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HomeMy WebLinkAbout0100 OAKVILLE AVENUE - Health 100 OAKVILLE AVENU�C OSTERVILLE A = 143 008 0 00 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments W Y 100 Oakville Ave Main House Property Address r- Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 51 on the computer, use only the tab Chad Hathaway key to move your Name of Inspector cursor-do not Hathaway Septic Inspections use the return Company Name key. P.O.Box 151 r� Company Address Forestdale Ma 02644 Cityrrown State Zip Code 774 274 2581 12866 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Z':' 6ner11/26/2020 ecto (gnat Date The systerf� inspector shall submit a c of is inspection report to the Approving Authority(Board of Health or DEP)within 30 days of mplef g this inspection. If the system has a design flow of 10,000 gpd or greater, the inspe rand system owner shall submit the report to the appropriate regional office of the DEP. Th origin I-form should be sent to the system owner and copies sent to the buyer, if applicable, and a-a proving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts r= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �a 100 Oakville Ave Main House Property Address Diggs Owner Owner's Name information is required for every Osteryllle Ma 02655 11/26/2020 page. Citylrown State Zip Code Date of Inspection C. Inspection- Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This inspection is not a guaranteeand applies no warrantyof the described septic components in this report including but not limited to piping structual intergrity of components and life exspectancy of leaching and described components. This inspection is to describe conditions witnessed at time of inspection only. Regular tank maintenance and water conservation can prolong life of septic systems Information on care and do's and-don't's can be found at town health dept or mass. ov 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)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. ❑ Y ❑ N ❑ ND (Explain below): E t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Oakville Ave Main House Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary- (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ® Y ❑ N ❑ ND(Explain below): ❑ 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, ' safety and the environment: l5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Oakville Ave Malin House Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis-must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 100 Oakville Ave Main House Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large'systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Oakville Ave Main House Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the.system received normal.flows in the previous.two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/2 6120 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 f Commonwealth of Massachusetts r= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Oakville Ave Main House Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Cityrrown State Zip Code Date of Inspection D. System- Information 1. Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: currentDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Oakville Ave Main House Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste.holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: pumped 3 years ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Oakville Ave Main House Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2000 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1.5' feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: 20+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): none t5insp.doc-rev.7,/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 100 Oakville Ave Main House Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1500 gal If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No .Dimensions: 1500 gal Sludge depth: 811 Distance from top of sludge to bottom of outlet tee or baffle 22" Scum thickness 3., Distance from top of scum to top of outlet tee or baffle 31' Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? tape and sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 2 inlet tees and 1 outlet tee. tank in good cond. recommend pumping for maintenance I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Oakville Ave Main House Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: P feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top scum of to to of I P. outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: i Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Oakville Ave Main House Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Citylrown State Zip Code . Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank cont. 9 9 (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Dbox in good condition. no carry overs no major decay l5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 f Commonwealth of Massachusetts - ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Oakville Ave Main House Property Address Diggs Owner Owner's Name information is required for every OsteNille Ma 02655 11/26/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 4x 500 gal L.0 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 I Commonwealth of Massachusetts r= (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Oakville Ave Main House Property Address Diggs Owner Owner's Name. information is required for every Osterville Ma 02655 11/26/2020 page. Cityrrown State Zip Code Date of Inspection D. System. Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): leaching camera inspected through Dbox Chambers dry clean sidewalls in good cond. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Oakville Ave Main House Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,v 100 Oakville Ave Main House Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately M1 COIL ) cc k y � _ 131 R3 E3 , A"-, -�� t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments u� 100 Oakville Ave Main House Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 20+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: lot slopes steep to pond. estimated 20' enbankment to pond. bottom of SAS 5' below grade Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 100 Oakville Ave Main House Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 009 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments V � 100 Oakville Ave unit 5 Duplex I Property Address. Diggs Owner Owner's Name . information is required for every Osterville Ma 02655 11/26/2020 '' page. Cityrrown State Zip Code Date of Inspection ` Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information- filling out forms :5.1 ( 15 h V� 4— on the computer, use only the tab Chad Hathaway key to move your Name of Inspector cursor-do not Hathaway Septic Inspections use the return key. Company Name P.O.Box 151 Q Company Address Forestdale Ma 02644 City/Town State Zip Code 774 274 2581 12866 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was,performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 11/26/2020 spec Signa ure Date The system inspector shall sub ' a copy of his inspection report to the Approving Authority (Board of Health or DEP)within 30 ys of comp) in this inspection. If the system has a design flow of 10,000 gpd or greater,th nspector and the system owner shall submit the report to the appropriate regional office of the DE . Th ,original form should be sent to the system owner and copies sent-to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Oakville Ave unit 5 Duplex Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This inspection is not a guaranteeand applies no warrantyof the described septic components in this report including but not limited to piping structual intergrity of components and life exspectancy of leaching and described components. This inspection is to describe conditions witnessed at time of inspection only. Regular tank maintenance and water conservation can prolong life of septic systems Information on care and do's and don't's can be found at town health dept or mass.gov 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)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. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 f y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Oakville Ave unit 5 Duplex Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled.or replaced ® Y ❑ N ❑ ND(Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form �e Subsurface Sewage Disposal System.Form-Not for Voluntary Assessments 100 Oakville Ave unit 5 Duplex Property Address Diggs Owner Owners Name information is required for every Osterville Ma 02655 11/26/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate.nitrogen is equal to or less than 5 ppm; provided that no other failure criteria are triggered. A copy of the analysis_must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc.rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Oakville Ave unit 5 Duplex Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Oakville Ave unit 5 Duplex Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows.in the.previous.two.week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments d 100 Oakville Ave unit 5 Duplex Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Cityrrown State Zip Code Date of Inspection D. System- Information 1. Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: currentDate t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Oakville Ave unit 5 Duplex Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding.tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: none Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 f Commonwealth of Massachusetts - Title 5 Official Inspection Fora' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Oakville Ave unit 5 Duplex Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. City/Town State Zip Code Date of Inspection D. System- Information (cont.) 4. Type of System: Y ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1990S Were sewage odors detected when arriving at the site? Yes No 9 g ❑ 5. Building Sewer(locate on site plan): Depth below grade: 30"feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20'+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): none l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Oakville Ave unit 5 Duplex Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2'feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) 1500 gal H10 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'6"x5'6" Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 18,E Scum thickness 611 Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? tape and sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tees in place tank at working level no Visable decay or cracks.tank is due for cleaning t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Oakville Ave unit 5 Duplex Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plane): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts !� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Oakville Ave unit 5 Duplex Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ' Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): no Dbox t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Oakville Ave unit 5 Duplex Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working orders stem is a conditional ass. P P ,9 Y P 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts to Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments �a 100 Oakville Ave unit 5 Duplex Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Citylfown State Zip Code Date of Inspection D. System. Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 6'tall precast pit 112 full with clean sidewalls over current level. camera inspected from outlet of tank. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �. 100 Oakville Ave unit 5 Duplex Property Address Diggs Owner Owner's Name information.is required for every Osterville Ma 02655 11/26/2020 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;u 100 Oakville Ave unit 5 Duplex Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area bellow ❑ drawing attached separately A'7 /s SO4 I -30, U t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �a w� 100 Oakville Ave unit 5 Duplex Property Address Diggs Owner Owner's Name information is required for every Osterville Ma 02655 11/26/2020 page. CitylT'own State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 26+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: sloping land to low line area pond. estimated bottom of SAS below grade 10' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Oakville Ave unit 5 Duplex Property Address Diggs Owner Owner's Name information.is required for every Osterville Ma 02655 11/26/2020 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked Z C. Inspection Summary: p ry 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 f Fad As caz 12e vcs.Oj } 4`3- a MEMNON ■■ ■■ ■■■■■■■■■■ ■ ��" „ ■ ■■ ■■i ■ ■ ■ ■■■■Nommom MOONS No■■■■ "`'�■ ■ ■Lim ■E ■■■■ ■ i ■■■■■■■■ ■ ■/ ,. r�i! ■■■■ ■ No 'NOON ■ . ■ No E■' ■ ► NOON ! -- ! � ■ ■■ NOON ■® ■ NONE■■ ■ _ ■ ,� ■■ NOON _ ■ ■■■■■■■■ ■■ i ■■ ■ ■■■■� � � NOON mom ■ NOON No ■■� Obi■�■� ■■■�■■��i "�i■■■ ■ ■■ ■ ■ � �■ NONE■ ■ ■■ ■ ■ ■ � � — � I � ' ( 1 i � � � I I � ' i i I 1 � I � --- i I i .�; -- ` j i I ' I I i I i i - ! _T, I j I I _� ! i ! 1___�_-_ I I � � � � � I i_j � I I I ��__ I I I i i I �_I� �—�'— I i I I � I I r � I I � -j. i �� � � I ! 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( � �- i j i i i � I ; � �� � i � f r �� � � --r � - ' I � � I � I I � i -�- � i I � � � I i I i I i I � I I I I i I -- 1--�--�- i �t,_ � � � � � � � � I � � I � � � i i I I I � ` � I ' i-�-- f f_ DIME r* Town of Barnstable o� i snMsrns Department of Health, Safety, and Environmental Services ' A,O� Public Health Division P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health RECORD OF VERBAL COMMUNICATION ja V dd lcv L � c�� Y'f.e_. _a�-emu-, Gam,- -► �- ,1� oL., Ste•e. l �- w i�(etL rC (T An.�.�� J7 Oy�0v4� Cr�a4� 0-4 11,7/ , Z7 �,�►•�n/Y r ® �3e/��E' �„;-u�/i_.�.�e. p� �.� �- IZd Can !� 0— (T'���-�G/�,fi�/C✓fl`�� �r/0 �7�IYJ ,/ At—Lt•.i�L' dy r���-✓ ���a-� ev La-, el Ate- L,-1o, f 0 J-eZ '^,�Ow• ,��cvr �� d4i C41J iJ d- dl -tcl� ��,1�J a,-,d 4< cv d- &'L� -d r "oe- G. -t!2, c'V-ct . he k-0dTT--;"�Rn,oe_ &f 4, verbcomm.doc TOWN OF BARNSTABLE LOC2 TION MAW Oka SEWAGE # VILLAGE cU 5?"{�1 �G?� ASSESSORS MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY c LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER U✓1�� PERMITDATE: COMPLIANCE DATE: Separation Distance Between,the: Maximum Adjusted Groundwater Table and 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 . n �� j� ., .� f �� i `�. ., � `� � � �_�. :.� + A � ,. 'Pa- .e.� .. .. "I TOWN OF BARNSTABLE LOs k'n0N;;"l`00 ��¢,� 1 z1112 V SEWAGE # VULAGEr1,::7 V lI/= ASSESSO/R'S MAP &`LOT/ 95 -0 0 $ INSTALLER'S NAME&PHONE NO. y 77--0 3'Y 9 SEPTIC TANK CAPACITY '1`S'00 LEACHING FACILITY: (type) �Z— 00 601 F/ru (size) .�� x•a l.3 k NO.OF BEDROOMS ` BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: /0 —/— O/ Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (lf any wells exist on site or within 200 feet of leachinglacility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 306 feet of leaching-facility). Feet Furnished by ��� �'1�'���D x, f ;E . . ; ,. ` � . , . . .� �rec�� . o; ;� 1� a ,, �. _ �� m .. i ,. -. No. r �. Fee�� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS 01ppYication for 33igogar *pgtem Congtruction Permit Application for a Permit to Construct('Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /00 Owk—Vl /_ 14 VL' Owner's Name,Address and Tel.No. D9i Br✓i//i_ c�oE O�yQs Assessor's Map/Parcel 0 _ � Installer's Name,Address,and Tel.No. e171-03 4'7y Designer's Name,Address and Tel.No. /2 !/ Xs,,W-c Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder 00 Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank .1-s Description of Soil Nature of Repairs or Alterations(Answer when applicable) 2HrZ-1,111 A5'00 Akly . D✓� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is ued by this Board of Health. Signed Date — —DD Application Approved by - Date Z Application Disapproved for the following reasons Permit No. o�C`Y�b" S Date Issued nat 9—?,:(O—C)or� No._Z_WV r Z S - u' Fee g. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1.!ff • Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS /ww/�y if yh-L , L TY` ` , "r . ig %P �( ptent �on�tructior� erntit Application for a Permit.to Construct('Repair( ) Q)k6 Ion( ) O Complete System ❑Individual Components Location Address or Lot No. /dD QMk'V/Y//_ 14 VL: Owner's Name,Address and Tel.No. Osr�r✓��/,a Joy' O'9'Qs Assessor's Map/Parcel 3 _ 00 d o O ' /1 1 - osn lll,4. Installer's Name,Address,ani Tel.No. yy 7-C7 Designer Name,Address and Tel.No. Jost P� Vz (3,wvrvS ✓p3��h /�� /.� 0 5 �� Type of Building: Dwelling No.of Bedrooms _ Lot Size 1�4 sq.ft. Garbage Grinder 00 I Other Type of Building No.of Per Showers(Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day.-Calculated daily Eow gallons. Plan Date Number of sheets Revision Date Title ltl Size of Septic Tank C) Type of S.A.S. ,`/ ) '(DQ:)C-. Description of Soil , �a"fZ Nature of Repairs or Alterations(Answer when applicable) 9 s"Tlsr/ i fD0 6.1 s,r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance°rwith the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed Date y- 26-vo Application Approved by Date rf--'Z 6—ZVVO Application Disapproved for the following reasons Permit No. C�� _ `� Date Issued -2(c,-()( THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS -� (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( -Repaired( )Upgraded( ) Abandoned( )by ./�, ,,n� 12,t �z&4a —42 s at �Do 0,ok lVdl,_ 4)/� Q,�rf'y lip/l= has b n constructed in accordance with the pro isions of Title 5 and the for Disposal System Construction Permit No. "Zo4-m-Z�e dated Z� 710,W . Installer e lew Ge , S' Designer .16S464 ZZ rs Z-� The issuance of this permit shall not be construed as a guarantee that the system will:function as designed. Date w)-- Inspector s 1_& i a,4, --------------------------------------- No. Fee I THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lgioogaf Opgtem (Con!6truction Permit Permission is hereby granted to Construct(vpRepair( )Upgrade( )Abandon�: ) System located at a,A 1) �&/C✓,z&-aVc 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 ust be completed within three years of the date of this permit. Date: � ZG/?c3� Approved by 1/6/99 NOTICE: 'This Form Is To Be Used For the Repair Of Failed .Septic Systems Only. CERTMCATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, s-z:w, !,•����N4!.5 , hereby certify that the application for disposal works construction permit signed by me dated ov concerning the property located at /®D t,9-VJ--kly,/�= �►/� ���,E-�Vi,�� meets all of the following criteria: 1i'Elie failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. XI�The soil is cl.tssi5ed as CLASSiLand the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system p�There is no increase iri flow and/or change in use proposed �• There are an aariances requested or needed • The bottom of the proposed leaching facility will MLbe located less than five feet above the maximum a usted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] /1"'Lf the S.A.S. tall be located with 250 feet of anyvegetated ands, the bottom of the leaching facU:y will DZ be located less than fourteen(1)feet tlabove the maximum ad just did groundwater table elevation, Please complete the following: A) Top 01'Ground Surface EIevation(using GIS information) or B) G.W. ].1evation +the MAX. High G.W. Adjustment . — 14' _- D1ERiZIC'E BETWEEN A and B SIGNED : Propos,'c plan of DATE: 2C- oU Sketch � . q:health folder;CM system on back], jig rI 4 I' I 41��IT EIEvATION MAX EI E VATION - �4Jui34t� 1- MOON Aq got. I Om 4 i ;x: F ���vvrr,ti@uu4 .ram-,- s.. x ,.�.. �-• - ,. �y--•r t .`600�7e'61�k r` >�:,,•y s .'.�:, `. `.r ':, •._ :.., ,r„ . ;'.,; _ ix^``i.. ,,t`"4d�',r�'� ttr :. �. 'fi;: OEM* W ins -3't� #!.s .'t �5 ,,+�.Fr",-.�4J'F"'S.-?`�-';•�-r'----- ,a.,.. .F�:Y2`::. .i:.`' .s•{ ?t. .A .. - 'c: .',' •,T J fad..�>. rc r moon? 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' i.a.CTl1Nr,V _ w-4C mo 6,LaTanaa I -an•raC Krwma I' ' .Op wvia 9 1DOt.99 _ r_ soa•asa•ewi s % % ` V.+ 5 HOUSE 5� lvo cs 0 . co 0 i FORM30 Caw HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (fig f r-4,10 CITY/TOWN o DEPARTMENT 'o ADDRESS r- TELEPHONE Address 571" 0c.t<yij)e ��JdS `=��itOccupant i /+V-t. Floor Apartmentj\lo. No. of Occupants No.of Habitable Rooms �r�� No.Sleeping Rooms No.dwelling or rooming units No.Stories__ Name a�n� d address of owner oe ((?i��S _ c�c3'tnn re-h hSr" ie1 6/t. j Vfit 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.: 7or�- (kx S S > ❑ B ❑ F ❑ M Doors,Windows: O S UA J SDI Roof Gutters, Drains.- Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : C't' -ZO .•t,.a S i STRUCTURE INT. Hall,Stairwa : G i I d �L._ S cQ r-e-S i u awl Obst'n.: Hall, Floor,Wall,Ceiling: ° /Q-: e,d. ISvc Hall Lighting: C-:ii L8 pu.i 7V1 %Lv) 4VU-7 15W Hall Windows: its'g�t�✓ HEATING Chimneys: ej zCxq '" Central ❑ Y ❑ N E ui . Repair Al2(,,.r a.. ' S S 'i,S ) 4W 6WN , TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ✓4f3j11 &AAA Oln By /j A-y fG✓, Tr ❑ 110 ❑ 220 Fusing,Grnd.: i t p, AMP: Gen.Cond. Distrib. Box: (9 t,�fve ► jaf_je C eG, 3�1 Gen. Basement Wiring: DWELLING UNIT Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks pe Kitchen ©I< Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten., Gas, Oil,&jQLcjj hLi 1L. t e.`. Stacks, F ues,Vents,Safeties: Kitchen Facilities Sink 0_,4. j e kj .tiv S e. ,.lr Stove a.i j a-n-,U_ ti.� 35- Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: (' m.. A v-f-wf-0 4c. Wash Basin,Shower or Tub: ,,&-o (tip , t.+-- c,..A tyJ'il e< 44 e,w K Infestation Rats, Mice, Roaches or Other: Cr d h I-1 �Svv Pe 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 ��d_ dd�/ 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 G� PENALTIES OF PERJURY." INSPECTOR//� 0`��, TITLE DATE ` �� TIME .11 `10 ,�f A.M. THE NEXT SCHEDULED REINSPECTION S reCc',l g� / p M 6 1 .. ..,� M1' ..,;... ,.... ..,• ,:: ,,,$�Fj+ ..!.. ., —AVII," eml"r�M.,y P.7,; *,v+..x�: .`�v k�'w.vN'1iYf.i.rxVY.W.,,,;.,..x.. 1 410.750: 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 bathtuo 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. l�a,� e �� �.�-, ��-`�yap �- z ��s • �' S6-e- �r�9} C 1-Z Z-�� �- s.du��eo�- 6Y ck,,.a� i/✓d�@wj��;Yv�,, 5 w�=�.o 44� r-c.clsT 4t- r x"'"`.�v�,,(,,,, crv� „vt o.GGic.y R /-q ve j•.' 7 Spy S J .. � c03 498 999 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided, Do not use for International Mail See eveme Sentt St r e N m P ate,&ZIP CQd �� r e Postage Certified Fee Special Delivery Fee Restricted Delivery Fee rn Retum Receipt Showing to Whom&Date Delivered a Retum Receipt Stewing to Whom, Q Date,&Addressee's Address O TOTAL Postage&Fees f Postmark or Date L Cf) a oF�E Town of Barnstable • Department of Health, Safety, and Environmental Services '* inxxsrnsi.E, ' 9� 16,59. � Public Health Division P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health November 23, 1999 George R. Diggs 100 Oakville Avenue Osterville, MA 02655 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE H, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE, ARTICLE 51 The property owned by you located at Apt. 5A, 100 Oakville Avenue, Osterville , was inspected on November 16, 1999 by Glen Harrington, Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code H, Minimum Standards of Fitness for Human Habitation were observed: 410.351: There were no covers observed on living room outlet and light switch and kitchen refrigerator outlet. 410.351: Exposed electrical wires were observed in basement. 410.351: The faucet in the kitchen sink was observed leaking at base. 410.351: The kitchen gas stove was observed to have a gas leak. 410.500: The ceilings in each of the rooms were observed to have chipped and peeling plaster. 410.500: There was evidence of water damage (staining and peeled plaster) or water damage on living room ceiling. 410.500: There was no baseboard in bathroom. Insulation was exposed. 410.500: There was a one inch gap in wall above the mechanical ventilation in bathroom. 410.501: The door to main entrance was observed to have gaps greater than 1/8". 410.501: There was no storm door provided at the main entrance. You are directed to correct the violations of 410.351(stove) within twenty-four(24) hours of receipt of this notice. You are directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF BOARD OF HEALTH omas A. McKean Director of Public Health t_ Town of Barnstable Department of Health, Safety, and Environmental Services ,` Public Health Division P.O. Box 534, Hyannis MA 02601 Office: 508-8624644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Z. S 1999 OS IvL4 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II,MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 Ap-• S'A /Oa 4vt^1,-9, d The property owned by you located at. , was inspected on ��J1999 by Glen Harrington, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II,Minimum Standards of Fitness for Human Habitation were observed: 410.351: r 6s-�a w, 1 � r�o ti.-�.ov{�u.f f�J� r- 410.351: 410. �"� �. �.��,6.:2. vi S t i•,-lac. (,✓ws o la�e-r-v� 1 ec-C��,,,� 3 s 1 b wa-e 410.#M: a 4v� 410. Ce i l� 0-1�l ��o,ti,� > ne a(ow►��er� Iv G`u,r,e Ck_rJA 410 � (1 v;� as jAea plcs1/-e ) to i ^ �c.�l-f..,v c-zrw►. L.w ae'fi. a-. �aS eeS2�; 410 �,,�R r cr�tl 1 ti- G�c�) owe cua d'a. 'Z'j. 410.M: L i VZJ ►°In Gw►� 42it..'j��t.C- 5 Gv�_S Q�of P�✓rL0^ 4iJ �0` �O I- o Sb( 9 �� .o,,,, 1/,-e, Tres/w / /Is P P9 J �C(W aQ ���/"`J`.r�`"�� <� You are directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health pires/wp/q/Is r { j %l 1 fix. 4 �urvs4 DIGGS GEORGE R � 100 OAKVILLE AVE 00 OSTERVILLE " MA 02655 Al'� , v� �'� 00 0000 000 y/ a �te 080194 Janu�aryr„si DIGGS,GEORGE R d 0894 a 9320/114 5890 / 0 tag 217500 ) eft F 0000000000 100 OAKVILLE AVENUE 1127 ` 0276 / r 10 f y, Unassigned Road Name 0000 w 0000 r / .. p / Health Complaints 15-Nov-99 Time: 11:00:00 AM Date: 11/15/99 Complaint Number: 2144 Referred To: GLEN HARRINGTON Taken By: LS Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 5A Street: OAKVILLE ROAD Village: OSTERVILLE Assessors Map_Parcel: _ Complaint Description: GAS LEAK IN DUPLEX. FIRE DEPARTMENT WAS CALLED. THERE IS NO HEAT IN THIS RENTAL UNIT. THE ROOF IS LEAKING. THEY ARE ALSO USING PROPANE IN HOUSE FOR HEAT. Actions Taken/Results: Investigation Date: Investigation Time: 1 i i T � w� I 0 : � , i e i ,� I i� .� ... 1 l I �" � � � a, i ` '� t; . i .� ' �-'-- I �; i I !1 ,.- -' � I � ' I II �_� � � � � i .t I I i ' I � i i I I � � I j i i