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HomeMy WebLinkAbout85, 85A, 85B WOODLAND AVENUE - Health 85,85A,858 Woodland Avenue i « b ,1 Hyannis : °;�rt1 $Ar a A. = 269 . 061001 { .y. 7 r f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °ter M 85, 85A,85B Woodland Ave. Property Address 1,13 Capizzi wWy Owner's Name Hyannis MA 02601 4/20/17 0 City/Town State Zip Code Date of Inspection �' I-A I-A, Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR`15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4/20/17 Inspecto 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. 85 Woodland Ave-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 �0(5 a 4%S I Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 85, 85A,85B Woodland Ave. Property Address Capizzi Owner's Name Hyannis MA 02601 4/20/17 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: Pumping suggested every 3 yrs to prolong the life of the system B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. I ❑ 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: n/a ❑ 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 85 Woodland Ave-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 85, 85A,85B Woodland Ave. Property Address Capizzi Owner's Name Hyannis MA 02601 4/20/17 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: n/a ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ . obstruction is removed ND Explain: n/a C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 85 Woodland Ave•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 85, 85A,85B Woodland Ave. Property Address Capizzi Owner's Name Hyannis MA 02601 4/20/17 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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: n/a 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 El ® Liquid depth in cesspool is 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 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. 85 Woodland Ave-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 85, 85A,85B Woodland Ave. Property Address Capizzi Owner's Name Hyannis MA 02601 4/20/17 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® 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. 85 Woodland Ave•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 85, 85A,85B Woodland Ave. Property Address Capizzi Owner's Name Hyannis MA 02601 4/20/17 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)] 85 Woodland Ave-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 85, 85A,85B Woodland Ave. Property Address Capizzi Owner's Name Hyannis MA 02601 4/20/17 Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 6 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 660 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 144 GPD 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Fall 2016Date Commerciallindustrial Flow Conditions: Type of Establishment: n/a 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: Last date of occupancy/use: Date Other(describe): n/a 85 Woodland Ave-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 85, 85A,8513 Woodland Ave. Property Address Capizzi Owner's Name Hyannis MA 02601 4/20/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: No recent pumping per owner 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): Approximate age of all components, date installed (if known)and source of information: 2002 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No 85 Woodland Ave•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 f - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 85, 85A,85B Woodland Ave. Property Address Capizzi Owner's Name Hyannis MA 02601 4/20/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: >1 feet Material of construction: ® cast Iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10' feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 3" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) H-10 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1500g Sludge depth: 4 Distance from top of sludge to bottom of outlet tee or baffle >12 Scum thickness trace Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2„ How were dimensions determined? Measured 85 Woodland Ave-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 f Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 85, 85A,85B Woodland Ave. Property Address Capizzi Owner's Name Hyannis MA 02601 4/20/17 Cityrrown 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.): Pumping suggested every 3 yrs to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): n/a Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): n/a 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): n/a 85 Woodland Ave•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 85, 85A,85B Woodland Ave. Property Address Capizzi Owner's Name Hyannis MA 02601 4/20/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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.): n/a *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 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.): H-20 d-box, 6" below grade, average condition for its age Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 85 Woodland Ave•03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85, 85A,85B Woodland Ave. Property Address Capizzi Owner's Name Hyannis MA 02601 4/20/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 6 laterals, 25x36 ❑ 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.): Field was video inspected and is dry at this time, no adverse conditions, no indication of past fail, approximately 2' below grade 85 Woodland Ave•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GM , 85, 85A,85B Woodland Ave. Property Address Capizzi Owner's Name Hyannis MA 02601 4/20/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): n/a 85 Woodland Ave•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 85, 85A,85B Woodland Ave. Property Address Capizzi Owner's Name Hyannis MA 02601 4/20/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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. L( T? 3 33f s g� Ar t a r_S �: =Tsz� j I � a-� 85 Woodland Ave•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ti 85, 85A,85B Woodland Ave. Property Address Capizzi Owner's Name Hyannis MA 02601 4/20/17 Cityrrown 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: 162" 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: GW 162" 2008 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: see above 85 Woodland Ave•03/68 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures natures on this form at MO Main St. Hyannis. Take the completed form to the Town Clerk's Office,.1 st FL, 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: U3 a�f�Z , Fill in lease: C ..�. �•..,• ' APPLICANT'S YOUR NAME S: 1 .lam BUS E S YOUR HOME AD 5 N % f O DRESS: r�Z ' VT 9 ' TELEPHONE # Home Telephone Number O -!3 - NAME OF CORPORATION ;NAIVE OF NEW BUSINESS : 1 QO A ✓V'11 TY PE OF:BUSINESS iv`til w IS THIS,;A HOME OCCUPAxIpN? YES NO ,. p ADDRESS OF,BUSINESSe F : - MAP/PARCEL NUMBER Assessing]_ When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of.any.permit requirements that pertain to this type of business. Authorized ** u horized Signature COMMENTS: 2. BOARD OF HEALTH This individual has en i rm- of the permit requirements that pertain to this type of business. li l I( tr . '1A MUST,.;OMPLY WITH ALL Authorized Signature** l{AZARDOUS MATERIALS REGULATION'^ COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this.type of business. Authorized Signature* COMMENTS: TOWN OF BARNSTABLE Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: Di&S ` ,,,, BUSINESS LOCATION: ' �, Woo-bzA :0 ABC— PvAr y--ice INVENTORY MAILING ADDRESS: e , LVVOZL rV;b An) � yA6LVY-> TOTAL AMOUNT: TELEPHONE NUMBER: Sd$- 5.21f - 5")9 CONTACT PERSON: 7ewezw EMERGENCY CONTA ELEPHONE NUMBER: 9 MSDS ON SITE? TYPE OF BUSINESS: WV1N INFORMATION / RECOMMENDATIO S: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals(Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes ` /Vo —574V�eC �TC--Oe '� Laundry soil &stain removers (including bleach) V V z0b Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature d. Staff's Initia s i si # TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date �Z7j Time: In Out Owner C k l AA., Tenant Address iy-15 1 V� n� 2� Address �����1, � �`I14No�) a S ►�1,� Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities ' 1�A 44 �Y 4. Water Supply 5. Hot Water Facilities 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 13 Number of Vehicles Allow m AA Number of Persons Allowed (max) -5 — Person(s) Interviewed T&Ak-Y(— Inspector If Public Building such as Store or Hotel/Motel specify here I B L r � CI TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date-2LI6 Time: In Out Owner Cc, �dL l e �''c Tenant � /�/�I �— Address !w �'v� Address Compliance Remarks or Regulation# Yes NO Recom en ations 2. Kitchen Facilities � *--•-, ,. 3. Bathroom Facilities 4. Water Supply a- 1Q� RJ 5. Hot Water Facilities 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 _ 702- 17.Temporary Housing N A 18. Driveway Width � � < N r i oo �- V 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms 13 Number of Vehicle ed (max) Number of Persons Allowed"(ml"ax�).° � Person(s) Interviewed ,w1r1 t� r Inspect If Public Building such as Store or Hotel/Motel specify here Department of Public Health- Childhood Lead Poisoning Prevention Program Deleading Notification Please complete all sections of this form clearly. Incomplete or illegible forms will be returned. Lead Paint Inspector gQn M;soh License# 3i Inspection Date 5/7/9 9 Property Owner 0-AvAet ss kk LLC Property Owner's Address 16y5 Sc oju 4 - Nr,sNousn IRA_ Cn ►kj MA Zip Code Oa63$ Authorized person performing work:' g Cud%zel . Sr• Lic#/Auth.# MP,0Q0Sff Address of authorized person' 1(,qS SC,.n%V k - mgw6gn g2'j. 1 Cd4%aik . MA Zip Code c)-aC35 Telephone Number(SS) &q-t- ggqp Address where the work will be done: Building Name(if any) Floor Street Address $5 Wool6nct Apt No. 1&%Yi lIbvse . City �Tannis Zip Code oab61 The property is a_multi-family.v single family. ❑ Making paint intact(high risk) W"' Making paint intact(moderate Applying vinyl siding on exterior ❑ Demolition risk) [( Component removal(low risk ❑ Scraping ❑ Liquid encapsulant components) Component removal/replacement ❑ Covering ❑ Other: ❑. Dipping [ Capping baseboards The work will begin onT_/g/jA and will finish by at.The work will be done in the /am pin or weekends. In Case of Emergency Contact CX41u; YY1001 Owue Daytime Phone Sa- y a$-Q S t S Evening Phone &J g• 4a S- 4S I S I The Property Owner must complete and sign the following information: eraCD I certify that only authorized persons who have complied with the training requirements of the Massachusetts Lead Pd ning Prevention and Control Regulations, 105 CMR 460.000,will conduct deleading work. I further certify�.that the authorized person(s)will not exceed the scope of his/her authority and will be performing only those activities indicated above. A,Yhof the information contained in this document is true and correct to the best of my knowledge and belief. YY Date—'g`/c'3►tha .. - . —Signed The following people/agencies must be notified ten"days before beginning work: 1. Occupants of the dwelling unit 2. All.other occupants of the residential premises, if any work will be done in the common areas 3. Childhood Lead Poisoning Prevention Program,DPH Fax(781)774-6700 MWRHO , 5 Randolph Street, Canton, MA. 02021 4. Asbestos and Lead Program,DLS 19,Staniford St, lst Floor,Boston,MA 02114 Fax(617)626-6965 5. Local Board of Health/Code Enforcement Agency - - exim"ke 'C�ocaa u�►.1.41n 609-'tqo b3o� *if the home is on the State Register of Historic Places,call the MA Historical Commission at(617)727-8470. ' • • COMPLETE THIS SECTIONON DELIVERY Mimi all W Complete items 1,2,and 3.Also complete A. ' net e item 4 PRestricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse ddressee so that we can return the card to you. R ceived by(Printe ame) C. Date Delive ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 1? Yes If YES,enter delivery address below: ❑ No s, !'y Thomas Capi-zzi Jr. ", Centerville LLC 3. Se a Type ` 645 Newtown Road Certified Mail ❑Expms Mail Cotult,MA. 02635 ❑Registered 041elturn Receipt for Merchandise - -- —F �— ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number , 7008 1830 0002 0500 7911 (Transfer from service label) k l I; PS Form 3811,February 2004 Domestic Return Receipt 10259e-02-M-1540 i UNITED STATES POSTAL SERVICE First-Class-Mail �" � Postage&Fees Paid PS i • le Sender: Please print your name, address, and ZIP+4 in this l I I Town of Barnstable Health Division I � 200 Main Street i j Hyannis,MA 02601 I I I IKE r, nT Town of Barnstable Regulatory Services H nts. a ��dpo a6gg. �0� �FnMa?a Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Cert. Mail#7008 1830 0002 0500 7911 Office: 508-862-4644 Fax: 508-790-6304 Thomas Capizzi Jr. February 18, 2009 Centerville LLC 1645 Newtown Road j co Cotuit, MA. 02635 NOTICE TO ,ABATE VIOLATIONS OF 105 CMR 410.000 STATE SAN ARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND CHAPTER 170 OF THE TOWN RENTAL ORDINANCE. The property owned by you located at 85 Woodland Avenue (Main), Hyannis was inspected on February 18, 2009.by Timothy B. O'Connell R.S., Health Inspector for the Town of Barnstable on the basis of the rental ordinance:of Chapter 170. The following violations of the State Sanitary Code were observed: 105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements. Linoleum peeling up in bathrooms on first and second floor. 105 CMR 410.351: Owner's Installation and Maintenance Responsibilities. Open wiring was observed above the sink within the kitchen'. ,You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by repairing or replacing linoleum in both bathrooms; by installing face plate over open wiring. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance could result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER O OF THE BOARD OF HEALTH a. A. McKean, R.S. Director of Public Health Town of Barnstable Cc: Jennifer Ross Q.::Heal th/Order.loters/Housing violations/85 wood land.doc _ TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE If:MINIMUM STANDARDS FOR HUMAN HABITATION Date - " o Time: In /() . O-C Out 10 Owner `1'' Tenant Address ( � Address A- 0 3s I Compliance Remarks or Regulation# Yes Recommendations 2. Kitchen Facilities 3. Bathroom Facilities C - 4. Water Supply 04 5. Hot Water Facilities Ll ppmved-..: 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 j3 L PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms �� Number of Vehicles Allowed (max) c Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here r 'm THE COMMONWEALTH,OF MASSACHUSETTS FORM 30 CAW HOBBS a WARREN BOARD OF HEALTH CITY/TOWN o DEPARTMENT Zoo MN. 1 ,t4 ST �iA *A)Ak ADDRESS �M sey`0 TELEPHONE Address U �J �00 La,dJ®1 / VL Occu ant_.7ea-H liFUL S& Floor Apartment No. IN No.of Occupants No.of Habitable Rooms No.Sleeping Rooms 3 No. dwelling or rooming units_ No.Stories _ Name and address of owner —T H 0 ern A S CA i 2 Z i �J IIQ- I 0, CO TV c r 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 v Gutters, Drains: Walls: N 0 dLKIl o Foundation: Chimney: $ V W A —C BASEMENT Gen.Sanitation: Dampness: �^!� Stairs: S . Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑,VN1 Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑,P/ Waste Line: V 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 to Bedroom 2 1 35 Bedroom 3 SQ Bedroom 4 Hot Water Facil. Su lect.: Sta lues,Ve ts,S feties: Kitchen Facilities S' k 2 3 SIQ,ye Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted 'C c3 Q>C PoST s 0 Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICHfi MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING,,OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR J E AUTHORIZED INSPECTOR.(See Over) "THIS INSPEC ION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES 0 PERJU7 1 INSPECTOR TITLE i'���L-Y ��&(?EC_T02- A.M. DATE ' Ct O E2 TIME A.M. THE NEXT SCHEDULED REINSPECTION I� P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises,.shali be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to,meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. G Failure to provide adequate exits, or the obstruction of an exit, passageway or common area caused„b any object, ( ) P q Y P 9 Y Y Y l 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 securityrequirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of Ieadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. � , I FORM30 C&w HOBBsBWARRENTM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN Wn„� .-t 0 DEPARTMENT 'p ADDRESS LSv TELEPHON Address S w6oaAwo AA, l_F_ ,A-w�Occupant_H i CH A E_%_ E" j Floor Apartment No. No.of Occupants 1 No. of Habitable Rooms Z—, No.Sleeping Rooms No.dwelling or rooming units= No.Stories Name and address of owner 77TH(3r�S � u5 N� 6� v1-T VIA zd� Remarks Reg. Vio. YARD Out Bld s.: Fences: Garba e 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: ` G A Q_ Chimney: BASEMENT Gen.Sanitation: a f / Dampness: V Stairs: Lighting: STRUCTURE INT. Hall,Stairway: ' Obst'n.:Hallall,, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: 11110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom(1). Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: ks, Flues,Vents,Safeties: Kitchen Facilities Sink ove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted p 0 S? ¢ 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 F PERJU INSPECTOR TITLE ALTO' DATE s w 6 TIME I LP• J 1 A.M. THE NEXT SCHEDULED REINSPECTION �J /A P.M. 1 410.750: Conditions Deemed to Endanger o'r Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons'occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation',any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore'is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and-cold,-to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. ' (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation,or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. r!, - (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. � I .�ZnJVtr�� r �� FORM30 HOBBS&WARREN'M THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ALTH CITY/TOWN a DEPART gNT va 6o f ADDRESS / y M rr tilt 07-60' I�P�� TELEPHONE Address Occupant___. Floor -Apartment No. ___ No.of Occupants-1 No. of Habitable Rooms-2- No.Sleeping Rooms __ No.dwelling or rooming units_W4 _ No.Stories __�_✓1 -,— Name and address of owner —i � Remarks Reg. Vio. YARD Out Bld s.: Fences: © 269 5 5 Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: IT k Dual Egress: and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: St Wks, Flues,Vet ties: Kitchen Facilities rik ve Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other.- Egress Dual and Obst'n: General Buiidin Posted - Locks on Doors: ONE OR MORE OF THE VIOLATIO 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 REPORfN SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES PERJU Y." INSPECTOR_ TITLE_' &A Tn�f I � .M". DATE �� Q TIME—© / P. A111 A.M. THE NEXT SCHEDULED REINSPECTION P.M. , ,.. -.- - .- - -. ,.. "` °`,. ... - - ... „: .r s.;.�- r. � - .•w�. ,r .t. ..R'Y.-r. :rt.,".!A,o?,. ,.n a .. , .✓.r ., M 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shali 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 II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3) or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0) shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. � 5 P� N � FORM30 �i&� HOBBS&WARREN"" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H LTH I - -- CITYY/TOW�� " J 6-- EPARTMENT ---A RESS 1 M TELEPHONE 11 � Address 5 _ __—________ ________ t Occupan 's- p Floor -Apartment No. __-. No. of Occupants 3 6L:) No. of Habitable Rooms 5 No.Sleeping Rooms__3__._ No. dwelling or rooming units__-____—_ No.Stories __Z Name and address of owner_ pL 5 Remarks Reg. Vio. YARD Out Bld s.: Fences: 1 Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den —Living Room Bedroom 1 Bedroom 2 Bedroom 3 L Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: So!jk5 Flues nts,Safeties: Kitchen Facilities i - Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin, Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTO . See Over) "THIS INSPECTION O T IS SIGNED ND CERTIFIED UNDER THE PAINS AND PENALTIES' R U Y ' INSPECTOR TITLE DATE___( 0 0 TIME A.M. THE NEXT SCHEDULED REINSPECTION P.M. ..... Y .. a-. ,.p A rq,w .!•. _�. !e.i ;4: ., :a i"+ ` ,.Q. .. .. :d, , �. - A 4 410.750: 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 II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to.provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600; 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove.and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3) or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by-105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. v "ye. e Ce f Date To Whom It May Concern: I, \j\) , A-t�- C R o`z , voluntarily grant permission to the Town (Occupants name) of Barnstable Board of Health(Agent or Health Inspector)to inspect my dwelling unit located at - CLAJI ti�,`� in accordance (House#, [Apt\Unit#if applicable],stre ,)village) with the Town of Barnstable Code (Chapters 59 and 170) and the State Sanitary Code (105 CMR 410.000) on e'.\ \p @ V-\S p w\- ..-I hereby authorize andname (Date of inspection) yl1 -. A-Ce -fl� i .•to'be.my tenant representative--for the (Occupant representative) __. purpose of this inspection. 1i 1j is an adult person (Occupant representative) designated and duly authorized to act on my behalf and will be accompanying the Town of Barnstable Board of Health for the inspection, granting access to any and all locations (including bedrooms, bathrooms, closets, etc.,) allowing the use of photographs and answering questions. This authorization is only valid for the inspection date specified above, and must be renewed for any future inspection(s.) 1- 102711 Z `::L 7;i�a"-;'• ^' ,�aA.t1✓y��l.l����" \ A:L9ccupan�� Signature;t,,,r� �a;.;\TmDate:;r; O cupants Representative Signature \ ate Q:\Rental Ordinance\inspection permission 2.doc TOWN OF BARNSTABLE r:L ( �' � � LLOCATION ��S i+'�.�1��'SS0) w��Il�^d ve SEWAGE # ;Zi;v a- 202 VILLAGE 4w 04 r`3 ASSESSOR'S MAP & LOT II INSTALfUR'S NAME&PHONE NO. �n�, N CuA 1Lc `u� 77 3sq j SEPTIC TANK CAPACITY SUS LEACHING FACILITY: (type) C;e (size) Z X U / NO. OF BEDROOMS 6 BUILDER OR OWNER )Vuc vwt jf PERMIT DATE: COMPLIANCE DATE: S 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 Ad Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by LOT NO—: ADDRESS: F 014NERS RIME: SEWAGE PERMIT NO. : NEW: REPAIR: DATE ISSUED: DATE . INSTALLED: INSTALLERS NAME : INSTALLATION OF: WATER TABLE: FINAL INSPECTION BY: r, a DfWgING OF INSTALLATION ON REVERSE .SIDE : d-1=�7�2 C-t=f�.f"- . �, C3-3,33,s �- - - � � i . l � . �" .. �o�e" ( � f— —�— — 1 �. �, .� —,. � N®. Fee �— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS OfppYication for Migpogal *potem Construction Permit Application for a Permit to Construct( )Repair(act)Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. /� Ow er's Name,Address el.No.,l '4 4 '6sarc I t C Tz W ooc/�j AQ t.. Ass �.✓� 1��C I I o[ p o a i +�`1 �+ts I�� 1.�1cac,h �c ��t9rJtJ1 S Installer's Name,Addles ,and Tel.N��o]]... 'D-0 16 —�r�S'35IS Designer's Naa�m�e,Address and Tel.No. `/ -51 Q v • �. �►3 S y G 3 V,r� ST,is rr� S—�a Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building ! No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow r gallons per day. Calculated daily flow 6 g fl gallons. Plan Date /30 0-L Number of sheets crik— Revision Date Title Size of Septic Tank )'ra o Gja Type of S.A.S. '5 -X 3 b oacl Description of Soil Nature of Repairs or Alterations(Answer when applicable) Sc7b Cr c "1 X;. �� �y Y 1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of He Signed Date ¢ CS Application Approved by � Date s_ v 2 Application Disapproved for the following reasons Permit No. 2 0 o 2 -20,2 Date Issued ilk No' t 7 , N Fee THE COMMONWEALTH OF MASSACHUSETTS Enitered in computer: -PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS . Yes ` 0[ppYication-fat Mtopossaf brat Y Construction Permit Application for a Permit to Construct( )Repair(.1,c)Upgrade( )Abandon( ) 3.Complete System ❑Individual Components Location Address or Lot No. Ow er's Name,Addresstan el.No. �. b s� t�r� �Jco61t�, 1 A� ZK � l l _ Asses o s ap arcS1 {�, �,� ��� J�t ) S 1 � � i �))grJnll S Installer's Name,Address,and Tel.No.. ':n,6 —-7-)S-95114 Designer's Name,.Address and Tel.No. - -' Type of Building: "{ - Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria Other FiiC&es Design Flow 1 gallons per day. Calculated daily flow 6 c) gallons. Plan Date /30 0-L Number of sheets �'l•< Revision Date Title Size of Septic Tank )�� G�OCea-/ Type of S.A.S. S b �. icy- e Description of Soil a' / Nature of Repai -36 rs or Alterations(Answer when applicable) Date last inspected: i i Agreement: Th6'undersigned agrees to ensure the construction an&maintenance of the afore described on-site sewage disposal system in accordance with'the,provissions of Title 5 of the Environmental Code and not to place the system in operationtuntil a Certifi- cate of Compliance has been issued by this Board of He 1 Fi (� Signed A Date w'` Application Approved by Date S u 10 ? Application Disapproved for the following reasons y Permit No. U o 2 Date Issued .S v THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE MASSACHUSETTS d.T f Certificate of Compliance THIS IS TO CERT Y,that the On-site Sewage Disposal System Constructed( )Repaired (�,,,)Upgraded( ) Abandoned( )by "rr 1 Ir )r..J-�� at �S hSA 4.,ZS b �Ja��cr 9 i�ye_ wrr�� has been constructed 'n accordance with the provisions of Title 5 and the for Dis osal System Construction Permit o. 9oo�-2aa' dated o Installer (?_11r3% t �.�n�rf;fly� 1_-J Co Designer 2 v., _S_ The issuance,of pe t shall not be construed as a guarantee that the syst will f fiction as es'g ed. s � I . Date '" 4r st D 1 Inspector AP i No. 1 — �•��lp� ------------------------- 6 Fee .� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS migosO qY *p$tem Conelruction Permit Permission is hereby granted to Construct( )Repair( Upgrade( bandon System located at 4i 5 �S )2 �.1*. kl Z AvA and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: sha A 2 Approved by 3 4 � TOWN OF B/AR,N/SnTABLE LOCATION ftye SEWAGE # o a- 02 VILLAGE r ✓t,��', ASSESSOR'S MAP & LOT E 9'D6 -OU/ INSTALLER'S NAME&PHONE NO. �►�'��1 SEPTIC TANK CAPACITY I QUO f LEACHING FACILITY: (type) C e (size) X 36 NO.OF BEDROOMS BUILDER OR OWNER ac owt PERMITDATE: a Ua COMPLIANCE DATE: S 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 WeMn d Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by i �tus ASSESSORS MAP : 14 ! TEST HOL= LOGS NOTES • ��`� PARCEL : 0(,o 1 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH FLOOD ZONE: SOIL EVALUATOR : TSL .HIS LAN, 1995BOARD OF HEALTH SREGULATIONS. TOWN OF WITNESS Nor�v1� N REFERENCE: DATE: PPRAL., IE:) ZCO-2�- 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, PERCOLATION RAZE: 7►� SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO wtS LASS :t Sol, INSTALLATION. (1-1w `� ST �'� TH- I ;,5o TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE PA 5 LogM IO`I�3�� ' DETERMINATION. 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS �oAmq SPECIFIED OTHERWISE) LOCATION MAP 6 j S�. 28 P 2&1 S) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A ^�., 7 GARBAGE DISPOSAL. W AC25C E R 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON A BASE OF 6"OF CRUSHED STONE. 7� gxl5T7� G�sSRx�c.�_ 4 Rt` PUA4104�C�vS�� .. „ 'O FBI-Lto. �12 T1� �/_1260l12cm6NT"S 6k)C- !tot � plr->/6& r �urs�N w . S�vr �, 0 • M�� 2� S E P T I C. SYSTEM DESIGN Q l�O �� � �' q� w'N_...PP-iVit-TE_kt<.�1,�._.ww11!�C---1.5b___'.�F'..: . . .:. .._.. Zofj aC ` q.p FLOW ESTIMATE L-Evau. 9• loJ w No ��vrQs wll ' ��SQ9 4Ic A-� D . I ,BEDROOMS ATI GAL/DAY/BEDROOM - GAL/DAY 2 ����.._ 4-9L eA-sL-i .w:,+..___._. SEPTIC TANK _ t/t,d�laivl` 72gsvi • :.__._...__ _.........._ ._ _ ..:. µE �-I I j ' \ GAL/DAY x 2 DAYS - 1320 GAL C n a� -- °�) USE fS4Z GALLON SEPTIC TANK- NA&j SOIL ABSORPTION SYSTEM w x le r� i-t ri IrZ� - L SIDE AREA. N A BOTTOM AREA: O.W EylST. M Tay e -- -� _. SEPTIC"* SYSTEM SECT 14N p.M a fit. 4o.0 CL,40,7 j . �0 .r' �� r(►SPIN � �+ v 1 G,2 t twtJ4 Et-• 31-31) - .. 11u� , ,� 3�.0 3�.� -, t; Sly 0 �h � df � 2�p j)izt V a wA 42, � u y v€n� ►o" 14" �n�,s�i ��"' � l _ _ _ pw�Ll.IN�j ` ' , ¢S.r B 5 1' 3733 Z /� 371 a°•�/"SJ�av7Ld�kSt :.:` 6' e d--..yc� 3 n i! ! D-BOX 0.�3 a � - i DovB�.G WASt� $•ro."of �}D Tb of ,� •isI"#,v 3A-M13�.. �� Q �,SCX7 GAL 7! Iclakr SEPTIC TANK 3(0, !7 P&-7 • c�ssR?o 20 q?vv st�yE Id ors 42 wk � sE '� SITE AND SEWAGE PLAN 4' u 4' 4' v q' 013 LOCAT I ON : 8S, £ A-+ 85` Q k/�tx. .r� D W s E , PREPARED FOR : 6AT l 114A t;.. T .��__€Z.C_• f— Z S ---� U mow. 01140 4 a F�F®s� DARREN M. MEYER R.S. SCALE SvL7.E)� , pssi�PaQ �-�a 43 VINE STREET �=- DATE: aY DUXBURY, MA 02332 lz DATE HEALTH AGENT (781) 5$5-0293