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Home My WebLink About0351 SWIFT AVENUE - Health S 351' SWIFT'AVE.�,' �- � A - 166 006 T.FRVILLI'; 0 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 351 SWIFT AVE Property Address WILLIAMS ESTATE Owner Owner's Name information is required for OSTERVILLE MA every page. City/Town 11/7/09 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. ImpoMen filling A, General Information Men filling out forms on the computer,use 1. Inspector: only the tab key v to move your DOUGLAS A BROWN cursor-do not use the return Name of Inspector key. DOUGLAS A. BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Town State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the w information reported below is true, accurate and complete as of the.time of the inspection. The inspection — was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000).The system: ® Passes El Conditionally Passes ❑ Fails Q. Needs Further Evaluation by the Local Approving Authority Cg> a wwi 11/07/09 Inspect ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. """'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. t5ins•09/08 TiUe 5 Official Insp ection Form:Subsurfa Sewage Di sal tem•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments gY 351 SWIFT AVE Property Address WILLIAMS ESTATE Owner Owner's Name information is required for OSTERVILLE MA every page. Cityrrown 11/7/09 State Zip Code Date of Inspection B. Certification (cunt.) 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. 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 over20 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): t5ins•og/08 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form i a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 351 SWIFT AVE Property P KY Address WILLIAMS ESTATE Owner Owner's Name information is required for OSTERVILLE MA every page. City/Town 11/7/09 B. Certification (cont.) State Zip Code Date of Inspection B) System Conditionally Passes(cont.): ❑ 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 . Y or obstructed pipe(s). system will pass inspection if(with approval of the Board of Health): p p (s). The ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):. C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09M Title 5 Official Inspection Form::Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 351 SWIFT AVE Property Address WILLIAMS ESTATE Owner Owner's Name information is required for OSTERVILLE MA every page. City/Town 11/7/09 State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is.within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria 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. 3. Other. D) 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 ® 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 Y day flow t5ins•09M8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ''• 351 SWIFT AVE Property Address WILLIAMS ESTATE Owner Owner's Name information is OSTERVILLE required for MA every page. City/Town State Zip Code D of Date te of In Inspection B. Certification (cont.) Yes No ❑ ® 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 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 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: 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 D. Yes No ❑- ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Ins pection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 351 SWIFT AVE Property Address WILLIAMS ESTATE Owner Owner's Name information is OSTERVILLE required for MA 11/7/09 every page. Cityrrown State Zip Code Date of Inspection C. Checklist 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 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. El ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 351 SWIFT AVE Property Address WILLIAMS ESTATE Owner Owner's Name information is OSTERVILLE required for MA every page. City/Town 11/7/09 State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS BUILT CARD AND PERMIT SYSTEM CONSISTS OF A 1500 GALLON TANK D-BOX AND 4 HIGH CAP INFILTRATORS WITH 4 FT OF STONE AROUND AND 14 INCHES UNDER Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No .Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Lau ndry system Inspected? El Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 07-198 08-187 Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 11/09 Date 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °( 351 SWIFT AVE Properly Address WILLIAMS ESTATE Owner Owners Name information is required for OSTERVILLE MA 11/7/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)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): t5ins-09/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 351 SWIFT AVE Property Address WILLIAMS ESTATE Owner Owner's Name information is required fcr OSTERVILLE MA every page. City/Town 11/7/09 State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: 7/3/2000 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑cast iron ❑40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•ON8 Title 5 OffiGial Inspection Form:Subsurface Sewage[Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments gr 351 SWIFT AVE Property Address WILLIAMS ESTATE Owner Owner's Name information is OSTERVILLE required for MA every page. Citylrown 11 State Zip Code Datea o of f Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK COULD USE PUMPING AT THIS TIME Grease Trap(locate on site plan): 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 t5ins•09M8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �Y 351 SWIFT AVE Property Address WILLIAMS ESTATE Owner Owner's Name information is required for OSTERVILLE MA every page. Citylrown 11/7/09 State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 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). d).is copy attached? El Yes ❑ No dins-09108 Title 5 Official Inspection Form,Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 351 SWIFT AVE Property Address WILLIAMS ESTATE Owner Owner's Name information is OSTERVILLE required for MA 11/7/09 every page. Cltyfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert Of$ 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.): BOX IS LEVEL NO LEAKAGE SOME SOLID CARRY OVER PROBABLY DUE TO LACK OF MAINTENANCE 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.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: NO OBS PORTS APPEARS TO BE UNDER DRIVE WAY t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disp osal posal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 351 SWIFT AVE Properly Address WILLIAMS ESTATE Owner Owner's Name information is OSTERVILLE required for MA 11/7/09 every page. City/town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 4 ❑ 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.): 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 t5ins•09/GB Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 13 of 17 I r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �Y 351 SWIFTAVE Property Address WILLIAMS ESTATE Owner Owner's Name information is required for OSTERVILLE MA every page. City/Town 11/7/09 State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): t5ins•agroa Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "< 351 SWIFT AVE Property Address WILLIAMS ESTATE Owner Owner's Name information is OSTERVILLE required for MA every page. Cityrrown 11/7/09 State Zip Code Date of Inspection D. System Information (cont.) 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 t5ins•09= Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments rY 351 SWIFT AVE Property Address WILLIAMS ESTATE Owner Owner's Name information is OSTERVILLE required for MA 11/7/09 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10 FT++ 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: Before filing this Inspection Report, please see Report Completeness Checklist on next page. - p 9 t5ins•09/08 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 351 SWIFT AVE Property Address - WILLIAMS ESTATE Owner Owner's Name information is OSTERVILLE required for MA 11/7/09 every page. Cltyrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09H)8 Title 5 Official Inspection Form:Subsurface Sewage Ds g posal System•Page 17 of 17 i TOWN OF BARNSTABLE a LOCATION - 3 j SEWAGE # VILLAGE . ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY • LEACHING FACILITY: pe) (size) NO. OF BEDROOMS BUU-DER OR OWNER PERMITDATE: 00 COMPLIANCE DATE: _:: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply.Well and LeachingFacility ty (If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet j /1G0"l Gam, 1 /r P § a I . CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT 1 875 ROUTE 28 CENTERVILLE,MA, 02632 (508) 790-2380\FAX# (508) 790-2386 OIL/HAZARDOUS MATERIAL RELEASE FORM LOCATION: ADDRESS OF RELEASE <<?it 1.1 AftA c 9EL r ' t�� DATE OF RELEASE: PRODUCT RELEASED: 1;�)k ESTIMATED QUANTITY: L Ir rn CORRECTIVE ACTION TAKEN BY RESPONSIBLE PARTY: NOTIFICATIONS: �" FIRE DEPARTMENT:YES (✓S" NO( ) DATE: , TIME: 11-2 NATIONAL RESPONSE CENTER: YES( ) NO(w)-' DATE': TIME: DEPT. OF ENVIRONMENTAL PROTECTION: YES( ) NO(„� DATE: TIME:-- OIL SPILL COORDINATOR: YES ( ) NO(v- DATE: TIME: TOWN BOARD OF HEALTH: YES (v)'NO( ) DATE: 217zht- TIME: i nn TOWN HARBORMASTER: YES ( ) NO(0Y DATE: TIME: OTHER AGENCIES: COMMENTS: s rat,s t_t._AVACZ n :J so 5 4-A r;I.IJ2ha t,�. ��.s._-r€ae.-�L iE REPORT FILED BY: t�. __ - z� �' DATE: WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E.P. PINK COPY-BOARD OF HEALTH C.O,M.M.FORM x 58 f A Health Complaints 18-Jun-02 Time: 2:15:00 PM Date: 6/14/02 Complaint Number: 3479 Referred To: LEE MCCONNELL Taken By: LEE MCCONNELL Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name: Number: 351 Street: Swift Ave Village: OSTERVILLE Assessors Map-Parcel: 166/066 Complaint Description: Neighbor complained about excessive trash on Mr. Williams property. The Neighbor is fearful for his children's safety because there is a pile of wood and boards with nails sticking everywhere. There is also a wheelbarrel full of stagnant water with mosquito larvas ready to hatch. This pile of debris is approximately 1' from his bottom deck step. Actions Taken/Results: Lm investigated complaint at 351 Swift Ave., Osterville on 4/16/2002, there were two cars out front and the doors were open but nobody answered the door. Lm inspected the pile of debris on the Williams property. Lm observed a pile of wood with rusty nails jetting out everywhere, there was an old corroding grill and lawn mower and miscellaneous objects throughout the area. Lm observed the stagnant water full of mosquito larvas in the wheel barrel. This large pile of debris is approximately 1' from the abutting neighbors deck steps. Lm did not observe boundary markers but the large pile of debris did not appear to be 10'from abutting neighbors 1 Health Complaints 18-Jun-02 property. Between Donna Miorandi and Lee McConnell this is are third trip out to property regarding complaint, everytime no one has answered the door. Donna Miorandi issued a warning on 06/05/2002, giving Stanley five days to clean up yard. Lm will issue a$40.00 ticket until pile is cleaned up (6/18/2002). Investigation Date: 6/14/02 Investigation Time: 3:00:00 PM 2 +� p, * � � �x�; •� � '� �� P� r '„ . �"' _ � `l�+� '� J 4 ,,'� ��I iF�. � . A a-„ �� , c, ,.r�' :,�qK � ., , . _. :3 � ._� w�. R•r,.��i. '� .��.' w,.Z�` I , A . 1 i 061 3203826 ', �� -itr, � / \ �' C. v M � �� , . - ,� � � �� ' ', � �.: 061, 320- -4410 U)/ + A Health Complaints 05-Jun-02 Time: 11:00:00 AM Date: 5/3/1902 Complaint Number: 3401 Referred To: DONNA MIORANDI Taken By: BARBARA SULLIVAN Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name: Number: 351 Street: Swift Avenue Village: OSTERVILLE Assessors Map_Parcel: Complaint Description: Neighbor has junk and trrash lined up along the property line. Actions Taken/Results: DZM inspected and observed some old lumber, some brush along property line(?) and tires in rear yard. Shall send out a notice/warning to woman's son named Stanley Williams who is the son of owner, Helma Williams who is 94 and legally blind. Allegedly son is abusing her. Stanley Williams' number is 428-9589. Investigation Date: 5/3/2002 Investigation Time: 5:00:00 PM 1 •--.�."�r"""^"`...-e.�^'X+.....-ma's-. __. '. . rr.x'*'w^n.n..,ti..i+:.....»�M... ,+a.`�"lS.-d7�,.Cyr..`-"{".'tkx-,•'s'..-.rn.,..tti'^vr+.-..rr.f—,.:,. TOWN OF BARNSTABLE 996 Ordinance or Regulation WARNING NOTICE � Address of Offender A AP)F MV/MB Reg.# Village/State/Zip ,.` JC_i///,,,.,�ri.. , t, , r Business Name am/spm ' on ,,, bI .20 0 Business Address ; z � Signature _of/Enforcing Officer . Village/State/Zip Location of Offense ""/� 0/fiffi-W eEnforcing Dept/91v, s'ion Offense 1xj eC-7- Facts 1 f 1 .' � � 1<.F�.WA. t, t . �(_1t�1 d 4' LAAAW &4i O� Dili meet M C41940q —� This will serve only as a warning. At this time no legal action has been taken: It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations ill result in appropriate legal. action by the Town. up r) Y NTUA16 /10/ Alf' . V � ti TOWN OF BARNSTABLE ��! BA Ordinance or Regulation WARNING NOTICE Name of Offender/Manager ' r; Address of Offender W/FT A VC-,API'F My/MB Reg.# Village/State/zip �� _ ., i,,., y,,, ,,,,�. aMA 6q/ 07') , Business Name one . . sr Business Address Signature .of. Enforci�ng Officer Village/State/Zip Location of Offense 3JU V(f F Enf6rci4g Dept/Diva sridn r)/-mjJ Offensey tt (_3 A ' Facts fn uc 0/'1) J .., This will serve only as a warning. .At this time no legal action has been taken: It is the goal of Town agencies to achieve voluntary compliance of Town #. Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result i:n appropriate legal action by the Town. k . 7q_ T 6 /0,, T NAME OF OFFENDER _ DAD S 38 A Dnn f� TOWN OF ADDRESS OF OFFENDER BARNSTABLE CITY,STATE,ZIP CODE �.ME►p� "" MV/MB REGISTRATION NUMBER OFFENSE {{y,*f��{� t 4f �'y��yl.�'^(� ^��}�..[,}� 4t `..�(�{��f 1 (/\+`�s+ j`''� '} �j/) /^��+* • IfAN 1ASSfl1A:.A 9"`X.� ' v \.6 in ..wv+... 1_ `_.. it.-..r!i•`w.A4..4w `s L� , V W i �� CL V W �639• �0 ... y`�' }L�, _ '{y,^/y i `t 1,'}y}, E S �'"� ¢" ( 11/f+ j O plEO MPS ''-'a'r i V r:. -�.+C,.. e�4`�•t. C + L11 i Y i i\! .�1+?-\� 1 i -) Waoi 4-,s )a . \ Y 4S 1 TIME AND DATE OF VIOLATION LOCATION OF VIOLATION `J w NOTICE OF S%C� (A.M.L .M ON (0 { 20 c`" '?4 .1 t NVC, _ 6e_Vt.1) SIGNATURE OF ENFORCING PE ON ENFORCING DEPT. BADGE NO. w VIOLATION c� ''� , t�. � f-_Y 1 �L-, o OF TOWN I HE FBY ACKNOWLEDGE RECEIPT OF CITATION X ORDINANCE ❑2U'"nable to obtain signature of offender. THE NONCRIMINAL FINE FOR THIS OFFENSE IS Date mailed(0 ' OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. W REGULATION a (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, J before:The Barnstable Clerk,230 South Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. CL 12)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET, BARNSTABLE,MA 02630,Attn:21D Noncriminal Hearings and enclose a copy of this citation fora hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature No. 0wo Fee 60 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: VY PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppricatfon for Mi5pool *p tern Contruction Vermtt Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components 0 Location Address or Lot No. I Owner's Name,Address and Tel.No, OS Assessor's Map/Parcel ' 00 �Vh Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �t0"GQS��7'j I�/CI✓fS 5✓ /7 , Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �3-3Q gallons per day. Calculated daily flow -3�js. gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank I 'SOD Type of S.A.S. �Lc-` Description of Soil LU r4 Nature of Repairs or Alterations(Answer when applicable) c�e J ' C �7-pg,- _ee GZ i2 t �:r i t^.^ O i l 2 TLC 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 Environment 1 Code and not to place the system in operation until a Certifi- cate of Compliance has been' e t us o Signed a1 Date "7'370,70 Application Approved by kA Dateft Application Disapproved fo t e following reasons Permit No. Date Issued ( Fee No. ` . THE:COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS i' 0(pplication for Migpogar by tern Construction Perron Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) 16tomplete System O Individual Components Location Address or Lot No. ,�.... Owner's Name,Address and Tel.No. Assessor's Map/Parcel U�� , 00� ��,MS Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. p- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) 4 Other Type of Bih ding 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 S M) t `` Type of S.A.S. v k k C4 QIic i (—Zt�,l? Description of Soil / C U r'1 12 S G C►lY ".. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: v 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 Environme 1 Code and not to place the system in operation until a Certifi- cate of Compliance has been it d''b his Boaro of .east Signed * �yy ) d , Date 7` Application Approved by W 1 Date Application Disapproved for t e following reasons Permit No. Date Issued ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS r (Certificate of Compliance THIS IS TO CERTIFY, at the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded(L---y Abandoned( )by M 1 at Suit i CZ S�TI�2 Pia h n constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer t Designer / A ! % f/ //b�l/ �' r The issuance if this permit shall not be construed as a guarantee that the tenrw,all(function rides gne,. Date t Inspector Y ff ) I ----- ,--------------------------- No. --- JA THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi5pogaf *pztem Con!5truction Permit Permission is hereby granted to Construct( epair( )Upgrade )Abandon( ) System located at S w i l /4 try,..., a li 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 cin trapt be completed within three years of the date of t ' pe Date: Approved by" I T j TOWN OF BARNSTABLE LOCATION -�/ SG.�I f TT ylr/e . SEWAGE # U�� I VILLAGE �.�� ASSESSOR'S MAP & LOJT INSTALLER'S NAME&PHONE NO. �i, I b CZ�a e TeX 'T� C SEPTIC TANK CAPACITY X le-a - LEACHING FACILITY:1pe ) 7�/ 740.r (size) NO.OF BEDROOMS BUILDER OR OWNER i 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 �I ,e,n 7 7 i f U6r99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. , - l i CERTIFICATION OF SKETCH.kYD APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERtiLIT (-V=0TJ-T DESIGNED PLANS) hereby ceairy that the application for disposal works construction permit signed by me dated 7 =?' concerning the property located at Sw, O.S c meets all of the following criteria: or • T'ne failed system is tonne-ed to a residential dwell ing only.. t nere are no commercial or business uses associated with the dwelling. /Tne sail is classified as CLASS 1 and the percolation rate is less than or eoua.l to 5 minutes per inch. 7,aere are no wedands within !oo fee;of the proposed septic srsem L_,_ mere are no ornate wells within ifo fe"of the proposed septic srsern ,,4,lere is no increase in flow and/or change in Use proposed There are no variances requested or ne`ded Z, 7ae bottom of the proposed leacain;facility will not be located less than five Fee:above the tna..dmum adjusted groundwater table elevadon. (Adjust the groundwater table using the Frimpcor rr;echcd whet applicable] / If the S.A.S. will be located with 2-50 tee;of ax,ve?emted wetlands, the caaom of the proposed leaching Fac:li.ty will net be lccaced less Linn founee:t(1-,) tee;above the m3--cimum adiusted v*oundxater cable e!evatior� Please complete the rollowin;: A) Too of Ground Swtace =!(rvasion(ruin;GIS information) B) G.W. E?c..anon 0-the NLa (. ugh G.W. Adjustment c; ! D[T-FERE`+CE BETWEEN a,and 31 5 1 G-E) : ��,D ATE. (Si:e;c t proposed plan of s.stern on bac'c]. q::-caich;aide.:cc �, o �'` o� 9 ceSs��,L. TOWN OF BARNSTABLE ' ®� i s LOC.ATIOi� -�� :`:s'G,./fs� yld-e . . SEWAGE # A000"r� RAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 41 21h C. SEPTIC TANK CAPACITY X Sro LEACHING FACILITY: pe) /�r/�i/7`/ f6/�.�' (size) NO.OF BEDROOMS BUILDER OR OWNER u,-! PERMTTDATE: 00 COMPLIANCE DATE: 06 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 j Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by— i �r P 3 �33 C�> � ToViI4 OF BARNSTABLE LG,-A ilON �`"�� '�� SEWAGE # VII sAG E a j 'rv' - ASSESSOR'S MAP & LOT 69 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) .('(-�/d (size) NO.OF BEDROOMS �— BUII.,DER O OWNE 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 fac' ity) Feet Furnished by I - � t,. �T a,�- �y� ` ,��a' �' p��