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HomeMy WebLinkAbout0464 OST.-W.BARN. RD - Health 464 MARSTON WILLS A = 122 010 - - r Commonwealth of Massachusetts u;"P16 H . Title 5 Official Inspection Form ' a Subsurface Sewage Disposal'System Form-Not for Voluntary Assessments df 4� 464 Osterville W. Barnstable Rd. r ! Property Address Charlie Rogersg Owner Owners Name information is required for every Marston Mills MA 02648 6/17/15 ' page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information I I I on the computer, 97 use only the tab 1. Inspector: key to move your cursor-do not James Ford use the return key. Name of Inspector Company Name P.O. Box 49 Company Address Osterville MA 02655 City/Town _ State Zip Code 508-862-9400 ! S12482 Telephone Number License Number tr B. Certification I certify that I 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 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 Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes t4F-Fails, ❑ Needs Further Ev uatign by the Local Approving.Authority;` t, ,6/18/1'5 Inspettem s Signature f Date' The inspector shall submit a coPY'of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing thisinspection If the system is a shared system or has a design flow:of 10,0M'9* pd or greater, the inspector.and thesystem 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 describesfconditions 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-3/13 �ysm Title 5 Official Ins ection Form:Subsurtace ew e p S ag Dispo1 of 17 i, t� i Commonwealth of Massachusetts Title 5 Official Inspection Form 0 Subsurface Sewage Disposal!System Form -Not for Voluntary Assessments r 464 Osterville W. Barnstable Rd. Property Address Charlie.Rogers i Owner Owner's Name I information is I' required for every Marston Mills MA 02648 6/17/15 page. CltylTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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: i . i; 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. i Check the box for"yes", "nog or"not determined" (Y, N, ND)for the following statements. If"not determined please explain., The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tan', 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 t(ie tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 , f; I {. Commonwealth of Massachusetts Title 5 Official, .Inspection Form Subsurface Sewage DisposaliSystem Form -Not for Voluntary Assessments 3 •�y 464 Osterville W. Barnstable Rd. Property Address Charlie Rogers Owner Owners Name information is Marston Mills [: required for every __ MA 02648 6/17/15 page. Cityrrown i, State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 11 B) System,Conditionally Passes (cont.): ❑ Observation of sewage 6a'ckup or break out or high static water level in the distribution box due to broken or obstructed pipes) 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 r 'moved ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box;ls leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): i. a , 'r. I ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspecf�on if(with approval of the Board of Health): ❑ broken pipe(s)'are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is reLmoved ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is kequired 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 priv1y is within 50 feet of a surface water I ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 15ins•3/13 9 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 I �J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal�S stem Form -Not for Voluntary 9 P i Y Assessments t ry 464 Osterville W. Barnstable Rd.. Property Address Charlie Rogers Owner Owner's Name l information is Mills required for every Marston �' MA 02648 6/17/15 page. Citylrown t, 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: i ❑ 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. !i ❑ 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 thewell water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. E� 3. Other: Ij Ii D) System Failure Criteria Applicable to All Systems: t' You must indicate"Yes" or"No"to each of the following for all inspections: i,- Yes No 1. ❑ ® Back6p bf sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Dischlarge 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 1 day flow t5ins•3/13 `• Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 4 Ih Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal!�System Form -Not for Voluntary Assessments 'yr< 464 Osterville W. Barnstable R1. Property Address Charlie Rogers ' Owner Owners Name information is required for every Marston Mills MA 02648 6/17/15 page. City/Town f State Zip Code Date of Inspection B. Certification (cont.)j, Yes No E] ® Re ui q '�ed 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 tributJ�y 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. s ❑ ® 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 ami:nonia 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,OOtlgpd. ❑ ® 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 Ito 15,000 gpd. l 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 i ❑ ❑ the sy§tem is within 400 feet of a surface drinking water supply ❑ ❑ the syt:tem 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 110 CMR 15.304. The system owner should contact the appropriate regional office of the Department. i t5ins•3/13 ii Title 5 Official Inspection 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 •''t 464 Osterville W. Barnstable Rd: Property Address Charlie Rogers Owner Owner's Name information is [ required for every Marston Mills i. MA 02648 6/17/15 page. Cltyrrown State Zip Code Date of Inspectton C. Checklist i 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 aiay of the system components pumped out in the previous two weeks? I� ® ❑ Has th6system received normal flows in the previous two week period? li ❑ ® 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 A'facility owner(and occupants if different from owner) provided with ❑ ® information on the proper maintenance of subsurface sewage disposal systems? The sizg and location of the Soil Absorption System (SAS) on the site has been determined based on: it ` ® El 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)] g D. System Information. Residential Flow Conditions: 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 J , C` V� t5ins•3/13 t; Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i' ji Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal jSystem Form -Not for Voluntary Assessments is 464 Osterville W. Barnstable Rd Property Address i; Charlie Rogers Owner Owners Name information is Marston Mills s MA 02648 6/17/15 required for every ! page. Citylrown State Zip Code Date of Inspection D. System Information r Description: c r' r ; Number of current residents,*, n/a Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate seWrage system? (Include laundry system inspection ❑ Yes ® No information in this report.) I I Laundry system inspected?;' ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if avilable(last 2 years usage(gpd)): Detail: unavailable ) , F , Sump pumip? ❑ Yes ® No I`Last date of occupancy: f currently Commercial/Industrial Flout, Conditions: Type of Establishment: ' , Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/Qersons/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 t • Water mete-readings, if avilable: t5ins•3113 E Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 k 11 f Commonwealth of Massachusetts w W Title 5 Official' Inspection Form Subsurface -Sewage Disposal System Form Not for Voluntary Assessments 464 Osterville W. Barnstable Rj. Property Address C` Charlie Rogers Owner Owner's Name t" information is required for every Marston Mills j;. MA 02648 6/17/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/user Date f, Other(describe below): k {� General information Pumping Records: i{ Source of information: Il Unknown Was system pumped,as part of the inspection? ® Yes ❑ No II If yes, volume pumped: t° 1500 gallons How was quantity pumped determined? Reason for pumping: maintenence Type of System: ® Se tic tanla,, distribution box soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy Ir I ❑ 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): o. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 r, t . t Commonwealth of Massachusetts Title 5 Official .Inspection Form Subsurface Sewage Disposal�'System Form -Not for Voluntary Assessments 44 6 Ostervil le W. Barnstable Rd. Property Address Charlie Rogers Owner Owner's Name requir fo afi is every Marston Mills required for eve MA 02648 6/17/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: system installed -7/30/1999�-per as built card Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on trite plan): Depth below grade: feet Material of construction: r ❑ cast iron ® 40 !PVC ❑ other(explain): i Distance from private water,supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): i; A li 1 Septic Tank(locate on site plan): I: Depth below grade: 15"feet Material of construction: ' ® concrete ❑ n'etal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years i, • Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: l ' 1500 gal. Sludge depth: F, 2 G, t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 s t• 1, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage DisposaBystem Form 7 Not for Voluntary Assessments 464 Osterville W. Barnstable Rd. Property Address a Charlie Rogers Owner Owner's Name information is Marston Mills $ required for every Mars �: MA 02648 6/17/15 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) I" 27 Distance from top of sludge to bottom of outlet tee or baffle I, Scum thickness `` 10 I� Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of sc ,m to bottom of outlet tee or baffle 10 How were dimensions determined? measure Comments (on pumping re6ommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tees were present. There were no sign of Ieakage.The tank was pumped after the inspection. i y, rj 1; { Ft •. Grease Trap (locate on site plan): r Depth below grade: n/a feet Material of construction: ❑ concrete ❑ menrtal ❑ fiberglass ❑ polyethylene ❑ other(explain): C F a . Dimensions: " Scum thickness F: :1 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 l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i? Commonwealth of MassaI! chusetts Title 5 Official Inspection Form Subsurface Sewage Disposai'System Form -Not for Voluntary Assessments I 464 Osterville W. Barnstable Rd: Property Address Charlie Rogers Owner Owners Name information is required for every Marston Mills MA 02648 6/17/15 page. Cityfrown tt State Zip Code Date of Inspection D. System Informatid,n..(cont.) Comments (on pumping regommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): i i; i Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): r . Depth below grade: ' Material of construction: ❑ concrete ❑ metial ❑ fiberglass ❑ polyethylene El other(explain): N/a € Dimensions: is Capacity: i 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 alai!rn and float switches, etc.): ii r *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 pt . V i' Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal`System Form-Not for Voluntary Assessments 464 Osterville W. Barnstable Rd. Property Address Charlie Rogers Owner Owner's Name information is Marston Mills required for every MA 02648 6/17/15 page. City/Town State Zip Code Date of Inspection D. System Information (coat.) I! Distribution Box(if preser>t.must be opened) (locate on site plan): Depth of liquid level above 6utlet 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 i 4, Pump Chamber(locate oJsite 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.): E ;i i r I i * If pumps or alarms are not.in working order, system is a conditional pass. Soil Absorption System (�,AS) (locate on site plan, excavation not required): If SAS not located, explain why: j . r t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 t i r r . Commonwealth of Mass�chusetts Title 5 Official .Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .• 464 Osterville W. Barnstable Rd'. Property Address Charlie Rogers Owner Owner's Name information is required for every Marston Mills MA 02648 6/17/15 page. Cityrrown State Zip Code Date of Inspection D. System Informatiob (cont.) Type: ❑ leaching pits number: 6 infiltrators- ® leaching chambers number: 10'x 40'x 2' i ❑ leaching galleries number: J' ❑ leaching trenches number, length: ❑ leaching field's 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.): The infiltrators were 1/2 ful(.There was no sign of failure..A camera was used for the inspection. ( 1 ,f .Cesspools (cesspool must°be pumped as part of inspection) (locate on site plan): Number and configuration ' l Depth—top of liquid to inletl'invert c . Depth of solids layer Depth of scum layer 1� Dimensions of cesspool f Materials of construction i F Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 i' Commonwealth of Massachusetts F - Title 5 Official Inspection Form Subsurface Sewage Disposal;-System Form -Not for Voluntary Assessments 464 Osterville W. Barnstable Rd. Property Address i Charlie Rogers Owner Owner's Name information is required for every Marston Mills MA 02648 6/17/15 page. CltylTown t 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.): i J' 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.): N/a f+ ; f` e, i i i� •4 I` j . 4 4 M d, i J t5ins•3113 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 l Commonwealth of Massachusetts - Title 5 Official Inspection Form o Subsurface Sewage Disposal;System Form -Not for Voluntary Assessments `s 464 Osterville W. Barnstable Rd. Property Address i Charlie Rogers Owner Owner's Name information is required for every Marston Mills MA 02648 6/17/15 page. Cityrrown 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 J3 l ai f VtA1T Q '. 3 '13 ,(o ` S s qy qq Y 6. k' (, t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 i R ,i r �. Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal,System Form-Not for Voluntary Assessments F� 464 Osterville W. Barnstable Rd. Property Address Charlie Rogers Owner Owner's Name information is required for every Marston Mills MA 02648 6/17/15 page. CitylTown State Zip Code Date of Inspection r D. System Information (cont.) Site Exam: ❑ Check Slope i ❑ Surface water ❑ Check cellar ❑ Shallow wells i Estimated depth to high ground water: 30'+/' <: feet Please indicate all methodsused to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date,of design plan reviewed: Date ❑ Observed site (gbutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Topo and water'contours map ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how youlestablished the high ground water elevation: see above h h 'r. �l t . Before filing this Inspectioo Report, please see Report Completeness Checklist on next page. l5ins•3/13 4 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 y I; I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal!System Form -Not for Voluntary Assessments 464 Osterville W. Barnstable Rd. Property Address Charlie Rogers Owne Owner's Name information is t! Marston Mills required for every i MA 02648 6/17/15 page. Citylfown 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 s a I r +i ,j Il i r 1 �I 1 k' (I f id V . t5ins•3i13 €. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 r'� � /' r TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION C.J Date ( � f Time: In Out Owner I Tenant VT Address Address �q s �j A I It w14V Compli ce Remarks or Regulation.# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply g�t 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 — 2j S 17.Temporary Housing 18. Driveway Width 19. Number of Tenants Observed 3 ! (> () [SO PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition n/ Number of Bedrooms Number of Vehicles Allowed (max) U" Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here ,- FORM 30 CHIWD HOBBSB WARREN TM THE COMMONWEALTH.OF MASSACHUSETTS BOARD OF HEA1 THAI CITY/TOWN v W DEPARTMENT ,. o �✓ ri I ADDRESS GIN SVBy`0W TELEPHONE LL Address — Occupan 2 Floor Apartment bio. No.of Occupantsew- No. of Habitable Rooms 6 No.Sleeping Rooms No.dwelling or rooming units No.Stores Name and address of owner Remarks Reg. Vio. YARD 100, Out Bld s.: Fences: Garba e and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows.- Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: zID V Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: �--- Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 tl Bedroom 2 Bedroom 3 9 Bedroom 4 3-- Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink 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 INSPECTIO ORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES E Y." w c INSPECTOR TITLE DATE "� j" TIME P.M. (� A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises,shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to . include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. .ti (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. r dwelling unit in violation of the Massachusetts Department of Public (J) The presence of leadbased paint on a dwelling o d e g p 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. S its � r • ON .MPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,.and 3.Also complete A. Signat e item 4 if Restricted Delivery is desired. �`�/,/�J ❑Agent '■ Print your name and address on the reverse X -1,PI . 013 Addressee so that we can return the card to you. B. R i ed b Pnn d Nam e1 C� D' "ate of Delivery ■ Attach this card to the back of the mailpiece, , Y( or on the front if space permits. �`'rx `` / �� D. Is delivery address different from`item 1?iQ Yes 1. Article Addressed to: If YES,enter delivery address below;)S 13'No 3. S rvice'fYPe (° Certified Mail [3 E�cpress Mail �� ❑Registered OR Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fes) ❑Yes 2. Article Number (Transfer from service fabeq 1.0 0 6 '0 810' 0 0 0 0° 3 5 2 4"9 0'8 7 1r`h PS Form 3811,February 2004 Domestic Return Receipt 102585-02-M-1540; i UNITED STATES POSTAL SERVICE 1 Firs#-Class.Mailr,,r, Postage&Fees Paid USPS Permit No.G-10 I ' Sender. Please print your name, address,-and ZIP+4 in this box• + I A I I OTown of Barnstable f Health Division 1' ' 200 Main Street Hyannis,MA 02601 V I I ` ` I �41Fi.FF41liF1 4t�11t1FF!{�t1'.lt11k!!l}1!tI AIM 111.11111 tiIW Certified Mail#7006 0810 0000 3524 9087 Town of Barnstable Regulatory Services BARNSrABLE; ` y MASS. Thomas F. Geiler,Director ap i6gq. ♦� ArF°^"AY' Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 27, 2007 Charles Rogers P.O. Box 858 Osterville, MA 02655 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II —MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 464 Osterville W. Barnstable Road, Marstons Mills, was inspected on March 27, 2007 by Meredith Morgan, 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(A) —Ceiling Height. Ceiling observed to be 6'9", variance to be granted. 105 CMR 410.503(C&D)— Protective Railings and Walls. Guardrail at deck only 33 1/2" in height, must be 36" in height. Space between balusters observed at 12", must be 4 1/2". You are directed to correct the violations listed above within thirty(30) days of your receipt of this notice by raising guardrail height to 36"; by installing balusters that are no more then 4 I/2" apart. 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. Q:\Order letters\Housing violations\Rental ordinance\464 Osterville W.Barnstable Road.doc I 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. as R OF THE OARD OF HEALTH cKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Thomas & Amy LaJoie, Tenants Cc: Meredith Morgan, Health Inspector Q:\Order letters\Housing violations\Rental ordinance\464 Osterville W.Barnstable Road.doc � m THE COMMONWEALTH OF MASSACHUSETTS FORM•30 \" &W HOBBSB WARREN BO &,D OF HEALTH --- CITY/TOWN m o DEPARTMENT ADDRESS NE Address 1_0rydl>o W• , YN� Occupant -�mi' Amilvat Floor Apartm t No.— __ No. of Occupa�jts_�Q �... �I No.of Habitable Rooms No.Sleeping Rooms "t No.dwelling or rooming units__ _ No.Stories_ S Hills H4 Name and address of own r ha,vAe5?,t(/_y�`3� l�►'-�i✓IyP(i , �� �y( riYl 415 V Remarks Reg. Vio. /�QW YARD Out Bld s.: Fences: (JoClp Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: v Ct� ❑ B ❑ F ❑ M Doors,Windows: e Roof Gutters, Drains: yig 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 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 Pant Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Z Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flu. s,Vents,Safeties: Kitchen Facilities Sink 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 INSP TION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIE E R ." INSPECTOR TITLE jJam/►' DATE TIME /�'(J(J P•M• A.M. THE NEXT SCHEDULED REINSPECTION P.M. rr.,,��r:�,-.: � :h". -_...,,�.•a,aMr a:..n.s•�..r.,,..a��+w-v.h7.rtld^1......te'wi�M i.....m.+7i-..+a..a....W�'Y'isr.:lAl'#:.!A�....,�n....e+.e,�'T1-..�d"7�cF'Tir,b,r�'� Es...,...•.w 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 crder 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. ri r . C Shutoff and/or failure to restore electricity t o as ( ) Y 9 (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. TOWN OF BARNSTABLE Qp LOCATION l� ®� � - rSEWAGE # VILLAGE ���ST©�'f5 ��J�l� ASSESSOR'S MAP & LOT/ZZ- 1� INSTALLER'S NAME&PHONE NO. '/'0& SEPTIC TANK CAPACITY /sa- &C / LEACHING FACILITY: (type (size) /t NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: ' Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility J 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) Idle Feet Furnished by 449 e+R r 0 A4 , I� � YY + No. r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V Yes ' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplicatton for Mifspaal *pgtem Conztructton Permit' Application for a Permit to Construct( )Repair(16 Upgrade( )Abandon( ) El Complete System CPrIndividual Components Location Address or Lot No. ��`V 0,5,7�411�I uj, Owner's Nye,Address and Tel.No. 1� r� O l�oftK Assessor's Map/ParcellejZl li Z® Map/Parcel � j�l� A AM J l Installer's Name,Address,and-Tell.N/o�. y� Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building S �19L'�9 No.of Persons Showers( ) Cafeteria( ) Other Fixtures ,(,� Design Flow Ila gallons per day. Calculated daily flow 7 7� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank XW57-1,01y Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) / �7 l e le,*Ir 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 b this B and He / Signed Date 7��! Application Approved b � Date d g- Application Disapproved for the following reasons Permit No. I� Date Issued ve No. Feeu/ U'e Y Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS Yes 41PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 01pplication for 3Digpogaf 6pgtem Congtructiou Permit r Application for a Permit to Construct( )Repair(/)Upgrade( )Abandon( ) E]Complete:System :C0Individual Components Location Address or Lot No. uj,Bm�� Owner's N e,Address and Tel.No. , y ! rU LlrP Assessor's Mdp/Parcel �V/J O45 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. AoI reZ l T� Type of Building: Dwelling No.of Bedrooms `7 Lot Size sq.ft. Garbage Grinder(__�a Other Type of Building 5 r L�!!Ge No. of Persons Showers( ) Cafeteria( ) Other Fixtures t Design Flow //O gallons per day. Calculated daily flow 7��//0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank G'X157%/19 Type of S.A.S. 11 1�'' Description of Soil /or yorZ a? #41 Nature of Repairs or Alterations(Answer when applicable) 117 1'2 1e I1- Date last inspected: Agreement:The undersigned ag er a 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 b this Bd Hea an - Signed Date 71211W Application Approved b Date 7- Application Disapproved for the following reasons Permit No. " Date Issued THE COMMONWEALTH OF MASSACHUSETTS 12,2_-olp BARNSTABLE, MASSACHUSETTS. Certificate of Compliance THIS IS TO CE IFY, tha the On�site Sewage Disposal System Constructed( )Repaired (t/)Upgraded( ) } Abandoned( )by D G?hco , __ at ©S /1e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No _ ; «�✓— dated 43 • 1 J� Installer Designer .5r The that the s shill function as .esign�ed, Date spects G- Fee jl.► THE COMMONWEALTH OF MASSACHUSETTS- PUBLI;tHEALTH DIVISION - BARNSTABLES MASSACHUSETTS Digpogal *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair ✓)U grade( )Ab anon( ) I System located at ler 1-1//X and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to ' comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this e t. Date: �/ � Approve tby s . Ub'99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PEI IIT(WITHOUT DESIGNED PLANS) I, ,� 0��'�� ✓ �IrAee ereby certify that the application for disposal works construction permit signed by me dated 7/2 71ff , concerning the property located at X MW$,,�l Teets all of the following criteria: /The failed system is connected to a residential dwelling only. There are no commercial or business Zes associated with the dwelling, e soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. 7 There are no wetlands within 100 feet of the proposed septic system t✓ There are no private wells within 130 feet of the proposed septic system ere is no increase in flow and/or use change in proposed There / are no variances requested or needed The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor ' /method when applicable] 1 If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, e - ' _- Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation +the MAX High G.W. Adjustment. DIFFERENCE-BETWEEI`I A and B - `7 SIGNED : DATE: 71,>1>1,1ff [Sketch proposed plan of system on back]. q:health folder.cats Q� O i �s,_.,.!::.. -r.i..li:- � � 'a�' -L`,,,,��� � �,iy+" L� �_ �'•7 - fyr�.jltit _��,�.;—.'t� ,{f� �a_'J"�. Ow .._ ► / TOWN OF BARNSTABLE LOCATION �c lJ �✓ ��i�r� ' �� ��SEWAGE # VII.LAGEQl$TDeS ASSESSOR'S MAP & LOT/Z.2——6VD INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY h—c-- LEACHING FACILITY: (type1L/, i/,44;) J C^/ (size) IL7 NO. OF BEDROOMS BUILDER OR OWNER �L�7�lGl z�O PERMITDATE: 7 "Z.$ 1 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ,14�0,i V o �1 0 I ��tF1E Tp� Town of Barnstable 4 f QARhSCABJC.t;. , aA,O'g Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,DMD Junichi Sawayanji May 22, 2007 Charles Rogers, Trustee Maxwell Nominee Trust P.O. Box 858 Osterville, MA 02655 RE: Variance Request to Maintain Ceiling Height at r464=-Osterville-West— Barnstable-Road;'Marstons'MIlls Dear Mr. Rogers, You are granted a variance from Section 105 CMR 410.401, of the State Sanitary Code, Chapter 2, Minimum Standards of Fitness for Human Habitation. This variance will allow you to continue to utilize the dwelling at 464 Osterville-West Barnstable Road, Marstons Mills for human habitation with the lower floor-to- ceiling height currently in existence there. The State Sanitary Code requires a minimum floor-to-ceiling height of seven feet (84 inches) in every habitable room. However, at this dwelling, the existing floor-to-ceiling height is 81 inches within the upstairs portion of the house. You stated the house was constructed in 1977 and that there is no way to structurally modify the ceiling height within the second floor of the dwelling without expending a large sum of money. Although the lower ceilings could be a safety issue for taller individuals, the Board is of the opinion that the lower ceilings should not be a health issue for most individuals and it would be manifestly unjust to order you to raise the ceiling height in this dwelling constructed approximately 30 years ago, considering the projected cost to raise the ceilings. Sin rely yours V. ayn Miller, M.D. Chair an Ceil ingHeightVarianceRogers07.doc