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HomeMy WebLinkAbout0805 PITCHER'S WAY - Health (2) 805 PITCHERS WAY, HYANNIS A= s r 'I . _ _ . . _ _ . .. --__ . I. _ ... .. _ .. _ _ . . . _ _ . _ __. _ . _ .... _... . _ R �.—:M—�..�..:�z.:::.:I:�.....t�I.1,Ii.;-).,�1I:.,.1I1-r . .:.. . Commonweal h qf,lc,assa6ht��e ti a :_ " . I� �tabsurface Sewage Cisposal �yste�t Form Not for Uc:funtary Assessments. . / _ - ;�} 805 Pitchers Way ._._.__ _.. ... Property Address Celeste,Indrisano. Qwne:I .._. _ _._ ... ; Qwher s Name inforrnation is.. requIred for every Hyannis .: (ilia 02609 7/31/2013 is .11 ..: .. .. ... _ page : .. #,,:own State Zip Coale Rafe of Inspection lra'ape�tort resaits rrttat"be sasbrttitted on this fmrrn irtspectico,fors itta '�tot lie<alteretl rn1.a Way. l?lea�e1.see co pletepOss,'"ctaeckli1.st. t the onct'-f th.-fore lanp'go rtant 1Nten ' 1c�P fly! q. on the'computer use only the tab q Inspector ..:::I:�::�:z.I-:,.,-::-I.:.I:- ,,.-.l:I key to move your P- C/ cursor do not Sean:M Jones use.th.e"return- Gameof Inspector ,:1...I,:::-.-..:1.—.......I�.f.-�.-,...:.I.-�.:-,:..:.-.�—I:.,-.I.:.-:.1'I.._.:-I.�,..—....:.�. key. Capewlde Enterprises ..... ..... ..I........ 1, 0PMpany Name 153 Comrria�claI St: :—.1.U ��:::��.:� . 1. . I I I 1. .- 1. �� , : .: .. .. ... ..... ,....,� , ....1— 1:1: I .1 4.M.,.�r..0r,,:r,:M.r rb.�.I:I,.I:*.I.-�....._:.-r.:-:­......�r.�I.....r..1.�..�......r-.�.�,111iashpee IVIa 026' .. �_.. _____—m. Clty To State ZipCode 508 477 887,7 S,I 4522r: ,.. .....:. .... ... .. . - — 7elept one IN License f, ber �� t1C9oi F l certify that i have persdnaily inspected the sewage dtsposal,sysfem at Ir this address and that the information reported below Is'tru , accurate antl eomplete.as, t ie time of the inspection The tnspectiori. : was performed bas r.ed;on my tralntngA;and e pe fence In the propel function ar.nd'marntenance of on site s�rqewage disposal;systems 1 a a DEP approved systecrt"irtspept�r ptarsuanfto section 1`5 340€if Titles{3�0 .MR 1a Oq,q), The system: ® Passes ❑ Condltionaliy.Passes ❑ atis ,❑ "Need'd Ftaither Evaluation by the Laical Approving Authority w... . mm ... InspecEor.s Signature [Date . . . . .. .. _. -. . ..._.. The,sys#errs;inspector shall submit a copy of this inspaGtlon report to:<the Approving Autho ity{Shard of Neaith.or©EP}wlthm 3;0 days'of,cornpieting this,inspectlor If the systerra :s a shared systerrl;or has a design flow"cif 10,040.,,p or'greater,the;lnspector antl the.system..ovwner st ail submit the; report tot,e iappropnate regional offIoq:<f�the LEP The origii ai should be;sent to the system owner and ccapies sent to ttie,bu,yer, If"appileaoler., a9.nd the approving authority. *, *This,report'o>nly descries con,11 lort�:`atthe lrrte.s 'nspectioct.a�td ur tlerth corttli aorts,o use at:;th�t.ti e T is:ins ec io dries riot address how the syst rrt uvil'I plrrforrt�;in the:futU finder, . the eanrae or aiffeent c¢anclitiont €if:ue. . . ._ _ I. 35ms;,4l13 _ ritW5 OffiItForm:Subsurface-Sewage isposa!SysEem•Pao 1 0,17 ai , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 805 Pitchers Way Property Address Celeste Indrisano Owner Owner's dame information is required for every Hyannis Ma 02601 7/31/2013 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: ® 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: The dwelling located at 805 Pitchers Way Hyannis is served by a Title V septic system consisting of a 2000 gallon septic tank, distribution box and 2 1000 gallon leach pits. The system was found to be in proper working condition at the 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 J Commonwealth of Massachusetts. W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 805 Pitchers Way Property Address Celeste Indrisano Owner Owner's Name information is required for every Hyannis Ma 02601 7/31/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpsialarms 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 805 Pitchers Way Property Address Celeste Indrisano Owner Owner's Name information is required for every Hyannis Ma 02601 7/31/2013 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 '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �nM 805 Pitchers Way Property Address Celeste Indrisano Owner Owner's Name information is required for every Hyannis Ma 02601 7/31/2013 page. Cityrrown 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 W Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c,M 805 Pitchers Way Property Address Celeste lndrisano Owner Owner's Name information is required for every Hyannis Ma 02601 7/31/2013 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: i 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? ❑ Z 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? Z ❑ 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): 8 Number of bedrooms (actual): 8 DESIGN flow based on 310 CMR 15.203 (for example: 1.10 gpd x#of bedrooms): 880 gpd t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 805 Pitchers Way Property Address Celeste Indrisano Owner Owner's Name information is required for every Hyannis Ma 02601 7/31/2013 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 6 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 2011 = 211,700 gallons = 580 gpd 2012 =231,900 gallons = 635 gpd Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 805 Pitchers Way Property Address Celeste Indrisano Owner Owner's Name information is required for every Hyannis Ma 02601 7/31/2013 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: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped:' gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 805 Pitchers Way Property Address Celeste Indrisano Owner Owner's Name information is required for every Hyannis Ma 02601 7/31/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system installed 1985 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joint were ok, no leaks, vented through the roof Septic Tank (locate on site plan): Depth below grade: 2 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: 2000 gallons 6" Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 805 Pitchers Way Property Address Celeste Indrisano Owner Owner's Name information is required for every Hyannis Ma 02601 7/31/2013 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 3" 3" Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, took measurements 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 needs to be cleaned soon and again every year for proper maintenance. Outlet baffle was intact. water level was even with outlet invert. 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 805 Pitchers Way Property Address Celeste Indrisano Owner Owner's Name information is required for every Hyannis Ma 02601 7/31/2013 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: V 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 M 805 Pitchers Way Property Address Celeste Ilndrisano Owner Owner's Name information is required for every Hyannis Ma 02601 7/31/2013 page. Cityrrown 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.): Distribution box was in good condition, no rot, water level was even with outlet invert. Pump Chamber(locate on site plan): 1 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 805 Pitchers Way ,M Property Address Celeste Indrisano Owner Owner's:Name information is required for every Hy annis Ma 02601 7/31/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 x 1000 gals ❑ 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.): System consists of 2 1000 gallon leach pits with 4' of stone. pit#4 on asbuilt was found to have 4' of standing water with no sign of previous overloading. Pit#5 on asbuilt had 2.5' of standing water. Covers are on risers 1' below grade. 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 805 Pitchers Way Property Address Celeste Indrisano Owner Owner's Name information is H annis Ma 02601 7/31/2013 required for every y 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 - . . . . _ _ __. .__ ... ._ _ .. _ . _ ... . __ . . .:. .. . _ _ ._._ ..__ _.. .. .__. ... _ . _ _ ..._ .. _ . .. __ _.. __ ._ _ . . .._ _ __ _ ..._ . _ _. .. _ . ... ... . . _ ... ... _.__ _. . __ . _ _ _ _ ... . ._ _ __.. ._. .. . .. . . ... . _ . .. . . . . ... . . _ __ . . .. _ .. ._ _ ...._ . ._. ._. .. . _ . . _. ... . .. __ _ . ...... . __. _ ...... . _. __ _.. C �I! r---(i - - al Subsaacfaee Sa;w�ge�3tsposa9 Systeava Forma Riot for Voluntao.ry Assessments «�� . I. N, 80 Pitchers Wa _ Y Property Address:_,' .. Celeste IndnsahO . Owner .'-:I... ....... -- ..._.. --...: Ovrner s Name - information•is: H annis:; iVia Q260'1 713E/ fl13 requi[ed for every Y -_ ..... pa9Q CgylTowr:.: State Zip Code Gate of Inspection y0e :: n (coat Sketch t7f.Sewage Disposal System Provide a'view,of the seVvage d(sposaJ system, including tRs to at Least two permanent reference;landm"rks' bench narks.Locate:all wells;vuith n 1 flfl feef.,t ocat v hece publ c raterisupp(y'enters;the,.kiu ldirig.Check one of the boxes below. ® Hand sketch in:the area below `. ❑ d'rawing'attached separately . ;' 11 i { ) t . . � - `Z ( I. I. I.I. _ Z _11 0._ . I ( Z I-.�, i i .. � : : . ' 6:.R S', _. _. I. .II _. _ __ _ - ... ...._.. Y 3 t _.r `l _ _ - ... - , .. :, ?' .: , !, ( ` :�:.;:­­':­ �::�. , .: ­.L: .1 I ­­ ­..­'..­ ­ -� 1. I.. ...�: I.1.�. .. ..: : : , : .......... _4 . ._ . 1. .. . i5in6•3143 .. _ Twe 510ffi64(Inspe6tion Form:Subsurface Sewage Disposal System Page lb of 1 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 805 Pitchers Way Property Address Celeste Indrisano Owner Owner's Name information is required for every Hyannis Ma 02601 7/31/2013 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: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts ti, W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 805 Pitchers Way Property Address Celeste Indrisano Owner Owner's Name information is required for every Hyannis Ma 02601 7/31/2013 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 L0 CON ION S E-W A G E PERMIT NO. o t 3 .,r VILLAGE INSTA LLER'S NAME S ADDRESS Ll W U II*L D E R Olt- OWNER DA-TE HERMIT ISSUED g g4 D-AT, E C.OWPLIANCE ISSUED sJ �� IL Y : L- 0 C T I O fd i`�' SEWAGE PERMIT 110. -/ � L, VILLAGE IN:SIT A LLEIII NAME A, ADDRESS tl Max., BUILDER OR 0�1�ER � ` Pum A, DATE PERMIT IS5uE.0 DATE C0MPLIA..N'CE ISSUED.. ( j . j I I i i• \ 4 7,4 1:�-"4*W AN471, l�P TOWN OF BARNSTABLE BOARD OF HEALTH e ARTICLE 11:MINIMUM STANDARDS FOR HUMAN HABITATION �. Date Owner s J /L✓ ��/�/%�`,G Tenant f' Z'd Address �� � � � f Address Compliance Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 1 3. Bathroom Facilities `v' 4. Water Supply 7' 'Al S. Hot Water Facilities d� f� 6. Heating Facilities 7. Lighting and Electrical Facilities !ice" 8. Ventilation All 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 7 12. Exits 13. Installation and Maintenance of Structural Elements , 14. Insects and Rodents � ` 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal F 17. Temporary Housing PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Person(s)Interviewed InspectorL/ If Public Building such as Store or Hotel/Motel specify here HOBBS&WARREN.INC. TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date _ Owner Tenant Address C Address Compliance Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation r 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits IV' 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal ►� �` 17. Temporary Housing ' PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition APerson(s)Interviewed Inspec If Public Building such as Store or Hotel/Motel specify here FoRM30 c'w HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH B CITY/TOWN a DEPARTMENT �6_ m tea.+S�" /�`J o s� ►.wo 'o ADDRESS 7e Lt6 TELEPHONE Addressp� P1 .��i U✓>�_ IC�fil�ccupant . Floor Apartment o. No.of Occupants No. of Habitable Rooms No.Sleeping Rooms___ No.dwelling or rooming units No.Stories Name and address of owner K�+aKA O 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.: o k- ❑ B ❑ F ❑ M Doors,Windows: V++,. 1 w SG ,� Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: A/O Stairs: S avw. Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central gpIr ❑ N Equip. Repair TYPE: c Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Su .Ten.,Gas,Oi, e .. f(0 Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink S l Stove -e- e"+ i Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: CV V Wash Basin,Shower or Tub: 011 ,) 0-•-v.d Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors:a 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 F PERJUR 1,�4 INSPECTOR ��i TITLE � L - f DATE Z TIME P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. r ....,,,,r,,,a;•:iX�i`fA:+',.!�,'`t't;,. 'ina::.�C?Rw'�v`.yv;;.'�:A";�'Fu'�r„ 7Njw r ,�tiA!YR;, ntlg'!.:? Mara �r,}.;.f7brt:rn;'!. 'fitta, w' " w.✓�wlvm }�.��: wi"eA;. � , ,..G.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 heaith, or safety and well-being of a person or persons occupying the premises: This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D). Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide,adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) I (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or.failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health.