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HomeMy WebLinkAbout1374 MAIN STREET (OST.) - Health 374 Main Street Osterville A= 119-005 a TOWN OF BARNSTABLE LOCATIONSEWAGE # VILLAGE ASSESSOR'S MAP 6z LOT -f— INSTALLER'S NAME 6z PHONE NO.U&�,? lfl ed)24 SEPTIC TANK CAPACITY ZgM G t LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER 71 B OR OWNER , .d trl ,4&� DATE PERMIT ISSUED: ,' DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� ��� ' t � 1 a `�` i,vl � \Ir �� 'y �r �. ��'. '� a �y,.;., 00, No.h%.17..--- Fmc...$.......3...0...0.0... THE COMMONWEALTH OF MASSACHUSETTS APPROVED Barnstable Conservation Department BOARD OF HEALTH 0 6 S TOWN OF BARNSTABLE f • � ,���lirttt ux �#i��n�ttl nxk,� C�nn,��x�ar#inn �f�exmit Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at: Y Mai n S t r.e.e.t O s.t e r v i 11.e -•----•----------------•---------------------•-------•-----...---•-------------------....-----•-- . . ............... .........••---. .....- Location-Address or Lot No. ................Ap L l e s e e d ---------••-------............------------ Owner Address W J.P.Macomber Jr . = Installer Address dType of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms........------------------------------------Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building No. of persons....................._.-_- Showers 0.� yP g ---------------------------- P ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------ - - --- - - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic 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 Reg ilts Performed by------------_---- --•••-•••--••--•-••---------------•--•----•---•---••-. Date-----------------------------------..... Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........--.............. fX Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -----------------------------------------------------------•-------•--•----•••---•-----....................---•----•-•---••-•-----•-•-•....--••-----•-••--••' ODescription of Soil........................................................................................................................................................................ x Sand & gravelk U ........................ ...J.....--......................-----------.........---•---•--•-.........................-................................. Ww s .s ------------------------------------- --------------------------------------------------------------------------------•---•----------- U at re f Re airs or Alteration—Answer when a lic ble.............1-1000 gallon tank 1-distribution U 1- �(�0 gpallon leaching pit pack in in stone . Omitting cesspool. . �.c .... ••-- -•--••-•-••---•-- ------------•----•-----------------------------------•---•------------...----------------------------------------------•.. ---..-•7--• -•--......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compiian e has bee is e�d�b� the boa d of health. Signed / .. �l� ,d f-. —y...............-----' -------------------------------1. --------- I f Approved By -----------' - --�-- ------ --------_---------------------------------------- ---- Application Disapproved for the following reasons: .. ........._........ ... .......-' '' ......................... -' ...................... ......... . ....... ............' ............................... ............ .............. ............. . ..... ............................. ............................... Date Permit No. - ....... Issued ............................... Dam 1� ,. THE COMMONWEALTH OF MASSACHUSETTS,r BOARD OF HEALTK TOWN OF BARNSTABLE V i UPS Appliratiun for Ditjipwi t1 Wurku Tomitrur#tun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at: Main Street Osterville �. ... .................. ..•--- ...... -----•••••.._......---.._...------..----- ------••--------•---------•--------•--••--. --- ••....-•------•---••--••--••-....--••-•••. Location-Address or Lot No. .............Appleseed -------------------------------------•---••--...._._..-- -•-••••-••--•-•••-•-•-------------•------....-•-••---•••••---•---.........._••••••....-•-......... Owner Address W J.P.Macomber Jr. IcistalIer Address go d Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons------.---------.------.---- Showers ( ) — Cafeteria ( ) QOther fixtures -----------------•----•-•-•------------...........-•----------•------------------------ ---------------••-------•---•--•-•------------••......----••- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity........---gallons Length................ Width---------------- Diameter.....--......--. Depth..... .......... x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No...................... Diameter--------------.----- Depth below inlet..--................ Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) '" Percolation Test Results Performed by--------- -•------•-•-••----•-----------•-------------••-•----•-•-•-•---- Date........................................ a a Test Pit No. I................minutes per inch Depth of Test Pit------.------.------ Depth to ground water..----.................. fXq. Test Pit No. 2................minutes per inch Depth-,of.Test Pit.--------.------__- Depth to ground water......-----..--.....--.. - .. ----•-----••-----------•--•-•---•.....................................•---------•-----------.............--•--------•--•----•------...----•._...........-•-- `,�" Description of Soil.................................. x' Sand & gravelk V -------•-•::--•--•--•--•-----•--•--••-•-•-----•-•••-•-•-••-••••-•----••--------•••---------•---•-••••------------------•-••••••............................................................... - !---------------- ----------------------------------------------------------------------------------------------------------•-------- M+, `•1 Natur' f Re a'r or Al_terati ns—Answer when a licable.-.-----.-.._1-1000 gallon tank 1—distribution 1-1(��0 gpa� on leaching pit pack in in stone. Omitting cesspool : ,rS -••-- ------------------------•-•-------------•-----••----••••-••------------••--•-•--•----•-----•----------•.......---...----••------•-----•---•-••--...----------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance,has bee . is�sued[gb/yy the boa d of health. Signed : .... ..:----------------_-- ....... 1..—. 1-0 .94 . ------ - Dam ...C..`..------------------------------- Application -ApProved By ........... '.. D e r Application Disapproved for the following rearonf- ----------------------------------------------------------------------------------------------------------------------------------- ................................................................................................................................ ................................. .................... . ...........................'---------- Permit No. V_` ...�,..7......................... Issued ....,�'� 77/..." Dare ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�Ertifira e of Compliance t TJH . . TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( XXIt lacombere Jl�. by at . Main Street Osterville ................- --- ------------- --------- --_......---------------------------------------------------------------.....................------------....-----------------------------------------....._.. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. -._�.�.-_..�..'-------------- dated ------------------------------------ ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------/777...- `` ... .....- --------- Inspect©.r--�..L'.�. ''- • .L,,- - - V THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE $ 30.00 No....f.L/ .-1.... FEE........................ Myviitt1 Worb Tunutrudiun rrmtt Permission is hereby granted-------------•------------------------------- J.P.Macomber Jr. to Construct or Re air 4X an Individual Sewage Disposal System *,,� an air sterville ------------------------•....••••-••-•--...••......-•--•--••--.............. Street as shown on the application for Disposal Works Construction Permit No7y:2. ----- Dated.......1- n_-g<<-�'....._.... �� l / ..................................•..... Board of Health DATE---------=---�-=-----"---:-----y- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE LOCATION f 3��( llci.d 2 SEWAGE # A VILLAGE �S�'E��i��� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE.NO. lNwt.E• brAsw. 50ph£ »rytcr S"Ze-771-$776 SEPTIC TANK CAPACITY 251 LEACHING FACILITY: (type) kqL( d b kao (size) d991-19d NO.OF BEDROOMS BUILDER OR OWNER rape Coef Ar,�, f PERMIT DATE: g o 3 COMPLIANCE DATE: Flat,Zos— Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility qa Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by P14 - MU.P cp - of oz- SIZ }� ._' Or4 a e. 1 1+ tl (. W vV Town of Barnstable Regulatory Services BAMS1.ABLF, Thomas F. Geiler,Director �$ 4SS 39. A,ag Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 f A housing inspection of your property revealed no violations of 105 CMR 410.000, State Sanitary Code II. Enclosed please find a copy of the inspection report and your "Certificate of Registration. Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable QAOrder lettersWousing violations\Rental ordinance\no violation letter.doc _4 z Certified Mail#0000 0000 0000 0000 000o Town of Barnstable sanitsras . Regulatory Services p'b k q Thomas F. Geiler, Director . Public Health Division Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 0 date Po &na\meea 0- - ddressma/ city,state,zip ' 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. 7 C,b b5 f• _ The property owned by you located at 13 y ) �� � ���was inspected on i�- /13 / �av6 b 70 (Address) Y , Health Inspector for the Town (date) (� sp tor's name) of Barnstable, (Reason for inspection) The following violation(s) of the State Sanitary Code were observed: (State code violation number-violation description) 105 CMR 410. 105 CMR 410. 105 CMR 410. 105 CMR 410. Q:\Order letters\Housing violations\Rental ordinance\template.doc w 105 CMR 410. The following violation(s) of the Town of Barnstable Code were observed: Town code violation number-violation descri tion §170-Z- v� §170-_ - Y u are dire to correct the ove with>< _ (written#) (#) of ou eceipt of this notice by 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 THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: (Name,tenant,owner,Fire Dept.,Building Dept....) Cc: (Health inspector's name) (Generic codes located at QAOrder letters\Housing violations\Rental Ordinance\GENERIC CODES.DOC) QAOrder letters\Housing violations\Rental ordinance\template.doc 'fORM30, HtiW HOBBSBWARREN n THE COMMONWEALTH OF MASSACHUSETTS �� BOA D F HEALTH CITY/TO '/ W �� V o g `' y 1ARTMENT O;L GO cG ADDRESS 7 l7f � /p(,/ Ll (1 '1,y Sv0y0r w 11 t l TELEPHONE ` Address �� -t "''' -- Occupant_+�`�"' `♦ ��'"_" _ ���� Floor Apartment No. No. of Occupants No. of Habitable Rooms q No.Sleeping Rooms,--- �...__ No.dwelling or rooming units1__ No.Storie Name and address of owner _ _ ►^�- Remarks Reg. Vio. YARD Out Bld s.: Fences: Garba e and Rubbish g� Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htS : STRUCTURE INT. Hall,Stairway: N 0bst'n.: Hall, Floor,Wall,Ceilin Hall Lighting: t 5FXow Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 'Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT ` Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen 5 Bathroom 2n/ _ Pant Den —Living Room - Bedroom 1 " Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: I Zd b 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 INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR _ 'J 0 Vt' TITLE l DATE I X-(3' 0'6 e TIME - (S _ P•M• THE NEXT SCHEDULED REINSPECTION l A.M. P.M. l-+:=•ai.r ws.; --.v„a;_ ,�.:..:.Yv.rl++w.rv.-...r....���.-.:,.r'�.'+w.�v.-.._,k � ,+..rtT C:$'c,d..�i+�'5..,�,."+r+-,��"^�w4.},`,{.-:.�..T'a+:•GFs�.-e"'�s.."*w+1..�w�r'.-i-�5....:.::�,..,.:�.iPi'r'"�..r5iy✓i..l^v� 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in-accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: - (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. i.yy.a'^7Y Ik.�,..yv.^,......+r 4p*rin:fa`.+.�.r 1 r ry'♦ t F'1 M - - _� M t �. . 1 T_. .. 1� r_ , THE COMMONWEALTH OF MASSACHUSETTS ORM�30 Ilnw HOBBSB WARREN ^ BOARD OF HEALTH CITY/TOWN — W o g DEPARTME T M Go lw ± 'o� \ ADDRESS / Y V {j/P TIELEPHONE VY �r f3?y c` .�— , CA4,14I Address Occupant _ Floor -_Apartment No. No. of Occupants No. of Habitable Rooms_ H No.Sleeping Rooms �.. No. dwelling or rooming units- - 1 No. Storied �r�- M ., Name and address of owner__ Q Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : ' STRUCTURE INT. Hall,Stairwa NIV-0 01 Obst'n.: Hall, Floor,Wall,Ceilin : Hall Lighting: 19+ �- Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks_-, Flues,,Vents --PLUMBING: Su ply 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 2 A/ L Pantryn p, r () e Den 0 - A r r Living Room Bedroom(1) o Bedroom 2 �... Bedroom 3 t Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: I x v a 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 t Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR - © TITLE DATE # -(3' ©E7 TIME - f 5 _ _ - P•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� 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. f J Town of Barnstable Regulatory Services MRNST"M' Thomas F. Geiler,Director MAM 9�p26 9. r Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 December 13, 2006 Attn: Osterville Fire 4 Health Inspector Timothy B. O'Connell 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): 1374 (B)Apt.Main Street Osterville, Assessors Map-Parcel: (119-005): -Smoke detector was located within 20' of a bathroom and\or kitchen and did not appear to be a photo-electric smoke detector. This was present on both floors of home. c Timothy B. 'Connell-Health Inspector QAOrder letterAHousing violationARental ordinanceUire ViolationsTIRE TEMPLATE.doc 137q �C7 Certified Mail#7006 0810 0000 3524 8103 �of� Tti Town of Barnstable P Regulatory Services BAR NS'CABLE, '� 9 Thomas F. Geiler,Director i639. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 25, 2007 Cape Cod Academy c/o Margot Bordman P.O. Box 469 Osterville,MA 02655 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE U—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 1374(B 1) Main Street, Osterville was inspected on January 22, 2007 by Timothy O'Connell, 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 410.500 - Owner's Responsibility to Maintain Structural Elements— Observed door at main entrance which does not close or lock properly. You are directed to correct the violations listed above within twenty-four (24) hours of your receipt of this notice by fixing or replacing front door. 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. QAOrder letters\Housing violations\Rental ordinance\1374B1 Main Street.doc s: .. t 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 BOARD OF HEALTH �-Aclelan, R.S., CHO Director of Public Health Town of Barnstable Cc: Richard Silva, Tenant Cc: Timothy O'Connell, Health Inspector Q:\Order letters\Housing violations\Rental ordinance\1374B 1 Main Street.doc i Certified Mail#0000.0000 0000 0000 0000 T Town of Barnstable Regulatory Services Thomas F. Geiler, Director . Public Health Division . Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 A date � name o tc , es N� city,state,zip 1 I NNOTICE 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 (-374 (81) M4,-: yl was inspected ` (Address) on�/ �'/ 0� by , Health Inspector for the Town (date) (Inspect 's nam of Barnstable, (Reason for inspection) The following violation(s) of the State Sanitary Code were observed: State code violation number-v' lation descri tion 105 CMR 410. 500 -auk -: a c e 105 CMR 410. 105 CMR 410. 105 CMR 410. Q:\Order letters\Housing violations\Rental ordinance\template.doc I I •/ L 105 CMR 410. The following violation(s) of the Town of Barnstable Code were observed: (Town code violation number-violation description) §170-_ - §170 - You are directed to correct the violations listed above within c ( tten#) (#) .� of your receipt of this notice by s 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 THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: (Name,tenant,owner,Fire Dept.,Building Dept....) Cc: (Health inspector's name) (Generic codes located at Q:\Order letters\Housing violations\Rental Ordinance\GENERIC CODES.DOC) QAOrder letters\Housing violations\Rental ordinance\template.doc I FORM30 HhW HOBBSS WARREN M THE COMMONWEALTH OF MASSACHUSETTS �� BOARD OF HEALTH CITY/TOWN DEPARTMENT A 6 �oJ ADDRESS _( C 0 g WM 0y`0� O TELEPHONE , Address 3 7�{ �� ` � __'Occu ant_y)✓G P _ Floor Apartment No _No. of Occupan�s - No.of Habitable Rooms3 No.Sleeping Rooms __— No.dwelling or rooming units_ . No.StorieB Name and address of o er w }�D i ;o q(o ' Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: O B ❑ F ❑ M Doors,Windows: 107 5 Roof - Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central 9Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: 110 ❑ 220 Fusing, Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den —Living Room Bedroom(1), Bedroom 2 Bedroom 3 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 INSPECTION REPORT SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJU Y.' INSPECTOR TITLE u DATE TIME �j A.M. THE NEXT SCHEDULED REINSPECTION I UJ P.M. �.'r�> ..-�.+,i hw•:rt"f'.,n �• 4t�,r r�.�+u3..:�i,�.,..�'�1r'/••"Sir f� '"r+"t..� ._b'�:3i'w�. M,:•�T:«: ::"..-�: 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply,with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3) or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. �S=��� o� � � �1��I� ern �3�y �� � a � ��'` I P _ � .. I f 04/08/2003 09:26 5085404003 RABESA/WARREN PAGE 02 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION DO Property Address: 1374 Main Street(Osterville) ED Owner's Name:Cape Cod Academy.IncOwner's Address: PO Box 469Osterville.MA 02655-0469 Date of inspection:March 20.2003 Name of Inspector: Gary J and/or Jane E Rabesa �,fZs S I N Company Name: Rabesa Subsurface,Inc dba Warren Cesspool Service Mailing Address: 72 Sandwich Rd GJr-SS Po b East Falmouth,MA 02536-5602 Telephone Number: 509-540-7143 y S- .,M i 4 CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes V Conditionally Passes C'P` Needs Further Evaluation by the Local Approving Authority Fails Ins ector's Situ Date: March 20,2003 The system inspec shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments Title V system,in good condition,for` op . Barn served by sing) cesspool with no failure criteria per DEP regulatio . Barn cesspool fails Town of Barnstab Health regulation Part VIII: Section 5.00 and must be re er current re ' S. ""This report only describes conditions at the time of Inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form on p 6/I5/2000 pa ge ge 1 04/08/2003 09:26 5085404003 RABESA/WARREN PAGE 03 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1374 Main Street fOstcrvill 1 Barnstable,MA Owner: Caoe Cod Academy,Inc Date of Inspection: Match",700-3 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: YES X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System 41 is Title V compliant and meets regulations. System#2 is a single cesspool and will require replacement per Town of Barnstable regulations. B. System Conditionally Passes: NO 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 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)arc replaced obstruction is removed ND explain: Warren Cesspool Service 508-540-7143 Ti+le G G.w�,nFinn Rn.w,4/1-Z MAAA 2 04/08/2003 09:26 5085404003 RABESA/WARREN PAGE 04 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1374 Main Street(Ostcrviille) Barnstable, Owner: Cape Cod Academv.Jqc _ Date of Inspection: March 20 2003 C. Further Evaluation is Required by the Board of Health: NO 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(l)(b)teat 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. 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 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: Warren Cesspool Service 509-540-7143 T:a, c 3 04/08/2003 09:26 5085404003 RABESA/WARREN PAGE 05 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1374 gin Street Osterville .Barnstable,MA Owner:_ Cane Cod Academy Inc Date of Inspection: March_20.2003 D. System Failure Criteria applicable to all systems: You most indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X` Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/day flow _X 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. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply, _X Any portion of cesspool or privy is within a Zone 1 of public well. _X 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. IThis 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.) NO (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. F- Large Systems: N/A To be considered a lar e s stem the system myst serve a facility with a design flow of 1 000 to 15 0-0 0—falf. 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"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. Warren Cesspool Service 508-540-7143 Tc+ra C r.,,..o,-t:..., r..,..c/1cmeinn 4 I 04/08/2003 09:26 5085404003 RABESA/WARREN PAGE 06 �...�..._�qI ..� ,.,.,i,........,.i,] li ,� :. 1 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: J374 Main Street(Osterv_iille) Barnstable.MA Owner: Cape Cod Academy,Inc Date of Inspection: Mar h 20,2003 Cheek if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes No x _ Pumping information was provided by the owner,occupant,or Board of Health x Were any of the system components pumped out in the previous two weeks? x 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 7 x _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) x _ Was the facility or dwelling inspected for signs of sewage back up? x _ Was the site inspected for signs of break out? x _ Wcre all system components,including the SAS, located on site 7 x 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? ' x Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems 7 The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no x_ Existing information. For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)(310 CMR 15.302(3)(b)) Warren Cesspool Service 509-540-7143 All c'Innn 5 I 04/08/2003 09:29 5085404003 RABESA/WARREN PAGE 03 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1374 Main Street(Oste ille) Barnstable-MA Owner: Cane Cod Academy,Inc Date of Inspection:March 20,2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):n/d Number of bedrooms(actual):2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):n/d Number of current residents:none Does residence have a garbage grinder(yes or no): no Is laundry on a separate sewage system(yes or no):no [if yes separate inspection required] Laundry system inspected(yes or no):n/a Seasonal use:(yes or no): no Water meter readings,if available(last 2 years usage(gpd)):2002 averaged 33 gpd/2001 averaged 33 gpd Sump pump(yes or no): no Last date of occupancy:over 6 months COMMERCIAL/INDUSTRIAL:YES Type of establishment:Wool Shoo Design flow(based on 310 CMR 15.203):n/d gpd Basis of design flow(seats/persons/sqf,etc.): 1719 sq ft of shop arcs Grease trap present(yes or no):A2 Industrial waste holding tank present(yes or no):no Non-sanitary waste discharged to the Title 5 system(yes or no):no Water meter readings, if available:see residential usage above Last date of occupancy/use:over six months OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:(agent)No known recent pumping& 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 X Septic tank,distribution box,soil absorption system X Single cesspool Overflow cesspool Privy _no_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: 1994 permit on file for shop's system. Barn's cesspool is probably pre 19701s. Were sewage odors detected when arriving at the site(yes or no):no Warren Cesspool Service 508-540.7143 f 04/08/2003 09:29 5085404003 RABESA/WARREN PAGE 04 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1374 Main Stree (Osterville) Barnstable,MA Owner: Coe Cod Academy,Inc Date of inspection: March 20,2003 TIGHT or HOLDING TANK: NO(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: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: YES(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: none 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.):Viewed by remote camera,there was no failure criteria noted. It is about nine feet below grade with no risers. PUMP CHAMBER: NO(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.): Warren Cesspool Service 508-540-7143 T:.1a 9 T-.n-.n ,;,n 04/08/2003 09:29 5085404003 RABESA/WARREN PAGE 05 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1374 Main St eet O terville Barnstable MA Owner: Ca Pe Cod Academ Inc Date of Inspection: March 20,20Q3 SOIL ABSORPTION SYSTEM (SAS): YES (locate on site plan,excavation not required) If SAS not located explain why: Type x leaching pits,number:one leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Typc/name of technology: Comments(note condition of soil,signs of hydraulic failure, levelof ponding,damp soil,condition of vegetation, etc.):The 4'deep by 6'wide precast H-20 leach pit had only six inches of liquid and no previous failure signs. The cover is 3'below grade over 8'of risers. CESSPOOLS:YES(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration:one:one sin le cesspool for ELM Depth—top of liquid to inlet invert:- Depth of solids layer: none �— Depth of scum layer:no scum Dimensions of cesspool:-CdeephjgLwjLde Materials of construction:concrete lock Indication of groundwater inflow(yes or no): no Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Dry at time observati n there were no previous failure signs. It r a ca be in struccover i 3"below grade. Wit uacodon. Th ownershi Town of Barnet le re quires u radc to curre t Title V re ualt'ons. PRIVY:NO(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condi~soil.signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Warren Cesspool Service 508-540-7143 T4I6 G /1AAA 9 04/08/2003 09: 29 5085404003 RABESA/WARREN PAGE 06 Page 10 of 11 OFFICIAL INSPECTION FORM..—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1374_Main Street(Osterville) Barnstable.MA Owner: Cape Cod Academy,Inc Date of Inspection:March_20.2003 SKETCH OF SEWAGE DISPOSAL SYSTEM NOT TO SCALE 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. System#1 lei 3 ,`a � A ScalDl � p�p� 51 R�A2 stow. A.31' � d g� C-3 Shop Darn a .to System#2 Warren Cesspool Service 508-540-7143 T:rl-i h�n..oi.f:..� C...-„4/1 cmnnn 10 04/08/2003 09:29 5085404003 RABESA/WARREN PAGE 07 Page 11 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1374 41kin Street sterville Barnstable,MA Owner: Ca Cod Academy.Inc Date of Inspection: March 0 2 03 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water is greater than 20 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: Checked with local excavators, installers-(attach documentation) X Accessed USGSdarabase-explain: use f U GS the C urve m s d water level co tours r vided th oa a a Cod om lesion, You must describe how you established the high ground water elevation: Grade to bottom of Icach pit is 13. Grade to bottom of cesspool is 8'3". From USGS survey maps, the elevation of this property is over 50'MSL,groundwater is 10'+/-MSL and possible high ground water rise is no more than 6'. Warren Cesspool Scrvice 508-540-7143 741...c n—4i1 cr)nnn I1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS �I25fdl DEPARTMENT OF ENVIRONMENTAL PROTECTION MAP � � Y or PARCEL, LOT TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1374 Main Street(Osterville) Barnstable,MA Owner's Name:Cape Cod Academy,Inc Owner's Address: PO Box 469 Osterville,MA 02655-0469 Date of Inspection: March 20,2003 RECEIVED Name of Inspector:Gary J and/or Jane E Rabesa MAR 2 4 2003 Company Name: Rabesa Subsurface,Inc dba Warren Cesspool Service Mailing Address: 72 Sandwich Rd East Falmouth,MA 02536-5602 TOWN OF BAR HEALTH DEPT. Telephone Number: 508-540-7143 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature Date: March 20,2003 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments Title V system in good condition. Barn served by single cesspool with no failure criteria. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 ' Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1374 Main Street(Osterville) Barnstable,MA Owner: Cave Cod Academy,Inc Date of Inspection: March 20,2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: YES X 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: B. System Conditionally Passes: NO 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 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: Warren Cesspool Service 508-540-7143 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1374 Main Street(Osterville) Barnstable,MA Owner: Cave Cod Academy,Inc Date of Inspection: March 20,2003 C. Further Evaluation is Required by the Board of Health: NO 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(l)(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. _ 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 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: s Warren Cesspool Service 508-540-7143 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1374 Main Street(Osterville) Barnstable,MA Owner: Cape Cod Academy,Inc Date of Inspection: March 20,2003 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow —X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X_ 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.] NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must serve a facility with a design flow of 10,000 ayd to 15,000 apd. 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"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. Warren Cesspool Service 508-540-7143 4 Page 5 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1374 Main Street(Osterville) Barnstable.MA Owner: Cape Cod Academy.Inc Date of Inspection: March 20,2003 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No x _ Pumping information was provided by the owner,occupant,or Board of Health x Were any of the system components pumped out in the previous two weeks? x Has the system received normal flows in the previous two week period? x Have large volumes of water been introduced to the system recently or as part of this inspection? x _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) x _ Was the facility or dwelling inspected for signs of sewage back up? x _ Was the site inspected for signs of break out? x _ Were all system components,including the SAS,located on site? x 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? x _ 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 SAS stem Absorption S on the site has been determined based on: P Y (SAS) Yes no x Existing information. For example,a plan at the Board of Health. x Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] - Warren Cesspool Service 508-540-7143 T,+1. 4 r•..—zii ciInnn 5 Page 6 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1374 Main Street(Osterville) Barnstable,MA Owner: Cave Cod Academy,Inc Date of Inspection: March 20,2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/d Number of bedrooms(actual):2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): n/d Number of current residents: none Does residence have a garbage grinder(yes or no): no Is laundry on a separate sewage system(yes or no): no [if yes separate inspection required] Laundry system inspected(yes or no): n/a Seasonal use:(yes or no): no Water meter readings,if available(last 2 years usage(gpd)):2002 averaged 33 gpd/2001 averaged 33 gpd Sump pump(yes or no): no Last date of occupancy:over 6 months COMMERCIAL/INDUSTRIAL: YES Type of establishment:Wool Shov Design flow(based on 310 CMR 15.203): n/d gpd Basis of design flow(seats/persons/sgft,etc.): 1719 sq ft of shop area Grease trap present(yes or no): no Industrial waste holding tank present(yes or no): no Non-sanitary waste discharged to the Title 5 system(yes or no): no Water meter readings,if available:see residential usage above Last date of occupancy/use:over six months OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:(agent)No known recent pumpings. 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 X Septic tank,distribution box,soil absorption system X Single cesspool _Overflow cesspool Privy _no_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: 1994 permit on file for shop's system. Barn's cesspool is probably pre 1970's. Were sewage odors detected when arriving at the site(yes or no): no Warren Cesspool Service 508-540-7143 'r;rto c G.._4i11zi,)Ann 6 - Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1374 Main Street(Osterville) Barnstable,MA Owner: Cave Cod Academy,Inc Date of Inspection: March 20,2003 BUILDING SEWER(locate on site plan) Depth below grade: 14" Materials of construction: x cast iron_40 PVC_other(explain): Distance from private water supply well or suction line:24"/20' from town water line Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: YES(locate on site plan) Depth below grade: to grade/14"(over 100"/86" risers) Material of construction:X concrete_metal_fiberglass_polyethylene—other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: standard H-10 1000 gallon septic tank Sludge depth: 10" Distance from top of sludge to bottom of outlet tee or baffle:23" Scum thickness: none 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:onsite 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 septic tank appears to be in good structural condition although it should be monitored because of the depth below grade. It should be on regular maintenance based on use. GREASE TRAP: NO(locate on site plan) Depth below grade:_ 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Warren Cesspool Service 508-540-7143 I Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1374 Main Street(Osterville) Barnstable,MA Owner: Cape Cod Academy,Inc Date of Inspection: March 20,2003 TIGHT or HOLDING TANK: NO(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: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: YES(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: none 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.): Viewed by remote camera,there was no failure criteria noted. It is about nine feet below grade with no risers. PUMP CHAMBER: NO(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.): Warren Cesspool Service 508-540-7143 Page 9 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1374 Main Street(Osterville) Barnstable,MA Owner: Cape Cod Academy,Inc Date of Inspection: March 20,2003 SOIL ABSORPTION SYSTEM(SAS): YES (locate on site plan,excavation not required) If SAS not located explain why: Type x leaching pits,number:one 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 4'deep by 6'wide precast H-20 leach pit had only six inches of liquid and no previous failure signs. The cover is 3"below grade over 8'of risers. part of ins ection locate on site plan) CESSPOOLS: YES(cesspool must be pumped as pa p )( p ) Number and configuration:one:one single cesspool for barn building Depth—top of liquid to inlet invert:------- Depth of solids layer: none Depth of scum layer: no scum Dimensions of cesspool:6'deep by 6'wide Materials of construction:concrete 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.):Dry at time of observation there were no previous failure signs. It appears to be in good structural condition. The cover is 3" below grade. PRIVY: NO(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.): Warren Cesspool Service 508-540-7143 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1374 Main Street(Osterville) Barnstable,MA Owner: Cape Cod Academy,Inc Date of Inspection: March 20,2003 SKETCH OF SEWAGE DISPOSAL SYSTEM NOT TO SCALE 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. 3 b, � A sewer' � P, Sl Rcf12 Sewu�' "a 5hbp o w Own Warren Cesspool Service 508-540-7143 Page l l of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1374 Main Street(Osterville) Barnstable,MA Owner: Cape Cod Academy,Inc Date of Inspection: March 20,2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water is greater than 20 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: Checked with local excavators,installers-(attach documentation) X Accessed USGS database-explain: use of USGS survey mans and water level contours provided through the Cave Cod Commission. You must describe how you established the high ground water elevation: Grade to bottom of leach pit is 13'. Grade to bottom of cesspool is 8'3". From USGS survey maps, the elevation of this property is over 50'MSL,groundwater is 10'+/-MSL and possible high ground water rise is no more than 6'. Warren Cesspool Service 508-540-7143 No. � 1 r r.'°, &)e SO THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYicaltion for Miopoml *potent Com9truction Vermait Application for a Permit to Construct( )Repair( )Upgrade(:/)Abandon( ) E Complete System El Individual Components Location Address or Lot No. 137�f M�611 S'V e 8r- Owner's Name,Address and Tel.No. C)S- ec-iAe- Ca1X Ccd, Assessor's Map/Parcel P 0.30 A,L1(09 III-00S oskf(-v; oz(.ss Installer's Name,Address,and Tel.No. Desiggner's Name,Address and Tel.No. Suilt�Gh Eny�hcenng .0, 13vx 05kerv�lk 0116ss- SD9-4Z8-1 4 Type of Building: C Se wT r-oz. wo°CSH�� Dwelling No.of Bedrooms 3 Lot Size Z.48 Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3-5Z. gallons per day. Calculated daily flow 3 3 gallons. Plan Date $ Z7103 Number of sheets I Revision Date Title -PrOP as,Cd ScAk_ 9p5rao(, Size of Septic Tank I SOO GA10"5 Type of S.A.S. Z-S06 G&. e-KmW-RS 1 N A- Description of Soil 0-114" A L,4y�r- LONMY SAA)b 10YR`I�`� 1ZxZ5' FlEcb 14-38" 3 Lid` L 1d1EP SAA1-0-Sohe NIJr& 10x V� 319-49" C 1 LA'16k Mtii� 5600 ZSy5/q 68�-IZ4`' CZ Lklts'2 Z.SY6.14 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and nyintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Envir n tal Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this oard ea . 4, Mg—me-a-, _ r Date Application Approve Date Application Disapproved for the following reasons Permit No. -N00..3 —`��"� Date Issued 4 0 T Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS i Yes PUBLIC HEALTH DIVISION - TOWN:OF BARNSTABLES MASSACHUSETTS ZIppfication for Miopogaf 6p!Ael m ConMruction,Permit Application for a Permit to Construct( )Repair( )Upgrade(,-,,)Abandon( ) Cco plete System f O Individual Components Location Address gr Lot No.13 , M4�rj Sj«e� Owner's Name,Address and Tel.No; Os ervAe_ 0-,p (.oz(. Rcmder 1 i Assessor's Map/Parcel 1?0.3e 9(pq f I19- 005 oskemlk, MA onss Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ` Sc1\tJav1 E� �nee���, - 0. 3iox t%5i `4 \j t l� g.� �,t USke, it k 016 oZ,&-S g- S' .$-LIZ 8'-1, c Type of Building: (CAe-:)e-W Fob `vVoa`e:Stior�'� Dwelling No.of Bedrooms :3 Lot Size Z.95 -sq.ft _ Garbage Grinder Other Type of Building No. of Persons Showers;( ) Cafeteria(" :-) Other Fixtures �v `" ✓� y Design Flow 33Z gallons per day. Calculated daily flow. r- 3 --tom gallons. -� Plan Date S/Z l 0 3 Number of sheets Title -@roe ast-o( Se6 iL Up! ru dP_ _.. Size of Septic Tank ISOO fAln� % Type of S.A.S. 2.-50d'GAt Unae KS IIJ'A iz:xZS` 1=1E�D Description of Soil 0-19" A LA`/tR� LC&MY -SANb 0191.13 ICI-353�� , LA4Ef_ Ot1ED, AKES. 10YR - -GR C( LA ER SAPZJ C Z.SYS/1 68-17_4" CZ LA`f1L2 75Y(y Nature of Repairs or Alterations(Answer when applicable) ti+ ifi 1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environm tal Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this oazd o ealth gne t' Date Application Approved�y Date $) U Application Disapproved for the following reasons { Permit No. ;;�00 3 '9- Date Issued Wd��''.'S `�✓ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTI�F_lY, that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded(- ) - Abandoned( )by at M41k) 5;TCIy9—i DSTeQ\)tL1.0 has been constructed in accordance with the provisions of Title and the for Disposal System Construction Permit No. goO - .2I dated Installer ` _-�^ Designer The issuance of this permit shall/notJ e-construed as a guarantee that the s ern i. 1�14 as designed. Date --------------------------_----- -- ---1— No. FeeSV THE COMMONWEALTH OF MASSACHUSETTS' PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migogar 6pelem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(✓)Abandon( ) System located at MCI V S-rKet_T . 0STEgWILL,G. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the 'are of this Date:_ 4 I��" � M APProv`by Massachusetts Department of Environmental Management Office of Water Resources 147136 TYPE OR PRINT ONLY Well Completion Repoli 1.WELL LOCATION GPS (OPTIONAL) LATITUDE 141' 2c.15 2Z LONGITUDE 0"10° _Ia.JTV DATUM Address at Well Location: EV S Property Owner/Client: Subdivision Name: Mailing Address: City/Town: 0 1S'�[e{4� L C ���4. 0 G.e l City/Town: Assessors Map �I q Assessors Lot#:00S NOTE: Assessors Map and Lot# mandatory i no street,addr ss.available Board of Health permit obtained: Yes q _4 l C� Not Required ❑ Permit-Number� ��aG�Date.lssusued 2.WORK PERFORMED 3. PROPOSED USE 4. DRILLING METHOD: L5 New Well ❑ Abandon ❑ Domestic ES Irrigation ❑ Cable /­�`°� _Auger ❑ Deepen ❑ Recondition ❑ Monitoring ❑ Municipal ❑ Air Hammer"^,,0' Direct Push ❑ Replace ❑ Other ❑ Industrial ❑ Other ❑ Mud<Rota ❑ Other 5.WELL LOG Water Unconsolidated Consolidated '6. SITE SKETCH(use permanent'randmarkswith:distances) Bearing > ® a a Other Rock Type and From (ft) To (ft) Zones U' (5 m Material Description Ir i � 4 , N\,' • ��: r 7. WELL CONSTRUCTION 8.CASING Total Depth Drilled -' '( From (ft), To (ft) Casing Typeaand Material Size•I.D. (in) Well Seal Type Date Complete SC } vxkL�A 9. SCREEN From (ft) To (ft) Slot Size Screen Type and Material Screen Diameter 10. FILTER PACK/GROUT/ABANDONMENT MATERIAL 11. ADDITIONAL WELL INFORMATION From (ft) To (ft) Material Description`-,. -a Purpose Developed? C.Yes ❑ No Fracture Enhancement? ❑ Yes C3,No Method Disinfected? ES Yes ❑ No 12.WELL TEST DATA(ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) 13. STATIC WATER LEVEL-(ALL WELLS) Yield,� Time Pumped Drawdown to Time to Recover Recovery to Depth Below Date Method (GPM)„-- `�16 s&min) (Ft. BGS) (hrs& min) (Ft. BGS) Date Measured Ground Surface (FT) ZIA 14. PERMANENT PUMP(IF AVAILABLE) 15.-NAMEIADDRESS OF PUMP INSTALLATION COMPANY Pump Description t?- 's• r�l .f O Horsepower l© LNes�" \Aen �, v Pump Intake Depth a (ft) Nominal Pump Capacity 10 (gpm) }( Lac W OZ63 16. COMMENTS _V '` ` 17.'WELL DRILLER'S STATEMENT This well was drilled altered, and/or abandoned under my supervision, according to applicable i } � rules and regulations, and this report is complete and correct to the best of my knowledge. Driller: i 7T Supervising Driller Signature. e- A /s.:rrn Lf Registration #: Firm:^ $ r. ? �''v F() ���,� ;'; X"" ,+'r Date: I-r S- t, i: Rig Permit#: NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion. BOARD OF HEALTH-COPY Kitchen 9.5 x 13.25 ,= 126.87 LR/DR 9.5 x 21.3 = 202.35 BDRM 11.5 x 19.5 = 205.25• Outlet Bath 8.0 x 9.5 — 76.00 ��,�� GFI Outlet Laundry 6.5 x 6.5 = 42.25 Q Ceiling Light /2' Closet space 9.5 x 2.0 _ 19.00 O Ceiling Fan = 6.5 x 2.5 16.25 . . Q Smoke Detector ' Halls 12.5 x 3.75 = 46.87 ! 3.0 x 5.5 — 16T50 ® Heat Sensor r Total Area 751.34 sq ft ® Phone Connection TO TV Connection J J G m � � L�P6R�t,pW9L 'iZiTG,Ht� S ' ! dF SirtKs.lLAv.•+t�'F t 77®GlASeT 3` r - 1 w6 r1 Le 7 ",7L-- iLactn�DIut.0G'AtLeALO L :,, .4iFs&0o,►+n, N , ; � 6P,sE $vr� •�EA� $taaE BaAao ;a� .i" . :I. �0 3 I - t 5'-4• 4 4 15•_,01• - 22 i 2846 2846 FULL 2846 2846 BATH All windows are Harvey DH U-factor 0,37 833.6 TOTAL NEW SQUARE �0 FOOTAGE ON SECOND FLOOR a00a — p BEDROOM #1 Cu carpet M N 233.2 SQ. FT.. BEDROOM #2 carpet 390.8 SQ. FT., 00 Cu access , STORAGE plywood - - - 16'-11�• _ _ access access to crawl to crawl space space 3/16=1' CAPE COD ACADEMY SECOND FLOOR M.L. C❑NSTRUCTI❑N CO, INC, 508-428-3380 Michael P, Leary pool- 3'-3 " 2846 00 2846 00 otal new square 2ootage on DINNING RQQM D First ft. 771.1 stor age e LAUNDRY .4cu carpet , Cuu 4 N yin t 144 SQ. T„ o —� I F o plywood FT9 SQ 59, . KITCHEN " 1 2 6 141,7 SQ,FT vinyl - _. 160.4 SQ. r, 'Lj -64" Ln Ll -TRU EW THERMA _ 262 H33 luornor _ Bedroom EXISTING T O vinyl LIVING ROOM 4 SQ. carpet 0 ,AFT., 286;1 SQ. FT:,,- � I 1 00 00 (1.1 Laundry m EXISTING BATH Living room/Dining Area EXISTING EXISTING Kitchen EXISTING 3/16=1 CAPE COD ACADEMY FIRST M.L.CONSTRUCTION.CO,INC. FLOOR 509-42e-3380 MICHAEL,LEARY N WNW • • • N will -1 .ems. 111111011101 0111 �+,. ���; ����� ��� '1.1�11111■illel■Ir111®�. 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'� "'�." 1 -pt•K �..x�ty7� ��': ^x RY,� t ..t - ". • It M' �, z.��:,t.:;\ c �'� ...,a•, ,� � �. v��� �..r>�. -�. t,,...t,e....Yi' ':' :•+� . .r't�:.l 't ! * ,sue �`�ti �r R. 1. s v- !y v F 4-a4"`'b.-.i.'�`'�64i;i.^",tUF'^+�+` "X „Y•� �:,� ���ri^ �`w"G.'...�..'. �'_ � .,'�'"., 4.'�'t _ L ..d 'Qt� • >. yam;,✓+. ` " 1 ,4 167, N h �r �ba 7 { �`' � 4.; '"5, " �m4o e•, 4 4dl ,4; n .a "nr may, 1 �; s �R mac,.�-�.. v-p, �l� wi hw "j�. a'� .��cy e r � ;�.' - �� ©" �rtis. t � !! Q s 'n,� �.r� 1a.n a„•' p w , A .�v. � _'• ," .'.. z� kq-:, -.�, .�.a• j ;..� .'.ems," ;r.Al1Tr Fr. �� N nrf.[c, e%.qL. ��y rs`+95� �3q o a•. .�+ .e. 'c� �-�� �A ,� _ _'" .. � mq.. 'att sir_ .tir '.y�.. �,Xit v��irl'9 v - :. .� i�ti7 � \,n•4 KS" �� ''4�r�Si,..d a�"�" ��.., tr .t ir �. ._ e try i�a ra[ y,.,�•',V,..��y �.'t,` �ONC MA o 1l 'fh., a 'u �" ft.,`�t.�i7 t •�. � c�, fk': w:c4 l5J ®o .may,' p p�'6prb; � ,!F-. �; .'•s�"�� '` '�',,(/�a. `o �� �' .,��•� �[s - `�� r , �pda ''�ttns .il h.,,, n '9 ,. ' n .� ar0 s 4.{•{1���, ,7ry _ �Fe ° a' �'tF. _ � ��'� ikF 7." � j +i�f ti� U it =\ ��`.� •S+� ���n��y�.. ;�� 'Ok �Ilk •�lLn6 r?P'° r.*R, q '` ,� •�;�`�"�". �_ ,r. �� � «. .rp.. •� 0 It r. L1S'I-P,�'vi ll� �1- = 1� 4-0 0� - 1V®Me Esther Herchenroeder ` PO Box 97 „per Marstons Mils MA �o�j M/4` 02648 � - � APR28 PM t @ , f �`o� (0 a� T3 5 } P r ai;o� -4 105t- V4AI &� t� r,2,3 and 4. ..se"RETURN TO'''space on the ore t0 do this will prevent this card from aturned to you.The return receipt fee will provide You the name of the person delivered to and the date of —• delivery. For additional fees the following services are C available. Consyljt postmaster for fees and check boxes) for service(s) requested. - r;� 00 1. Show to whom.date and address of delivery. w 2: ❑ Restricted Delivery. 3. Article Addressed to: ' Ms. Esther Herchenroeder Ms. Janice Upham 1374 Main St. Ostervillef Ma. 02655 4. Type of Service: Article Number Registered ❑ Insured Certified ❑ COD El ��� �/� O Express Mail Always obtain signature of addressee,or agent nd - DATE DELIVERED. O 5. i natu — Add ssee 3 X i y 6. Signature— Agent 5 X 33 7. Date of Delivery C 'f�JO Z S. Addressee's Address(ONLY if requested and fee paid m c>, rn v UNITED STATES POSTAL SERVICE'. OFFICIAL BUSINESS SENDER INSTRUCTIONS Print your name,address,and ZIP Code in the t eace below. Complete kerns L 2,8,and 4 on the reverse. e Attach to troll of article N space permits, PENALTY FOR PRIVATE M otherwise aft to back of ardele.- USE.sm e Endorse article"Ratum Receipt Requested" i adjacent to number. RETURN TOBOARD OF HEALTH O � STABLE T.�." ox M (No.and Street,Apt.,Suite,P.O.Box or A.P.No.) HYANNIS MA. - (City,State,and ZIP Code) P 522 462 803 RECEIPT FOR CERTIFIED MAIL NO INSURA*NCE COVERAGE PROVIDED .NOT FOR INTERNATIONAL MAIL (See Reverse) C. Ne Wool Shop C. SIrT W'fain St. P.O.,State and ZIP Code no lle 02655 6 Postage $ vi * Certified Fee 1 . 50 Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to whom and Date Delivered C4 Return receipt showing to whom, an Date,and Address of Delivery mTOTAL Postage and Fees $1 5 0 U. -7 6 Postmark or Date CD LL N a STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES.(see front) 1. If you want thA receipt postmarked,stick the gummed stub on the left portion of the address side of the article Iea,jng the receipt attached and present the article at a past office service window or hand it to your rural carrier. (no extra charge) 2. If you do not want this receipt postmarked,stick the gummed stub on the left portion of the address side of the article,date,detach and retain the receipt,and mail the article. R 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card, Form 3811,and attach it to the front of the article by means of the gummed ends if space permits.Otherwise,affix to back of article. Endorse front of artrle RETURN RECEIPT REOUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee, endorse }, RESTRICTED DELIVERY on the front of the article. d 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If return receipt is re- quested,check the applicable blocks in item 1 of Form 3811. d 6. Save this receipt and present it if you make inquiry. 9 d n February -6, 1985 Me•. .19s then•Herehenroeder Me. Janice ;Upham The, Wbol' .Shop, Inc.. _ 1374' ruin Street," Osterville.,. MA. '02655 . Res Your underground .fuel_ tank at 13,74"Main Street, Oeterville Dedr Me.. Herchenroeder and Me. Uphame On•April 18, 1983,, you notified .thatall: tanks twenty years .of age, or.o2der, must.-be.:tested annually _,for ea a. We have not rece-fted, any.• testing results 'from you ,for your tank which io 29 ryears old, arid..was, last tested on,Ottobe- r 7, 1943. If your "tan k' was- teated in 1984, .please send us a'topy",of. the teat result a., . Fai;ure' to have the-•,tank tested could"'result ,in a fine of not`;aore -than.. $200: Lach•eepaaoate day:s �fai�lure._Co. Comply with an order. -shall consxi tute'.A 'separete'-violation. -For your-Information, our`:.reviled .Health: Regulation to Prevent' Leak nk . ,of Underground Fuel and-Chemical' Storage Systems.'which •became effective' December 20, 1984 ' states that all. underground, fuel etorage' tanke and sYstems :30 years=of, age, or older, shall :be removed under, the 'direction of.,the Board of,11eal'th or the 'hire Chief. ' A.•copy of our� regulation ; - .Enclosed. �If you have Iany questions; please call us at 7754120', extension:'182. ' Very truly ours; Robert 'L• : C de, Chairman An J e hbaugh Grove eh D. BOARD' OF.HEALTR TOWN OF -BARN 9TABL8 Jt110MM encl: . l U TOWN OF BARNSTABLE D I UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME i \ - 0 CID� � 1(L D ADDRESS M k", VILLAGE LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL — 1 cl S(o (Give same information for any additional tanks on reverse side of card) i , DATE OF PURCHASE OF EACH: 1. `9 S 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: / PASSED DID NOT PASS l J August -1 ' 498.0 Managery .> The Wool -Shop, Inc. :x :1374•.Main •Street Ostery lle, Dear;Sire, f. Theinformation =you returned' to ids �ln_dica` ",the age o one of ` your underground fuel tanks` as `beinq twenty-gout years ,old: E h'You must have ,this,,tank` Ites.t, using the Kent-;Moore Pressur6. Test, ';by November ,20, 1`984 ' Flease:submit testing results "and . .- ` :their interpretation :.to4`this ;of'fice prior... to Novenber`20; 198.0 r Y. In` addition;, this .tank must>have 'thing ,test'.performed "annua2ly and the results` seat to'this office °' #.: For your convenience,. we havey unclosed a+l.isting.`of ;companies. " perform this testing. You" nay" also:,iatiiize any other'':concerns" qual'i€ied to perform this a testing Very trul .yours Jobh-•M Kelly­­-y Director 'of Pub lic.#HeaIth Ne encl.: a " T • � .. -, , ... .- - ... ;r. a ,; - � •y' t CERTIFICATION OF PRESSURE TEST DATE: ij _I L •/f TANK #: COMPANY NAME: / Za in ADDRESS: ut LENGTH OF TEST: 41-7.4 , METHOD• S. PRESSURE TESTED: " L _ ks CLEAN HARBORS, INC. Company Representative: / Al y s w 7tl N1 S o Ll, G O Daol Ado ass No.and Subot(s) Clry Sute Deb of Ten T From TANK TO TEST CAPACITY ` t L.tlq' r(Jl• Nominal Capacity L.t�r �i By most accurate / `T r• ❑� Station Chart Idmury or poeimn Gallons Engineering Data capacity Chan available ❑ Tank Manufacturer's Chan Canons ❑ 'y{_ / la there doubt as to True Capacity P ❑ t ❑er+nd etw tsae Seo Section"DETERMINING TANK CAPACITY" Charts supplied with TSTT . Sthm FILL-UP FOR TEST Suck Readings Total Gallons to K in. GaUans ea.Reflecting Slick Wear Bottom �before `r-- FlIE•up Inventory to V.in, Gallons e EIg up.STICK BEFORE AND AFTER EACH COMPARTMENT DROP OR EACH METERED DELIVERY QUANTITY Tank Diameter ✓/ 1 YA Product in fug tank(up to fill pipe) C�' SPECIAL CONDITIONS AND PROCEDURES TO TEST THIS TANK VAPOR RECOVERY SYSTEM See manual seciiom applicable.Cheek below and record Procedure in log 126). ❑ Water In fork ❑ High water battle In tank excavation U ❑Stage 1 ❑ rfa(s)being teased with WLLT ❑Stage U TEMPERATURE/VOLUME FACTOR(a)TO TEST THIS TANK (617)432.4216 IS TOdaY Warm(d?❑ Colder?E)_•F Product in Tank_•F Rllilp Product on Truck_•F Expected Change(.Or-1 The-naFSeetscr residing after circulation(r� F , 2 Narmw �. JIM'S PUMP&TANK SERVICE Digits pbr Fin range of expected change 9 2 3 FEATURING KENT•MOORE TESTING EQUIP. Acted quantity in gallons Coefficient of ei parrafon for volume Change in this tmrk •P.0.80K 224 fug Lot*(is or 17) Involved product por eF JIM CHASE HARWICH.MA 02645Thi�' I volume change per'F(24) OIgHs per•F n tom Volume Cha tow Is nge per digit. tam Range I-) Compute to 4 decimal piacae• factor(a) HYDROSTATIC LOG OF TEST PROCEDURES PRESSURE VOLUME NFASURFtiM M TENPERHURE COMPS 1011 NET VOLUME ACCUMULATED CONTROL RECORD 10.M1 6AL USE FACTOR Isl EACH READING CHANGE ShMDipe Leery DYE Record details of settingU in Inshee Prodon in Product Temsaru-e y 9I0 terd raeee p etsl6e Gnduets' R Chensa CempauGon AOjssimem . Tay Eas 0arecae and running test(Use full as sD 1-) Thermal High- (0•(a)- Rseiwiag L Ito Seas- "ums TIr1F IeOgth Of line it needed.) of hich Oelere A. Prodod Readmit Lomx—- ErPennioa« Esparuron(«)- Y leer tan/oeaDua _ IN-.1 Reading Reston. Resdias Reading pewrered(+l a I0 Coamttiae— Convection l-1 cho�+D-oar F 1 NJOMI-ND/(n (WR one LL4 Z, A,.it.0 t. �, 4 q , . �`r eeid 40 ." +. 010 1f 1`t?� j c�3ll }� y I N 6 r Auqust 19', 102 `Ms. 'Esther Herchenroeder Ms Jani•ae Upham . The,'Wool Shop - 1374 Mait •Street Osterville; `Ma. - Dear.Ms..` Herchenroeder':and Ms." Upham: Underground fuel tanks twenty. years. old :. that,have a capacity of over- SOO ga3 .tons, must be tested.,each;year. foi:'.leaks. Tha• Kent Moore .Pressure Test- is the preferred test; ,however, an empty tank can be'..tested'bi aa: 5'.PSI air pressure',_ test held for a �i.nimum..of two hours. The .air•,pressure test 'cah- only, be done, on an empty tank and-is not the preferred te$'.t ; Your 1.,'000 gallon. tank.is ,25 years,old,and�Was tested on February'; ,,:19 182 You are directed to have the tank tested by,:October 15, 1962, and' a copy of the results 'must be` sent, to ,the Health.Department. Failure 'to."have the tank'1 ested could result in `a 'fine of not more, than�.'$200. Each separate day's:.'fai.lure to comply with 'an` order shall constitute'a separate', violation. . We.'would appreciate -your coopearation -in this matt~it so..vital. to the water quality,of the town: 5 Please call-.if-you have any questions 182. Very truly yours PObe'rt L.'- Childs, Chairman Ann Lane EBhbaugh . } 177 Inge. M D BOARD`OF: HEAL F a r TOWN OF BAMSTABLE JMK/mm ; CERTIFICATION —OF PRESSURE TEST DATE: ` / 1 TANK C., COMPANY NAME: 1451, ADDRESS• zeal, �., LENGTH OF TEST; - MEN ra67 PRESSURE TESTED; CLEAN RAR.BORSO INC. Company Representative: April 21, , 1983 Ms. Esther Herchenroeder; . Ms. Janice Upham 1374:Main Street Osterville,,. MA. 02655 Re: .Underground Fuel-. Tanks. at 1374 Main St.,Osterville, leased by Johnny-Appleseed Dear 'Ms. Herchenroeder and Ms. Upham; You, are reminded that underground.-fuel tanks, twenty years:'of .age, , or older, that-have- a-capacity-of over 500 gallons. must be tested each year for .leaks.,. The Kent Moore..Pressure Test• is the preferred test; however,' an empty. ,tank can•,,baetested by. a 5 PSI Air Pressure Test held fora minimum-of. two hours, ' The air_ pressure .test _can only be done :on an empty tank and ••is not the preferred test. ",' Xour tank is twenty-six .years old and ;was tested on.Septeynber 7, 1982. -You- are directed .to again have the tank- tested by November i; 1983, and a copy. of the• results 'mus��be .sent to _this ,'office..by November. 1. -Failure to have -the .tank tested could result.; in A fine -of not tore than, $2a0.- Each separate .dayf's failure -to. comply.•with an' order shall' constitute a. separate..violation. We'would:appreciate your cooperation, 'im, this matter, so •vital to public safety and the Nater' quality oft he town. Please call if you have' any:questions: 775-1120, .e:;ctension. .182. . 'fiery rail yours, Ro t L. Childs,'. Chairman ,Ann JAqe. augt BOARD OF` HEAD . 'oLa rb46 eig all n a r or inc: OIL POLLUTION CONTROL/TANK FARM MAINTENANCE CERTIFICATION OF PRESSURE TEST . DATE : February 13 , 1985 TANK 1, 000 gal Dome Treating Vuel. Tank COMPANY NAME The Wool Shop ADDRESS : Osterville, MA LENGTH OF TEST : 4 hours 14 ` METHOD Nitrogen purge ' PRESSURE TESTED :. 5 pounds PSI CLEAN HARBORS , INC . Company 'Representative : 24 HR. SERVICE (24 HR. RI OFFICE' 617-585-5111 P.O. BOX 193 • KINGSTON,MA 02364 401-351-60%,':. *'SENdi"R: Complete items 1,2,3 and 4. Put your address in'the"RETURN TO"space on the 3 reverse"sidiei F�ilure to do this will prevent this card from W being retyrnedrto�ydu.The return receipt fee will provide you therrame of`h person delivered to and the date of deliver. Fo e d iggqqqqnaI fees the following services are e availab e.c nsulc stmaster for fees and check box(es.) Tor seryicel r ad. W r• I IS o hom,date and address of delivery. pp 2. ❑ ' iri Delivery. V 00 3 Ar cl'tfa.sn ressdd to- t I MI Ee'x Herchenroeder Ms.! TcelUpham Y 1314' Street Osterville, MA. 02655 4 Type of Service: Article Number ❑ Registered ❑ Insured ® Certified ❑ COD P 522 444 222 ❑ Express Mail Always obtain signature of addressee gr agent and DA"fE DELIVERED. O 5 Signature— Addressee O x 3 y 6. Sign ur��nt ' -3 x !�4� O >f 7. Da Ye of Delivery C =�7-c IM 8 Addressee's Address(ONLY if request d ee p—a M m n rn UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS SENDER INSTRUCTIONS �a Print your name,address,and ZIP Code In the u®fie® space below. • Complete items 1,Z,8,and 4 on the reverse. • Attach to front Of artlde if space permits, PENALTY FOR PRIVATE otherwise atlix to bade of amide. USE.SM) • Endorse article"Return Receipt Requested" adjacent to number. RETURN TOWI�4 OF BARNSTABLE TO HEAL'T i DEPARTMENT (Name of Sender) 367 MAIN STREET (No.and Street,Apt,Suite,P.O.Box or R.D.Nay.) HYANNIS, MA. 02601 (City,State,and ZIP Code) p7 fi 14 y P 522 444 222 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) sent to Ms. Esther Herchenroed r Ln __, Ms. Janice Uphnrn CD Street and No. C CO 1374 Main Street c P.O.,State and ZIP Code . 02655 Osterville, d C7 Postage $ y * Certifidd Fee 1.67 Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to whom and Date Delivered 01 Return receipt showing to whom, 10 Date,and Address of Delivery T mTOTAL Postage and Fees $ U. 1 1.67 Postmark.or Date e�+ E February 26, 1986 `o U. N IL s STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES.(see front) s 1. If you want this receipt postmarked,stick the gummed stub on the left portion of the address side of the article leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier. (no extra charge) 2. If you do not want this receipt postmarked,stick the gummed stub on the left portion of the address side of the article,date,detach and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card, Form 3811,and attach it to the front of the article by means of the gummed ends if space permits.Otherwise,affix to back of article. Endorse front of artile RETURN RECEIPT REQUESTED adjacent to the number. 4: If you want delivery restricted to the addressee, or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If return receipt is re- quested,check the applicable blocks in item 1 of Form 3811. 6. Save this receipt and present it if you make inquiry. w r' QpfTHE Tp`O TOWN OF BARNSTABLE OFFICE OF BAEASS L, M�eo : BOARD OF HEALTH . °0 1639' 367 MAIN STREET HYANNIS, MASS. 02601 February 26, 1986 Ms. Esther Herchenroeder Ms Janice Upham 1374 Main. Street Osterville, MA. 02655 Re: Your underground fuel tank at 1374 Main Street,' Osterville. Dear Ms. Herchenroeder and Ms. Upham: Our records indicate that your underground fuel tank is thirty years of age and has not been tested since February 13, 1985. The Board of Health Regulations require removal of all tanks thirty years of age, or older, under the direction of the Board of Health or the Fire Chief. -You are directed -to have this tank tested using- the Kent-Moore Pres sure Test by April 1, 1986 and removed by January 1, 1987. Please be advised that failure to comply with an order could result in a fine of not more than $200. Each separate day's failure to comply with an order shall constitute a separate violation. We would appreciate your cooperation in this matter so vital to the public safety and water quality of the town. Please call if you have any questions - 775-1120, extension 182. Very truly yours, h . Pe1 AZA 1y , irector of P lS is .Health JMK/ka �jl s I ' n ZONE: OWNER: / BA — Cape Cod Academy, Inc. ° ► ' , y, l I Area (min.) — N/A P.O. Box 469 i56 Osterville MA. 02655 6 r. m• ,. C. rt 1 cfl / Frontage (min) = 20' N Width (min) = N/A _ Setbacks: ASSESSORS REF.: Fron t = 20' Map 119, Parcel 005 - Side NIA N/A S4 Rear = OVERLAY DISTRICT. r � . . x' r; 00� 7� I DIRECTIONS: WP — Wellhead Protection District .� �S;r'� � �� j ,,r ` • �� ►:ri ro As Shown on Zoning Map Of TheM. " v. 9� From Hyannis — Take Route 28 Town Of Barnstable — last amended / towards Osterville; Take a left August 16, 2001. t ' i �� ' •�t' I onto Osterville West Barnstable Q• ' ° t 7 t� . . . `I Existin 2€ss cot To ee ,o. Road and follow to the end; Take 7p e ed r bondoned etc' a 2t .4 Y a left onto Main Street; Woolsho dl a t,e �° p FLOOD ZONE.. Pro sea is on the ,1• left #1374. Zone C Septic System Pt `PQ o - / Community Panel No, t0*' J,111ties TEST HOLE- 1 #250001 0016 D �t. Q ..i;�x,7. • r p • tin9 . P Pp / E"''ierl SPA BY:SULLIVAN ENGINEERING,INC. July 2, 1992 �+ } // -� t2 08/27/03 Location Mai3 25 I "= LAWN EL.55 1 2,000±' / A LAYER I OYR 4/3 BROWN 14" LOAMY SAND EL.53.8 / TH_t I B LAYER I OYR 4/6 BARK YELLOWISH BROWN 38 MED.SAND-SOME FINES EL.51.8 I I C I LAYER 2.5Y 5/4 Paved ON � \ " LIGHT OLIVE BROWN V@ —56 68" MED.SAND EL.49.3 C2 LAYER 2.5Y 6/4 I \ LIGHT YELLOWISH BROWN / 124" MED.SAND EL.44.7 NO GROUNDWATER ENCOUNTERED - C APPROX OROUNTWATER @ EL.B wool ShOD F F.O.BL 33 P.O.JUL." S." ,��F, - 330 Rule Calculation / 'pft arkinn n Existing Flow From Woolshop L 33 2,500 SF of Office=187.5 GPD (n Gj6• / _ e 2 Bedrooms=220 GPD / I lac Tank H-20 Total=407.5 GPD 1 Plow,Egoilian ...--..._..__ '. propose Flow From Cottage � �, 3 Bedrooms(Potential Development) =330 GPD Bedding a"T's irF.�..e.uavo...ag Total Flow For Lot=737.5 GPD— t� e eePerTiNes I ""owmebs.mw•ei.r.r . Total Lot Size=2.48 Acres(From Assessors) 56 ExistingSeptic System I m Tneo.e.P_�e�alksy\ f DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM 297.4 GPD/Acre<330 GPD/Acre(Project Complies) I NOT TO SCALE Pa T.O.B.Mq Lot Size: 2. 48 A cres h NOTES Design Data A 1.Water Supply For This Lot is Municipal Water. (Potential Developement) P.i.hQh 5 Single Family-3 Bedroom / — 2.Location of Utilities Shown on This Plan Are Approx. i — PB. With NO Garbage Grinder At Least 72 Hours Prior to Any Excavation For This Arai F•b Daily Flow=110 x 3=330 GPD Project the Contractor Shall Make the Required Septic Tank:330 GPD x 200%=660 GPD r �� Notification to Dig Safe(1-888-344-7233) Use 1500 Gallon H-20 Septic Tank 3.The Contractor is Required to Secure Appropriate 4$ w 3' Permits From Town Agencies For Construction Leaching Area 1 i LFACHINGDefined b This Plan. 330 GPD/0.74=446 SF Required ZIP 5D?.1�'a'F � r CHAMBER v4•-inn y n 4.Install Risers to Within 12 of ' Sidewall=2(12'+25')2=148 SF Finished Grade. Bottom Area=12'x 25'=300 SF a I 5.All Structures Buried Four Feet or More or Subject 448 SF Total Provided to Vehicular Traffic to be H-20 Loading. 'r 6. septic System to be Installed in Accordance With Leaching Chamber Design PLA N N VIEW CROSS SECTION CHAMBER 310 CMR 15.00 Latest Revision and the Town of /`I NOT TO SCALE Barnstable Board of Health Regulations. All Pipes to be Schedule 40. Use SCALE: 1" = 40' 2-500 Gal.Leaching Chambers in a 7.All Piping to be Sch.40 PVC. 12'x 25'Washed Stone Field as Shown. Title: PREPARED BY. PREPARED FOR: Notes: SITE PLAN Inc. 1.) The topographic information shown was PROPOSED SEPTIC UPGRADE Sullivan Engineering, Cope Cod Academy compiled from the Town of Barnstable G.I.S. zr AT PO Box 659 P. O. BOX 469 cu Osterville, MA 02655 1374 MAIN STREET Bomstoble (0sterville), Mass. (508)428-3344 (508)428-3115 fax Osterville, MA 02655 . O Draft: JOD Field: JOD 40 0 20 40 80 160 v August 27, 2003 AS NOTED Review: PS Comp/Draft: JOD Dote: Scale: Prof. # 98083 Drawing # ---- - - ---_. ---------- _ - - -