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HomeMy WebLinkAbout0026 BLOSSOM AVENUE - Health 26 BIOS OTn A.venuO • t r Osterville _ . .. A- 117 —049AV , • e s.r " q c t Q i. ,y ' p 6- o. • 0 o r ' Commonwealth of Massachusetts W Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 Blosom Avenue `5 'CH 7M Property Address i �� , Margery Welch I Owner Owner's Name information is required for Cisterville MA 7/01/08 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: When filling out A. General Information forms on the computer, use 1. Inspector: only the tab key to move your Carmen E Shay cursor-do not Name of Inspector use the return key. Shay Environmental Services, Inc. Company Name r� 185 Ashumet Road Company Address Mashpee MA 02649 City/Town State Zip Code 508-539-7966 3080 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 ( 10 CMR 15.000). The system` W to ® asses� ❑ Conditionally Passes ❑ Fai), .M Elds Further Evaluation by the Local Approving Authority V���1or�'Asy�'". CA "BE6 (n°E SHAY 21Q7/01/08 —`� Insp ctor's Signature Date RTIF� a �FS fNSPE�OT r, The system inspector shall submit a copy of this inspection report to the Ap rity (Board of Hiealth or DEP) within 30 days of completing this inspection. If the system is a s ared system or has' 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. 26 Blossom Avenue,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 0 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 26 Blosom Avenue Property Address Margery Welch Owner Owner's Name information is required for O:sterville MA 7/01/08 every 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: Overflow leach pit is empty, primary ccesspool has 3' of water in it. 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. ❑ 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: ❑ 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 26 Blossom Avenue,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 Blosom Avenue Property Address Margery Welch Owner Owner's Name information is required for Osterville MA 7/01/08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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.- 26 Blossom Avenue,Osterville 03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 Blosom Avenue Property Address Margery Welch Owner Owner's Name information is required for Osterville MA 7/01/08 every page. City/Town 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: 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 1/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. 26 Blossom Avenue,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 26 Blosom Avenue Property Address Margery Welch Owner Owner's Name information is required for Osterville MA 7/01/08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to AII,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 11 of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 26 Blossom Avenue,Osterville•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 26 Blosom Avenue Property Address Margery Welch Owner Owner's Name information is required for Osterville MA 7/01/08 every page. Gity/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)] 26 Blossom Avenue,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 Blosom Avenue Property Address Margery Welch Owner Owner's Name information is required for Osterville MA 7/01/08 every page. CityTTown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4404 GPD Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms). 440 Number of current residents: 2 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 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Currentl 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: Last date of occupancy/use: Date N Other(describe): 26 Blossom Avenue,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts ulvv! Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 Blosom Avenue Property Address Margery Welch Owner Owner's Name information is required for Osterville MA 7/01/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: - Source of information: Board of Health 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: April 19, 1989 Were sewage odors detected when arriving at the site? ❑ Yes ® No 26 Blossom Avenue,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 Blosom Avenue Property Address Margery Welch Owner Owner's Name information is required for Osterville MA 7/01/08 every page. City/Town State Zip Code Date of Inspection D. System Information cont. Y (cont.) Building Sewer(locate on site plan): Depth below grade: 2.5feet 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.): No evidence of leaks, plumbing properly vented Septic Tank(locate on site plan): Depth below grade: 1.5 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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? 26 Blossom Avenue,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 26 Blosom Avenue Property Address Margery Welch Owner Owner's Name information is required for Osterville MA 7/01/08 every page. Ciy/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.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): 26 Blossom Avenue,Osterville-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 Blosom Avenue Property Address Margery Welch Owner Owner's Name information is required for Osterville MA 7/01/08 every page. City/Town 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.): *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 No D-Box Present 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.): No D-Box Present Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 26 Blossom Avenue,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 Blosom Avenue Property Address Margery Welch Owner Owner's Name information is required for Osterville MA 7/01/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System SAS locate on site Ian excavation n required):p y (SAS) ( p of equ ed): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 2 -6'diam x 6' D ❑ 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.): SAS fuctioning properly, no evidence of any liquid around overflow leach pit. Riser present to grade in Garden, No liquid in overflow, 3 feet of water in primary cesspool 26 Blossom Avenue,Osterville-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 I f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System form - Not for Voluntary Assessments 26 Blosom Avenue Property Address ` Margery Welch Owner Owner's Name information is required for Osteryille MA 7/01/08 every page. 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 1 Depth —top of liquid to inlet invert 3 Depth of solids layer 5.5' Depth of scum layer 1/4" Dimensions of cesspool 6' x 6' Materials of construction. Cement Block Indication of groundwater inflow ❑ Yes ® No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No evidence of hydraulic failure. Cesspool acting as a septic tank with an overflow leach pit. 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.): 26 Blossom Avenue,Osterville•03/08 Title_5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 Blosom Avenue Property Address Margery Welch Owner Owner's Name information is required for Osterville MA 7/01/08 every page. City/Town 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. t a / 1 C) l� C'r2 SSQ�'o� bqC Ct+ 26 Blossom Avenue,Osterville•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 26 Blosom Avenue Property Address r Margery Welch Owner Owner's Name information is required for Osterville MA 7/01/08 every 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: 14 feet 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: Inspector has performed engineering design and perc test on this street. 26 Blossom Avenue,Osterville-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 f Town of Barnstable P�O�1HE Tp�� o� Regulatory Services aRrrsrnse, : Thomas F. Geiler,Director plE 639. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this.Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed, on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. i OASEPTUDisdaimer Private Septic Inspections.DOC SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■'Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ' ❑A t ■ Print your name and address on the reverse bX V" C�C ddressee so that we can return the,,-card to you. B. Re ived b (Printed Name) C. Date of Delivery ■ Attach this car6to the back of the mailpiece, f/i �6 or on the front if space permits. / " " D. Is delivery address different from item 1? Yes 1. Article Addressed to: If YES,enter delivery address below: 0 No 3. Service Type io Certified Mail ❑Express Mail ❑ Registered *Return Receipt.for Merchandise ❑ Insured Mail 10 C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 1 2. Article Number .RuYR003 ~1,680, 0.00415458 44-701RR (Transfer from service label) !F 3 3 I F PS Form 3811,February 2004 Domestic Return Receipt f 102595-02-M-1540 STATES Pds�-� .St" �TM.M1 4 mrnti =:OE av UNITED TA �..�:,..�., (u " nd w.x'mo��yia�dl I • Sender: Please print your name, address, and ZIP+4 in this'box • I I I .� Town of Barnstable Health Division 200 Main Street Hyannis,MA 02601 „.,,,11,1„111,,dill„111111,,,i1*1111,111 Al t f , Certified Mail#7003 1680 0004 5458 4470 IKE t ti Town of Barnstable Regulatory Services K v + AARNS'fA©LE, 6 SS � Thomas F. Geiler,Director 39. ArEDMAtp Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 8, 2007 Margery Welch 3008 Dunraven Drive Louisville, KY 40222 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 26 Blossom Avenue Osterville, was inspected on June 7, 2007 by Meredith Morgan, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the Town of Barnstable Code were observed: 1& 70-10—Smoke Detector and Carbon Monoxide Alarms. No CO detectors provided; inoperable smoke detector in basement. You are directed to correct the violations listed above within twenty-four (24) hours of your receipt of this notice by installing CO detectors on every habitable floor within ten (10) feet of each bedroom and by repairing or replacing inoperable smoke detector. 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 will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Q:\Order letters\Housing violations\Rental ordinance\26 Blossom Avenue.doc Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE ARD OF HEALTH omas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Meredith Morgan, Health Inspector Vivian Nault, Owner's Representative Q 1Order letterMousing violations\Rental ordinance\26 Blossom Avenue.doc FORM30 H&W HOBBSBWARRENTn THE COMMONWEALTH OF MASSACHUSETTS �_� BO RD OF HEALTH vbl I've CITY/TOWN o ..ll DEPARTMENT Ra (IV ADDRESS _ � �f �TELEP NE &�l- Address cXx3lo _At he_ Occupan lU Floor Apartment No. No.of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming unit No.Sto� r�i�es, ,,�� // Name and address of owner 5� Ql�._.11r. -l/V/5✓/��� �c�✓ Remarks Reg. Vio.4/66-pp YARD Out Bld s.: Fences: �oC 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: Dejr W Stairs: Li htin STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: / Hall Windows: e HEATING Chimneys: Central N Equip. Repair TYPE: 64� 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.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink ° Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin, Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Buildin Posted 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 INSPECT N REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENAL PE U . INSPECTOR TITLE MA 1C C (J I DATE TIME A.M. THE NEXT SCHEDULED REINSPECTION P.M. \1. r p rr, 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits., or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. , (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. r TM THE COMMONWEALTH OF MASSACHUSETTS FORM 30 C�I�w HoRBs&WARREN BO RD OF rHEALTH CITY/TOWN V b . DEPARTMENT QW E l ADDRESS TELEPHONE Address c� 'I A ie Pr'✓l Ile Occupan It 1 Floor Apartment No. No.of Occupants No.of Habitable Rooms No.Sleeping Rooms No. dwelling or rooming units_ No.Stories Name and address of owner d' tC. 'J� �iPn.).Jim. +�t/i/�st�i j1e k'V Remarks Reg. Vio Z n-- 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 o0 Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: , Dampness: (; ! p . N,`'� / (k i !0 . 17010 Stairs: Kit 1 oy'( )Irl P Li htin h U h, I 1 �,.vlr ory, lj 1,Y"( STRUCTURE INT. Hall,Stairway: Ik ,�,'t } .ir..j () p --� ,or,( 1') Obst'n.: l.V( l'1 I Hall, Floor,Wall,Ceiling: Hall Lighting: (1p-ho(44_1 My* Hall Windows: Ur 1 P V /)ZIP ;P __` HEATING Chimneys: 1 Central ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: -Sup I Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusin ,Grnd.: AMP: Gen. Cond. Distrib. Box.- Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 l _ ' Bedroom 2 0 Bedroom 3 14,P4 z Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect..- Stacks, Flues,Verits,Safeties.- Kitchen Facilities Sink °F Bathing,Toilet Facil. Vent., Plumb.,Sanit'n. I Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other.- Egress Dual and Obst'n: General Building Posted {'_ Locks on Doors: ` ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTfE OF PE JU Y." INSPECTOR 1 TITLEIkAtk t'Y 14 / A.M. DATE l . TIME l� ' M A.M. THE NEXT SCHEDULED REINSPECTION . P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises,shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of 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. (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. Town of Barnstable P�pFTHE Tp�� h� p� Regulatory Services > BARNSTABLE. > Thomas F. Geiler,Director 9 MASS. 3639. Public Health Division ArFO MAC A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 7, 2007 Attn: COMM Fire Health Inspector Meredith E. Morgan conducted a rental inspection in accordance with Chapter 170 of the Town of Barnstable Code. In accordance with the State Sanitary Code, 105 CMR 410.482, the Health Department is required to notify the Fire Department if there is a smoke detector violation, or possible smoke detector violation. The following property had possible smoke detector (and\or CO detector) violation(s): 26 Blossom Ave. Osterville Assessors Map-Parcel: (117-049): CO detectors lacking throughout home and smoke detector in basement not operable. Property is currently not occupied. Meredith E. Morgan -Health Inspector QAOrder letters\Housing violations\Rental ordinance\\Fire ViolationsTIRE TEMPLATE.doc LOCATION SEWAGE. PERMIT NO. VILLAGE Qr,"F-,F f-'v 4- INSTALLER'S NAME i ADDRESS. ' R U I L D E R OR OWNER DATE PERMIT' ISSUED DATE COMPLIANCE ISSUED L LQ � r 6�,o �r No. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... ........................... Appliration for 11ispasal Vorkii Tomitrurtion Prrmit Application is hereby made for a Permit to Construct or Repair (.)() an Individual Sewage Disposal System at: a-)j 12.1. ..................... ............. ................................................................................ Cey?rl --Coca -.Add 12/j pr)Lot.No. .............................. .......... ----------------------------------------------- TIP less--- ............................................. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons_....__..__................. Showers Cafeteria 0.4 . Other fixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid capacity............gallons Length................ Width.______._....... Diameter_____-_-_____-__ Depth....__......._.. Disposal Trench—No. .................... Width....._......._.._... Total Length.................... Total leaching area............-------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.._................. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.____......__....... Depth to ground water.-_......_....._._...__. Test Pit No. 2................minutes per inch Depth of Test Pit___................. Depth to ground water..____.............._... ........... ........................... ....................................................................................... 0 Description of Soil.................... .............................---.......---......................................... x U ......................................................................................................................................................................................................... ..................................................................................................------------ ------- ............................................ U Nature of..Repairs or Alterations—Answer when applicable____________ ---------------_---_---- ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the boar of health. Signed... _- --- ....../. ........ Date Application Approved By.......................... . ................. ..... ......... ......... ........ .'r Date Application Disapproved for the following reasons:..................... .................................................................................... ........................................................................................................................................................................................................ t Date PermitNo........................................................ Issued....................................................... Date ------------------------------------------------------------ 4 , e No.......................... Fmc............-_.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . . . `.. � Appliratiaan for Disposal Marks Tnntitru.rtiaan ramit Application is hereby made for a Permit to Construct ( ) or Repair (A') an Individual Sewage Disposal System at }1� / No ociinRAdess ... .--••••................•.. _.__.__.._.`...... --- .................... ..... j Ow er j, t W ..... j � `t s1,} fit 1!� J--....P:`se'.a': ._EX ... ----3. f - �..3_r ...� ..'}'.f�'SS._...-•........................ Installer ' Address UType of Building " Size Lot............................Sq. feet .., Dwelling—No. of BedrooWis............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ----------------•----------------------........-------'------•---------------•------------------------•---------------------•--••--••----............. W Design Flow.............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. :..:. Width.................... Total Length.__.........____.... Total leaching area......_..._.._..____sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by...•••----•--•••-••••••-•••••--•--•---•••••••----•---••-•-••••------•:.... Date........................................ Test Pit No. 1...........:....minutes per inch Depth of Test Pit.................... Depth to ground water......--................ 44 Test Pit No. 2................minutes per. inch Depth of_ Test Pit.................... Depth to ground water........................ a ...................................... ---•........................•---•••••---.................... DDescription of Soil................... -� G ... ...................................................................................... U •-•-----------------------•-...............................................m............................................................-............................................................... --- U. Nature of.Repairs or Alterations—Answer when applicable....-_....--.1__'1b1%�L...._..... r�......................... . -------------------------•------------------------------------------------...----•--••••--•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the board of health Signed 7 ! •'� � ' ` y)P_ A-•- i Date Application Approved'BY ......--•--•-----.....•••. ................................ ` Date Application.Disapproved for the following reasons:.............................................................................................................. ......................................................................................................................................................................................................... Date PermitNo.............:.:.::...:............................_.... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD f.' OF1y' HEALTH! l., 'L'... :,, .............O F..... t✓.��c ;ad s./r;l�Jfif e............................. Tntifirat a of Taampliaurr THI,S_I T CERTIFY That, the Individual Sewage Disposal System constructed ( ) or Repaired (,1 ) by......... .,. . .1 2r',1�:::r : � i -......•--•--•.....------ 1 installer at.. . -----_ ,�; ..iy-t w.. a, . - g.t. t.c_ e . has been installed in accordance cwith the provisions of I T ;�5 15e State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated---..........--_--.................I............. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........................................................................---•• Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS p BOARD OF HEALTH , •' %.li .............OF.......G - FAO.IBC.�f.(Le! ....................... No......................... FEE--••-•---.....�... . i as tl aark Tom udivit rumlit n/� y� Permission is hereby granted.... 1. ._.r.. (r.1,<./ /.- �.�5................... to Con stru ( r Re air ( . ) an Individual a rage Dispos ystem //__ f� df••• � �---------•----------•---••----. �./�// st�as shown on the application for Disposal Works Construction P b._�_�^______________ Dated.......................................... ___ ___ .__ --—. Board of Health 1.- DATE....................................................................... .. FORM 1255 A. M. SULKIN, INC., BOSTON '