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0030 MARSTON AVENUE - Health
30 MAR TONS AVE.,HYANNIS A= a 6 `P` T+IJWN�1lF:E�itN TABLE gp ,ey' 4N d rS f fAaj'SSES50lt+S lVL�►P&.Li)T VILLAGE �G n rl � IN5TA 1.'l2'S NA11t �t P IOia NO fii�a c T XCAPACITY. X OX LEA+CiItNG ANCO"wry (tea) NO (y�r� pLOdl�/iiS ...- uILDER 0 OMIR FERMITDK;fE ;,...�...... ��.-.�.- SaIMtaOm T�seunca lstvieeaa ;; ,, e� NlaKimum Ad Gt autadw�cer Table 4a the i3auam�k X.aau:htng i�nclity lhlva8a5 'Jl1At�r:;ranl'1?lcsI! �ci Y.eaG6��ng actymaiy cvflls vx(st' oil We withiii 20 feat'oft l�a�t ittg f��ii<t}�) &�a®9 VV�t4d and lLeachln�r t�acilf�y( a��y w�tland5 exist �ee + etau��OQ fc et Icu0 Og�mcili a �urnt3had by `r � K '' � I cif � c.♦� v� � � _ � W � � '-- -- -- — o 0 a` `O a C. j q:,� -- W 1 , W co � Q U O kA 1� � ' T0441 ?;APU'VSTABLE LOCATION ���/�S'•�(/S SEWAGE M ` SVILLAGE ZZ49—/7;y L4:2J' /A ASSESSOR'S MAP & LOT D;STALLER'S NAME&PRONE NO. SEPTIC TANK CAPACITY � ® LEACHING FACILITY: (type) S (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Le thing Facility(If an wetlands exist within 300 feet Pf I 1-in ility) Feet Furnished 4 �Y2' B.t .R ti Commonwealth of Massachusetts Title 5 Official Inspection Form f�. ' IN Subsurface Sewage Disposal System Form Not for Voluntary Assessments ' IM 30 Marston Ave > Property Address fV Karen Twomey "r Owner Owner's Name Q information is required for every Hyannis �/ MA 02601 10-6-16 page. City/Town State Zip Code Date of Inspectio .A 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. A. General Information 9?R) 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 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 Ev on by the Local Approving Authority 10-6-16 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 0 1 Commonwealth of Massachusetts :I,i Title 5 Official Inspection ®r �,.+ (. � I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments }!a , 30 Marston Ave Property Address ,Karen Twomey Owner --?Owner's Name information is .Hyannis MA 02601 10-6-16 required for every page. F-City/Town State Zip Code Date of Inspection -B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. 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. p System will ass y inspection if the existing tank is rep'aced 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Dispossl System•Page 2 of 17 Commonwealth of Massachusetts ILI Title 5 Official Inspection form 121I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Marston Ave Property Address _ Karen Twomey Owner Owner's Name information is required for every Hyannis MA 02601 10-6-16 page. City/Town 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): 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•3/13 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 1 Commonwealth of Massachusetts 1a=1 Title 5 Official Inspection Form r� W. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Marston Ave Property Address Karen Twomey Owner Owner's Name information is required for every Hyannis MA 02601 10-6-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 '/Z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal Svstem•Page 4 of 17 ` Commonwealth of Massachusetts a Title 5 Official Inspection Foram �-`;I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Marston Ave Property Address - Karen Twomey Owner Owner's Name information is required for every Hyannis MA 02601 10-6-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed 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 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 �r Title 5 Official Inspection Form -`l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �r s} ter 30 Marston Ave Property Address Karen Twomey Owner Owner's Name information is required for every Hyannis MA 02601 10-6-16 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 Commonwealth of Massachusetts �aa Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u.�•s! 30 Marston Ave Property Address Karen Twomey Owner Owner's Name information is required for every Hyannis MA 02601 10-6-16 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 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.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 10-2016 Date Commercial/Industrial Flow Conditions: Type of Establishment: •t. 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 I Commonwealth of Massachusetts .a=1 Title 5 Official Inspection Form ! Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Marston Ave Property Address Karen Twomey Owner Owner's Name information is required for every Hyannis MA 02601 10-6-16 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--pumped few yrs ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form f� ' 1�'I Subsurface Sewage Disposal.System Form Not for Voluntary Assessments All 30 Marston Ave Property Address Karen Twomey Owner Owner's Name information is required for every Hyannis MA 02601 10-6-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) t Approximate age of all components, date installed (if known) and source of information: 1970's with newer leach field in 1980's Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 12"feet Material of construction: ®'cast iron ® 40 PVC ® other(explain): Orangeburg Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. 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: 1000 gal Sludge depth: 12° t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form -+ -IfEI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a' 30 Marston Ave Property Address Karen Twomey Owner Owner's Name information is required for every Hyannis MA 02601 10-6-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined. Tape 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 is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Irl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Marston Ave Property Address Karen Twomey Owner Owner's Name r information is r. required for every Hyannis MA 02601 10-6-16 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: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: M 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 a=i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Marston Ave Property Address Karen Twomey Owner Owner's Name information is required for every Hyannis MA 02601 10-6-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): There are 2 d-boxes and both are in good working order with no sign of back-up from fields. 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. 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 Commonwealth of Massachusetts :aa Title 5 Official Inspection Form ,!�'I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments J£!� 30 Marston Ave Property Address Karen Twomey Owner Owner's Name information is MA i anns 02601 10-6-16 required for every Hyannis page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type. ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 3-4x4x4 ® leaching trenches number, length: 1-10x30 ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: < . . Comments (note conditiofrof soil, signs of hydraulic failure, level of ponding, damp soil, condition of f vegetation, etc.): Both leach fields in good working order with no sign of back-up into d-boxes or surrounding stone. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form -W.I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Marston Ave Property Address Karen Twomey Owner Owner's Name information is required for every Hyannis MA 02601 10-6-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Form -A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Marston Ave Property Address Karen Twomey Owner Owner's Name information is required for every Hyannis MA 02601 10-6-16 -- page. City/Town 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 0cze//t � . At 5 E o � 3 -3 -33' 8-3 - 30 ' t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 - Commonwealth of Massachusetts a 01 Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form Not for Voluntary Assessments 30 Marston Ave Property Address Karen Twomey Owner Owner's Name information is required for every Hyannis MA 02601 10-6-16 page, Cityfrown 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: 12 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date cf design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at 12'. 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 Title 5 Official Inspection Form i.l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49.,} 30 Marston Ave Property Address Karen Twomey Owner Owner's Name information is required for every Hyannis MA 02601 10-6-16 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 ' f FOR MAIL-IN REQUESTS Please mail the completed application form to the address below. Also, please include the required fee amount (see fees at bottom of this page). Make check payable to: Town of Barnstable. , Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 To get rental registration application forms, go online at www.town.barnstable.ma.us. Go to the Department Menu. Locate the Regulatory Department. Then, within the Regulatory Department, you will find the Health Division and its Applications. FEES Fee: $90.00 Per Unit plus $25 for each additional rental unit on the same property, with the same owner. For further assistance on any item above, call (508) 862-4644 1 TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date J� ' cp- ( Time: In 7 d 6-0 Out Owner 1 � �-�iN� C 'W O M&y Tenant lM Y k",- Address 9 a"k eq 2;'tJ W F- o'q-04-� Address Vrw►,rt-S'-�� FYI�C�L���� , torl4 ���SAS N1 �� � VV✓� t3�-�d I Compliance Remarks or Regulation# Yes XNO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities p pmve& it ,Ate ��`"`.� '^...5..��-•"' 4. Water Supply 5. Hot Water Facilities r 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal -� 17.Temporary Housing 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms J Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here TOWN.:,7 &RNSTABLE LO:�ATION 90 /�`_�� SEWAGE # ,?C-- VIfLAGE /UPS l ASSESSOR'S MAP Sz LOT ' P INSTALLER'S NAME Ex PHONE NO. SEPTIC TANK CAPACITY_ LEACHING FACILITYAtype) (size) Af aC �'Ac Q NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �7 - DATE PERMIT ISSUED:_ DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Cam.. A,V - , "i E r No.._ .: Fps... . .......... THE COMMONWEALTH OF MASSACHUSETTS q�- BOAR® OF HEALTH .............7�"`- I.......OF..... .. ........... .... ................................................ Appliratiou for UispusFal Works Tomitrurtion Trutt Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......... 0.........lr�.... r ---------------- ...................... Location-Address t .or Lot 'v o. ...................1 a.-fa....__' .tYL.�rO� ._.......'...____.'._...'._.. .............-_.......__....'...'.'_..'.. ___._.___._...........'_._'_"_..._"_."'..__"'.-- Owner r Address ..................... �-- - ------------------- -------------------------------------------------------------------------------------------------- Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.................................. .Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ------------------------------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter---------------- Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area-______-------.-----sq. ft. Seepage Pit No---------_---------- Diameter.................... 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........................ fL4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' -------------------------------------------•----....------------------........................--'---......................................................... 0 Description of Soil........................................................................................................................................................................ x x -------------------------------------------------------------------------------------------------------------------------------------------------------------- --- V Nature of Repairs or Alterations—Answer when applicable..............2j--.-- � - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i i LE 5 of the State Sanitary Code— Th ndersi ed furt er agrees riot to lace the system in operation until a Certificate of Compliance has be ''ssued b e b d o he . Signed..... ------------------- --. Date .. •-- Application Approved BY..... J Date Application Disapproved for the following reasons-----------------------------------------•-------....----------•-----------------------------------------'--'--'- Date PermitNo. �-�4............-........... Issued....................................................... Ds t. t t f THE COMMONWEALTH OF MASSACHUSETTS �° - BOARD Off" HEA-�L/TH ----... !�;fa.' --.......OF......-P�,:G w�rg-�t??r: i. - Appliration for Bi4poaal Works Ton5trnr#ion "erntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .... ......................P 0 .� " Location-Address or Lot No. ................................................................................................. ................................................................................................. Owner Address ►W-1 "''f ........ .... .......~................... Instailer Address Type of Building Size Lot............................Sq. feet .. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers 0.ai YP g ---------------------------- P ( )--- Cafeteria ( ) QOther fixtures -----•------------------------------•------•-----------------••••--•----------------------------------'-----------. ------ w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid'capacity..._._......gallons Length................ Width......_......... Diameter---------------- Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-.-._-__-_----_____--__- Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................:_. Depth to ground water------------------------ ------------------------------- •--------------------------------- •------------------------------ --------------------------------------------------------- 0 Description of Soil........................................................................................................................................................................ x w V Nature of Repairs or Alterations—Answer when applicable--------------I......... ., ..---X_--y.R-`' ,°,,---_ ---- r. "/- ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'i'IE , p of the State Sanitary Code—Th ndersi .ned further agrees not to place the system in operation until a Certificate of Compliance has beWissued b ,the b " d of..hearfth. Signed-A/�=`.�`l! . J- --- ` _!�?'�' ..... j ... ................................ ✓ 7 r Date Application Approved B ..... '� !� -=r. ............................. ------ Date Application Disapproved for the following reasons:................................................................................................................ ---------- -----•---------------------'•----------------------------•-•-------...--.. ------- - ------------------------ - - ------------------------------------------------------- Date _ Permit No......... - ........................ Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a. .. OF. ....................... (9rr#if iratr of Tontpliattre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ,. ._ - Installer at...................-------•--•----•-----•-------------------'-------'-----------'--'---------•---•-•----...----....._-_.._..•-••----------------------------------------------"--•-•------•--•--- has been installed in accordance with the provisions of TI T E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....... ....V.. ..... dated------------------------------------------------ THE ISSUANCE OF-THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................... ............................... Inspector----------....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t� !!!?!t,h...........OF..........1 ,3. _-? _.>.: ±::_!?"............................... NO.. .:_..... FEE..-o --••••-•-----•....... Dispoll tl n kv C�1anstr ion ernti# Permission is hereby granted.......... .:----•-------. ..................... --•-••----•.................•-••------......................-' to Construct ( ) or Repair ( ) an Individual Sewage Disposal, System e 4 at No............... .,,1..............6'1-�_ ,;�_��.��_ �f==L Street �.�„ +77 as shown on the application for Disposal Works Construction Permit No._�1:: Dated.......................................... ...............'----------• -• �` "'--^-.�---•--------'---......------- /`:�j � � r^ Board of health DATE............... ...�- lf......-(�--D•-•............................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �' -\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION i TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 30 Marstons Ave West yannispor ,Mass. Owner's Name: Randy Swetish Owner's Address: 10 Wheeler Road Marstons Mills,Mass, 02648 Date of Inspection: 4/6/01 Name of Inspector: (please print) Joseph P.Macomber Jr. RECEIVED Company Name: J.P.Macomber & Son Inc Mailing Address:. Box 66 Centerville,Mass. 02632 APR 2 2001 Telephone Number: 5 0 8—7 7 5—3 3 3 8 TOWN OF BARNSTABLE HEALTH DEPT. CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: AA, 114111 Date: �� The system inspector shall 4bbmit 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. Notes and Comments ****This report only describes conditions-at the time of inspection and under the conditions of use,at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 30 Marstons Ave West Hyannisport,Mass. Owner: Randy Swetish Date of Inspection: 4/6/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D =SystemPasses- A16 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: SAS dry at time of inspection. B. System Conditionally Passes: 4JQ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Answer yes, no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. A-V The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: —A1Q Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed Alf, ND explain: 2 Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 30 Marstons Ave West Hyannisport,Mass. Owner: Randy Swetish Date of Inspection: 4 6 01 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: •TGAD Cesspool or privy is within 50 feet of a surface water WL Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines s that the system is functioning in a manner that protects the public health,safety and environment: eo 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. 4d The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. / 6 The system has a septic tank and SAS and the SAS is less than 1 Op feet but 50 feet or more from a private water supple well'". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: ti-vt� 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 30 Marstons Ave West Hyannisport,Mass. Owner: Randy Swetish Date of Inspection: 4 6 01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No/ ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ischarge 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 thedtstn butt on box above outlet Invert due to an overloaded or clogged SAS or cesspool /P?C V'X y' squid depth in cascpoQHs less than 6"below invert or available volume is less than '/,day flow : , Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number — �oftimes pumped�. �y portion of the SAS,cesspool or privy is below high ground water elevation. y 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 I of a public well. _ t� Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] 4 44 (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303.therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large 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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above)'- yes no the system is within 400 feet of a surface drinking water supply _ /the system is within 200 feet of a tributary to a surface drinking water supply /the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. ' 4 Page 5 of I 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 30 Marstons Ave West Hyannisport,Mass. Owner: Randy Swetish Date of Inspection: 4/6/01 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No 7Pumping information was provided by the owner, occupant, or Board of Health Were any of the system components pumped out in the previous two weeks 1/ 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,4NXCluding 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 ? f he Soil Absorption S stem SAS on the site has been determined based on: The size and location o fy (SAS) Yes no -/_ Existing information. For example,a plan at the Board of Health. /� — Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)(310 CMR 15.302(3)(b)) f . 5 Page 6 of 1 I ' OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address.30 Marstons Ave West Hyannisport,Mass. Owner: Randy Swetish Date of Inspection: 4 6 01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN now based on 310 CMR 15.203 (for example: 110 gpd x a of bedrooms):: Number of current residents: �_ Does residence have a garbage grinder(yes or no):Q Is laundry on a separate sewage system (yes or no):2L (if yes separate inspection required) Laundry system inspected (yes or no): Seasonal use: (yes or no): 1W Water meter readings, if available (last 2 years usage(gpd)):� Sump pump(yes no): a- � A&I -� Last date of occupancy: ncy: COMM ERCIAUINDUSTRIAL Type of establishment: Design now(based on 310 CMR 15.203): l gpd Basis of design now(seats/persons/sgft,etc.): Grease rrap present(yes or no): Indusmal waste holding tank present(yes or no):&_4 Non-sanitary waste discharged to the Title 5 system (yes or no):�J11 Water meter readings, if available: Last date of occupancy/use: ,t/ OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: lirp 7'- Was system pumped as pan of the inspection (yes or no): If%es. volume pumped:4 gallo s -- How was a tiry1 pumpe determined?��¢.k//I:.cj Reason for pumping: _ y •101 TYP OF SYSTEM eptic tank, distribution box, soil absorption system Single cesspool dbverflow cesspool Privy ( Shared system(yes or no)(if yes, attach previous inspection records, if any) /tt)lnnovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) &g Tight tank ofA Attach a copy of the DEP approval Other(describe): Approximate aee pf all comp onents,date installe if known) anD source of in ormation: Were sewage odors detected when arriving at the site(yes or no):/!� 6 01i30,`2001 21:22 FAX 508 428 8829 RG SWETISH BLDR 0t TOWN OV BARNSTABLE LOCATION O /9e &,4a- SEWAGE 0 OC-rAL? VILLAGE L4j6WAAS PO-Z ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.� SEPTIC TANK CAPACITY LEACHING FACILITY.(type) (size) /�X�rX NO. OF BEDROOMS_ PRIVATE, WELL OPLJZKILIC RATER BUILDER OR OWNBR_--��—=� DATE PERMIT ISSUED;_ DATE COMPLIANCE ISSUED: ti - YARIANCE GRANTED. Yes No I 4 71 vi a f Q � j I -- - ...� Page 7 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 30 Marstons Ave West yannisport,Mass. " Owner: Randy Swetis Date of Inspection: 4 6 01 BUILDING SEWER (locate on site plan) Depth beloµ grade: le e Materials of construction: —cast iron —40 PVC iOother(explain): _ Distance from private Hater supply well or suction line: /O'1' Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear ticfht.No evidence of . l _akaQR 9vstPm ; s ja000 4t, J vented through the house vent. SEPTIC TANK: (locate on site plan) A' Depth below grade: _ / Material of construction: Concrete iametal fiberglasylo polyethylene i(il)other(explain) li tari; is metal list age: � is age confirmed by a Certificate of Compliance (yes or no)/�(attach a copy of certificate) ,, Dimensions:p'`',f4 1 /1 Qlt%1B )'i Sludee depth. Distance from.top of stud a to bonom of outlet tee or baffle: Scum thickness: � Distance from top of scum to top of outlet tee or baffle: n Distance from bonom of scum to bo ym of outlet tee or baffle: Hoµ mere dimensions determined: Comments (on pumping recommendatiinlet and outlet tee or baffle condition. structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump the septic tank Inlet & outlet .tees are in place.The tank is structurally sound and shows no evidence of leakage. GREASE TRAP locate on site plan) Depth below grade: ?//� Material of construction:t), concreteed metaLt L,?fiberglass h polyethylenW4 other (e..\plain): yi4 — Dimensions: &A Scum thickness: Alof Distance from top of scum to top of outlet tee or baffle: Al-I Distance Irom bonom of scum to bonom of outlet tee or baffle: Date of last pumping: IV4 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet inven, evidence of leakage, etc.): Grease trap not present. L Page 8 of 1 1 4 ' OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Marstons Ave West Hyannisport,Mass. Owner:Rany Swetish Date of Inspection: 4/6/01 TIGHT or HOLDING TANWv—C (tank must be pumped at time of inspect ion)(]ocate on site plan) Depth below grade: CIA Material of construction:V4_concreteA metal fiberglass polyethylene 44 other(explain): Dimensions: AA Capacity: AW gallons Design Flow: N gallons/day Alarm present(yes or no): _o Alarm level: Ah� Alarm in working order(yes or no): All Date of last pumping: W4 Comments(condition of alarm and float switches,etc.): Tight or holding tanks are not present. DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Al 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.): Distribution box has two laterals No evidence of solids caiz'y ' Qver.No evidence of leakage into or out of the box PUMP CHAMBER(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): V,4 Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Pump chambgr is not present ' S 8 Page 9 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 30 Marstons Ave West Hyannisport,Mass. Owner: Randy Swetish Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: &12a 14 Type Al0 leaching pits,number: n � � leaching chambers, number:,%--b leaching galleries,number: 6 A�Q leaching trenches,number, length: O leaching fields, number,dimensions: d overflow cesspool, number: O 4)6 innovative/alternative system Type/name of technology: Title Five ( 78 Code) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Loamy sand to medium fine sand.No signs of hydraulic failure or ponding.Soils are dry.Vegetation is normal-The gallies are dry at this time. CESSPOOLSI,(�,r_(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: d Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum laver: ,t)� Dimensions of cesspool: IU14 Materials of construction: ' Alld Indication of groundwater inflow(yes or no): do Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Cesspools are not present. PRIVY,t6ty.(locate on site plan) Materials of construction: Dimensions: 4-W Depth of solids:_41 Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy is not present. 9 Page 10 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM IN (continued) Property Address: 30 Marstons Ave West yannisport,Mass. Owner:Randt Swetish Date of Inspection: 4/6/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. • o ar 4x c t, �'�Zz 3 IV 10 � ! r Page I I of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propern• Address: 30 Marstons Ave West Hyannisport,Mass. Owner:Randy Swetish Date of Inspection: 4/6/01 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water /Q/ feet Please indicate (check)all methods used to determine the high ground water elevation: ,l ��btained m s stem desi glans on record - If checked,date of design plan reviewed: 7ky Dl bserved site(abuning propemabservation hole within 1 SO fee��jj o�f SAS) pecked with local Board of Health-explain: !/Checked with local excavators, installers- (anach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used; Water Contours Map. Gahrety & Miller Model 12/16/94 " II f 1 r/1T•-.i.'1•I-'TI•"\1'R. IT PTIRTTRITI.!'RRI.1,'•.t�ef/TRRTIRR�L A�1I��'IRn .rT'\Tr Pr� -.TOWN OF OF Barnstable BOARD OF HEALTH SUIISURFACF SEHAUE 1 I SR)SAL SYSTF,M INSPECTION FORM - PART D •- CERTIFICATION T^.•T•••",— .,I.••�-T,.TT\,1•AIlITTRT1f1T1R1'.r•.•1."tVT11i\RR�•�'AI�A�/A' 7R\ V wasI I, -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 30 Marstons Ave West Hyannisport,Mass. ASSESSORS MAP, BLOCK AND PARCEL #� OWNER' s NAME Randy Swetish PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Son Irfe.' COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town yr Clty Stet♦ LIP COMPANY TELEPHONE ( 508 ) 77.5 - 3338 FAX ( 508 1 790 -1578 CERTIFICATION STATEMENT 0r I certify that I have personally inspected the sewage disposLi7 system nt this nddress and that the information reported is true , accurate , and omplete as of the time ofeinspection . The inspection was performed and any ecom,nendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Che one : • V System PASSED The inspection which I have •conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 , 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have con ucted has found that the system fails to protect the F)tlblic health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . inspector Signature Date /A ne copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF NBAL'1'lI, • If Lhe . inspect ion FAILED, the owner or•"ho" orator shall up grade pgrade ' tho eyatem within one year of the dote of the inspection , unless allowed or required otherwise as provided in 310 CMR 16 . 305 , partd . doc ter , Town of Barnstable o� Department of Health, Safety, and Environmental Services MAS& ,0� Public Health Division lED1A0�� P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health RECORD OF VERBAL COMMUNICATION v t 'n OIL^ e� S , w ✓I�C c�r1 p �w C'CCQ11 verbcomm.doc .._ ._.. __ _. ... ... . >:..•�. _-e5�k2�!h'`.o-. _. ..s.'�.. . .. .Y _..�kr�sig7c.Y6_ =:i'r .�... .`:r. �•/ .`t` - .. �, HOWMG ASSISTAnCE CORD TEL 508-4771 32 983 508-477 p301 Q 460 WEST MAIN STREET I HYANNIS, MA 02601-3698 FAX: 508-775-7434 REINSPECTION OF ANNUAL INSPECTION Name [` C v C►f d�N��u N In accordance with program regulations, I have scheduled the reinspection of your annual reinspection: at Datt M Time If you cannot be there, please have a responsible person present so that I may complete the inspection. If repairs are not complete, please call me Monday through Friday between 8:00 - 9:00 AM at 771-540.0, ext. �.39. IT IS IMPORTANT that you or a responsible adult be present for this appointment. The inspector must have access to the entire unit including the basement. Your landlord has the option to be present at this inspection. Please inform him/her of the date and time. FAILURE TO KEEP AN INSPECTION APPOINTMENT COULD JEOPARDIZE YOUR PARTICIPATION IN THIS PROGRAM. Thank you for your cooperation regarding this matter. Sincerely, c- SU-'Ti' Robert D. Shea Inspector I?xT 2-3 5 G (e f(�nrt Housing Assistance Corporation 5 :nspect>Form>REAnnual oFINME Town of Barnstable sins Department of Health, Safety, and Environmental Services 9� MASS. ,�� Public Health Division p'ED""0�A P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,Rs,CHO FAX: 508-790-6304 3 Director of Public Health RECORD OF VERBAL COMMUNICATION z- 112000 i' zC) am �° tl y0 cc zC0-�-f0-�-C, �T r �,v' -TO J'J r11i-� 3 4%-,s 14ve 6�,a.,,r ka c cQ re _I o ``''^ T. d. 1 v dv ("o 4- -JF-Q. Izd", Jwend;s (,\ tt.a ICQ IN.sL (.Q-11 kk C-C"' e_ tv&A S� CVAA,'-, IS kA '�- �/a `�t,r vut,l-S W d r 4L . (Zt 9�d, �LL'� fs S�•-Li Ce�.��� � �-eF. 1 �s ►�� �xQcQ m I c�^�- ��.n WGN M f�/f� �'r^ cw rt 4-C'('& � • S �c'MP! .1 � G ® c'-C.f'.0 01✓v.a1 `oi ¢�� w(_S S Le_ ca-�A /Vh/s s, (s a( 4- o/ d qp o zy LQlni S ` PO CQXX lr. fGvPi9�i7�'� �cl 1 Ga^✓ IcL kmk a-C C.e sJ 0,4-- L (- C az(z �u r verbcomm.doc SENDER-- 'a ■Complete items 7 and/or 2 � s a a a e a s a r@C@IVt3 the w ■Complete-items 3,4a,and tolkowng services(for an q ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. ai ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑.Addressee's Address permit. r�a d ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery W c ■The Return Receipt will show to whom the article was delivered and the date a delivered. Consult postmaster for fee. 0 3.Article Addressed to: 4a.Article Number d :��GL�� �ivefi� Z Zo3 �Q /�/3 E 4b.Service Type c°� ❑ Registered - Certified °C N /0 e I m ❑ Express Mail ❑ Insured fc — ❑ Return Receipt for Merchandise ❑ COD vt c 7.Date of Delivery D 5.Received By: (Print Name) 8.Addressee's Address(Only if requested W and fee is paid) _ ai � 6.Signatur r orAg ht) _..._ 0 X PS Form 3811, December 1994 1025e5-97-e-0179 Domestic Return Receipt +, UNITED STATES POSTAL SERVICE Off' Mq First-Class Mail p `Jit+ LISPge&•Fees Paid ao Permif C Print your nay des , and ZIP j Public 9001tb Olvislon Town of Barnstable P.O.Box 534 H ,Massachusetts 02601 ##ii jj `{ j(ji i{ iiiijjj} j1 (( iiii tt yy jj y{ jj jj SSj} ,.¢..i�..Y+i I�r.311�.`s��!i�1 1l�ElElililltll3�lEf}fi1t114liiiiEllEE41Ei11Ej11�11313IIE41E11 4 Z 203 499 143 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. �t Do not use for International Mail See reverse Sent Wain _a/J ( K-� Sj t&��u b GLE(�C� C`���r/� PPo, ice,State,AP.,�ptte Postage //G, C/r�>$ Certified Fee Special Delivery Fee Restricted Delivery Fee in CO Return Receipt Showing to Whom&Date Delivered n Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ CO Postmark or Date 0 LL //2—S/ 201! d Stick postage stamps to article to cover First-Class postage,certified maiVee,and N charges for any selected optional services(See front). I 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service a window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q) greturn address of the article,date,detach,and retain the receipt,and mail the article. I LO 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the I gummed ends ri space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the O O addressee,endorse RESTRICTED DELIVERY on the front Lof the article. M 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. LL`6 6. Save this receipt and present it if you make an inquiry, 102595-97-8-0145 a Town of Barnstable s Department of Health, Safety, and Environmental Services MRMABM 16 9. ,m� Public Health Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-775-3344 Director of Public Health January 25, 2000 Randal Swetish 10 Wheeler Rd. Marstons Mills, MA 02648 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 30 Marstons Avenue, Hyannis was inspected on January 10, 2000, by Glen Harrington, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II,Minimum Standards of Fitness for Human Habitation were observed: 410.100 The burners on the kitchen stove were observed to be inoperable. 410.351 The dishwasher was observed to be inoperable. 410.351 The toilet seat was observed to be broken. 410.351 The refrigerator was observed leaking water. The gasket on door was observed to be broken. 410.351 The plunger in the bathroom sink was observed to be inoperable. 410.351 Severe soot damage was observed in basement which was caused by furnace blow-back. 410.504 The shower enclosure was observed not to have proper seal with wall. 410.551 The latch on the storm door at main entrance was observed to be broken with sharp edges. You are directed to correct these violations 105 CMR 410.100, 410.351 (refrigerator) and 410.351 (soot damage) within twenty-four(24) hours of receipt of this notice. You are also directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than$500. Each separate days failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH 6� �homas A. McKean Director of Public Health Eclosure: Gold copy of Inspection Report cc: Robert D. Shea, Hausing Assistance Corporation 460 West Main Street, Hyannis, MA 02601-369 FORM30 Iiw HOBBS&WARREN n THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN DEPARTMENT ^M — --—ADDRESS .76 1 `• Y&V U SVey`e —1 1 TELEPHONE oo � o 1Address p __ 1 A Floor Apartment No. No. of Occupants__ - No. of Habitable Rooms 15- _No.Sleeping Rooms__.3____._ No.dwelling or rooming units—/ _.—. No.Stories. Name and address of 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 OM Doors,Windows: 0_4t� cy, 11v 15- l Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation.- Dampness.- Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair �k- at,� ✓ e0w-s-dl !'.2,,vtScvf- cwf -P 4#01 TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: u'w v ❑ MS ❑ ST ❑ P Waste Line: ds'c H.W.Tanks Safety an Vent s -nk* n v 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 Q �S Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,(bi Elect.: ©�' Stacks,Flues,Vents,Safeties: Kitchen Facilities Sink St is ea ix (,vct -6 a&Gef P,vt e.� Stove 17cr -) tj tc,_6 U - o-Sri f le Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: S ot.,,t.•- bo c& "t f 1ce3 L110 Wash Basin,Shower or Tub: /3+-o Iv r Jecc 4- /o Infestation Rats, Mice, Roaches or Other: 4-ov t , b kv3 4 ft_ p E 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 2ERJJU ' rTvY INSPECT _ �21Y TITLE_ DATE00/ 1, TIME 7 ��9 _ A.M. THE NEXT SCHEDULED REINSPECTION 3� V /2C P.M. FORM 30 CIW HOBBSB WARREN rn THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ (3 �I_V�154-0-tob- CITY/TOWNS9 w ��L a DEPARTMENT P yK ,r 3 tj -?_oft a,,:,, S r� , �y Q,,,"zo ---- ADDRESS 6�/q - I &t/ G,M sey`0 � f/ (�.� T TELEPHONE Address /�r/ 1 e w Occupant_ O L%"St° 1", Floor Apartment No. No.of Occupants-1 No.of Habitable Rooms X No.Sleeping Rooms_,_ No.dwelling or rooming units / No.Stories----I Name and address of 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: Central ❑ Y ❑ N E ui . Repair co - /0 I I TYPE: Stacks, Flues,Vents: PLUMBING: Su I Line: c/w v ❑ MS ❑ ST ❑ P Waste Line: o*'C,H.W.Tanks Safety an Vents -ck�L4,- olv ^, °NnS /D ELECTRICAL Panels, Meters,Cir.: ❑ 110 11220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT She Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks dS Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten., Gas,01V Elect.: 10q Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink SL . i Qot tct f.A -6CaGcf hpe(+� /0 7� ve Sto vv t- C� e-s i Idle 1e ' /C /o Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: S vt.-,, b"& "tt 1veS L-1/v SW Wash Basin, Shower or Tub: /�'� 9va' jea+ y,n Infestation Rats, Mice, Roaches or Other: Xevv4 , 4 t 4 LZ v 7 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 IRERJU INSPECT TITLE l� e f l 0 2,6 z� 32 DATE TIME P 17�a/�� l A.M. THE NEXT SCHEDULED REINSPECTION P.M. r 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 endange-or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure-o 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, p-essure 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 dispcsal 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&ectrical 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 b 105 CMR 410.503 A and 410.503(B). q Y O (5) Failure to eliminate rodents, cockroaches, inset 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. 4 oFtTti Town of Barnstable s�vsrnst.E, Department of Health, Safety, and Environmental Services Public Health Division P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Z S 3a.4.0w—Y 0, 2 a-w NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 3 o M o-�,A+cane vw.Fc. , W yo\,,wzo The property owned by you located at , Celle , was inspected on � a-Y 1,), by Glen Harrington, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II, Minimum Standards of Fitness for Human Habitation were observed: /OO 410. �i�.2 (o v�„y,,� o,.�f{.� U. ;f c 11 e. W�� 0 6R f-�.•�e�fl 1 e o ro e,o,Ga 410.351: C6-0 a) e 16 1 ef did � c c� o�,�►�(�%. 410.351: �r(y-f a e�� w�c 1 o b d-e,-v-e of ySr (��a Gc a ve a 410 : 3S� : r��►^i cf' na dvr cwa-) o bf-e'rrit ok �e.a 410. o-h t.e/vv.44 le. � 410 : ?S-I 71-11-Ar(��^ l�. -e t�`�'�`ro,vv. S c r.:(� tAru J o 4e rv,e d ctd 6, Ami; 410 ' 410.551: - (��,� qv" a-k%-� .5 W4O2. pires/wp/q/Is VOU N,..e oQ,kn�4J ' ou, c. q.l v. 35-/ (5cx4 t.v ZI1).L1o.,vs 61 rece-1>- d l You are directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health Pig C(o j1&� arY �/ cL�,.� dz a— "7�'F✓ C, pires/wp/q/Is Health Complaints 06-Jan-00 Time: 9:15:00 AM Date: 1/6/00 Complaint Number: 2195 Referred To: GLEN HARRINGTON Taken By: GLEN HARRINGTON Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 30 Street: Marstons Avenue Village: HYANNIS Assessors Map-Parcel: 288/095 Complaint Description: is Inspector for Housing Assistance Corp. and he inspected above property and discovered that the furnace in basement hiccupped and back-drafted soot into entire house. The occupants reportedly cleaned the living space but the basement is still full of soot. Mr. Shea stated that he was in basement for a few minutes and he said he could taste and feel the soot in his lungs. The occupant is reportedly immuno-depressed so there are health concerns beyond the normal. Tenant is 790-1049. Owner is Randall Swetish, 10 Wheeler Rd., Marstons Mills, 428-3367 Actions Taken/Results: Investigation Date: Investigation Time: 1 01/14/2000 10:07 FAX 508 428 8829 RG SWETISH BUR z02 HOWInG AUISM(ICE CARP ; 83 ® 460 WEST MAIN STREET/HYANNIS.MA 02601 FAX:508.275.7434 HEATING SYSTM4S AND/OR HEATING APPLIANCE CERTIFXCATION Per $OCO, please verify the heating system(s)/heating appliance to be in safe gperativact condition. This requirement includes Cleaning, servicing, and certification of all heating systems/ appliance in the unit. This certification is required only once during the duration of the tenancy. If this information was submitted last year, it is not required again. Owner Name: e.*Sll Tenant Name- Unit Address- Date certified: Y' . 1S Name of Contractor/company:-. 1)42 L 0-10 C . 7i-L ` D/(. Cy. l N Q— Contractor License : on //llg-ltj`j the heating System/heating apJalia Cw-a in the above unit is/are certified to be in safe, OPerati.ng condition. signature of Liemsefcontractor t4 Nleatri.c heat systems are exempt from this requirement. CRPE COD NUILDINC Richard Davis INSpE�� 1230 Newtown Road Cotuit, MA 0263 ED 508-420-0260 0�1 1 8 1991 TOV�OF LETTER OF INITIAL LEAD NON-COMPLIANCE DATE t6 `7-rl/ Dear l 1 4 Th s—letter is to certify that I inspected the property located at "-sf,9.Vs _a _,apartment no. , and relevant common areas, in the city or town of_`, FfX , for dangerous levels of lead according to 105 CMR 460 . 30 (A) through(F) : Procedures For Initial Insbection,Regulations for Lead Poisoning Prevention and Control, and determined that there were VIOLATIONS. The inspection was conducted on 16 ?-c(( ** Please be advised that Massachusetts law requires that only certain residential surfaces be free of lead paint . (Deleading must be done by a licenced deleader MASS. state law) NOTE: A copy of the report must be on site at the time of re-inspection which is after the deleading process. STRIP ALL WINDOW WELLS OR COVER WITH FLASHING. SEE NOTE FOR FURTHER REQUIREMENTS. DO NOT PRIME OR REPAINT UNTIL THE INSPECTOR HAS SEEN THE BUILDING. NOTE: MASS. GL CHAPTER 111 S.S. 190-199 Requires that : On both the interior and the exterior of any dwelling, loose offending paints or putty, regardless of surface or height, must be removed. The surface should then be sanded, reputtied and repainted with a non-leaded material in order to reduce further deterioration. Any chewable surface within (5) five feet of a standing surface must be stripped to the bare wood and repainted with a non- lead paint. FEDERAL LAW 24CFR Part 35 Dated 1 April 87 requires stripping be done to the (5) five foot level and as above. ** As of above date of regulation Sinc ly, it will be the responsibility of the owner to be aware of (OCttAA� any future changes in the law. Richard Davis I 1074 Inspector Licence # Report # 0 �4 At the time of inspection children under 6 were living in the house OYES GYfNO O INCONCLUSIVE THE COMMONWEA;Ty OF N,1,ASSACT �`S�l BOARD OF HEALTH NOTICE TO ABATE A-N-;U-IISANCE l 1 0 19 t) e As occupant of 3'E�-1 l J+l'�?�dJ � �V�: AlVW/ you are hereby notified to remedy the conditions named/below within 24 hours of the service of this notice, according to Massachusetts General Laws, Chapter III, Sect n 123 0 If at the expiration of time allowed these conditions have not been remedied, such further action will be taken as the law requires and a fine ofC$Ift-d8'per day may be charged. (l By Order of the Board of Health Inspector FORM460 ,�07ARREN,IN D,t � rA -- /� TOWN OF BARNSTABLE LOCATION� iARSTONS AVENUE SEWAGE # �7/ VILLAGE HYANNIS ASSESSOR'S MAP & LOT a �^ ogy i INSTALLER'S NAME & PHONE NO. BCK 778-0444 SEPTIC TANK CAPACITY 1000 GST (Previously Installed'by Macomber) LEACHING FACILITY:(type) LEACH TRENCHES (size) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER PUBLIC p BUILDER OR OWNER L. HANSON DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ell, � � TOWN OF BARNSTABLE ypF THE Taw OFFICE OF B.»9T BOARD OF HEALTH 9�G AE �9 367 MAIN STREET S 39. HYANNIS, MASS. 02601 �A December 12, 1988 o r Randall & Kathleen Swetish 10 Wheeler Road Marstons Mills . MA_ 020AI NOTICE TQ ABATE VIOLATIONS Q1 Ila CMR: 15 , 00 TEE STATE ENVIRONMENTAL CODE TITLE Y_: MINIMUM REQUIREMENTS FAR. TEF, SUBSURFACE DISPOSAL U SANITARY SEWAGE The property owned by you located at '30 Marstons Avenue, TH'y n is, Mass . , was inspected on December 9;1988 b Donna Mlorandi, Health Inspector for the Town of Barnstable because of a complaint. The following violations of 310 CMR 15 . 00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage . Regulation 15 . 02 (20) : Overflowing septic system, this violation is a serious public health hazard. Regulation 410 , 300 : Sanitary drainage system not maintained in good operating condition - septic overflowing. These violations are also listed under regulation 410 . 750 and are deemed a condition that endangers or impairs the health or safety of the occupant and the public . You are directed to have the on-site sewage disposal system pumped within twenty-four (24) hours of receipt of this notice and to keep it pumped as many times as necessary to keep from overflowing until the system is upgraded. You are further directed to hire a licensed sewage disposal works installer within seven (7) days of receipt of this order to evaluate and submit plans for this upgrading. Permits must be obtained from this Department. You may request a hearing before the Board of Health if written petition requesting same is received within seven ( 7) days after the date the order is served. Non-compliance could result in a fine of up to $500 . 00 . Each day's failure to comply with an order shall constitute a separate violation. You are also subject to a ticket citation for each day violations are observed. There is an automatic $25 . 00 fine per -day. PER ORDER OF THE BOARD OF HEALTH �1- C Thomas McKean Director of Public Health