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HomeMy WebLinkAbout0257 POND STREET - Health 257 POND STREET, OSTERVILLE A=119-032 ti fl . II i r 1 - COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICEOF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE.5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 257 Pond Street J x Ostervilk.MA 02655 I G I Owner's Name: t Scott Peacock&Scott Crosby Owner's Address: "Date.of Inspection: January 6 2012 Name of Inspector: (Please Print)'James M.Ford Company Name: Jantes,M.Ford Mailing Address: P.a Box 49 Ostervillec MA 026554049. Telephone Number: (508)862=9400 CERTIFICATION-STATEMENT f certify that I have personally inspected the sewage disposal'system at this address and that the information repofted o below is true;accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the properAinction and maintenance of on site sewage disposal systems I Am a DEP approved system inspector pursuant to.Section 15.340 of Title 5(310 CMR 15.000). The system ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails v> ; r— M Inspector's Signature: Date: January 10,2012 The system inspector shall su it a copy f.this inspection'report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection: If tlie system is a shared system or has a design flow of 10,000. gpd or greater,the inspector and the system owner shall submit.the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,.if applicable,and the"approving. authority. Notes and.Comments ****This report only describes conditions at the time ofInspection and under the conditions of use at that. time. This inspection does not.address how the system will perform in the future under the same or:different conditions of use. Title 5 Inspection Fonn 6/15/2000 page l • _ t Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 157 Pond Street Osterville.AM Owner: Scott Peacock&Scott Crosby Date of Inspection: January 6.2012 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist, Any failure criteria not evaluated are indicated below. Comments: B: System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced.or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or.not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years oldis available. ND explain: Observation of sewage backup or,break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken,.settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed. distribution box is leveled or replaced ND explain: . The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The.systemmill pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL" INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 257 Pod Street Osterville.AM Owner: Scott Peacock&Scott Crosby Date of Inspection: January 6 2012 C. Further Evaluation is Required by the Board of Health: . Conditions exist which require furt4prevaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system.is not functioning.in a manner which will protect public health;safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh , 2. System will fail unlem.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 aseptic.tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance **This system passes if the well water_analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic'compounds indicates that the well is free from pollution from that.facility and . the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy.of the analysis must be attached to this form: 3. Other: b 3 Page 4 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 257 Pond Sheet Osterville,MA Owner: Scott Peacock&Scott Crosby Date of Inspection: JmivaiT 6.2012 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool . ✓ Discharge or ponding of,effluent to.the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. ✓ Static liquid level.in the distribution box above outlet invert due to an overloaded or.clogged SAS or cesspool _ ✓ Liquid depth in.cesspool is less than 6"below invert or available volume is less than%rday 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. ✓ Amy 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 I of a public well. _ ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ ✓ Any,portion:of a cesspool or privy is less than 100 feet but greater than 50 feet.from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic.compounds indicates that the well is free from pollution from that facility.and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No _ (Yes/No)The system fails: I have determined that one or more of the above failure criteria,exist.as. described in 310 CMR 15.303,therefore the system.fails. The system owner should contact the Board of Health to determine What will be necessary to correct the failure. E. Large System: To be considered a large:system the system must serve a facility with.a design flow of 10,000 gpd to 15,000 gpd You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes . No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a.mapped Zone II of a public water supply well . If you have answered"yes"to any,question in Section E,the system is considered a significant threat;or answered "yes".in Section D above the large system has failed. The owner.of operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR. 15,304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST.. Property Address: 257 Poiid Street Osterville MA Owner: Scott Peacock&Scott Crosby Date of Inspection: January 6 2012 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? . Has the system received normal flows in the previous two week period? ✓ . Have large volumes'of water been introduced to the system recently or as part of this inspection? . ✓ Were as built plans of the system obtained and examined?.(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓. — Was the site inspected for signs of break out? ✓ Were all system components;excluding the SAS,located on site? ✓ _ Were the septic tank manholes uncovered,.opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ Was the facility owner(and.occupant if different from owner)provided with information on the proper maintenance.of subsurface sewage disposal systems The.size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the.field(if any of the failure criteria related to Part C.is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. - 5 Page 6 of 11 OFFICIAL INSPECTION:.FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 257 Pond Street Osterville.kL4 Owner: Scott Peacock&Scott Crosby Date of Inspection; January 6.2012 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: N/a Does residence have a garbage grinder(yes or no): N/a Is laundry on a separate sewage system(yes or no): N/a [if yes separate inspection required]. Laundry system inspected(yes or no): no Seasonal use(yes or no): no Water meter readings,if available(last 2 years,usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently ' COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR.15.203): _gpd Basis of design flow(seats/persons/sq/ft etc.)`.. Grease trap present(yes or no): Industrial waste holding.tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use:. OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--'How was quantity pumped determined? Reason for pumping: - TYPE OF SYSTEM Septic tank,.distribution box;soil absorption system Single cesspool s Overflow cesspool Privy . Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Altemative.technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Date ofinyallation 5115198 per.as=built card Were sewage odors detected when arriving at the site(yes or no): No 6 r� e Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 257 Pond Street Osterville,MA Owner: Scott Peacock&Scott Crosbv Date of Inspection:. January 6.2012 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 24;, Material of construction: ✓ concrete metal fiberglass polyethylene . other(explain)'. If.tank is metal list age: Is age confirmed by a Certificate.of.Compliance(yes or no): (attach a copy of certificate) . Dimensions: 1 S00 gal. H-20 Sludge depth: 2" Distance from top'of sludge to bottom of outlet tee or baffle:.. 30 Scum thickness, 10" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee.or baffle: 16" How were dimensions determined: Measuring stick Comments"(on pumping recommendations,inlet,and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.). The tees were vresent. The liquid level was even with the outlet invert. There did not appear to be any signs ofleakaee. GREASE TRAP:, None'(locate on site plan). Depth below grade: .. Material of construction: concrete _metal _fiberglass polyethylene other (explain): Dimensions: Scum.thickness. . :, Distance from top.of Scum"to.top of outlet tee or,baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet,tee or baffle condition,structural integrity,liquid levels as related to.outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 257 Pond Street Osterville.MA Owner: Scott Peacock&Scott Crosby Date of Inspection: Januai;v 6: 2012 TIGHT or HOLDING TANK: None (tankinust be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass .polyethylene _other(explain):. Dimensions: Capacity: gallons Design Flow- gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): - DISTRIBUTION BOX ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-Box was normal.No solids were present. PUMP CHAMBER: .None .(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump,chamber,condition of pumps and appurtenances,etc.): 8 . . Page 9 of 11 OFFICIAL-INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 257 Pond Street Osterville,MA Owner: Scott Peacock&Scott Crosby Date of Inspection: January 6, 2012 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required). • lain why: . not located ex If SAS o 0 p Y Type leaching pits,number: leaching chambers,:number: 3 leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow..cesspool,.number: Innovative/alternative system Type/name of technology: Comments(note condition.of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): 7here.did not appear to be any signs of failure. . CESSPOOLS: None .(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 or no): Comments (note condition of soil;signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions:: . Depth of solids:.' Comments(note condition of soil,signs of hydraulic_failure,level of ponding,condition of vegetation,etc.): 1 9 , F . Page 1.0 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 257 Pond Street Osterville.MA Owner: Scott Peacock&Scott Carosby Date of Inspection: January 6,2012 SKETCH OF SEWAGE DISPOSAL.SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public.water supply enters the building. 31) o 4a 10 Page l l of 1.1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: 257 Pond Street Osterville.MA' Owner: 'Scott Peacock&Scott Crosby Date-of Inspection: Jantiary 6,2012 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30+1- feet Please.indicate,(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If .checked,date of design plan reviewed: Observed.site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Topographic and water contours maps Checkedmith local excavators,installers-(attach documentation) Accessed`USGS database-explain: You must describe how you established the high ground water,elevation: Using Barnstable topouavhic-and water contours maps the naps were showing approximately 30'+/-to ground water at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This.report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed,written or•implied, relating to the septic system,the inspection,this report and/or any components of the septic system which have not been locgt'ed and inspected. - 11 f � i TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION -- J Date � �� Time: In 3�(� Out /o L Owner � /1� Tenant Address a. ��U� 'c� . Address c U"! Compliance Remarks or Regulation# Yes O Recommendations 2. Kitchen Facilities 3. Bathroom Facilities AD A�v ^ Cot rl� 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 15. Garbage and Rubbish Storage and Disposal , 16. Sewage Disposal 17.Temporary Housing 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) < Person(s) Interviewed Inspector. If Public Building such as Store or Hotel/Motel specify here ��� �� ., euk c. a i,� i Town of Barnstable Page 1 of 1 '<<Back Building Style Cottage Interior FloorsCarpet Model Residential Interior Walls Drywall Grade Below Average Heat Fuel Electric 'I4 Stories 1 Story . Heat Type Elec Baseboard1 Exterior Walls Vinyl Siding AC Type None 9'k _ Roof Structure Gable/Hip Bedrooms 1Bedroom 71 Roof Cover Asph/F Gls/Cmp Bathrooms 1 Full Replacement Cost $61421 living area 675 AS 10 Depreciation 15Year Built 1940 Total Rooms Rooms f Building Style Cottage Interior FloorsCarpet Model Residential Interior Walls Drywall Grade Below Average Heat Fuel Electric Stories 1 Story Heat Type Elec Baseboard AiS' �1. Exterior Walls Vinyl Siding AC Type None Roof Structure Gable/Hip Bedrooms Bedroom 2 1 Roof Cover Asph/F GIs/Cmp Bathrooms Full Replacement Cost $54181 living area 532 Depreciation 20Year Built 1940 L ,a Total Rooms Rooms Building Style Cottage Interior FloorsCarpet - - - -- Model Residential Interior Walls Drywall Grade Average Minus Heat Fuel Electric Stories 1 Story Heat Type Elec }- Baseboard Exterior Walls Vinyl Siding AC Type None Roof Structure Gable/Hip Bedrooms 1 6 Bedroom Roof Cover Asph/F Gls/Cmp Bathrooms Full Replacement Cost $71131 living area 654 2 Depreciation 8Year Built 1989 1aw Total Rooms Rooms http://www.town.bamstable.ma.us/assessing/assess06/printO6.asp?mappar--119032 3/1/2007 i Date `.� i i i i voluntarily grant permission to the Town (Occupants name) of Barnstable Board of Health (Agent or Health Inspector)to inspect my dwelling unit located at PM ( in accordance (House#, [Apt\Unit#if applicable],street,village) with the Town of Barnstable Code (Chapters 59 and 170) and the State Sanitary Cod'e (105 CMR 410.000) on I hereby authorize and name (Date of inspection) i to be my tenant representative forjthe (Occupant representative) purpose of this inspection. �� -�Qt✓�C. is an adult person (Occupant representative) designated and duly authorized to act on my behalf and will be accompanying the Town of Barnstable Board of Health for the inspection, granting access to any and all locations i (including bedrooms, bathrooms, closets, etc.,) allowing the use of photographs and answering questions. This authorization is only valid for the inspection date specified above, and must be renewed for any future inspection(s.) Occupants Signature \ ate I Occupants Representative Signature \ Date I QARental Ordinance\inspection permission 2.doe i i ' rORM30 C&w HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LTH CITY/TOWN Z m 6 DEIVARTMEINA � Gib SV•y`oW ADDRESS TELEPHONE Address — Occupant Floor Apartment N No.of Occupants No.of Habitable Rooms No.Sleeping Rooms \' No.dwelling or rooming units No.Sto 'es Name and address of owner P, Remarks Reg. Vio. YARD Out Bld s.: Fences: A Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: 4VI-) VI-1 ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: 0 --�, Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Qf Dampness: Ll Stairs: I FA Li htin ' STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 �f f Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: F ues V nt Safeties: Kitchen Facilities Sin ove 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 V101 AT,mK CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJU I'rl— ( Ek �k_ INSPECTOR TITLE-4et DATE I A ' 6.1 TIME A.M. THE NEXT SCHEDULED REINSPECTION �� P.M. _ ,-r.. .y - ._ '..-� .--,+fi..r`$^,.. - '`-�±'�.: -'tr -_-• ,ti. 1,r-r..r,. ..r.�':''h".^.. ... r""Y+c''.....:.rF .r .. h n r n 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 prcvisions 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 r lack f( ) p y g s s o ac o a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. � i 1 I Date _ I i voluntarily grant permission to the Town (Occupants name) I of Barnstable Board of Health (Agent or Health Inspector) to inspect my dwelling unit located at -, ' ,) Pond in accorda nee (House#, [Apt\Unit#if applicable],street,village) with the Town of Barnstable Code (Chapters 59 and 170) and the State Sanitary Code (105 CMR 410.000) on I herebyauthorize and name � (Date of inspection) t to be my tenant representative for;the (Occupant representative) purpose of this inspection. Rfaubcj(— is an adult person (Occupant representative) I designated and duly authorized to act on niy behalf and will be accompanying the Town of Barnstable Board of Health for the inspection, granting access to any and all locations (including bedrooms, bathrooms, closets, etc.,) allowing the use of photographs and I answering questions. This authorization is only valid for the inspection date specified II above, and must be renewed for any future inspection(s.) I - `i 1 � f Occupants Signature \ Date \ I Occupants Representative Signature \ Date; L i QARen[al Ordinance\inspection permission 2.doc I V I I F6RM30 C&w HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H LTH Fo CITY/TOWN W DEP TMENT ADDREdS �M Spy`0 (� n TELEPHONE Address ell'CaTv"�Y Occupant Floor Apartment No. No. of Occupants I No. of Habitable Rooms No.Sleeping Rooms_4 / -- No.dwelling or rooming units No.Sto 'es cam"l� 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 IV Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair ~' TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. sup.Ten.,Gas, Oil, Elect.: S cks, Flues,Vents,Safeties: Kitchen Facilities ink ve 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 ECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR TITLE DATE� TIME Lfb A.M. THE NEXT SCHEDULED REINSPECTION- 16 0!= P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises,shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation,or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Fail.ure 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^ PEACOCK .BUILDING & REMODELING INC. 1046 Main Street, Suite 7 Post Office Box 171 Osterville,MA 02655 Voice 508.428.7600 Fax 508.428.7625 May 21,2007 To: Re: Rental Inspection Dear: ft JU& The Town of Barnstable has created new rental.ordinances which require them to inspect rental properties within the town which I had to agree to as a registered rental property owner. I am trying to set up dates and times with their office for them to be able to inspect your rental property. I was hoping for either Thursday the 24'�'or Friday the 25`"of May. Please fill out the enclosed permission paper so that I can meet the inspector at your house. If you have any questions,please call me on my cell phone at 508-364-7353. Sincerely, S�- J. Scott Peacock Scott Peacock Building&Remodeling,Inc. Date I, MAL Amad , voluntarily grant permission to the Town (Occupants name) of Barnstable Board of Health (Agent or Health Inspector)to inspect my dwelling unit located at 257 c p6nj Sf osS e-Ni I IL Ma . in accordance (House#, [Apt\Unit#if applicable],street,village) with the Town of Barnstable Code (Chapters 59 and 170) and the State Sanitary Code (105 CMR 410.000) on I hereby authorize and name (Date of inspection) Lcaack- to be my tenant representative for the (Occupant representative) (� purpose of this inspection. W is an adult person (Occupant representative) . designated and duly authorized to act on my behalf and will be accompanying the Town of Barnstable Board of Health for the inspection, granting access to any and all locations (including bedrooms, bathrooms, closets, etc.,) allowing the use of photographs and answering questions. This authorization is only valid for the inspection date specified above, and must be renewed for any future inspection(s.) 6-17 Occupants Si a ure \ Date Occupants Representative Signature \ Date Q:\Rental Ord inance\inspection permission 2.doc FORM30 C&w HOBBS&WARRENT. THE COMMONWEALTH OF MASSACHUSETTS t BOAR OF H H CITY/ OWN W y DEP TMENT �. 'pGADDRESS .,M Syoy`e • J� � TELEPHON Address Occupant Floor Apartment No. No. of Occupant No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No ories 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: 92 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 r 35 Bedroom(1). �- Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Ve is afeties: Kitchen Facilities inI S U - 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 INSPECTION MORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF P FI ." INSPECTOR TITLE A. DATE ' ._v TIME l �Z M. THE NEXT SCHEDULED REINSPECTION " P.M. jr b 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health,or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum_requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is.issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required i6 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. J p � . L mmr ru .. ru -a CO IMC . ,.,'p• � tr I C I A _ � r ru -' Postage $ m t� rq Certified Fee �+ ? ((��� y �9lfark C3 Return Receipt Fee O (Endorsement Required) �H re Q� C3 Restricted Delivery Fee V� C3 (Endorsement Required) ru O Total Postage&Fees m C3 (Z,�S 4----- �- 6 o --------- -- C3 3`treet,Apt No.; or PO Box No. O�� v City State.Z%P 4c - ----------------------- d2/,G Certified Mail Provides: v A mailing receipt a A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mall may ONLY be combined with First-Class Mail®or Priority Mail®. a Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Retum Receipt maybe requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mallpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized aggent.Advise the clerk or mark the mallpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present It when making an Inquiry. PS Form 3600,August 2006(Reverse)PSN 7530-02.000.9047 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. 'gnat item 4 if Restricted Delivery is desired. Agent ■ Print your name and address on the reverse X' Addressee so that we can return the card to you. eived Print ame C. Dateof Delivery ■ Attach this card to the back of the mailpiece, lam_/ or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No alp �P3 t .. SC 3. Service Type A10 IL V-1 (1-Certified Mail ❑Express Mail �1 ❑Registered ❑Return Receipt for Merchandise �4 U 7r / ❑Insured Mail ❑C.O.D. C© / 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7007 3020 0001 3429 8622 (Transfer from service label \'PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSV44StAVICtl l l{;i'4 i lilt l i jl, �} i' I it I t` t{ rst-Class Mail Postage&F6es Paid LISPS Permit No.G-10 I Sender. Please punt your name, address, and ZIP+4 in this box I --C) car A' G I -rHZOO � I Af I � Z66 I � C ST. � Town of Barnstable Regulatory Services Bar` .table r Thomas F. Geiler,Director ;mericaCity * &ARNSMBU, Public Health Division �A 1639• Thomas McKean Director 1ED MA'1 A 2007 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 CERTIFIED MAIL 7007 3020 0001 3429 8622 October 23, 2009 Scott Crosby & James S. Peacock r C/o Crabtree CPA & Associates 426 North St. Hyannis, MA 02601 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 257 Pond St. Osterville, Unit C was inspected on October 15, 2009 by Jaime Cabot, R. S. 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 410.401 — Ceiling Height: Ceiling height on second floo was observed at 6'4", Seven feet is the required ceiling height. You are directed to correct the violations listed above within thirty days of . your receipt of this notice by seeking a variance from the Board of Health; seeking relief from the minimum ceiling height requirement. 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. ER OF THE BOARD OF HEALTH Thomas" McKean,�RS.., =HO Director of Public Health Town of Barnstable TOWN OF BARNSTABLE Approved: BOARD OF HEALTH MLD Cert: ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date �� ��% Time: In U Out 1 � Owner �Go'r'( 1- ff�. ��`� 't 12c'Sy Tenant Address 115 ZA 2 C 9,� a dz't t-t S�. 1 Address 7-S PO r-rJ Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities �. L-t a(6, 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities. 10. Curtailment of Service 11. Space and Use I tj criccK c®I�►v""�o��l i 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed 2 PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms 1- Number of Vehicles Allowed (max) Number of Persons Allowed (max) Z- Persons Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here of'THE T Town of Barnstable ti Regulatory Services Barnstable Thomas F.Geiler, Director AN-America City BARNSTABLE, Publie Health Division 63 s`�� Thomas McKean, Director Eo nt'� 200 Main Street 2007 Hyannis, MA 02601 Office: 508-862-4644: Fax: 508-790-6304 CERTIFIED MAIL 7007 3020 0001 3429 8622 October 23, 2009 Scott Crosby & James S. Peacock C/o Crabtree CPA& Associates 426 North St. Hyannis, MA 02601 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 257 Pond St. Osterville, Unit C was'inspected on October 15, 2009 by Jaime Cabot, R. S. 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 410.401 — Ceiling Height: Ceiling height on second floor was observed at 6'4", Seven feet is the required ceiling height. You are directed to correct the violations listed above within thirty days of your receipt of this notice by seeking a variance from the Board of Health; seeking relief from the minimum ceiling height requirement. 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 hall 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. P + ER OF THE BOARD OF HEALTH ......... Thomas . McKean; R.S., CHO Director of Public Health Town of Barnstable 1171613 Z, No. Fee $5 0. 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for Miopoaf *pgtem Con,5tructfon Permit Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. 257 Pond Street Owner's Name,Address and Tel.No. 4 2 8—5 7 9 3 Assessor'sMap/Parcel Osterville Paul Wheaton 428 Wianno Ave Osterville MA 0265 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. W E Robinson Sr Septic Service PO Box 1089 , Centerville, MA 0263 Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder(no) 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 Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic System ccnsistinq of 1500—gal H-20 tank, D—Box and 3 stonepacked precast, 1Pach chambers. 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 issued by this Board-pf.Heakh.. Signed — Date " ^9 Application Approved by o Date Application Disapproved f r the following reaso Permit No. Date Issued f.i,.. .,-,}a`... - +.-�s1w."'1.a•,.r,.. � .-r. .. ..--r _. � �♦d r-. :..-, .. .-..ry ...-,..t,�a^ �•. --.. .:�"F. )1g16 3 � No. Fee $5 0_0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH-DIVISION - TOWN OF BARNSTABLEs MASSACHUSETTS Zlpplication-for„;Di!5pogal *pgtem Congtruction Permit Application for a Permit to Construe()Repair(x).Upgrade( )Abandon( ) ❑Complete System ❑Individual Components i Location Address or Lot No. 257_-Powliii Street Owner's Name,Address and Tel.No. 4 2 8—5 7 9 3 Assessor's Map/Parcel Osterv`?lle Pau1'WWheaton 428 Wianno Ave O terville MA 0265 Installer's Name,Address,and Tel.No. 7 7 5-8 7 7 6 Designer's Name,Address and Tel.No. W E Robinson Sr Septic Service 3' PO -Box 1089, Centervil6e, MA 0264 Type of Building: Dwelling. No.of Bedrooms 4 Lot;,Siz"e -`� sq.ft. Garbage Grinder(no) 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- `'fit Type of S.A.S. Description of Soil sand N. i Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic System ' consisting of 1500-gal H-20 tank, D-Box and 3 stonepacked precast R ' leach chambers. - Date last inspected: E� 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 issued by this Board He h. ' Signed / Date - Application Approved by 1 Date Application Disapproved f r the following reaso e f .ro �v Permit No. Date Issued -'' THE COMMONWEALTH OF MASSACHUSETTS Wheaton BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that,the On-site Sewage Disposal System Constructed( ) Repaired (xx)Upgraded Abandoned( )by at 2_57 Ponel St, Osterville has�Ilbe n constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ted Installer W E RObinsonS r Septic Sry Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date F— n Inspector No. t Fee$5 0.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Wheaton �Migogal *pgtem Congtruction Permit Permission is hereby granted to'Construct( )Repair(x )Upgrade( )Abandon( ) System located at 257 Pond Street ,Osterville Installer: W E Robinson Sr Septic Sry 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: Cons con must e c leted within three years of the date of t ' pe t. a Date: Approved by J 0 / � NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. r CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS)" I, William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated 1`' -9 concerning the property located at 257 Pond Street Osterville, meets all of the r following criteria: * There are no wetlands within 100 feet of the proposed leaching facility. * There are no private wells within 150 feet of the proposed septic system. * There is no increase in flow and/or change in use proposed. * There are no variances requested or needed. * If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) �J° B)Observed Groundwater Table Evaluation(according to Health Division well map)J0 SIGNED: DATE LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998 (Attach a sketch,plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). --T 09 � 1 Q i_ - ,,� 91, ox TOWN OF BA.RNSTABLE �' C LOC�iTION SEWAGE # VILLAGE C> 5 ) ASSESSOR'S MAP & LOT // tom. INSTALLER'S NAME&PHONE NO. fb b->,�sd �— SEPTIC TANK CAPACITY � j 14 3 k4 A 6 4, .� LEACHING FACILITY: (type) s (size) N .OF BEDROOMS BUILDER OR OWNER PERMIIDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility. Feet Private Water Supply Well and Leaching Facility (1f.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 a �® i 1 1 iE Y / ®pp T Ji TOWN OF BA.RNSTABLE ? : ocATION ;S� �� A 5 1 SEWAGE VILLAGE 61 ASSESSOR'S MAP_& LOT .INSTALLER'S NAME&PHONE NO. O 6 .�-sd �— 7_Il irt' 7 SEPTIC TANK CAPACITY 4t5'O.L c'yk- LEACHING FACILITY: (type) `� C (size) NO.:<OF BEDROOMS BUII.DER OR OWNER PERMITDATE: I,v"3 d COMPLIANCE DATE: Separation Distance Between the: M.A-ximum 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 i i f i i I ; , f TOWN OF BARNSTABLE FfNyt �� cp LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size)MOO ��f NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER/mac BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No —� 1 �� f o 0 I �V``� n � � l.y c �' -. , a Y L ® CATION SEWAGE PERMIT GO• �s? Z7/2� VILLAGE INSTA LLER'S aA-M� & ADDRESS /44-6 C�sspoa l �2v�c� BUILDER OVER Qv DATE PERMIT I-SSUED �� .� 3 _ y2_ DATE C=OM.PLIAN-CE ISSUED o� , � � ,,r � \ � / �'�- I � �� i � r � co � r` ��,�� �� � a - s _�' ,y, #81— c I� LOCATION SEWAGE PERMIT NO. 257 Pond St VILLAGE Osterville., MA 02655 o INSTALLER'S NAME i ADDRESS A & B Cesspool Rervt('e 19R R; s],-„mo eara, K3za 3s4- Aa�9� 8UIL0EIt OR OWNER Paul W. Wheaton 7 Clyde Court, IW,- Park, New Yn-rk DATE PERMIT ISSUED 6�16/8i DATE COMPLIANCE ISSUED o W 17 w � Cb .� Q ` •G2� t.1 TOWN OF BARNSTABLE LOCATION .57 PUrd st; 0S*,, ' U I << I7,A SEWAGE # Y VILLAGE le ASSESSOR'S MAP Cz LOT INSTALLER'S NAME PHONE NO. Al 6&0 ,I SEPTIC TANK CAPACITY &9490 LEACHING FACILITY:(type) (size) 117 7A/` NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER/'/r(a&Z BUILDER OR OWNER /,4 e A-t�,, DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No � � > �� � � �- _± i �. -, r i � �� V � ^ ,� t 1 ��, = {` V � 81- 33 y No................_....... Fps..$... .,Q4... .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................ .own....OF....Baxnstable........ --------------------------------------------------- ,� -hra#ion for Dhipoii al Works Toustrnrtion rrani# Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at• ' 257 Pond St., Osterville, MA 0265�j•_.._.... .... •-.......... - ...... ..........................----•---.........._.._.................. Paul W. Wheat onLocation.Address or Lot No. ..........., Hyde_-Park,..N;Y_...L?. 8__.......--_ Ogner Address W A & B Cesspool Service, 128 Bishops Terrace=.Hyannis, MA 02601 a --------------••--------....•-••-•••••••........ ............-••••••..... Installer Address d Type of Building Size Lot.... .....................Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons..............3_...-_.-_-. Showers — Cafeteria a Other fixtures - -•------------------•-•-- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test'Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •--•--------------------------------------------••---..:.... .............. 0 Description of Soil............Sand.....................•--..........-•--•-••--------•------••----------------------•---------•-----------------------------------•-----------------.. x W --------•----•-----------•-----•------•--------------------------------•------. ----•-------------•----••----•--------------------••--------•----•----------------•-•-•-••---•----------....--•••••---- UNature of Repairs or Alterations—Answer when applicable.........Install.anion..ra£..a•-1-,-00D--gald.or�--pxe-cast, ---Atom...1aQke.d._leaala_Pit---(avex-Elza.)------------•------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I IL LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by tho bo f health. / Signed ......... �. - . -•-------�f 1 ------ 1 Da Application Approved By--•------•-.. •/0• ---------------•-6� ....$a. Date Application Disapproved for the following reasons----------------•-----------------•--•--------------------------------------------------------...---------------- .....--•--•.....................................•-----------....-•---•-•------•---------------------•-------...---------------------•---------••-•-------•-----•-•---.....-----------•---------......... / Date Permit No............81- .......-•------.. Issued................ y Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............T..awn................OF...................Rarn stable........................................ Trr$ifirFate of ToanpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Reppaired (X) by A & B Cesspool Service t 128 Bishops Terrace, Hyannis, .MA 02601_.-._775-6264 Installer at .......25� Pond St : Osterville, MA 02655 -••Paul W. Wheaton ------------------•- --- --- ---------------------------------- has been installed in accordance with the provisions of TITLE ,5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..81....3.?_y.................... dated....64---/81----------------------._--•- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........Z/---•-f-81....................................................... Inspector............................................................................... No.81 3 5..:' .... Fics.$...5..,00........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .T own.....O F....Barnstable............................................................ Appliration for Bispos al Works Tonotrurtiun rrmit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: 257 Pond St., Osterville, i41A....02655 ................__...__....................................._..... ...-.._.. - ................... Pahl W. Wheat On Location•Address or Lot No. ---_.-__ 7_.Clyde CourC, Hyde__Park,_•_N.Y, 1253.8............. Oyvner Address W A & B Cesspool Service, 128 Bishops Terrace, Hyannis. MA-••-•026Q1_-••-. .............•••..........••• .... Installer Address UType of Building- 2 Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of ersons____________ 3....______. Showers — Cafeteria a YP g •---•-•-••--......•-•-----•• P ( ) ( ) Q' Other fixtures..................d - ----------•-•-------•--------••--•----------•----------•------•-------------------------••............ W Design Flow............................................gallons per person per day. Total daily flow----_.......................................gallons. 04 Septic Tank—Liquid capacity.............gallons Length................ Width................ Diameter---------------- Depth................ W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 .............................................. •:..••-••.............•..............---••-...._......_......---••_..-•••--••-••----•••-•-.._...-•--•---....-- O. Description of Soil...........Sand_............................................... x V ..............................................•-----•----•••••----••----•........._...___......--•--••....••-•--••••---------••••-----•••----•-•-•--•---•••-•-------•--•-••----------•---•••-----........ W U Nature of Repairs or Alterations—Answer when applicable._-____•InStallatinn...of..a..1,.000.•.ga11On..pm•t.cast, stgne...p eked-_ e� �i QY rfl�tQ)A Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beep issued by t bo f health. Signed... - -- ------ ........6/._•-� 1- Application Approved B ;-�"' ` "�' �' '' L1.1.Va� '"'-=�---._...--•-•---'----/L__�=�✓•�---•----•--------•------- ----•-----------V Date _4?,lb...._._ Application Disapproved for the following reasons:--••-...•...............••-••-•----•-••••-•..............•-----•--•-•-•-........_......••-•----••-•-------•-•- •.........................••-----••---••._..--••.............-•-•••......••-•••---•-----••-•---•......._....._....-----------•••---•-••••----•----•-•--•-------•---------••---•-•---- --••------•-•- Date Permit No............81- -------------------------------------- Issued-----.....----- ....................... Date \ THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEALTH ................ ................OF..................13&=Atabl.Q........................................ 1 Turrtif irair of ToutpfiFanr TH1s IS TO CERTIFY, That the Individual Sewage Disposal S,7stem constructed ( or Re aired (X ) byA & B Cesspool Service, 128 Bishops Terrace, Hyannis, MA 02601 7.175� -62b!� • -•--••-•---•-••••....-• 257 Pond St Osterville, 14A 0265�ns-al-1paUl W. Wheaton has been installed in accordance with the provisions of TITLE 5 of The State Sanitary de s described in the p j� application for Disposal Works Construction Permit No.81--- ? ................... ................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......7/..../81....................................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town OF Barnstable l— ........................ •---•----...................................................... 5.c 0........................ FEE......................... ElftiposFal WorkiiAnna rnr#irrn rrmi� A & B Ces ool Service 128 Bisho s Te , ya ......... Permission Is hereby granted -•----- ........ p rrdCe H nnis 02 0 to Const�u t (� ) or Repair (X) an Individual Se ra e Disposal System at No....... 7....and St., Osterville, MA 0295 - Paul 4I. Wheaton -----------------••-•--•----.........•-••--••-•••--••--•-----••. ....................... Street as shown on the application for Disposal Works Construction Permit No 81.'...___.....,Dated.......6 -............................................... $;;®rr1 of Health DATE........... .................................:................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ..........L5..90._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Town-------------------OF__......BarTl.5t.able..................................................... Atirt nation for Utz wial Works Cnnnitrnrtion 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: 257B Pond St.:.:...Osterville.t.-n---•-026.55------------ ..............................= Location-Address or Lot No. Paul WhBaton Location Clyde-S t xs..New-_York,-- :..it.............................. Owner Address W A & B Cesspool Service 128 Bishops Terraces Hyannis, MA---02601--_- Installer Address QType of Building Size Lot.. ......... ...........Sq. feet U Dwelling—No. of Bedrooms............ ................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons...................._....__ Showers ( ) — Cafeteria ( ) a Other fixtures -----•-------------------•--•--- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.............._..... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----_------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------.............................................................. Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test.Pit.................... Depth to ground water........................ P4 --- and O Description of Soil.................. .................................:............................................................ ------------------------------------•-------•-••---- x W -----------------------------------------•--•------------•----------•--------------------------------------------------------------------------•-- ..................................................... U Nature of R airs or Alteratio s—Answerwhen applicable.______installation ofa 1,000__gallon, 'pre-cast stone paced leach pit(overflow . a .................................. i Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with �. the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in peration until a Certificate of Compliance-has be n issued by�theboa�rof aSi ed - ---- - -•-- -- JIL. ........ ate PPlication Approved . --- ----------- IQ/1-3/82-------- .......................Date ......._- - � Apr lication Disa rove or he following reasons:.................................................................... ..._ ...........F........................ ..................................................................--...---..-.--....-----••------.....-_-••--------------------------------------_--••-_-..._..-- -Date +. rmit No.......... --•..8...-., 1�� ................. Issued.............. _................. - t Date /�' No.... 2::•...1.....-. FizB........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............TO -- ---.......OF............Parn;atable....--..:......................................... Appliration for Dispaii al Workii Tonitratrtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at 257B Pond St. e...Osterville.;<-EA-•---025.55.------•- ---------------------•-- Paul Wheaton Location-Address or Lot No. 7...C lyde-S t,.,.. Y.......................... --.......................................................................... Owner Address A & L- Cesspool Service 128, Bishops--Terrace,,_-l.I,yanni.s,-..TfiA....02501.-- ........... . Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms._______.___...............................Expansion Att c ( ) Garbage Grinder ( ) Q, Other—Type of Building ____________________________ No. of persons____________________________ Showers ( ) — Cafeteria ( ) QI Other fixtures __________________________________ d W Design Flow............................................gallons per person per day. Total daily flow_.____._.____._.._.___._.___.___._________._gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width----_........... Diameter................ Depth............. x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) - `" Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ L% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....._.................. -----Q• Description of Soil........................................................................................................................................................................ x U -------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ W ----•--------------------------•----•-----•:-•---•----•-•••--------•----•---------------•-----------....-•--------------•••-----•--------••-••••--------- - x installation._ a of -_1 y OaEl---gsll-on;---p•�-east U Shore 4 its tp}LfD0ve#�j yvhen applicable------------ •--............................................ -•---------------••--•------•-------------------------------------------------------•------•••--•----------•-•-•--------•-------••----•-------•-------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI- 5,.pf,_th.f..State_Sanitary-Code-The undersigned further agrees not to place the system in -operation until a Certificate of Compliance has been issued by the board of healthSi ed- , ' x 10 1 R2 t / Application Approved ==``.. •-------- --- ----10�� `-Rz------ Date Application Disapprove or the following reasons__________________ ••----------•-•--•-----------• .............. ................................ �..�.✓ � Date 2= Permit No......................- -----_. Issued................ 9/13/82 — Date-•--•---•.................•-••- i z THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ((�� own Barnstabl e . ..........................................O F........ ........ ..._.......................................... .. Tlertgfiratr of Tontpli anrr THIS IS TO CERTIFY, That the Individual Sewage.Disposal System constructed ( ) or Repaired ( X) ��, A & D Cesspool Service, 128 Bishops Terrace_,._Zjya,_nnis_,_._?4A.... -.......................................... ' Installer °`,,,at. 257B Pond St.. , Ostervi lle, _i,1 02655 --_Paul Wheaton - ----- -------------------------------------------------------- has been installed in accordance with the provisions of TITL_.- r of he State SanitaryCode as described in the r t, ---------------- dated 1c/13/ 2 application`for Disposal Works Construction Permit No-------2_. ____ �� t THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON E® S A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 10/ 3/}�2 DATE.... 0 __ •....................•------....---------. Inspector........._..THE COMMONWEALTH OF MASSACHUSETTS ] BOARD OF HEALTH r 2� ...........::•.�:?n............OF.............. `uY21et.a a.. ............................................. No---------------.... FEE...............'---5.00 1 Disposal Works T41notratrtion rrntit , Permission is hereby granted.............A & R Cesspool--Sez'v3�@-----.._._..-------------- --,......._..----------........_.........._._.. � to Construct or Reppair ( an Individual Sewage Disposal System at No..•-•••----- �s3 _ fond St. :_..tJstery lle,...'.�A.•--o?b55_..-_-:Eau1-Xheat.o1------------------------------------------------•----- treet _ 10/13/82 as shown on the application for Disposal Works Construction , el mi Dated_________________________________________ 413/82 _. Board of Health ATE................................................................................ p� FORM 1255 HOBBS & WARREN. INC., PUBLISHERS lk st.