HomeMy WebLinkAbout0072 OAK RIDGE ROAD - Health -061
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Ak-
TOWN OF BARNSTABLE
LOCATION. �/ (��Jb// R/ b 6AC PC—' SEWAGE#d0 l or,
VILLAGE ASSESSOR'S^MAPP&PARCEL IVG�
INSTALLER'S NAME&PHONE NO. 'J ...2SUd�
SEPTIC TANK CAPACITY I SCUD
LEACHING FACILITY:(type) Q� (size)
NO.OF BEDROOMS 2—
OWNER-
PERMIT DATE: 3 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility Feet
FURNISHED BY
LG,17
101 A
1 �.
1 /66j
b offn,x
'577
� �
�5 c
C � ✓7 '
`'T ff 11
No. V Fee /
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01pplitatlon for Disposal *pstrm CoYCBtCUttion VPrmit
Application for a Permit to Construct( ) Repair(L) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Loot No. v �=�Zn f Oyv�er's Name,Address,and Tel.No.
A0 s�Flvlap//a4 Z a S� Z2� �� J �s��`�74,ly,6 iC/S7—
Inataller's Name,Address,and Tel.No. 6 63 -�7)7-�,t- Des erJ NaLpe,A�lress,and Tel No
rya �c E'S �G }v��/yam .� : AW.V, �I��J L.
1XIOnLi-r-r41�0
Type of Building:
Dwelling No.of Bedrooms Lot Size i' sq.ft. Garbage Grinder(—j
Other Type of Building No.of Persons i'" Showers( ) Cafeteria
Other Fixtures
Design Flow(min.required) gpd Design flow provided pd
Plan Date Number of sheets / Revision Date / 7 �.
Title S,�, F 7� ii ilk/ L,� / aTv t�f c4v_/ r•
Size of Septic Tank Type of S.A.S. � - S'P 6o L zc% � 2>2 CcJ :;64 s-.iAj",,fC_
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) T-A Z L ��tm ��`L d:' S 6#:)EZ'
r ( �
Date last inspected: r..
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code an�no place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date
Application Approved by Date _;k
Application Disapproved by Date
for the following reasons
Permit No. ' Date Issued
i k4.
Fee
THE!COMMONWEALTH OF MASSACHUSETTS Entered in computer:
y Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ftplitation for- Disposal *pstem Construction Permit
Application for a Permit to Construct( ) .Repair(LAgrade( ) Abandon( )x ❑Complete System ❑Individual Components
Location Address or Lot No. ' Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel 1 �%���
Installer's Name,Address,and Tel.No. " �(�g -�?,7�,Sp Desi. ers NaEie,,A&ess;and Tel.No.
�Y.c/�v y�hE'.a ��iN�'' �• °� , "Xtiv .
�d -
t Type of Building: `
Dwelling No.of Bedrooms �� Lot Size sq.ft. Garbage Grinder( -
h'\ Other Type of Building z o$ 6 jZ"F- No.of Persons ✓ Showers( ) Cafeteria
Other Fixtures
Design Flow(min.required) gpd Design flow provided d 1
Number o l( '
Plan `Date S � �/ 7 f sheets Revision Date v
I � dJ Title c .>!'�' .� �r_6E�"J.E� i � 4e f � P-
Size of Septic Tank /� � ype of S.A.S. - s� (fi L L61�z 1�2
Description of Soil r
Nature of Repairs or Alterations(Answer when applicable) /s � / �T C—A/,_,*A1
ey S07) L C
Date last inspected: /
tt Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and no place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date /
Application Approved bye Date
Application Disapproved by.: ' Date
r'
for the following reasons
t
Z
Permit No. Date Issued ~_2-
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( k< Upgraded( )
Abandoned( )by6 ;-�
at f 6f - has been constructed in accordance 0
with t�visions of Title 5 and the for Disposal System Construction Permit No Afl-O`-( dated
Installer ���f7�,t � C�/ �� esigner
#bedrooms Approved desi ow gpd
The issuance of this permit sh 1 not be nstrued as a guaran a thatXhe system ill function des'gn d.
-Date �XZ spector
----- a -------------R-------------------- - ------------------------------------------------------------ -----------
No. G I V Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION : BARNSTABLE,MASSACHUSETTS
MispoBal *pStem Construction Vermlt
Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( )
System located at � Ar z z)x-) 0 5 1 4422 l F
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.,
Date ?j`' � �I "" r � Approved by '
Town of Barnstable
Regulatory Services
Thomas F. Geiler, Director
MASS. ' Public Health Division
9�'Are1 u. 0� Thomas McKean, Director
200 Main Street, Hyannis,MA 02601
Office: �1_1
862 4644 Fax: 5 8-790-6304
Date: Sewage Permit# Assessor's Map/Parcel Cp
Installer&Designer Certification Form
Designer: ���� � Installer: � �
Address: �,I � � � Address:
On `'- ' was issued a permit to install a
(date) - (installer)
septic system at (�f 2 w b 4ased on a design drawn by
�An ( ddress)
W IV7 0- f�" 0( �?b dated 2r ,
(designer)
certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or sep .c tank. Stripout (if required) was inspected and the soils
were found satisfact�o 4 1,�, �.
� W(,
W.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local u '-rions. Plan revision or
certified as-built by designer to follow. Stripout (if r? cted and the soils
were found s isfactory. OF
b� DAgVID y
1?
(Installer's Signature) MASON �i
,9 No.1066 0 �;
n
Is P
esi er s Signature) 1 J
PLEASE RETURN TO BARNSTABLE PUBL�,
OF COMPLIANCE WILL NOT BE ISSUED UN i iL, isv i n inn r ORIVI AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
gAoffice fonns\designercertification fonn.doc
McKean, Thomas
From: McKean,Thomas
Sent: Monday,April 10, 2017 8:35 AM
To: Desmarais, Donald; Lavelle, Timothy; Malkus, Karen; McKenzie, Marybeth; Miorandi,
Donna; O'Connell,Timothy; Parziale,Jim; Stanton, David
Subject: 72 Oakridge Road
F.Y.I.
Somebody left a floor plan and an affidavit in my in-box regarding 72 O.akridge Road, with a sticky note indicating it's
from Adam Hostetter.
The affidavit is signed by Linda Jones claiming it was a three bedroom house 45 years ago. She also wrote in her
affidavit.the following: "it appears there was a remodel at some point and they combined two of the bedrooms into
one." The attached floor plan shows two bedrooms on the first floor, and a "bedroom or family room" in the
basement.
These documents will be placed into the file.
,
1
oakridge
Affadevit
March 15th 2017
Linda Jones
Harbour Ridge Yacht and Country Club
12600 Harbour Ridge Blvd
Palm City FL 34990
Dear Barnstable Board of Health,
My name is Linda Jones and I have spent a fair amount of time at 72 oakridge raod in Osterville over the years.
s
My sister and her husband lived there with his parents after getting married,over 45 years ago.The home was
always a
3 bedroom house. Dan Hostetter's parents were in one room,Dan and Priscilla were in another and their first child
Kristin was
in the 3rd. It appears there was a remodel at some point and they combined two of the bedrooms into one.
If you have any questions,please feel free to call me.
Sincerely,
Linda Jon
802-734-1576 '
I declare under penalty of perjury(under the laws of the United States of America)that the foregoing is true and
correct.
Page 1
._..._.., ----_._._._. _ _ ... _ -._. -.-..__, __._.-_,...- ___ _ __....
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oak2
Affadevit
March 22nd 2017
Dear Health Dept,
i
My name is Priscilla Hostetter and.this letter is to conform that 72 oakridge rd in Osterville was always a 3
bedroom home.
My husband grew up there and then we raised our first child Kristin there for the 1 year of her life,48 years ago.
If you have any questions, please dont hestitate to reach out. My cell is 508-648-7900.
Thank you,
Priscilla M. Hostetter
208 Oyster Way
Osterville Ma. 02655
I declare under penalty of perjury(under the laws of the United States of America)that the foregoing is true and
correct.
B
Page 1
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION
Date 2
A�A2
P `
Owner I•``0.L i to Tenant
Address O � ` Address
Complionce Remarks or
Regulation# Yes No Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities `
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents �V l
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Person(s) Interviewed Inspector
If Public Building such as Store or Hotel/Motel specify here
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Certified Mail#7003 1680 0004 5458 5446
BIKE Tpf,,� Town of Barnstable.
Regulatory Services
= UA[uvsrABM
M^ g Thomas F.jGeiler,Director
i6gq. �a
Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
August 31, 2007
Priscilla Hostetter r
770A Main Street % j S
Osterville, MA 02655 _
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.
r .
The property owned by you located at 72 Oak Ridge Road Osterville, was inspected
on August 28, 2007 by Tim 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 410.351 -Owner's Installation and Maintenance Responsibilities. Open
wiring on stairs leading into basement(i.e. switch box with hanging wires).
105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements.
Waste pipe under sink is leaking.
105 CMR 410.503A-Protective Railings and Walls. Lacking handrail on stairs
leading into basement as required by 780 CMR of the State Building Code.
You are directed to correct the violations listed above within thirty (30) days
of your receipt of this notice by pulling building permits if applicable; by installing
handrail leading into basement in accordance with 780 CMR Mass Building Code;
by installing face plate on light switch at top of stairs;by fixing all hanging wires in
stair well area of basement.
Q:\Order letters\Housing violations\Rental ordinance\72 Oakridge Road.doc
*Node: Lower apartment not to be occupied as dwelling space until requirements of
Building Department are adequately met.
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.
(:RE"RDER E OARD OF HEALTH
o7mas A. McKean, R.S., CHO
Director of Public Health
Town of Barnstable
Cc: Tim O'Connell, Health Inspector
QAOrder letterMousing violations\Rental ordinance\72 Oakridge Road.doc
Certified Mail#0000 0000 Woo 0000 oboo
r Town Of Barnstable
Ate.
Regulatory Services
sag i� Thomas F. Geiler, Director
Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
date
name
address
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.
The property owned by you located at 7 d 9.;-f,� was inspected
/ (Address) p
on / _ by ?U , Health Inspector for the Town
(date) (Inspector's name
of Barnstable,
(Reason for inspection)
The following violation(s) of the State Sanitary Code were observed:
State code violation number-viola 'on descri t' n'
105 CMR 41 .6031 _ &v--
105 CMR 410. 3
61,e_
Q:\Order letters\Housing violations\Rental ordinance\template.doc
U40 5 CMR 5�
a
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
n� (30 ) days..
p
of your receipt of this notice by Tim itten#) (#)
j
You may request a heanng b„fore the Board of Health if written petition requesting same
is =ved within to (10 days after the ate the der is s 'ved_.
Non-compliance will r ult in a
fine of $100.00 per violation. Each days 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
t FoRM30�C&w HOBBSB WARREN TM THE'COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE H
W
b r APARTMENT
60
ADD ESS
OA-K Pv?�
TELEPHONE
Address Occupan � c
Floor Apartmen o. No. of Occupa is `z-
No.of Habitable Rooms No.Sleeping Rooms_ � �_ -�
No.dwelling or rooming units ` No.Storie 1
Name and address of owner
�7
7 0 OATN emarks 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,Stairway: (a ®
Obst'n.: r
Hall, Floor,Wall,Ceilin : q(0 56-c,)
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen. Cond. Distrib. Box.-
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
—Pantry
Den
—1-11ving Room
Bedroom(1).. Lt
Bedroom 2 s
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Pen.,Gas, Oil, Elect.:
S cks, Flues,Ve Safeties:
Kitchen Facilities 6irik
ve
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin,Shower or Tub:.
Infestation Rats, Mice, Roaches or Other: _
Egress Dual and Obst'n: 0 = '
General Building Posted <
Locks on Doors: i
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 E T IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIER U '
I
INSPECTOR TITLE �
> � AM.
DATE 70 TIME
A.M.
THE NEXT SCHEDULED REINSPECTION Il 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 dangeFs 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 impairmentto health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable. '
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating,gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
�' to remedy said condition within the time so ordered by the Board of Health.
r,FORM30 CAW HOBBSBWARREN'M THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF ,TH
CITY/TOWN
W
PARTMENI
t r
g
ADDRESS
T LEPHONE
Address Occupan
Floor Apartment No. No.of Occupants
No. of Habitable Rooms --No.Sleeping Rooms
No.dwelling or rooming units No.St ,r, n
Name and address of owner "" -- � Y
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 0bst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Li htin : ,
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen.Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
—Pantry
Den
—Living Room
Bedroom 1 �•= 5�7 156
Bedroom 2 P
Bedroom 3
Bedroom 4 t
Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.:
S cks, Flues,Vents,Safeties.-
Kitchen Facilities A
e
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 INSPECTI0 ORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES O P RJ R ."
INSPECTOR_ 1 TITLE
DATE �` TIME r G M
A.M.
THE NEXT SCHEDULED REINSPECTION ` P.M.
„ AW
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(8)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)ar.d 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. �y
(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 CWR 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.
' TM THE COMMONWEALTH OF MASSACHUSETTS
,.FORM 30 �&W HOBBS 8 WARREN
BOARD OF H-A,UT
f CITY/TOWN
r W
DEPARTMENT e
ADDRESS -
4�M
T LEPHONE
�'
Address Occupant
Floor Apartment No. No. of Occupants
s No. of Habitable Rooms_No.Sleeping Rooms
No.dwelling or rooming units No.St,r es
Name and address of owner
Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage
I
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
} ❑ B ❑ F ❑ M Doors,Windows: lH. ..
Roof
Gutters, Drains:
s Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
s Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway: toe
Ob4in. ;
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
r ❑ MS LIST ❑ 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
G Bathroom
Pantry "
Den _.
Living Room „
Bedroom 1 _ , PAOk�) 7 Sa
Bedroom 2 (� I
Bedroom 3
4
Bedroom 4 i 1-7;1 TV—
Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.:
Stacks, Flues,Vents,Safeties:
Kitchen Facilities in mk-
�St�ve
Bathing,'Toilet FaciL Vent., Plumb.,Sanit'n.: % j
Wash Basin,Shower or Tub..
Infestation Rats, Mice, Roaches or Other: "
Egress Dual and Obst'n:
General Building Posted _
Locks on Doors: _
f ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
,i 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)
I "THIS INSPECTIO E ORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
S PENALTIES OF P RJ R ."
INSPECTOR TITLE r `�
/ A.M.
R DATE TIME � P•M �
THE NEXT SCHEDULED REINSPECTION T P.M.
1
q
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 violations pursuant to 105 CMR 410.830 h 410.833 nor shall failure to through P O P 9
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.
it 1 MR 41 .2 B 410.251 A 41 .2 and the lighting in m-
(D) Failure to provide the electrical facilities required by 05 C 0 50( ), ( ), 0 53 e g g 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). 0
(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.
l
}FORM 30 H&W HOBBS&WARREN'm THE COMMONWEALTH OF MASSACHUSETTS
<s; 4 BOARD OF —--
CITY/TOWN
a i DEPARTMENT
4,
ADDRESS
M yvey`o
TELEPHONE 1
Address 7 � — Occupant
Floor Apartment No. No.of Occupants
No.of Habitable Rooms _No.Sleeping Rooms
No.dwelling or rooming units r, No.Stories f —
Name and address of owner � '✓��� .
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 : W ,
STRUCTURE INT. Hall;,Stairway:
Obst�.n.
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows: j
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 11220 Fusing,Grnd.:
AMP: Gen.Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
—PantryR
Den _
Living Room
Bedroom MA (12,e 7 SCE
Bedroom 2 v G x (`` .. ._. f 1 1 r
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.:
Stacks, Flues,Vents,Safeties:
Kitchen Facilities 1118i,4
tS•to"ve w
�- Bathing;Toilet Facill. • Vent., Plumb,.,Sanit'n.: b
Wash Basin,Shower dr Tub:'
Infestation Rats, Mice, Roaches or Other: ' -Egress Dual and Obst'n: 7; {
General Building Posted. 0 1/), .4) s
1
Locks on Doors: Y
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 nTHE�PAINS AND
PENALTIES OF PWRA RY."
t
INSPECTOR TITLE
.,a..-.., a A.M.
DATE ' TIME _��
�•...._ 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,
( ) P 9 9 9 9 P P 9 9
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.
f
'xINE Town of Barnstable
{.?� T°� '
Regulatory Services
* snxxsrAst,e.
y MAss. $ Thomas F.Geiler,Director
�p .t639 �0
le 639 Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
June 18, 2007
Priscilla Hostetter
770A Main St.
Osterville, MA 02655
RE: EXIT ORDER 72 Oak Ridge Road, Osterville Map : 142 Parcel : 001
Dear Ms. Hostetter :
This letter shall serve as notice that the building department has become aware of a
building code violation at the above address. In accordance with 780 CMR 121.0 and T
780 CMR 3400.5 you are notified that the basement bedrooms are declared
dangerous and unsafe and their use must cease immediately. Additionally, the
building is located in a RC zoning district which allows for a single family dwelling only
and not a multiple family dwelling as was observed to be the case on site. The property
must be brought into compliance or be subject to criminal prosecution as provided for by
780 CMR 118.4. A building permit is required to bring the property into
compliance and must be applied for by July 5, 2007. You may call this office at(508)
862-4034 with any questions. Thank youfor your anticipated cooperation in this matter.
By Order,
ey L. Lauzon
Local Inspector
Q:zoning5
" pUI E loy, Town of Barnstable
Regulatory Services
yHARNSTABM
MASS. Thomas F.Geiler,Director
Fo;o•. Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
August 21, 2007
Priscilla Hostetter
770A Main St.
Osterville, MA 02655
RE: EXIT ORDER 72 Oak Ridge Road, Osterville Map : 142 Parcel : 001
Dear Ms. Hostetter :
This letter is to follow up on a letter sent by this office dated June 18, 2007 in which you
were directed to cease the use of a basement bedroom. To date, this office has received no
response and it was observed on a follow up inspection on July 26, 2007 that the violation .
still exists as the bedroom was in fact still being occupied. It is unfortunate that you have
chosen to be uncooperative and this office will proceed with criminal prosecution as
provided for by 780 CMR 118.4.
By Order,
*Jfr L. Lauzon
Local Inspector
Qzoning5
Town of Barnstable P#
b Department of Regulatory Services n _ 12
:
Public Health Division v$.�ma te
MAS9•. ,p. - - - .M R
6���6 200 Main Street;Hyannis MA 02601 ?
Date Scheduled Time. Fee Pd. r +
[ a77:
Soil Suitability Assessment for Se
' � e sp.osd
Performe WitessedB Uv
LOCATION & GENERAL INFORMATION
Location Address Owner's Name
• - u 1..�`J''G�C..����� j Address i �` �'y..�� "
' Assessor's Map/Parcel:. `L F1 Engineer's Name,T t �4 V�F Y
l 1 1 OV t
NEW CONSTRUCTION 'REPAIR �/ Telephone#
Land Use Slopes(%) Surface Stones '
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft 7
,
Drainage Way ft Property Line ft Other ft
SKETCH:(Street name;dimensions of lot;exact locations of test holes perc tests,locate wetlands in proximity to holes)
w aY t Y 4.
�n'a .:: y .-.^.mac ___ ,vim, - .�' ,. - ors } r -
. -�
10,
r Parent material(geologic) Depth to Bedrock r
Depth to Groundwater: Standing Water in Hole: + ' Weeping from Pit Face.
Estimated Seasonal High Groundwater
- DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: in.
Depth to soil mottles: in..
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.-
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level '
PERCOLATION TEST Date Time
Observation _
Hole# �� Time at 9". `
Depth of Perc Time at 6"
Start Pre-soak Time @ Time(9"-6")
End Pre-soak
Rate Min./Inch
Site Suitability Assessment: Site Passed- Site Failed: Additional Testing Needed(Y/AI)4
Original: Public Health Division, ' Observation Hole Data To Be Completed oti Back-------- --
° ***If percolation test is toconducted within 100' of wetland,you must first notify the
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
DEEP OBSERVATION HOLE LOG Hole#
Depth from i Soil Horizon Soil Texture Soil Color Soil _ Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
.» pp ,* Consistent %Gravel
C'
Hq
DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil _ Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
Consistency.%Graven_
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Text-are Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel) .
Flood Insurance Rate Map:
Above 500 year flood boundary No_ }fes
Within 500 year boundary No ✓- }res
Within 100 year flood boundary No_ Yes .
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring perv'o terial exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth f naturally occurring per4ous material? Vj
Certification m
I certify that on l' l G (date)I have passed the soil evaluator examination approved by the
Department of Enviro ental Protection and that the above analysis was performed by me consistent with
the required training,experti an Fie n e described in 310 CMR 15.01117.'
Signature Date Z ?PT
Q:\SEPTIC\PERCFORM.DOC
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ASSESSORS MAP: ��
TEST N{ALE LOGS 4�_
PARCEL: �=OC,�
__. _ --_.._ _._ 1 file installcttinn shall c�itn�I with "i'itle V as,� i,,R-t i +�luard of
t ) i "lid Town oiq�h,O . i -1
y SOIL EVALUAI OR : � 4 G I lealth Re ulations.
�, FLOOD ZONE: �� ��L/� ��� - �
___ _ W 17NESS : ► , 2 1'he installer sli,_.__ ) 'ill verify the location of utilities,sewer inverN and septic
REFERENCE: _^c1�__+✓ C . _ /rdG7T ' /� DATE• 43 L \ components prior to installation and setting; hale elevations.
PERCOLATION RATE: y All �r , ,
� h 1 3) A gravity seplsc piping to be 4 inch Sc.l� I{1 i VG at 1/8 lte,
per loot. The first
Y- ✓ two Icct out ol'Ihe d-box to the icaching shall be level.
-V 4C' T b � ' 4) This plan is not to be utilized Ior property line determination nor any other
H TH--- 2 -- purpose other than the proposed system installation.
5) All septic components must meet Title V specifications.
� ._1Ul` __. ��'" AN6) Parking shall not be constructed over II10 septic components. y
l _ F a
,/ 7) The property is bounded by property corners and property lines.
4t7____ __,� ✓ µ� _ - - -f __ . H The property owner sliall review design considerations to approve of total
' O _ / 'l� ► .i�t.' design flow and number of bedrooms to he considered for design. Receipt
LOGAT 10N MAP � t �` � g �eipt
_ ! 2- _'��l.t� _ `%E1fL0ovtit�j -. N�1 ►1n� �t ,J�ct- of payment For the plan and installation haled on the plan shall be deemed
1 approval of the design flow by the owner.
t. 1 M(12,1 9) The exis(ing leaching or cesspools shall be pumped and filled with material
per Title V abandonment procedures. Those within the proposed SAS shall
0 be removed along with contaminated soil and replaced with clean sand per
t(�� U�1 Title V specs.
10)System components to be 10 feet from water line. Sewer lines crossing (lie
water lint; shall be sleeved with 4 inch SCI140 PVC with ends groiited it'
applicable. The proposed SAS is being installed below the water service
line. The line is to be sleeved as af`oreinit)iioned and maintained in place.
SEPTIC SYSTEM DES ( GN
W t 1) lfa garbage grinder exists it is to be removed and is file responsibility of the
1N
owner to ensure such.
FLOW EST I MATE 1?)The installer is to take caution in excavation around the gas line if such
exists.
_ ____ �-- ^�, �� /���� )E DROOMS AT �� GAL/DAY/BEDROOM - GAL/DAY 13)1.'ne installer shci-II verify the location,quantify curd elevation of the sewer
`lt� ( I lines exitin+j the It
prior to (lie installation.
�' � - - - — -- 14)This plan is representative only tliat a system can tit on a property ineeting
---- .__--- --__-_ ( SEPTIC ANK—�_
_�� --------�" ` --- 1� 'Title V requirements.
X / ,��Ai Ii 'COAL/DAY x 2 DAYS - `f GAL
USE�tZ0 GALLON SEPTIC TANK
10� SOIL hBSORPTION SYSTEM�� .: I
SIDE AREA: �.r.!r{- 2: i X 7i bit r z DAVID s4�
- BOTTOM AREA: 17 . {�,� t� s
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SEPTIC SYSTEM STEM SECTION
.fi, _ � .�__ _ 10Kw ter
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C� GAL �j�•r7 -�!��-� - , /
SEPTIC TANK
k1 �!'I. `—p �►� / � � ��' _� ti-_7?OV$_L'G�'�'_t✓l�t•� y�7nr{�
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3 ► ,v vczr__ i. _ �, . �� .. _ +5 1 SITE AND SEWAGE PLAN
0
of
LOCAT I oN : 41Z ow_ lzl �, ebl�D
1R ;> , 1 l_I t,U O �`� �, ! `t _!L�� f�Q _L)t4V ".-V) 1. Q dor,; ) uC _ )41
t 4 'ram k
o �� ���170
PREPARED FOR :
.. VUtaj ' "41_ p: f e U+�o Acuuit �'�l
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P�AP�� f IV ID CMA I)A i L ICO _ C)nC E;NV I RONMEN AL DESIGNS
DATE HEALTH AGENT
:AST SANDWICH . MA
� ( 504 ) 833- 2 177
ASSESSORS MAP : � z
e ---/- - ------ -- TEST HOLE LOGS
� PARCEL :
!) The installation shall eornp� with Title V and Town o Woard of
SO I L EVALUATOR : �1y1 I lealth Regulations.
FLOOD ZONE: �� � L�G� a g
_ __._. _. .._ WITNESS : 2) The installer shall verify the location of utilities, sewer inverts and septic
REFERENCE: _a1 _ C.L ,Oq� -_.__ _ 2
I l� � ___ .._�_ DATE: `°•L \ components prior to installation and setting base elevations.
3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first
PERCOLATION RATE: � r
9 1 g Y p p P g I �.
"C -�
Ev. b M V/ two feet out of the d-box to the ie��cl�ing shall be level.
4) This plan is not to be utilized for property line determination nor any other
� TH- I � 6 ,Ob TH-2
purpose other than the proposed system installation.
5) All septic components must meet Title V specifications.
"' 1�\ 6) Parking :,hall not be constructed over 1110 septic components.
-
7) The property is bounded by property corners and property lines.
8) The property owner shall review design considerations to approve of total
LOCATION ON MAP � � 1 yl- / - --- �,� T1� -11 design flow and number of bedrooms to be considered for design. Receipt
L t C� g P
�19L1� of payment For the plan and installation based on the plan shall he deemed
w_(� 2 \ CSC �_ approval of the design flow by the owner.
0-1�.i 9) The existing leaching or cesspools shall be pumped and filled with material
`�
per Title V abandonment procedures. Those within the proposed SAS shall
4 `l O be removed along with contaminated soil and replaced with clean sand per
� 2 vv a1j•� (�Q�tQ Title V specs.
1 \ 10)System components to be 10 feet from water line. Sewer lines crossing the
water line shall be sleeved with 4 inch SC1140 PVC with ends grouted if
- — applicable. The proposed SAS is being installed below the water service
line. The line is to be sleeved as aforementioned and maintained in place.
SEPT IC SYSTEM DES I GN 11) If a garbage grinder exists it is to be removed and is the responsibility of the
owner to ensure such.
FLOW ESTIMATE 12)The installer is to take caution in excavation around the gas line if such
exists.
3EDROOMS AT �D GAL/DAY/BEDROOM GAL/DAY 13)Tne installer shall verify the location, quantity and elevation of the sewer
J ��---�— I 4�7W'� � I 2� ` lines exiting the dwelling brior to the installation.
- �� -
---- ---- - 'Co I SEPTIC TANK — 14)This plan is representative only that a system can fit on a property meeting
1I "Title V requirements.
7i�_CiAL/DAY x 2 DAYS - `fk GAL
01
1 USE IC TANK
\
O Sol
I LSORT I ON SYSTEM
�ri�0 F I i �OtI4�
�- DAVIDSIDE AREA: 2, X X b�
o B `
J BOTTOM AREA,: 7r �,( �.7 C�,�) ,+ ?�� ",.ASOPi
_....cow_. ,p {Vo. 1066
—
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S E P T C SYSTEM SECTION
GAL 3�•rl � - �'�� 0 Z,
SEPTIC TANK o °
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r��—U --� 21_ SITE AND SEWAGE PLAN
LOCATION : AA
.�' ''Co qq 00 ->b LV4W� \P X
-
t -5 - -- - ----- Fbetp Vt p PREPARED FOR : —
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v4f, I�q W L*M AL
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2 � N P� ► C � - Ic _: �� I)AV1D B , MASONRb l)AILIZ 13 0
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W
IT (Z ._ _ _-- _ 1 --I��� - "IE� - DQC ENV I R0NMENIiAL DESIGNS
W VJ, 12 �� EAST SANDWICH MA
-_-__ _ _. ----- ----_ �___-__� I � _ DATE HEALTH AGENT SO Z ( 8 ) 833- 2177
�1 _��, _-