. •-........-••-•••-•--••••• - ..... -------------------Owner i C=ic.• .d Aa ress - Installer Address � d Type of Building Size Lot........_��... _.� �......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) PL4 Other—Type of Building ! �j ...... No. of persons........�/............... Showers ( ) — Cafeteria ( ) Other fixtures ..................... .._.._.. ------�- e W Design Flow............... ____.................gallons per person per day. Total daily flow........ ---_-•--------_-...--...gallons. WSeptic Tank—Liquid'capacity��°O-.gallons Length_P_ �..... Width.! I^___.._ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length....._....`......�.. Total leaching area....................sq. ft. Seepage Pit No.__....j.......... Diameter._....`.....__..... Depth below inlet._7... Total leaching area._ Z Other Distribution box ( ) Dosing tank ( ) '"' Percolation Test Results Performed by................':rl' _L...:"-!......- :�'��°..-.............. Date..a�!�-- a ,--------------.......... 4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..__..._:....i.: .; ri, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......_U�i .. P4 --........................................................................................................................................................... O Description of Soil...... tclr� --� l ............................................................... U -------------- j- __----fl� ----�.,�tlf`........... .__......h--//��--------�/j _-----�llrr�....-__----•-•----•------------ UW ----------------------------------------=------•-----------------•------•----.::------•------....-•----------...----------------------------------•----------------------------•----•••-•------•------- Nature of Repairs or Alterations—Answer when applicable................................................................................................ .......................................................-.................I-•--•------..............-•-•--.......-•--•------•-••-•-•----•-•------•--•--••-------•-•-•-•-•-•--•-•-•-•-•-•----............ Agreement: The undersigned agrees to 'install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE, 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. - ,r � �,, i yJ ate Application Approved By...... .-... . .. ----. `�. � ` Date Application Disapproved for the following reasons--------------•-•-------.........-----------------------------•------------------•-----..._......-----...._-••-•- ...................................................... .....•----------•--...----........---------....---------------------------------------------------------•--•----...-----------------•------------ Date PermitNo......................................................... Issued...................................... Date THE COMMONWEALTH OF MASSACHUSETTS �,. BOARD f OF H-•E�A-LT/H�! ..... /..... ..-................00......'!'.. t' {.ram}'/!!................................................. Tr Trrtifiratr of Tomplianrr THIS IS TO C . TIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by..../ ., err• /-�f..tCt Gfi�_.`.._1..... :.._..._.. ��..,4 ) kistaller /� , ...................... - has been installed in accorda> ce.with the provisions of Tom` j of The State Sanitary Code as described in the -..r.-.....- , , ARA application for Disposal Works Construction Permit �o, dated___ _______________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION PSFACTORY. DATE..---•--.....r..r_ .-�`�--"-•____________________________________•-•--•---- Inspector......... ------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS �.- BOARD OF HEALTH z, c,© -G f i� t. t✓ r No. ..................... FEE........................ Rapnp//al arks �nnotrnr�ion Permit Permission is hereby granted....l,_111�1 _.. �t"�c: =?�_._._+1 _._... '�!%�� to Construct ( .) or Repair (� ) ,An Individual Sewage,Disposal Stem l at No...-.• /- -' �r_---- t.�'�ft- .... !-.lr c{ �C% . `� 1 y-•-- Street as shown on the application for Disposal Works Construction P r it No --- "_ Dated_.._ `_y�__k"�_i.-.0_.`---_....... • ! - Boa d of Healt DATE.' y ......................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS l SEWAGsoE PERM I NO. 0 VILLAGE l 3 �f��rMn S, INSTALLER'S AM it ADDRESS oe 5L, y 3 UIL�DER OR tiL Q n _�.raz • ( a . DATE PERMIT ISSUED 2 _ � 7- moo. DAT E COMPLIANCE ISSUED i _ � I �'Err s � � �0 N OTE S . .� I ---- - - - - - - --�-' I Ia—A.�.L E�.rE,�/. S��•../,J AIQ.E MEA.�f 5EA L.�\/E�... 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