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0007 BLUE HERON DRIVE - Health
7 Blue Heron ]Drive Osterville A= 094—003 I ---�, TOWN OF BARNSTABLE LOCATION / a/_)ke kenf / Or SEWAGE #01008- O78 s _ VILLAGE ,,yy .,s ASSESSOR'S MAP & LOT09 Y' 003 INSTALLER'S NAME&PHONE NO.:3- /C�.00—/ /C-- SEPTIC TANK CAPACITY Q, 000 (SA11''.kf LEACHING FACILITY: (type) F GYw 2),f1vA600 `C 9� (size) NO.OF BEDROOMS v BUILDER OR OWNER r�aSR1,,"o 3v Aa,0 V PERMITDATE: 3 d—O S COMPLIANCE DATE: U Separation Distance Between the: _. • .r Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet ` Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility,(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 19 4o3 a Lf 3„ G ARAM Tge, WN OF BARNSTABLE LOCATION 1 J�UL f6 SEWAGE# '.3 VILLAGE O ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY CQ,nn.SS LEACHING FACILITY-(type) 1'• (,�CG� /QUO (size) NO.OF BEDROOMS 6 OWNER bV YAr81n PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY For a A a 3 a- 3E-41 a� 6 3 sT yY No. ( �I '/�/r((-�JJ/7`' l CI ` "r Fee 'VC Entered incomputer: TH MMONWEALTH OF MASSACHUSETTS �g PUBLIC HEALTH DIVISION - TOWWOF BARNSTABLE, MASSACHUSETTS es 2'pplication for Mt5po5al * stem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(X Abandon( ) K.Complete System ❑Individual Components Location Address or Lot No. "7 [3 L Lj E P L T<0 N O R Owner's Name Address;and Tel.No. (��TE2VILLE /VJ/ASS "t.V4G 0A0i� MGMGTRus'� C/ORnSA�I�+^'DIJei3pRDoN to S' PLl A5•/¢/v'V1LL.6 f2D Assessor's Map/Parcel M 0 17 e//R O0 3 N I=LO VC-it N O N N Z Installer's e,Add s,and T I N� �8. Designer's Name,Address and Tel.No.5G51 `l2 - 3 49 'Kr, 2yCtiCCi��'f/cf Q StfLLIVgN ENCri1�+EERII/y 1we � % .D8� oS6JorL ®fir✓/Lt C /Yl A s f Type of Building: Dwelling No.of Bedrooms Lot Size ®a 14(g AC Garbage Grinder (Pty Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 7 76 gpd Design flow provided —7"7 q gpd Plan Date F6 B . 2(p , 2 Number of sheets I Revision Date Title SME PLA1J— -S &P-TIC SY_57E01 LJA,21'ADt Size of Septic Tank '2000 C-AL Type of S.A.S. 1�12X 741 Lt:Ae k,n,p Ch Ama a R +v/ ,. T Fuowo,r-cc,smrs Description of Soil C� L 0 A M „ t3 P.Nf ,s N Y�L. Ld/9MY�'AP0 t G Y R [�/� CA Ct C,L0tic YC-I—ZeW AGD. Si9A/n -Z SY 6A , %'G 'PALE -/,CC'L. IMZ- Nature of Repairs or Alterations(Answer when applicable) 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 Environ ental C e nd not to place the system in operation until a Certificate of Compliance has been issued by this Board Healt . 3 F00/,o8 Signed Date Application Approved by ' Date Application Disapproved by: Date for the following reasons Permit No. Date Issued I No { v X/ t4_ Fee �DO -- Entered m m THE C MMONWEALTH OF MASSACHUSETTS computer:ib - I4es Cf 6 �g PUBLIC HEALTH DIVISION - TOWN OF 'ARNSTABLE, MASSACHUSETTS j I }. 11 Yscation for- g o ar tent Cori tr�� � � �p � ucttou Permit Application for a Permit to Construct( ), Repair( ) Upgrade(X Abandon( ) [Complete System ❑Individual Components Location Address or Lot No. '7 B L U S N fr TT0 N R Owner's Name Address,and Tel.No. OS7EJtb 'II-LE AJ,45S TH6 CJ96 Ali;MC-r(XU5TjCkRasq��'/"DOU3ARD�N to 5 PLt;A5,Q1VT;eiLL6 RD Assessor's MapMarcel - d 9 y�p Oo 3 4- w VL R N0 N N S T Installer's ame,Addre,�s,,and Tel N� c) - Designer's Name,Address and Tel.No. �Of�-42L-3 3 49 �8� fcE�S c��� /(�/ �� .jS te/ 'SsUP,402dMM Ci6 ec�►>vy trvc ,Z ", Oslc��,`l!I C?S_r�r'Vi Lit L= /)4.4ss e -Type of Building: Dwelling No.of Bedrooms Lot Size 0, y (, A c sq-dfp Garbage Grinder (AA-Y Other Type of Building No.of Persons, Showers( ) Cafeteria( ) " Other Fixtures -- Design Flow(min.required) 776 gpd Design flow provided Z 7 Q gpd Plan Date FG g . 2 fo 2oc>Sr' Number of sheets ( Revision Date Title S 1TE PLA 1►�_ S E F�T1G S YSTE/i'1 LJPe.<,:rAQi Size of Septic Tank '2 000 CP.-AL Type of S.A.S. (2�X�H' l.,�g a!„r.y Chra iu►Q�1Z w/ Description of Soil 00 Ls O A M � Q G3 R N'i 5 N Y L. l..O/AMV.S�a ANA 10 V f2 G/,c ► � dLI!/Li: LLew AGD. S/9AIA 'Z•5Y 4/CP PA L. IYDG D Nature of Repairs or Alterations(Answer when applicable) I 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 C , e and not to place the system in operation until a Certificate of Compliance has been issued by this Board Health Cb/7' _Q Signed /� , Date Application Approved by Jy Date Application Disapproved by: / J Date r for the following reasons t...u�� Permit No. Date Issued ,- ----------------------------- -------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance La THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( x) Abandoned( )by S Ho f c (I-, '� 1 at -7 6 LLJ L M L aox- D rz, as I-Z R✓I L t, , 10,4 has .eeMcucte�i cco dance with the provisions of Title 5 and the for Disposal System Construction Permit No. "(/ dated Installer�9( hc,c c �( .,l c� Designer 5ULLi1141 i --W6jWCtAAW-4- I it., #bedrooms Approved design flo '77p gpd The issuance of this 'ermit shall not be construed as a guarantee that the system wi'l functio as desi igped. Date '�1 i,X Inspector ———————————— ———————————— No. l / / -- _ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS &5po!gal lbpotem Construction Fermat Permission is hereby granted to Construct ( ) Repair ( ) Upgrade (� ) Abandon ( ) jSystem located at BLl1C f�L�RG� Q t✓L, G�S"TL 2✓!G.L�;' /Yll�S_S 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. i Provided: Construction must bl comp dted i hin three years of the e date of this p it. Date ( Approved by / / f r Town of Barnstable Regulatory Services NAM ��� Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601, Office: 508-862-4644 Fax: 508-790-63.04 Installer& Designer Certification Form Date: s $ 08 Sewage Permit# n�s Assessor's Map\Parcel 09— Designer:,Suti.iV14N ,6EWCIfVgGaINCr IN Installer: �2RVC //�.���l.s/�� "7 pAa ic.jF(L (RD 8 "Po In c T. �/ Address: Q sTC--t1V 1 L-i_G M i4 s s Address: s/cur, 6 On 3-6 O -_'Rrvice ho cG.� ��r was issued a permit to install a (date) (installer) septic system at -7 1B Lu& 'A 6%&iv D R. d sY c mV i u_c based on a design drawn by Sc,L[-r vr�ry (address) v" G_:N& rVr=c in.& irvc-dated FAMQd oo (designer) I certify that the septic system referenced above was installed substantially according to the design,which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e.greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified.as-built by designer to follow. �F ass Staller's Signature) P rE, yG� l ) o suLLIV N (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION.CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.THANK YOU. Q:Health/Septic/Desiper Certification Form 3 26-0.4.doc Town of Barnstable f Department of Regulatory services a e 3 Public Health Division Hate 0 MAM 09,a�� 200 Mani Street,Hyannis MA 92601 Date Scheduled . • '• 0 U Tlme Fee Pd. . f g ' ,� Sol SuitaUility Assessment o�' Sewa a Das osal Performed By:_ \ ^-- `` pC.�A� Witnessed Dyi 7CN�Y\a r 1i0�Gnfit i ,i� LOCATION t4z GENI+;RAL INFORMATION. i s Owner's Name l-(APC Mrvr- -VCJ.j� Loc ation J ��131 t eC0•r� t' � U �• G .. , R o�Ub v►� j Address bS Z"s .,.�vmk- P`ck Ne,r �err4r-,,.PT 0-1t(I.(C . Gigincer's Name Assessor sMap/Parcel: 0 rly 7l)b'3 - � "�, . • NSW CONSTRUCTIOK 1tBPAlR I Telephone H sw(3—'-12 IFS 3l ` Land Use QetiAr n a \ Slopes(%) J�6 Surface Stones M Distances from: Open Water Body � n : Rossible Wet Area_ qp 1T Drinking Water Well _1t .t R Other /V pr R Drainage Way �o It Property Line _ $KI±;TCII;(Street name,dimensioris of lot,ex6ct lot ations of test holes&perc tests,lociite wetlands in proximity to(roles) I � . i BP!SI61 IN. .v 1 � . I � m. 11 ! i tj 10 I ]e'rrontycrddt 1 �`-�,�'��• 56.E f' 1 si ., 4— parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: 1�Z CSC 41 Weeping from Pit -ace Csliinnted Seasonal tiigli Gmundwater ' DETERMINATION rORISLASONAL IIIGI�WATER TABLE Method Used: in. L in` De tit to soil mottles R ` Depth Observed standing in obs.hole l"'9 p Depth to weeping from side of obs.hole ht .Groundwater Adjustment Index Well g .11rR 5 Reading Date:01 0$ Index'Well level 9 Adj•factor Z,S' "Adj.Oroundwatcr Level_ PERCOLATION TEST Date . zs. Time Observation -� Time at 9" Hole g << at 6" _ Tinie ' Depth of Pero Start Pre-soak Timer Time C� :� u, :.•, End Pre-soak .. • hate MinAnch Site Suitability.Assessment: Site Passed ' ` . Bile Failed: Additional Testing Needed(Y/N)' Original: public NeetUt Division Observation Hole Data To Be Coinpleted on Back------ \� *** test is to be conducted within 100' of wetland,you must first notify the V �� If percolation 11arnstable Couservation Division at least one(1)week prior tor beginning. Q:I IEALTI UW P/PERCFORM I EI';P OBSERVATION HOLE LOG Jlolc it Ucpllt fioin Soil Horizon _ Suit TcxIma Soil Color Suii pthcr Surtltcrj(hr.) (USDA) (Munsoil) Mottling (Strucinra,Sloncs,lluuldcis. Causlstanav:%gravel)_ 75'r L � 5r1r�� i DEEP rOBSER sA T ,ON HOLE LOG Hole It Depth from Soil} xt 1 Soil Color Soil Other Surface(in.) (USE A) l (Munsell)- Mottling '(Structure,Stones,Boulders. Consislurcy.%Gravcp _ 0 3Z�t COAr4!'�4V' +rD l oil K V/ DEEP OBSERVATION MOLE LOG Mole# Depth from. Soil Horizon Soil T xlure Soll Color Soil Qthcr SurCnco(in.) (USDA). (Munsell) Mottling (Structure,Stunes,Boulders. Consislencv.°/u I'mycl) I -------------- DE �P•OBSi;ItVATION IIOLI•;LOG Mule! Depth horn Soil Ilotiwa Soil Texture Soil Color Suii Other Surface(in.) (USDA) ) (Munsell) Mottling (Structure;Stones,Boulders. j Consislcircv %Grdvcl) i Flood Insurance Rate Man Above 500 year flood bomtdary No_ 'Yes ✓ . . WlIhln 500 year boUndary No Ycs Within,l00 year flood boundstry No✓ Yes`: feet of natural! occur s Material De' th of Naturall bccurrin Perviou ;rui pervious material exist in all areas observcd•tilroughouttke Does at least fourY g area proposed for the soil absorption system? if not,what is die depth of naturally occurring pervious material? CertiCcatiun 1 certify that on- I D (date)I have passed the soil evaluator examination approVcd by the' Department of Cnvrrotuucutal Protection and that the above analysis was performed by.tne consistent Willi the required training, pertise and experience described in•310 CMR 1.5.017. Dalo o Z Z e> Signaturo Q:IICALTI-11W PmeRCIFORM T°� ' Town of Barnstable Barnstable THE ti Ala-America City yr . °��� Regulatory Services Department �%O � Public Health Division t° - 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO January 3, 2008 Rosalind Dujardin 65 Pleasantville Road New Vernon, NJ 07976 q t C)'6 Q as" kl- ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 7 Blue Heron Drive, Osterville MA was inspected on November 2, 2007 by James Ford, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system FAILED under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: Single cesspool used for downstairs washer, bathroom and slop sink. Single cesspool is an automatic failure in the Town of Barnstable. You are ordered to repair or replace the septic system within Two (2) years from the date of this notification. You also have the option of tying into the current Title V System. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE OARD OF HEALTH ho c ean, S., CHO P Agent of the Board of Health ` Q:\SEPTIC\Letters Septic Inspection Failures\7 Blue Heron Drive.doc 7005 1160 0000 0191 0027 of„ T Town of Barnstable ; BARN Regulatory Services Department + SfABLE. =�A MASS. � Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO 1v 3 July 24, 2007 1®- Cape Meme Partnership V 4 c/o Rosalind Dujardin _ 65 Pleasantville Road i New Vernon,NJ 07976 Dear Rosalind, l./ I am writing in regards to the rental inspection performed by Health Inspector Meredith Morgan on May 25, 2007. At the time of the inspection, it was observed that there was a room that had egress issues. It was also noted that there were no CO alarms provided. I am curious if the violations have been corrected as directed on the order letter? I understand you live out of state, and at the time of the inspection the property was vacant. I am curious if you could provide evidence, such as a picture, to show the door entrance has been widened? Or, if you are going to be in the area, we can schedule the re-inspection during that time. If the property currently has tenants, you may also furnish their name and phone number so I can contact them directly to schedule this re- inspection. Please respond, either by mail or a phone call, so we can discuss this matter and issue the Certificate of Registration. Thank you for your cooperation, it is truly appreciated. Respectfully, Caitie Barrett Health Division Assistant Rental Program Coordinator #508-862-4072 Direct Line SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,"2,and 3.Also complete A Sign ure item 4 if Restricted Delivery is desired. 0 Agent • Print your name and address on the reverse ❑Addressee so that We can return the card to you. B. R ceived by(.Panted Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. �Mv - D. Is deliv ' 'em 1? ❑Yes 1. Article Addressed to: If de ,enter delivery addr s� w: ❑No `` v �1 1 3. Service � � I D Certified lW _g - ressMail ❑Registered !j Return Receipt for Merchandise ,A ❑Insured Mail ❑C.O.D. 4. Restricted Delive ?(Extra-Fep� -� ❑Yes 2. Article Number { � 0 3-11680 000 0 4 s 5 4 5:8* 4i319 M (transfer from service labeo PS Form 3811,February 2004 Domestic Return Receipt I02595-o2-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 Sender: Please print your name, address, and ZIP+4 in this box �:> Town of Banistable _ Health Division Fo 200 Main Street Hyannis,MA 02601 0 a • � i Certified Mail#7003 1680 0004 5458 4319 �oFVE To Town of Barnstable Regulatory Services • BARNSrABLL T MASS Thomas F. Geiler,Director i639 ATf°^"AAA Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 31, 2007 Cape Meme Family Partnership 65 Pleasantville Road New Vernon,NJ 07976 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 7 Blue Heron Drive Osterville, was inspected on May 25, 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 State Sanitary Code were observed: 105 CMR 410.450—Means of Egress. Room in basement not to be used as bedroom 'due to lack of egress issues. The following violations of the Town of Barnstable Code were observed: 170-10—Smoke Detectors and Carbon Monoxide Alarms. No CO detectors provided in basement, I" floor or 2°d floor. 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 10 feet of each bedroom and by ensuring that basement room not be used as bedroom by widening room entrance to a minimum of 5 feet wide. QAOrder letters\Housing violations\Rental ordinance\7 Blue Heron Drive.doc 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. 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 TH BOARD OF HEALTH a . McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Meredith Morgan, Health Inspector QAOrder letters\Housing violations\Rental ordinance\7 Blue Heron Drive.doc &w HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS FORM30 C BOA OF HEALTH CITY/TOWN o DEPAPTMENT �lai c AbDRE S G^M SV B`•y �� In TELEPHONE Address �U e y� �✓(�If cupan Floor Apartmen o. No.of Occu�?nts No.of Habitable Rooms No.Sleeping RoomsSSL No.dwelling or rooming units No.Stories Name and address of owner �, a� . I0465, to Uev RemarksN � YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains.- Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: 10 Dampness: 5 Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: 1 Hall Windows: eaoas HEATING Chimneys: t l -. 1 Central ElN E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBIN : 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: WO vpw j V Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pant , 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 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 1 P C 10 RE RT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALT F R URY ' INSPECTOR TITLE A DATE TIME �(/o �y .M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. PIP- 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. y (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. 't �iJ 1 v Town of Barnstable �pF SHE Tp� Regulatory Services nAaNSTAf3LE, • Thomas F. Geiler, Director 9�p MASS.1639. ��� Public Health Division lfD µp'I a Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 25, 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): 7 Blue Heron Dr. Osterville Assessors Map-Parcel: (094-003): CO detectors lacking in basement, on first floor and on second floor. Property currently not rented. Meredi E. Morgan -Health Inspector Q:\Order letters\Housing violations\Rental ordinance\\Fire ViolationsTIRE TEMPLATE.doc I .��pfSHE Tp�� Town of Barnstable Barnstable Regulatory Services Department AMmedcaCh BARN STABLE, O D MASS. ,�� Public Health Division �pTED MAC A, 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director V \ FAX: 508-790-6304 � Thomas A.McKean CHO uac v November 1, 2007 Cape Meme Partnership 65 Pleas nt' ,ille Road Uj hjQw Ve' on, NJ 07976- C'!] CII) .4 JJ 1 :.2008 Rntal Registration'—Chapter 170 Rental Properties ca l r Ca-e 'eme Partnership, i� hb PI ase be aware that fees to register your rental units located in the seven villages of Barnstable are due by January 10, 2008. Checks can be payable to: Town of Barnstable and sent to 200 Main Street, Hyannis 02601. The fee is $90 per address ($25 for each additional unit on the same parcel). Please also be sure to reference the address and unit number of each rental unit you are registering, as well as updated tenant info (name'and phone number). A$10 late fee will be assessed to those that register after the due date r t Should you have any questions, please contact the Health Department at ,5087862;46441. J:\Renewal Letter 2008.doc COMMONWEALTH OF.MASSACHUSETTS J J EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF:ENVIRONMENTAL PROTECTION 4 TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 7 Blue Heron Drive. Osterville MA 02655 Owner's Name: Rosalind Cross Duiardin Owner's Address: Date of Inspection: November 2 2007 �t 1 Name of Inspector: (Please Print) James M. Ford 1 . Company Name: James M.Ford ==`F Mailing Address: P.O.Box 49UD _ �F Osterville:MA 02655-0049 Telephone Number: (508)862=9400. CERTIFICATION STATEMENTS _ I certify that I have personally inspected.the,sewage disposal system at this address and that the informarion reported; below is true,accurate and complete as of the time of the inspection. The inspection was perfonne rimaedon po training and experience in the my 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 e ds Further Evaluation by.the Local Approving Authority ✓ a' s , Inspector's Signature:, . Date: November 12 2007 The system inspector shall sut'tcopy of this inspection report to the.Approving-Authority(Board of Health or.. DEP)within30 days of completing this inspection. If the system is a shared,system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to.the appropriate regional office of the DEP. The original should be sent to the system owner and copies:sent to the buyer, if applicable,and the approving authority. Notes and Comments:. The single cesspool failed and the overflow cesspool passed ""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system:will perform in the future under the same.or different . conditions of use. Title 5 Inspection'Forth 6/15/2000 page 1 f , Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 7Bl4e Heron Drive Osterville MA Owner: _Rosalind Cross Dujardin Date of Inspection: November 2 2007 Inspection Summary: Check A,B,C,D`or E/ALWAYS complete all of Section D A. System Passes: ✓. I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The werflow'cesspool passed inspection B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. 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): brokenpipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed i e s . The pass inspection if(with approval of the.Board of Health): P p system will broken pipes)are replaced obstruction is removed ND explain: 2 i Page 3 of 11 ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: '7 Blue.Heron.Drive Osterville MA Owner: Rosalind Cross Duiardin Date of Inspection: November 2.2007 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 II . 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 11 of a public water supply. _ The system has aseptic tank and SAS and the SAS is within 50 feet of a private water supplywell. The system has a septictaik 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 and volatile organic.compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure-criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 7 Blue Heron Drive Osterville MA Owner: Rosalind Cross Dujardin Date of Inspection: November 2 2007 D. System Failure Criteria applicable to all systems:' You must indicate either"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or:surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth.in cesspool is less than 6"below invert or available volume is less than %2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of tunes pumped— Any portion of the SAS,cesspool or privy is below high ground water elevation. ! Any portion.of cesspool or privy is within 100 feet of a surface'water supply or tributary to a surface. water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or-less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner,should contact the Board of Health to determine what will be necessary to correct the failure: NOTE. Single cesspools fail in the Town of Barnstable E. Large System: To be considered a large system the system must serve a facilitywith a design flow of 10,000 gpd to.15,000 gpd. You must indicate either."yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system.is within 200 feet of a tributary to a surface drinking water supply the system is located in a.nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone II of a public water supply well If you have answered 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 15.3014. The system owner should contact the appropriate regional office of the Department. 4 C Page 5 of I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART g . CHECKLIST Property Address: 7 Blue Heron Drive Osterville MA Owner: Rosalind Cross Duiardin Date.of Inspection: November 2 2007 Check if the follow' ing have been done: You must:indicate es or"no"as to each of the following: Yes No Pumping information was provided bythe 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 th e 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 i 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 orl tees,material of construction,dimensions,,depth of liquid,depthl 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' Yes No Existing information. For�example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part G is at issue approximation of distance is unacceptable):[3 10 CMR 15.302(3)(b)]. ; 5 I Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 7 Blue Heron Drive Osterville MA Owner: Rosalind Cross Duiar (in Date of Inspection: Novemb"er 2 200.7 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 6 Number,of bedrooms(actual): 6+ DESIGN flow based"on310 CMR'15.203 (for example: 110 gpd x#of bedrooms): 660- Number.of current residents: 0 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): Yes [if yes separate inspection required] Laundry system inspected(yes or no): Yes Seasonal use(yes or no): Yes Water meter readings,.if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Su»nmer use COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310"CMR 15.203): 1 L---gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system.(yes or no): Water meter readings,.if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information` Unavailable Was system pumped as part of the'inspection(yes or no): " 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) ` Tight Tank . Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: A leach pit was added on 1011185(per as built card) Were sewage odors detected when arriving at the site(yes or no): No 6 w Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Blue Heron.Drive Osterville MA Owner: Rosalind Cross Duiardin Date of Inspection: November"2 2007 BUILDING SEWER(locate on site plan). Depth below grade: Materials of construction: cast iron 40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) (Cesspool acting as a septic tank) Depth below grade:. 5" Material of construction: concrete _metal._fiberglass _polyethylene ✓ other(explain) Cesspool block If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):certificate) (attach a copy of Dimensions: 6'W x 5'T)c 8'bottom to grade Sludge depth: 2„ Distance from top of sludge to bottom of outlet.tee or baffle: Scum thickness: I" 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: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.); The cesspool had]'of liguid on the bottom An outlet tee was present The cover was 5"below grade GREASE TRAP: None (locate on site plan) Depth.below grade: Material of construction: _concrete _metal —fiberglass of eth —polyethylene o p Y they .(explain): Y 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert, evidence of leakage,etc:): 7 Page 8 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Blue Heron Drive Osterville MA Owner: Rosalind Cross Dujardi_n _ Date of Inspection: November 2 2007 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Commments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:.. None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert; Connments(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.): PUMP CHAMBER: None (locate on site plan), Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8. r Page 9 of 1 F OFFICIAL INSPECTION FORM.-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: 7 B1ue Heron Drive Osterville MA Owner; Rosalind Cross Duiardin Date of Inspection: November 2 2.007 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 -6'x 6'(1000 Qal)w/30stone(hand probed) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields;:number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level,of ponding,damp.soil,condition of vegetation,etc.): The leach it was d and clean. The scum line was 6"u rom the bottom. There did not appear to be an cover was S belo si ns o allure. The " w grad?. CESSPOOLS: ✓ (cesspool must be pumpedas part of inspection)(locate on site plan) Number and configuration: 1 single(for downstairs washer and bathroom) Depth-top of liquid to'inlet invert: Depth of solids layer: Depth of scum layer: -- Dimensions of cesspool: 6' "x I'T x 8.5'bottom to grade Materials of construction: — Cesspool block Indication of groundwater inflow(yes or no)- No Comments (note condition of'soil,signs of hydraulic failure,level of ponding,condition of vegetation;etc.): The single Cm spool serves a downstairs washer bathroom and s ?p sink. A sin r1e cess ool autotnaticall ails in the Town o Barnstable.It needs to be re-routed to the main s stehi. PRIVY: None (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property.Address: 7 Blue Heron Drive Osterville MA Owner:- Rosalind Cross Duiardin Date of Inspection: Novemler 2 2007 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. . 6 r 3 Es-p( y • Page 11 of 11 OFFICIAL INSPECTION FORM-'NOT.FOR VOLUNTARY ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Blue Heron Drive Osterville MA Owner: Rosalind Cross Dulardin Date of Inspection: Novetnber 2 2007 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 14+/: feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from.system design plans on record-If checked,date of design plan-reviewed: Observed site(abutting property/observation hole:within 150 feet of SAS) ✓ Checked with local Board of Health-explain:_ Topographic and water contours nzapS Checked with;local excavators;installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Usinz Barnstable to o ra hic and water contours ma 9s,.the maps were showing approximately 14'+/--to ground water at this site. This report has been prepared only for the septic system and components described herein. This septic was inspected as of the date.of inspection. This report is.not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,.either expressed written or implied,relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 r Town of Barnstable 0f THE 1p� Regulatory Services 51,E Thomas F. Geiler,Director 9�A1639. •�� Public Health .Division TED pM�A Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 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/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s 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 Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. r _mix IA•7ION SEWAGE PERMIT N0. liILIAGE • 1---NSTA LLER'S NAME a ADDRESS �! �'I �� �. �li %i1 a✓yZ_. d U I L 0 E R OR OWNER DC31-1 2 c?14U D TE PERMIT ISSUED Z DATE COMPLIANCE ISSUED d � U �1 j ' G No... S � F�s......... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF........l G:vyrsrlidsaY�L DO A Putt#ion for U asal arks Tomitr�� � ixr#uan rrrmt# Application is hereby made for a Permit to Construct ( ) or Repair (,T an Individual Sewage Disposal' System at: ........ ....!�� . .....►�1>w:�:: 7�.. .�:.�a, _ .�s � 11 .- ........... --- ............... ..........-•-...........-•-.. Loc tt*ion Ad�drges Lot No. ) .......... -• ..i`t _ � _ �st.r.4: ?�:Shc ......................... r Owner b. Address �n��!t' 1✓....?lr: � i� � ......--•----•----. 4 Instaper Address Type of Building Size Lot............................Sq. feet ►. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type ype of Building ............................ No. of persons....:....................... Showers ( ) — Cafeteria ( ) Otherfixtures. .. ---•-•---------••-----•----------------•------------- ....................................... W Design Flow............................................gallons per person per day. Total daily flow............................................. 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 ( ) Percolation 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 •-•----------•------•-••------•.............................•--•--•••-•--..........--..........•-----••.._...--•-•-•--......._.----. -•--•---•-----------•-- 0 Description of Soil........................................................................................................................................................................ V ...................................................... c. .r / : [... ............ - a _ .L � (L ._ t _ior Alterations—Answer when a Plicable- _Ano A U ature of Re ............ ----••----------------------•--•---•--............•.......---•-•--------••-•----• --•------------•--------.---------------•-•----•-----------_---•-------.------------------.------------------..------- Agreement: The undersigned agrees to install the aforedescribed .Individual Sewage Disposal System in accordance with the provisions of iImU 5 of the State Sanitary Code—'The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed t r (,z3ilfi r--•---... .. ` .:� ....._..-- / Date Application Approved By..-- ...---_. .. ............. ........................•-- _ -Z4- ....... Date Application Disapproved for the ollowing reasons----------------•---••---.............-----------------...--------•-••--•------••-----------------•-----•:..-•-•- ..........................................-.............................................................................................................................................................. Date PermitNo......................................................... Issued • -....................................................... Date Nd.. g5._�. � Fss........!. .._.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Le) .............. Appliration for Diu uuttl Varks Tonstrurtiun rrntd- Application is hereby made for a Permif'to Construct ( ) or Repair (*-T an Individual Sewage Disposal System at: I' -Loc ion-Addres a ..... _ ��-'�.tn��' '..................:. ...:.... � ...4__!_��-� • ._ !_e.r ..at Lr.o.t !uteNV! N Owner ...../am-f oe. .-,-.J.1 1(.:.------,.�... 1 ------•-•- ----_-- n3/ staller- Address Type of Building Size Lot............................Sq. feet a Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q Other fixtures ............................... Design Flow...........................................gallons per person per day. Total daily flow..................:.........................gallons., WSeptic Tank—Liquid ca.pacity..........._.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.(. ) g : a° Percolation Test Results Performed by ....................................................... Date.-...................................... Test Pit No. I................minutes per incht Depth of Test Pit.................... Depth to ground water.................... GL, Test Pit No. 2________________minutes1per inch ti Depth of Test Pit.................... Depth to ground water........................ P4 --••----•-••------..............................................................................=------------ ....:. .......... r<. Description of Soil.................................................................... =-------------------------•-----•---•----•----.........---:::----- IW ---------••------------•--•----•--- -......................................................................------------. --=-- - --•- .............................................. x — ---------...-•-------------------------------------------------------------------- ---•-- ) / U ature of Repairs or Alterations—Answer when applicable__..<E._..ri. .......... rnr...lot............... L i j ' s 1T ......................................................................................................._.-------------------------------------......................................................... Agreement: The undersigned agrees to install the aforedescribed .Individual Sewage Disposal System in.accordance with the provisions of.TITL , 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation.until a Certificate of Compliance has been issued by the board of health. Signed ) ....:��-�s.....-_.-.. •' D to Application Approved By.......... ...... _ .•-•••-•• Date Application Disapproved for the ollowing reasons-................................................................................................................ "--=------------••-•--------.......---...........................••----... •- Date PermitNo..................... -- -'Issued...................................................... Date c: THE COMMONWEALTH OF^MASSACHUSETTS BOARD OF HEALTH ` ! ..........................................OF..................................................................................... Trrfifiratr of Tuutphattrr THIS IS.TO CERTIFY, T. t thekpdividual Sewa Disposal System constructer (' ) or Repaired by............................................... __-1-�.�.- ---•--C WR� • - Installer ...................7........Fs. .c ti ---N-------� " C....... has been installed in accordance with the provisions of TITLu j of T e State Sanitary Coe as described in the application for Disposal Works Construction Permit No......... -- tO._... dated._.. ........... +r �,�,. E ISSUANCE,-OF THIS CERTIFICATE SHALL NO BE CONSTRUED A A G RANTEE THAT THE SYSIN WILL FUNCTION• SATISFACTORY. !1✓ :. Inspector.. DATE------••-•-..::.0_.:_.I .---• !�'l�._....... ..•• ................................. _ THE COMMONWEALTH OF MASSACHUSETTS -` BOARD OF HEALTH fQ ...........................................OF..................................................................................... No..... FEE....... .......... t Mapasal Works Tunstrnrtiun ry mit Permission is hereby granted... Q ---••--•---- !V•_Q-- ------------------- to Construct ) or Repair an Individual Beau a Disposal System at No.......... `L__� .!+_ ( nQ.!�?...........P _ J i --._.. = .... bf Street �y� Cr r Z s as shown on the application for Disposal Works Construction Permit No �.'"_ ated_•-•_•-----.• -_•--_-_•____-•�.... ,. z 'DATE g r ealth 1 ' ,oA o 0 F...G..16.2 ' (ZGMOVEEX\ST,L..EAGH i�;1T d- � ' 11 o � See Note o w No.4(Typ.) 47G.15.2 �. © .FDRO.P, 5A5. PUMP 4.Ftl- W L. /CLSAN ... - ° �� s6 ." MATC�2\AL z Ra-Mbt4rNG-LEAe-H P175,, _ Q 4 - 12. _ 66 14:28 �j���l P - - 3 • '.i - Top El.13.2 2000 G611onP Tank `OC 13.48 Septic 13.23 V$ - House Bot.EI:IL7 Exist. - 1/ 163 04 to be Removed 13.03 12.86 03020 , 0 3 .: .509 ^,,- 9 }@;.� # I Bedding as Groundwater` Adjusted 9 . 7' ,:�� \�` /fie.y• - - �\ l. Per Title 5 EIev.6.7 . o z } 1 ` DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM; - •.•�'� z - rr 1 :I - - - Not Scale Groundwoter Adjustment. „ �, k I,H;zt .-1 N .I Groundwoter�E1.4.2 © o•. , a, i'ndez W'el'I:MI W 2'9 Zone,A I Adjustment: 2.5, J'an.,2008, 1 o I o O `p_gox - I :: G.round.w.a.te.r..E'.I.`6.7- p Adjusted a sEP'r'ic. _ _ . f GOMhA ,EP LOCUS. PLAN �\N:k p.I L i_ --7 Scale 1 =2000 /� - --- -W + x }. i I - V.': 6 - . 1 TCR : - - ..CONCRL•T@RISERS- ,--__ .._ _ - .. '` �sseSSars Ma.p'094 - 10 _... _. •',�, - I �,_': � � IIN �� As Re4ulaen : ABR,� - =1�I,_ Parcel003. rA Zoning . RF-1 TREPIRe .. - _� - 3/'d`-.11 2`DOU ALE TO MEET PROP: SE SMWOLR• _0 •N M Setbacks. 1� 7 - -.ggE�.DEV6:L INVErZT. I _ V./ASFI STONE _ 01f=p PI30FIl� \ . -� Front 30 y,_o., Side 15' 15,3 Z- L4 In:, i- Rear 15 ..: _ -. M1 N.TD Groundwater Overlay CROSS SECTION OF.CHAMBER District:: AP Not to Scale 1 ;NOTES z -- ' - I. Water Supply For This Lot Municipal Water. M DESIGN DATA 2.Location of Utilities Shown on This Plan Are Approx. sT : Sin r At.Least 72 Hours Prior to Any Excavation For This 6. S1ngle.Famlly ,7 Bedroom Project The Controctor Shall Make The Reqquired' cp o Garbage Grinder_ tion to DIG SAFE-.I-888-344-7233.; Tr, 1 L_ N Natifica ! - Daily Flow-I:iO:x7='770gpd . / a'' Septic Tank-770 d x 200%=1540 d 3.The Contractor is Required to Secure Appropriate u .-_ P . 9D 9P N O/o/3 46,W1 56.81 63./9 From Town A�enFres Fer 6ensfr�Ef+st1 Use a 2000 Gallon Septic Tonk 1; LEACHING AREA ed byTh ., a Defined is Plan: 4.Install Risers.as Required to Within 6"of Finished, BL UE HERON DRIVE. C.B.Rin! 770 gpd/0.74=d.0�41 s.f.'Required• Grade.'... Sidewall' 0.96�12t74)2= 165s.f. ' (3')Feetor- 5.All Structures Buried More ThanThree B.otfomArea .l2 x74. = 888s.f. VehiculQrTtafficistobeH-20Locrding.: y \ 1053s,f.Total Provided. Subject to 6.Septic System to be Installed'inAccordaace'With LEACHING CHAMBER,DESIGN 310 CMR 15:00 Latest Revision And.The?own of PLAN V E W ; All Piping tobe.Schedule 40 PVC.Use _ Barnstable Board of Health Regulations. _ li- / + 4'x 8'Fiowdiffusors in a l2 x74'Washed I Piping lobe Sch.40 PVC. Scale,: F - 30 Stone Field as Shown. _ 7 All _ 8'.Depthof Inlet:Tee Below Flow Line• fo"Min• :. . Depth of.Outlet Tee Below Flow Line:141 Min.' With Gas Baffle. L,H.-I C< .15,Z.,. :. 7.H.-2 13L. 1 S,Z 9.Install© Sewoge Injector Pump in Laundry Area .' O LOAM _ • And.Pipe to House Sewer. - ir.� O'AIv1Y SAND' \4YR 6/!0`;.", 8 " LLOA'M�!'SAtvo 1.0„YR 6/40 - - 1_L_OW 'MSD, .: OLIVL'YELLOW:MEI�, .. w CI SAivD -7O _ C 15A5 AGE Y E L L-O.W.-: M L D r .:...:-:. ALE t= O. t CZ. SAND- ZrSr7/y. : _ k - . 1_ASS 4 MAFLf31AL.. e^_ d'GRouNCrNAThR� 132 .�1.1.1�. I\I.O Gi�pUtYDWATtaa DATE: TAN. c5, Z0, - - O c , G N SEPTIC: D.EPfiH: ROSALIND . DUnJARDIN UPGRADE S.L1,LL.IVAN'E NCr1.NEEl3.UV G 1.n1G:: • Al- 3 m3733 : 7 BLUE WITIVCSS �, tvtlOR"A'NDI,T4;.Ci.,B-CN OSTERVtLLEOMASS. SCALE AS SHOWN ` _DATE .FEB 26,2008 SU LLIVAN ENGINEERING INC. OSTERVIL LEI MASS. I I,o' -- ---- -- - 1 { ill'1 2 8 IVIS N '-9 SofPOaT oVE 2 I oul-4)E + • � , � � _1 3_G."Era yT, i rg Q (J£cK A-MP FRa aUl i ftouJ NS F/2;zT PLO a2 PLAO _�X��,�n.,r �J/ nlcw PoRCbJ-r KrT�N-e'►,? 6eAf Dpa 1 4� J 'P-A o f s �� 003 X P E �r 5 OF T, ro w 5 v N-T a _ 15- "t-AEI Aj d- a -7-a'a" Itycl7't 13 io" Up RVCiBfre liOo� �6EeJ 5 0 ppe RT ?Iva Ka v eFtow a lyf " NE W +v Z M1 ` a8'ta s-rtPS FBI Rf�#0, �NLARG�v' h� rq rootceT y awsr, 62ooM 1-7' A ata 1 0o ExlsT. T e• r - Wei X3' c o yE T `DEG NBw 1i-71/2 a B'+T* .. y�4� • - ��;5,. •,0' aEana Giza xts7 'D Ea Roos ra p uw.nsrx±ul R,c_ �EtN aGK A7aP ro A)kw)�C*'VEl3ty M&C# rty 3Aw Z 'o e � bokwN 'MA Ff e, 4,51�H Q -f'Q0 Ex15 77 u6 t,J�NgW t f ki . t Agc.'G 3 oFS f a