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HomeMy WebLinkAbout0275 OST.-W.BARN. RD - Health ,27.5 QST-W.BARN RD Marstons Mills A = 121 — 007 — 002 P-7 �F r E TOWN OF BARNSTABLE BOARD OF HEALTH II ,, ', ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date / / _/ / VlJ �S.Fn Time: In 6 Out Owner '_33� Tenant AICC C Address Q�U1`: Address Compli ce Remarks or Regulation# Yes Y NO Recommendations 2. Kitchen Facilities Aoorovecf; 3. Bathroom Facilities ' 4. Water Supply i 5. Hot Water Facilities 1 d] 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 cf Bedrooms Number of Vehicles Allowed (max) e� Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here Date jA-,C /i ZOIO To Whom It May Concern: I, �ANtiE ZAVAC Y`ei , voluntarily grant permission to the Town (Occupants name) of Barnstable Board of Health(Agent or Health Inspector)to inspect my dwelling unit located at 2 77- OS l' fi 5� i�Y L� 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 V (Date of inspection) to be my tenant representative for the (Occupant representative) purpose of this inspection. �" L- r f T 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.) \ 1z //0 c pants Signa \ Date ccupants Representative Signature \ D to ?— Date !) To Whom It May Concern: voluntarily grant permission to the Town (Occupants name) of Barnstable Board of Health (Agent or Health Inspector) to inspect my dwelling unit located at �Lin accordance (House#, [Apt\Unit#i applicable],street,village) with the Town of Barnstable Code (Chapters 59 and 170) and the State Sanitary Code (1.05 CMR 410.000) on I hereby authorize and name (Date of inspection) tj� -/&%QUPQto be my tenant representative`for the Lin (Occupant representative) purpose of this inspection. '. - is an adult person Occupant r(kresentative) 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//0 cupants gnature \ Date Occupants Representative Signature \ ate Q:\Rental Ord inance\inspection permission 2.doc TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date i — j U Time: In Out 10 19-3 G Owner Q_ D Tenant Address S Cv Address �� �j (� `r,✓_ t Compliance Remarks or Regulation# Yes YNO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply Approved: . 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 • • 1 • • DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signat re 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. B. Received by(Printed Name) C. Date of Delivery ,■ Attach this card to the back of the mailpiece, 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 3. Service Type DZ la ®Certified Mail ❑Express Mall ❑Registered f Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2..Article Number 7006 0810 0000 3524 7984 (Transfer from service labeq PS Form 3811;February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POST h- i F FFFeF1 fiE(� ii ;F pplim, First-Class Mail rT r$ Fry =11 € r{� �: r 'Postage 8 Fees Paid - USPS Permi4 No.GG10 • Sender: Please print,your name, address, and ZIP+4 in this box• 2 bib Yea•c, -Z� � l•�hh:S L poA czbo� Certified Mail#7006 0810 0000 3524 7984 P�oFz Tati Town of Barnstable h o Regulatory Services g Y + UARNS-rABLE, ` Q MASS. ---- -- -- -- Thomas_F._Geiler,_Director . - O rE°MAR Public Health Division Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 10, 2007 Linda Letourneau t—'31—0 572 Cotuit Road Marstons Mills, MA 02648 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE H— MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 275 Osterville—West Barnstable Road, Osterville was inspected on January 8, 2007 by Donald Desmarais, 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 violation(s) of the State Sanitary Code were observed: 105 CMR 410.3517 Owner's Installation and Maintenance Responsibilities - Open grounds were found on outlets throughout house; GFCI outlet in kitchen not working properly. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by pulling any required permits (if applicable) by repairing or replacing the open ground outlets in accordance with 527 CMR 12.00 of the Massachusetts Electrical Code; by repairing or replacing GFCI outlet in kitchen. 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. QAOrder letters\Housing violations\Rental ordinance\275 Osterville-West Bamstable Road.doc L Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF HE BOARD OF HEALTH r as cKean, R. .;CHO Director of Public Health Town of Barnstable Cc: Donald Desmarais, Health Inspector t Q:\Order letters\Housing violations\Rental ordinance\275 Osterville-West Bamstable Road.doc l FORM 30 IiW HOBBS&WARREN'" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :1 CITY/TOWN F b DEPARTMENT c� ADDRESS �,N Syey\0 TELEPHONE Address 5_0 'h7� Occupant Floor Apartment No. No. of Occupant] No. of Habitable Rooms No.Sleeping Rooms__!__ No.dwelling or rooming units _ No.StorieT- __ 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 Doors,Windows.- Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation. r�`•n 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.: QQ AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Wall Ceils. Wind. Doors Floors Locks Kitchen Bathroom c Pantry -(Q Den .Livin Room Bedroom 1 o Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Te t Stacks, Flues,1_eKT7S5 eties: Kitchen Facilities in Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALT S 0 URY." INSPECTO TITLE V A.M. DATE l TIMES A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation an other violation has the potential to fall within this category in an given specific situation but may not do so Y p 9 Y Y9 P in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards`that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A) and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. • yea If�, , o Commonwealth of Massachusetts , Executive Office of Environmental Affairs N 0 V 3 1995 = Department of • Environmental Protection WHUM F.wow DwIBta h Cornnionm SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property.Address: I7s ��— �'��"sf�bat �� ©,Sf' Address of Owner. Date of Inspection: /D— /6— 9S Of different 6/0 C'?a sw"S wa y Name of Inspector: v014 , y A741fv LL D��r�r Ito Mp, Company Name, Address and Telephone Number: CERTIFICATION STATEMENT I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on. my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION.SUMMARY: .Check.A, B,C, or D: Al SYSTEM PASSES: I have not found information which indicates that the any ' system violates any of the failure criteria as defined in-310 CMR 15.303. „n Any failure criteria not evaluated are indicated below. B]. SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the,replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or NO). Describe basis of.determination in all instances. If"not determined",.explain why not The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or"filtration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (swiaed is/15/9s) 1 One wh+ar sum 0 eo.ton,mmmAhu"to amos 0 FAX(617)tIN"100 9 Td"Owrre(6171=24M SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t PART CERTIFICATION (continued) Property Address: �7 S O.tt W/�rnf!s►��i ©Svi 1�1 Owner: Ca.fuv/yTrr,A/�s r.. Date of Inspections BI SYSTEM CONDITIONALLY PASSES (continued) h*A•_<v° Sewage backup or breakout or high static water level observed in the distribution box Is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed CI 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 the public health, safety and the environment. 4 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a swfaLe water supply or tributary to a ' surface water supply. _ The wstem has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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 lets than S D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.503. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or dogged SAS or cesspool. } Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or dogged SAS or # cesspool. I 1 . a i c. (revised 8/19/95) Z • 4_l'-3 ,w� 4 .i. ,. ' to�. .. ..• n , t e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: ¢7 S O�r1-tv �4r� Ral' OS�rv�7�+ Owner. CAwsur Date of Inspection: qs- 01 SYSTEM FAILS(continued): Static liquid level in the distribution box above outlet invert due to an overloaded or dogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. _ Required pumping more than 4 times in the last year NOT due to dogged or obstructed pipe(s). I Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E]LARGE SYSTEM FAILS: 9 he following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) '--° `The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatrrment tam requirements of 314 CMR 5.00 and 6.00. Please consult the local regional officeinformation. of the Department for further infoation. � e Imr�rla�d •/is/!5) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ?7S Os�- u//,�lq...,s �1� Rot ds7i/'v, Owner- Cola w, /1�Ilaa�/f Date of Inspection: /0_/6'9S Check if the following have been done: fumping information was requested of the owner, occupant, and Board of Health. 1/None of the system components have been pumped for at least two weeks and the system hasbeen receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. /M As built plans have been obtained and examined. Note if they are not available with N/A. ✓The facility or dwelling was inspected for signs of sewage back-up. ✓The system does not receive non-sanitary or industrial waste Flow ✓The site was inspected for signs of breakout. ZAII system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. ,6,::�Ihe size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner land occupants, if different from owner) were provided with information on the proper maintenance of Sub. Surface Disposal Svstem. i i tttwta" 1/lb/9S) 4 1. I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 171 c9d W&i "A3kw 4^1 Owner: Ceasr/r /L1r�so<<f Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: gallons Number of bedrooms:_ Number of current residents: O Garbage grinder(yes or no):_.&p Laundry connected to system (yes or no): NO Seasonal use (yes or no):_&jP Water meter readings, if available: T cZ&4r Last date of occupancy: T&-.t f"S' COMMERCIALANDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (ye or no)_ Non-sanitary waste discharged to the Title 5 stem: (ye r no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING, RECORDS and source of information: System pumped as part of inspection: (yes or no)_h If yes, volume pumped: gallons Reason for pumping. TYPE OF SYSTEM . . Septic tank/distribution box/soil'absorption system 4-0' Single cesspool Overflow cesspool ---..._.._ ...._..._.. . Privy Shared system (yes or no) (if yes,attach previous inspection records, if any) ' Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: U-47 -' Sewage odors detected when arriving at the site: (yes or no) Nv (revised 8/13/95) s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 21s Owner: 042,1w/LYelvlfs Date of Inspection: ,b 5 t,k, p.•. SEPTIC TANK: (locate on site;—Ian) - Depth below grade: Material of construction: _concrete _meta FRP other(explain) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee orKffle Scum thickness: Distance from top of scum to top of outlet tee or bafflDistance from bottom of scum to bottom of outlet Comments: (recommendation for pumping, conditio f inlet and outlet tees or baffles, de of liquid level in relation to outlet lnvert, structural integrity, evidence of leakage, etc.) GREASE TRAP: (locate on site plan) 1 Y., f Depth below grade: \� I ` ' • •� her(explain Material of construction: _concrete ,_metal _FRS—ot a Dimensions: \ Scum thickness: ► : ;.si '. Distance from top of scum to top of outlet tee or baffle: t ! Distance from bottom of?cum to bottom of outlet t or ba e Comments: (recommendation for pumping, conditio of inlet and outlet tee or baffles, depth of liquid level in relation to outlet imrert, structural integrity, evidence of leakage, etc.) ie •• 6 k., Izevieed !i/iS/951 ' t e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: A47.5' Sty 1J0v" R� �5✓�/�v�1/� Owner. Goy.X.r ii✓14v,�is Date of Inspection: TIGHT OR HOLDING TANK:_ (locate on, site plan) Depth beiow grade: / Material of constriction: _concrete_metal FRP other(explain) Dimensions: Capacity: aal Ions Design flow: Qallons/day , Alarm level: Comments: (condition of inlet tee, condition of alarm and fl/etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of'iquid level above outlet invert: Comments: ` (note if level and distribution is equal, evidence solids carryover,le`idence of leakage into or out of box, etc.) PUMP CHAMBER: ' (bate on site.plan)• rr-.....--...•ter.. �. . Pumps in working order.(yes or no) _. _. _... Comntert<s: (note condition of pump chamber, condition of pum and urtenances, etc) } (swi��d ti/IS/9ti1 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2 / ` Owner: Cer-Sp✓ A40- t1 Date of Inspection: �D�!/-9s� °.) ,,��. _ ."'",;'-".•' . SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excav ion not required, but may be approximated by non-intrusive methods) ° If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number:_ `' leaching galleries, number. leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs . hydraulic failure, evel of ponding, condition of vegetation,etc.) CESSPOOLS: „ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: 3' Depth of solids layer: ` n" Depth of scum layer:_ 74. Dimensions of cesspool: ry X 0, 8-64i r fA'hTW'e Materials of construction: Ciprep-A. Indication of groundwater: /i/oht inflow (cesspool must be pumped a part of inspection) s o/ ww s /�++ o� ��I �.•� r " 7'i:wi '' '" vat h Jt— AON ks oor Comments: Inote condition of soil, signs of ydraulic failure► level of ponding, conditiop of vegetation, etc.) , ibw 0"0e 07Ceeswgf0, see0--S e. �r/wa7.rr �'or 0it aI , bw�le(r+.. t "'A oH-C dweavo+ ,..{ 't'i P"y;.,y,.z,.t cyi:;z$` -'iv,• sit eT`. PRIVY- (locate on site plan) Materials of construction: Dimensloris: Depth of solids: Comments: (note condition of soil, signs of ulic failure, vel of ponding, condition of vegetation, etc.) , • s iY �A (revised 0/15/05) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ?7s O.sf• rl/ ,,7 Rol ®s/y f7l-, Owner. consar /y/mJf s Date of Inspection: i SKETCH OF SEWAGE'DISPOSAL SYSTEM: . include ties to at least two permanent references landmarks or benchmarks locate,all wells within 100' Irv,P; lu DEPTH TO GROUNDWATER Depth to roondwater:-31_feet method of determination or approximation: lyc er E/4 i 90 KEY NUMBER <1606 > NAME <MENDES, SALLY G > B-C 1 B-C 2 B-C 3 B-C 4 ZOC STREET 60 CESAR'S WAY CITY OSTERVILLE ST MA ZIP 02655-1208 REF 1 REF 2 PHONE ( ) - REF 3 REF 4 METER NO. < 1517> DATE READING CONS STREET <WEST BARNSTABLE RD NO. 275> 06/30/95 28 15000 CITY OST I ST LOC 12/31/94 . 13 1000O PHONE ( ) - 06/30/94 3 3000 04/25/94 0 0 ROUTE NUMBER 11 04/25/94 246 0 SERVICE DATE 10/14/88 12/31/93 246 5p00 METER DATE 04/25/94 06/30/93 241 10000 CAPACITY 7 12/31/92 231 4000 STYLE T10 SIZE 1 RATE SCHEDULE KEY PIT PLASTIC X NOTE LS MTR SEALED ELEC GROUNDED TO OLDPIPE ADDITIONAL CONS 0 ALTERNATE MIN 0 t 1 14 7 •i