HomeMy WebLinkAbout0663 RACE LANE - Health r
63 Race Lane
Marstons Mills F/R
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TOWN OF BARNSTABLE ✓
LOCATION 314 6'- 14. 1WY1,GnS/Yi 1/S SEWAGE # C;2 06'A �
VILLAGE�'I�1i�iS�ri�'JS ItiJ /lS ASSESSOR'S MAP & LOT—/O--a��
INSTALLER'S NAME&PHONE NO.
SE7j TANK CAPACITY 9'00,41
LEACHING FACIL=: (type �I�/'t�size)
NO. Ui BEDROOMS o? ``/I r
BUILDER OR OWNER Z994.)l Will
PERMITDATE: 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
t
1
TOWN OF BARNSTABLE
5(.
1.04CATION 3 RA SEWAGE # .'2 '��
VILLAGE � , � �_ ASSESSOR'S MAP & LOT ib*3— �I
INSTALLER'S NAME & PHONE NO.
"SEPTICP41CANK CAPACITY -/ -ct O
LEACIi NG FACILITY:(type) <-00 size) 1-2- X l�i
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: 14, L,,4Q—
VARIANCE GRANTED: Yes No
l G
!3
14 j 6-3. ZZL�
n 50
. �a
No. oCf�0 _ SOD Fee -5 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Zippfication for Mi=)Abandon(
pttem Conotruction Permit
Application for a Permit to Construct( )Repair ) ❑Complete System ❑Individual Components
Location Address or Lot No. (06 V 3 tt,( -( ",)-4 Owner's Name,Address and Tel.No.
L l S 9 i —j-G `J-e j/
Assessor's Map/Parcel k)l hi i W f r. C. Q mat a 3�?
3. M a 3 0a ., 4,9
, cars
Installer's Name,Address,and Te.No. Deessirer's Name,Address and Tel.No.
/Z j.rr.5 �6ov�.o�J' ccsn.f) T�, n7 Lgn,l� J'B
93 OSO✓fl �7
1�i�✓kr
Type of Building:
Dwelling No.of Bedrooms Lot Size l�X sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures bvmw
Design.Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil &eP Say I Lcf
Nature of Repairs or Alterations(Answer when applicable) Se e S-e h)- r � .�'��•�
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance hatImen iss y this Board of alt
Si ne -Date/0
Application Approved by DatV0 o2 oa
Application Disapproved for the followi reasons
Permit No. 0.00,a 5-0 0 Date Issued l0
No. .300A_ 560 ►COMMONWEALTH
1 I �t Fee* 56•THE OF MASSACHUSETTS. Entered in computer:
Yes
-: PUBLIC HEALTH DIVISION- TOWN OF BARNSTABLE, MASSACHUSETTS
ZIppYication for �i5po Y *pgtem Con.5truction Permit
Application for a Permit to Construct( )Repair( N Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. to 3 A.,(-{ tc 7 d Owner's Name,Address and Tel.No.
Assessor's Map/Parcel Y)'19 "S k n rh .//f /�. • Q--A a 3 a
23.) (M 03 0a 1 !!3 C.?Jrr
Installer's Name,Address,and Tell.No. Designer's Name,Address and Tel.No.
7
t
y
Type of Building:
Dwelling No.of Bedrooms c Lot Size of I/ 9;0 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons peLday. Calculated daily flow gallons.
Plan Date 17),4 3)od- Number of sheets Revision Date y r
Title
Size of Septic Tank Type of S.A.S.
Description of Soil: S P P Sc i L of_
v
Nature of Repairs or Alterations(Answer when applicable) S P P S"7° h
3"
- i
i
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 issue y this Board of ' al .
Si'gen-e-17 Date
Application Approved L 1 _. r Date/0
Application Disapproved for the followin reasons
Permit No. Q00Q " 5 0 Q Date Issued /0
----------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( )
Abandoned( )by lam!I j (o-c T�►rS Cc n 5')
at (64 -i C-r Lane > �y<S , ehj if has been constructed in acc rdance
with the provisions of Title 5 and the for Disposal System Construction Permit No.Dow- SU4 dated /v 2S b Z-
Installer 17/1i S a C-rh d C"SJ, Cc Designer
The issuance ofithA permit shall not be construed as a guarantee that the sy�Stelyy will�function�sdesii!gned.
Date t I t�l 0 a Inspector�`4 > l�. .
------------------------------
No. A 0Oe?—50 0 .lu Fee 5-0•
THE COMMONWEALTH OF MASSACHUSETTS yy c�
PUBLIC HEALTH DIVISION - BARNSTABtES MASlikbHUSE7TS
Migogar *pztem Construction Permit
Permission is hereby granted to Construct Repair Upgrade( Abandon
( )System located at Co(n
/
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 permit. rr
Date: O _a -U a- Approved by k a.,a9
P
TOWN OF BARNSTABLE
LOCATION /1 Cc., L SEWAGE #.
VILLAGE f37 i C L_C ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. Ell- A 1?0 S�
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
I
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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COMMONWEALTH OF MASSACHUSETTS Y� - F , R,,Ne 4, LE
i ay, ;s ' i
F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFI'MIRS
DEPARTMENT OF ENVIRONMENTAL PRO'FACT I'Pyl fi j 1,9; 08
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�'�M S.Iay ,........®..._...ram....-. - _
DIVi5ION
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE A DISPOSAL SYSTEM FORM
CERTIFICATION
Property Address: C�
Owner's Name: 2 _
Owner's Address
Date of Inspection: �y-/6 -✓�
Name of Inspector: please print) • � "
Company Name:
Mailing Address:
u
Telephone Number: 512
CERTIFICATION STATEMENT
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
Needs Further Evaluation by the Local Approving Authority
Fails
dZ- -
Inspector's Signature: 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
owner shall submit the report to the appropriate regional office of the
gpd or greater,the inspector and the system
m owner and copies sent to the buyer,if applicable,and the approving
DEP.The original should be sent to the syste
authority.
Notes and Comments
****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.
Title 5 Inspection Form 6/15/2000 page 1
i
Page 2 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: In,
Owner A, i
Date of Inspecti n: 1 —0
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
VS I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the_for the following statements.If"not determined"please
explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
Title 5 Inspection Form 6/15/2000 2
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
Owner:
Date of Inspectio :
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
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 I of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well".Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this form.
3. Other:
Title 5 Inspection Form 6/15/2000 3
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:93 DC 4 A
Owner:
Date of Inspection: z-A-42 6
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
-Ael Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
A-A Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
Any portion of the SAS,cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
w (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no li
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.
Title 5 Inspection Form 6/15/2000 4
L
I
Page 5 of 11
OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: .
Owner: <f
Date of Inspecti n
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?
r/Have large volumes of water been introduced to the system recently or as part of this inspection?
e/_ Were as 1:uilt plans of the system obtained and examined?(If they were not available note as N/A)
c/ _ 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?
to/_ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsLrface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
d/_ Existing information.For example,a plan at the Board of Health.
-61_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b)]
Title 5 Inspection Form 6/15/2000 5
i
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: .4Lx_�' i9
Owner: ../-4edes1
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): G= Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):
Number of current residents: Z
Does residence have a garbage grindergnor��r1 &10 A A/1&11".
Is laundry on a separate sewage system(yes o — [if yes separate inspection required]
Laundry system insp (yes or no) "
Seasonal use:(yes aE —
Water meter readin s if available(last 2 years usage(gpd)):�� / ./� 7 Al
Sump pump(yes o no -
Last date of occupancy-21i"-1 '�/ eeUPle"}
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): grid
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):_
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information e U U✓"� (1—
��� � � �
Was system pumped as part of the inspection(yes
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)
—Tight tank _Attach a copy of the DEP approval
Other(describe):
Approximate a e of all components,date sta ed kno n)aid souLo of information:
�6�yGo�3�1
Were sewage odors detected when arriving at the site(yes o�_
Title 5 Inspection For
m 6/15/2000 6
I
Page 7 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
rr��
SYSTEM INFORMATION(continued)
ffProperty Address: 160- 4
Owner:
ZM—
Date of InspeVn-
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction:_cast iron _40 PVC_other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK:_(locate on site plan)
Depth below grade:
Material of construction: concrete_metal_fiberglass_polyethylene
_other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate) ' 1, i1
Dimensions. i
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:3
Scum thickness:3
1.
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baff
How were dimensions determined: DCAW
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,kructural integrity,liquid levels
elat d to o�e invert,evidence of leakage,etc.): � �
GREASE TRAP:_(locate on site plan)
Depth below grade:_
Material of construction:_.concrete_metal_fiberglass_polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Title 5 Inspection Form 6/15/2000 7
I
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
o SYSTEM INFORMATION(continued)
Property Address:&S J�.4 14.
Owner:,G4
Date of Inspec ion:
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/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):_
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX:_(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
le a e into or o t of ib x,etc. : /r
as,
PUMP CHAMBER: (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Title 5 Inspection Form 6/15/2000
8
Page 9 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
p SYSTEM INFORMATION(continued)
Property Address:
Owner:
Date of Inspection:
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:_
AGleaching chambers,number: 2!--
_leaching galleries,number:
_leaching trenches,number,length:
leaching fields,number,dimensions:
_overflow cesspool,number:
_innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
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 or no):
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.):
Title 5 Inspection Form 6/15/2000 9
}
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:&531 /�1
Owner•/49-Q
Date of Inspection:LIrnl�c
—
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.
0
� 3
10
Title 5 Inspection Form 6/15/2000 10
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1
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Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner: Von.
Date of Inspe
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water/.�feet
Please indicate(check)all methods used to determine the high ground water elevation:
_Obtained from system design plans on record-If checked,date of design plan reviewed:
_Observed site(abutting property/observation hole within 150 feet of SAS)
_Checked with local Board of Health-explain:
_,ZChecked with local excavators,installers-(attach documentation)
�/Accessed USGS database-explain:
You m st describe ho, you established the high gr and water elevation:
Title 5 Inspection Form 6/15/2000
11
a
V
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COMMONWEALTH OF MASSACHUSETTS
w �
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
F DEPARTMENT OF ENVIRONMENTAL PROTECTION , .
m
FAILED INSPECTION
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ; r
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM . ,
PART AI�� R
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CERTIFICATION
Property Address: 663 RACE LN MARSTONS MILLS,MA 02648
Owner's Name: MITCHELL
Owner's Address: 663 RACE LN MARSTONS MILLS,MA 02648 : * '
Date of Inspection: 11/23/01
Name of Inspector: (please print) JOHN GRACI -� A '
Company Name: SEPTIC INSPECTIONS ����� �
Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 ._
DEC 2 u Luu� J 4.
Telephone Number: 508-564-6813 FAX 508-564-7270 *�
TOWN OF BARNSTABLE
CERTIFICATION STATEMENT HEALTH DEPT.
'
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 I.'
y
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: •�` H
t
Passes
_ Conditionally Passes ,
Needs Further luation by the Local Approving Authority
X Fails
Inspector's Signature: Date: 11/23/01
The system inspector shall submit a opy of this inspection report to the Approving Authority(Board of Health or DEP)withm�5 3
30 days of completing this inspecti n. If the system is a shared system or.has a design flow of 10,000 gpd or greater,the r ;
inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be ..
sent to the system owner and copies sent to,the buyer, if applicable,and.the approving authority.
Notes and Comments
SYSTEM FAILS TITLE V INSPECTION. SINGLE CESSPOOL DOES NOT MEET TITLE V REQUIREMENT. z
k
CESSPOOL IS IN HYDRAULIC FAILURE.LIQUID LEVEL IS OVER ALL PIPES.
This report only describes conditions at the time of inspection and under the conditions of use at that time.This 3
t�.
inspection does not address how„the system will perform in the future under the same or different conditions of use.
yea,
TitIF S Incnrrtinn rnrm 6/1 C/Donn ,.'=.t I k
Page 2 of 1 1 i
y p 7
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS y k
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A :
CERTIFICATION (continued) N
Property Address: 663 RACE LN MARSTONS MILLS,MA 02648 'u
Owner: MITCHELL
Date of Inspection: 11/23/01
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D 't
P
A. System Passes:
�a
_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310s.
CMR 15.304 exist.Any failure criteria not evaluated are indicated below. �k }
Comments: }
SYSTEM FAILS TITLE V INSPECTION.SINGLE CESSPOOL DOES NOT MEET TITLE V REQUIREMENT. �^
CESSPOOL IS IN HYDRAULIC FAILURE. LIQUID LEVEL IS OVER ALL PIPES. " 4
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. t '
R � u
se explain.
Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"plea ''
n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits.
71
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. � d
ND explain: n/a
" f 3
n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed'` 41, ;
pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of ,
Health): y .
_ broken pipe(s)are replaced
_ obstruction is removed . ;: , ",
_ distribution box is leveled or replaced
W
ND explain: n/a
6�°� ;
n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass `
y
inspection if(with approval of the Board of Health): �kea
_broken pipe(s)are replaced
_obstruction is removed
xz t
ND explain: n/a
1 r4..
fPage3 of I 1 jj
r
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM '
PART AR
CERTIFICATION(continued)
'
Property Address: 663 RACE LN MARSTONS MILLS,MA 02648
Owner: MITCHELL '
Date of Inspection: 11/23/01 ¢` q
C. Further Evaluation is Required by the Board of Health:
e
t
_ 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 s
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
7 }
• A
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functionin; in a manner that protects the ublic health safety and environment: ' � '
y g P P Y ;:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water y
supply or tributary to a surface water supply.
£' j
_ 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. b
_ 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 n/a
"This system passes if the well'water analysis,performed at a DEP certified laboratory,for coliform bacteria and
volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia '
nitrogen and nitrate nitrogen,'is equal to or less than 5 ppm,p
rovided that no other failure criteria are triggered.A copy
��..
of the analysis must be attached to'this form.
�t
3. Other:
n/a i4T ;
9r
r ' L
n�r+iF
u
A
Page 4 of 11
euk t
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
Y�
PART A
CERTIFICATION(continued) i
Property Address: 663 RACE LN MARSTONS MILLS,MA 02648
Owner: MITCHELL
Date of Inspection: 11/23/01
D. System Failure Criteria applicable to all systems: .
You must indicate"yes"or"no"to each of the following for all-inspections:
Yes No
X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool sp `
X Discharge or ponding of effluent to the surface of the ground'or.surface waters due to an overloaded or clogged i
SAS or cesspool
_ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
X Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day now t �,
X Required pumping more than 4 times in the last year IYSfI_'Cdue to clogged or obstructed pipe(s).Number of times,'...... ..
pumped nLa. ,
_ X Any portion of the SAS,cesspool or privy is below high ground water elevation. `
X Any portion of cesspool or privy is within 100 feet of a surface water.supply or tributary to a surface water supply. ..
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well. � >
_ X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with' � 'W
no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP
certified laboratory;for coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility'and the presence of ammonia nitrogen and nitrate nitrogen is equal to or .
less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be � :
attached to this form.]
X _ (Yes/No)The system fails.I have determined that one or in re,of the above failure criteria exist as described in 310
CMR 15.303,therefore the system fails,.'Tlie system owner should contact the Board of Health to determine what will be
necessary to correct the failure. F t ,
i
E. Large Systems:
To be considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd
You must indicate either"yes"or"no"to each of the following:
The following criteria apply to large systems in addition to the criteria above) '
yes no y^
X the system is within 400 feet of a surface drinking water supply
_ X the system is within 200 feet of a tributary to a surface drinking water supply �`
X 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"toany question in Section E the system is considered a significant threat,or answered', 'r
"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 15.104.The system owner }
should contact the appropriate regional office of the Department. *�a
r
I :� :
Page 5 of I 1 r;ti
OFFICIAL INSPECTION FORM—NOT FOR#VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM M, 4
$4;
PART B
CHECKLIST
Property Address: 663 RACE LN MARSTONS MILLS,MA 02648
p y
Owner: MITCHELLI., W.
Date of Inspection: 11/23/01 ;.
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
nrkrg i
Yes No j
X _ Pumping information was provided by the owner,occupant,or Board of Health ty-
X Were any of the system components pumped out in the previous two weeks?
X _ Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection? 3y
_ X Were as built plans of the system obtained and examined?(If they were not available note as N/A)
_ Was the facilityor dwelling inspected for signs of sewage back up?X
X _ Was the site inspected for signs of break out'?
X _ Were all system components,excluding the SAS,located on site? a
X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the t
baffles or tees material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? 1
X _ 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:
Yes no
X _ Existing information. For example,a plan at the Board of Health. ,
X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is
un acceptable)[310 CMR 15.302(3)(b)] �-,
,
A 3
<�
4 t'g;
{ 4 ''r
Page 6 bf 11
OFFICIAL INSPECTION FORM-NOT FORWOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ 5 ;
PART C
SYSTEM INFORMATION . .
Property Address: 663 RACE LN MARSTONS MILLS,MA 02648 '
Owner: MITCHELL a t'
Date of Inspection: l 1/23/01 � t
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 2 Number of bedrooms(actual): 2 ,.
DESIGN flow based on 310 CMR T5.203 (for example: 110 gpd x#of bedrooms):220
Number of current residents:2 '
Does residence have a garbage grinder(yes or no):NO
3 Is laundryon a separate sewage system(Yes or no): NO [if yes separate inspection required]
l
t Laundry system inspected(yes or no): NOs
Seasonal use:(yes or no): NO
Water meter readings, if available(last 2 years usage(gpd)): n/a
Sump pump(yes or no): NO
Last date of occupancy: n/a
5.
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a m ,t
YP
Design flow(based on 310 CMR 15.203): n/agpd
Basis of design flow(seats/persons/sqft,etc.): n/a '
Grease trap present(yes or no): NO
Industrial waste holding tank present(yes or no): NO 3 "
es ,
Non sanitary waste discharged to the Tale 5 system(y or no): NO
Water meter readings, if available: n/a " Y
Last date of occupancy/use: n/aT`I
OTHER(describe): n/a
GENERAL INFORMATION ..
Pumping Records
Source of information: n/a
Was system pumped as part of the inspection(yes or no): NO r '�
If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a ;
Reason for pumping: n/a 7,Y"
TYPE OF SYSTEM
_Septic tank,distribution box,soil absorption system
X Single cesspool "
Overflow cesspool
z �
a
_Privy :a ` .
_Shared system(yes or no)(if yes,attach previous inspection records,if any) z .
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from x`" .
system owner)
Ti t tank Attach a co of the DEP approval
— gh PY PP
Other(describe): n/a
led(if known)and source,of information:
Approximate age of all components,date instal
a }`
1965
' Were sewage odors detected when arriving at the site(yes or no): NO ;
�r � .
5
I
Page 7'of 11 .
p
4
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS *� .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 40 At
A w
PART C
SYSTEM INFORMATION(continued) ° '
Property Address: 663 RACE LN MARSTONS MILLS,MA 02648 .4
Owner: MITCHELL 4
Date of Inspection: 11/23/01 �� �r-
BUILDING SEWER(locate on site plan) i,
Depth below grade: 12"
Materials of construction:_cast iron _40 PVC Xother(explain):ORANGEBURG `
Distance from private water supply well or suction line: n/a
Comments(on condition of joints,venting,evidence of leakage,etc.):
TOWN WATER '
SEPTIC TANK: (locate on site plan) '
'�1 h
Depth below grade: n/a =r
Material of construction:_concrete_metal_fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) � �.,
Dimensions: n/a t .
Sludge depth: n/a
Distance from top of sludge to bottom of outlet tee or baffle: n/a
Scum thickness: n/a � '
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
How were dimensions determined: n/a
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related ? �� �
to outlet invert,evidence of leakage,etc.): 4', �
n/a .
GREASE TRAP:_(locate on site plan)
F
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a r"
Dimensions: n/a
Scum thickness: n/a �;
Distance from top of scum to top of outlet tee or baffle: n/a E ?��
Distance from bottom of scum to bottom of outlet tee or baffle: n/a 3�iW
Date of last pumping: n/a rI
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
�.. a:.
to outlet invert,evidence of leakage,etc.): k i
n/a �"`..
r
d.
• 1. ,
s
Y 4�
tl
Page 87 of 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS '
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM '
PART C
SYSTEM INFORMATION(continued)
Property Address: 663 RACE LN MARSTONS MILLS,MA 02648 3 .
Owner: MITCHELL
Date of Inspection: 11/23/01
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) ,> �
Depth below grade: n/a �
Material of construction:_concrete metal_fiberglass_polyethylene_other(explain): n/a '-
Dimensions: n/a
Capacity: n/a gallons }r
Design Flow: n/a gallons/day '
Alarm present(yes or no): N/A
Alarm level: N/A Alarm in working order(yes or no): NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a � .
DISTRIBUTION BOX:_(if present must be opened)(locate on site plan) j
1
Depth of liquid level above outlet invert: n/a
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into h,
or out of box,etc.): 4�
n/a
=ka .
PUMP CHAMBER: _(locate on site plan) )
Pumps in working order(yes or no):'NO
Alarms in working order(yes or no):NO '
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): "fir '
E
n/a "r` F
it
-
I h
i
Eh
j r 0'4�
R
Page 9of 11
OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART Ci>'
4.. M
SYSTEM INFORMATION(continued) s
Property Address: 663 RACE LN MARSTONS MILLS,MA 02648 .
Owner: MITCHELL
Date of Inspection: 11/23/01 "t "
SOIL ABSORPTION SYSTEM (SAS): _ (locate on site plan,excavation not required) j�fi �
If SAS not located explain why:
xh
n/ad„ �ba
n
Type ,�r , •
T
n/a leaching pits, number: n/a ';
rMa
n/a leaching chambers, number. n/a
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a .
n/a leaching fields, number: n/a 4��;
n/a overflow cesspool, number: n/a
Innovative/alternative stem '
n/a 1' � Y
Type/name of technology: n/a , '
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): ,
n/a ;'�
CESSPOOLS: X(cesspool must be pumped as part of inspection)(locate on site plan) Y z�fi
Number and configuration: 1
Depth—top of liquid to inlet invert: n/a x .
Depth of solids layer: n/a °
Depth of scum layer: 2" w` '
Dimensions of cesspool: n/a ,,
Materials of construction: n/a � s
Indication of groundwater inflow(yes or no): NO z �Y
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
CESSPOOL IS IN HYDRAULIC FAILURE.LIQUID LEVEL IS OVER ALL PIPES. :
PRIVY: (locate on site plan) - -§
Materials of construction: n/a
Dimensions: n/a
Depth of solids: n/a
Comments note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc. :
( g Y P g g )
n/a
A,
'fix_•
i
.Page 10 of 11
;W� Y
OFFICIAL INSPECTION FORM—NOT FOR,VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM `h
PART C
SYSTEM INFORMATION(continued) t
#n :x
Property Address: 663 RACE LN MARSTONS MILLS,MA 02648 Ry
Owner: MITCHELL �
Date of Inspection: 11/23/01 ,`
�P
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.
Locate all wells within 100 feet. Locate where public water supply enters the building. ,f .
n _{
3
rl�f ijG
2 Y
4
kry
k 7
Zr
Page q I of 11
µ
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ;.
PART C g
SYSTEM INFORMATION(continued) h,
Property Address: 663 RACE LN MARSTONS MILLS, MA 02648
Owner: MITCHELL
Date of Inspection: 11/23/01 =SITE EXAM
s
Slope
Surface water
_
_Check cellar a �-
Shallow wells _; n
Estimated depth to ground water 12 feet d
Please indicate(check)all methods used to determine the high ground water elevation: +F
s r}"•
NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a ; `
NO Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local'ezcavators, installers-(attach documentation)
r
YES Accessed USGS database-explain: n/a
X, x
You must describe how you established the high ground water elevation: r "
USGS MAPS AND CHARTS- 12 FT.
h
Grt�c�e �i is t.
a ;
E 1
1 yy e
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a
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t*rF}
Kn
+ hti; u3L
I T
0
August 12, 1996
Louis Arata
Joseph Mitchell
P.O. Box 523
Quincy, MA 02269
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY
CODE II,MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51
The property owned by you located at 663 Race Lane, Marstons Mills was inspected on
August 9, 1996 by Christina Kuchinski, RS Health Inspector for the Town of Barnstable
because of a complaint. The following violations of the Town of Barnstable Rental
Ordinance Article 51 and the State Sanitary Code were observed:
d0l_Q 410.500: The roof was leaking around the chimney area in the garage and along the
wall of the kitchen cabinets near the sink. These areas were heavily
stained and water was present.
�Jb► v 410.500: The window located on the right side of the basement has broken
glass.
410.482: The smoke detector in the basement was barely audible. The battery was
checked and found to be functioning.
410.500: Water was weep n through the foundation and puddling on the basement n,
floor.
410.504: Two wall tiles had fallen out above the bathtub area and exposed the
wooden studs underneath.
410.500: The storm gutter at the front of the house contained a lot of debris. The
tenant stated that water ponds on the front steps in the winter and turns to
ice.
You are directed to correct the violation of 410.482 within twenty-four(24) hours of
receipt of this notice by installing new smoke detector.
You are also directed to correct the remaining above listed violations within seven
(7) days of receipt of this notice.
You may request a hearing if written petition requesting same is received by the Board of
Health within seven (7) days after the date order is received. However,this violation
must be corrected regardless of any request for a hearing.
Please be advised that failure to comply with an order could result in a fine of not more
than $500. Each separate day's failure to comply with an order shall constitute a separate
violation.
You are also subject to non criminal citations of$40.00 for the first violation and $15.00
for each additional violation. Tickets will be issued daily until the violations are
corrected.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean
Director of Public Health
cc: Fire Department
1
1
THETp`o The Town of Barnstable
I PA"I ,ffi i Department of Health, Safety and Environmental Services
o 9�,� Public Health Division
367 Main Street,Hyannis,MA 02601
Office 508-790-6265 Thomas A.McKean
FAX 508-775-3344 Director of Public Health
August 12, 1996 r k[
off«
Louis Arata
Joseph Mitchell
P.O. Box 523
Quincy, MA 02269
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY
CODE II MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE, ARTICLE 51
The property owned by you located at 663 Race Lane, Marstons Mills was inspected on
August 9, 1996 by Christina Kuchinski, RS Health Inspector for the Town of Barnstable
because of a complaint. The following violations of the Town of Barnstable Rental
Ordinance Article 51 and the State Sanitary Code were observed:
410.500: The roof was leaking around the chimney area in the garage and along the
wall of the kitchen cabinets near the sink. These areas were heavily stained
and water was present.
410.500: The window located on the right side of the basement has broken
glass.
410.482: The smoke detector in the basement was barely audible. The battery was
checked and found to be functioning.
410.500: Water was weeping through the foundation and puddling on the basement
floor.
410.5,04: Two wall tiles had fallen out above the bathtub area and exposed the
wooden studs underneath.
410.500: The storm gutter at the front of the house contained a lot of debris. The
tenant stated that water ponds on the front steps in the winter and turns to
ice.
You are directed to correct the violation of 410.482 within twenty-four(24) hours of
receipt of this notice by installing new smoke detector.
You are also directed to correct the remaining above listed violations within seven
(7) days of receipt of this notice.
You may request a hearing if written petition requesting same is received by the Board of
Health within seven (7) days after the date order is received. However, this violation
must be corrected regardless of any request for a hearing.
Please be advised that failure to comply with an order could result in a fine of not more
than $500. Each separate day's failure to comply with an order shall constitute a separate
violation.
You are also subject to non criminal citations of$40.00 for the first violation and $15.00
for each additional violation. Tickets will be issued daily until the violations are corrected.
PER ORDER OF THE BOARD OF HEALTH
olaz
6124
Thomas A. McKean
Director of Public Health
cc: Fire Department C#-o
�G3 cQ L4e
ll �a4�-(60 Old Cry 0,14
L nvcs �c
MAW se h
NOTICE TU ABA E VIOLATIONS OF 105 CMR 410.00, STATE SANITARY
CU_UE IILMINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE ARIICLE 51
y
The property owned b you located at &&3 2a-ce La^�, 014h was Inspected on
'sty by C"&- 12S- Health Agent for the Town of Barnstable because of a
complaint. The (following violations of the Town of Barnstable Rental Or dins
Article 51 and (lie Sanitary Code 11 were observed: 1�
(0" q t �'l 4� 0-r
cJ
q/0 Soo 7 eve °� Pmwde� "
S rn0 k-e O��-�eG7et�V �►
s
pokd
t ce
You are directed to correct the violation of within 24 hours of receipt of this
notice by I iiY4-a(l iti{
You are Also directed to correct the remaining above listed violations within seven
(7) days of receipt of this notice.
You may request a hearing if written petition requesting same is received by the Board of
I lealth within seven (7) days atler the date order is received. Ilowever, these violations
must be corrected regardless of any request for a hearing.
Please be advised that failure to comply with an order could result in a tine of not more
than $500. I acl separate (lay's failure to comply with an order shall constitute a separate
violation.
You are also subject to non criminal citations of$40.00 for the first violation and SI5.00
for each additional violation. 'Tickets will be issued daily until the violations are corrected.
Enclosed are citation numbers due to violations
observed on
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean
Director of Public Health
Town of Barnstable
/ a> -
FORM3o Hoses&WARREN,INC.NOV.1979.1983 THE COMMONWEALTH OF MASSACMUSETTS
BOARD OF HEALTH
CITY/TOVVN
a DEPARTMENT
a 5 ADDRESS
TELEPHONE (�
Address L 3 � �' w' Occupant r� ►'r11!t A t'hl bV76 oO�
Floor Apartment No: No.of Occupants
No.of Habitable Rooms No.Sleeping Rooms 2k-
No.dwelling or rooming units No.Stories
Name and address of owner d P h_li r:4 r `�-
1 d r dX U UI t/(,,tw , (� .1�p/� Remarks Rag. Vlo.
YARD Out Bld s.: Fences: _Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches: f-tom r Oa&(Gt4 G�-v�c� c) r�o� C'�, �,�,, o,c_
Dual Egress:and Obst'n.: 6Lk^U-
❑B ❑ F ❑ M Doors,Windows:
Roof �,
Gutters, Drains: (,��, tic ,� , k ra _r , �74 ; (r)e O
Walls: l� .� �, n „ i Q
Foundation: r -fA,,,C_ c_, 1 W,.,) 7Je-4-re v -
Chimney: kn-44 1. , ) / A(� �
BASEMENT Gen.Sanitation:
Dampness: C ��'l/hGs'? lc. li-`� -�/ram vo-( 7..'
Stairs ./ v�i �)�.�. , , — l��/a / ✓iP--*�
Lighting: `
STRUCTURE INT. Hall,Stairway: t ,�. l.�fic (/ '!r7 CP 4ev vv'
Obst'n.: cti tI- 0, ,e _•1-� i
Hall, Floor,Wall,ceiling: 4A,r) ,,,-/ t,
Hall Lighting:
Hall Windows: 1 c, uL;f --k,)V-rti-1 -�ci ✓l� ,
HEATING Chimneys: P:51h„A^ - y-f�� ,►77 p}.0
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
Livina Room
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.:
Stacks,Flues,Vents,Safeties:
Kitchen Facilities Sink
Stove
Bathing,Toilet Facll. Vent.,Plumb.,Sanit'n.:
Wash Basin Shower or Tub:
Infestation Rats, Mice Roaches or Other:
Egress Dual and Obst'n: 's
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
PENALTIES�Oi OF PERJURY."
INSPECTOR (�V (/l � �G .TITLE
DATE TIME M: >
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
+ A
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 these 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 410.000 through 410.499
state minimum requirements of fitness for human habitation, any violation has
the potential to fall within this category in any given situation but may not
do so in every case and therefore cannot be included in this listing. Failure
to include shall in no way be construed as.a determination that other
violations 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 the violation(s) pursuant to 410 CMR 410.830 through 410.833
nor shall it 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 OIR 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) Shut-off and/or failure to restore electricity or gas.
(D) Failure to supply the electrical facilities required by 105 CMR 410.250(B);
410.251(A), 410.253(A), 410.253(B) and the lighting in common 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 system in operable
condition as required by 105 CMR 410.150(A)(1) and 410.300.
(GI Failure to provide adequate exits, or the obstruction of any exit,
passageway or common area caused by an object, including garbage or trash,
which prevents egress in case of an emergency 105 CMR 410.450 and 410.451.
(H) Failure to comply with the security requirements of 105 CMR 41b.480(D).
(I) Failure to-comply with any provisions of 105 CMR 410.600 through 410.6.02
which results in any accumulation of garbage, 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 lead-based paint on a dwelling or dwelling unit in
violation of the Massachusetts Department of Public Health Regualtions for
Lead Poisoning Prevention and Control 105 CMR 460.000.
(&) 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 dafety.
(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 facilities 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 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 operable.
(2) failure to provide a washbasin and a shower or bathtub as required
in 105 CMR 410.150(A)(2) and,. 410.150(A)(3) and 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,, gas-fitting, or electrical wiring standards
that do not create an immediate hazard.
W4 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.
(N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A)
through (M) shall be deemed to be a condition which may endanger or materially
impair the health or safety and well-being of an occupant upon the failure of
the owner to remedy said condition within the time so ordered by the board
of health.
I
0 SENDER: 1 also wish to receive the
V ■Complete items 1 and/or 2 for additional services.
■Complete items 3,4a,and 4b. following services(for an
■Print your name and address on the reverse of this form so that we can return this extra fee):
card to you. ai
■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address
permit. y
y ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N
« ■The Return Receipt will show to whom the article was delivered and the date a
o delivered. Consult postmaster for fee.
0
a 3.Article Addressed to: 4a.Article Number41
Q
E 11 �_�� z 4b.Service Type
0 , vSeP h (Yl t"C�YI�
[1 Registered CertifiedIM
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LU
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7.Date of Delive w
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p 5.Received By: (Print Name) 8.Addressee's Address(Only if requested
W and fee is paid) r
6.Signature:Oddressee or nt)
a°. X _
N
PS Form 3811, Dec—eftef319§4 Domestic Return Receipt
UNITED STATES POSTAL SERVICE First-Class MailPostage&Fees Paid
USPS
Permit No.G-10
s Print your name, address, and ZIP Code in this box •
Health Departmed"
v r of Barnstable ,
Box 534
t-tyarinlo> Maasaohusatts 02601 1
tieIII'1,,,�I�L��II;,{, 1�►:11�11111,fit ll
ASSESS"O.RS .DATA.'
MAP 10.3 PARCEL 21
WESSTER RD
LOCUS ADDRE'S'.S' I ,
#663 RACE LANE I � LOCUS LAND
DEED REFERENCE- 20748--122
,ONINC.�' D15TRIC7' 1 1%'
0 VL,7 LA Y DISTRICT• CP & RPOD
B17ILDINC SFTEACKS-
.FRONT 30' w
SIDE' & DEAR — 15` f
SHOSAEL k
PFEMA DATA: ZONE; "C " PONi:
PANEL 250001 0015 C
MAP REV AbrCIlST 19, 1985 HAMBLIN c 11
U
f ` POND
j rMBIA oA g�'T 12�'2 R = 20.00 .
v �'� L = 22.81
C p L �f��� o � .
N� ,0 "� t
46.7 4-
42:8' 9 �0. ��
O .
SEPTIC
PER \�
AS QUILT
R = 25.00 CARD ? GRAPHIC SCALE
L = 50.03 < 96.6' 'a�
0C' <)�� 30 0 15 30 60 120
LOT 42 � moo ,C.
`
21,952±SF IN FEET
F )
/ k2 1 inch = 30 ft.
�?;r'e:3
92.9' A ` /' r'O p
9 ,
0.
o 0. �. PLO T PLAIV OF LAND
` Prepared� For.'PORTABLE 11663 RA CE' LA1VE'
;a CAR—POR i
In
T"k Barnstable, Massa ch use t is
`T i� PROPOSED
�j GARAGE ►►►►AAAA �
ENLTH OF4� : Scale: 1 = 30 Date: October 12, 2007
O 31' ��� PEGIS)r �9S Prepared By
'� 'p ° STFpyFN� m ► Stephen J. Doyle and Associates
��O i �J.Yc 42 Canterbury Lane, E. Falmouth, MA 02536
�t` a Telephone: 5081540-2534
:►�y��r c io�'PP �� R vi.s -1 o z� B a n c 2-Ic
1 11-06-07 Add Septic
NO. DATE DESCRIPTION
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?nP OF
-,MUNDATTON'
EL
cROVND SURFACE EL 2 � P STANDARD ]VOTES
GROUND SURFACE Elm 2' _ Z U' �.''•t"
" �
1) TMS PLAN IS FOR THE INSTALLATION OF A SEPTIC SYSTEM.
OUTLET PIPE LEM � 2) ALL INSTALLATION PROCEDURES AND M� 1�IALS SHALL CONFYIRtK 7'n �?IO CMR 15.000, THE STATE ENVIRONMENTAL CODS
FIRST TWO FEET 3.2 VENT REIQUIRED -7 ,c� TOP EZ TIT7.E 5, AND T ME YV)FN OF ' /� !N_S SUBSURFACE D.'SPOSAL REGULATIONS
UM LEVEL MIN 2' LAYER DMJBLE WASHED 3) NO D=RM2X4IIUN HAS BEEN MADE AS M COMPLIANCE OF A VAILABL 7, PROPERTY INMRi�fATION WITH RECORDED DEEDS
c6 0 '� " D- vs�- ii2• STONE OR ZONING REGULATIONS.
INVERT EL 10 _
14 p (r0 -. n o t7 t' v o v EFFECTIVE 4) ?t7Ji'N WATER SERVICES 77ILS PROPERTY.
'' -7 2). -:5 a t7 a `� O o a SIDEWALL 5) THERE ARE NO KNOEN PRIVATE )FELLS ON THIS PROPERTY OR WITHIN 100' OF THE PROPOSED SOIL ABSORPTION SYSTEM
950 1.11
GAS BAFFZE AT OU7ZE"l �'i"a og`�
I11�PERT EL 3A SE MVE� EL . 6) ALL COVERS OF SYSTEM COMPONENTS SH"Z BE.BROUGHT TO W7=V .J'2" OF FINISHED GRADE, WITH ONE COVER OF ME
1MVRTEL
g, (o D_Kok L% o �/ x X 2�f ��Pry SEPTIC TANK BROUGHT WITHIN 6" OF GRADE
3/4 1 1/2 DOUBLE
WASHED STONE 7) ALL SYSTEM COMPONENTS SHALL REMAIN ACCESSIBLE FOR INSPECTION. NO STRUCTURES SHALL BE LOCATED DIRECTLY
INVE2r eL, (YYPI(AL) - C.riC GRAM br e �o / 5/rug
,�j L UPON OR ABOVE THE COMPONENT ACCESS .LOCATIONS; iYHICH WOULD Il,'TERFE'RE WITH THE PERFORMANCE, ACCESS, INSPECTION
Jots Gel Septic Tank �''J I �`` s�0 C °� �o��M PUMPING OR REPAIR
(Typical) ` Z 14 -Z o) EL -7 D - 8) NO DRIVEWAY, PARKING OR TURNING AREA, OR OTHER IMPERVIOUS AR94 SHALL BE LOCATED ABOVE A SOIL ABSORPTION
I /+� I Z I
�f horn of fEST eoLC SYSTEM, EXCEPT WHEN VENTING HAS BEEN PROVIDED.
/G 9) SEPTIC TANKS, GREASE TRAPS, DOSWG CHAMBERS AND DISTRIBU770N BOXF„S SHALL BE PLACED ON A 6" SY19NE BASE
TO ENSURE STABILITY AND PREVENT SEMMG.
10) . OUT7£T D.751 bUTION Lldf6 SH/�LL RMIAX IERR FMR A Lidj11LIJUN 0X 'W .F4�Sf f7� Fi�E� 0 �E7R I.F�UyH
.11) ALL SYSTEM COMPONENTS SHALL HE CAPABLE OF WITHSTANDING R-10 LOADING UNLESS THEY AP.E U1 DER OR IYITHIN 10'
OF DRIVEWAYS OR PARK1VG OR TfW)MG AREAS. Illy mucH CASE H-20 (;41{[POmwTS SHALL BE USED.
` 12) ALL BUILDING SEWER LINES SHALL HAVE AN INNER DIAMETER OF 4" AAT ShXLL BE CAST-IRON OR SCHEDULE 40 PVC.
13) 7N£ DEPT71 OF 7j#F_' TOP OF ALL S'TS71F'M COMPO»NTS SffCIL NOT F'W.VD 36 UNLESS MV77NG HAS BEEN PROVIDED.
17) IN THE AREAS OF ElCAVA7MN, 5�16TNC- GRAfDE'S SHALC- &W,' REES'TABL�fi[rD U_WLE,'SS NOTET AS I'ROPOs'E`t7 COVTOU!?,�,
R = 0..00' 15) IF SOILS ARE ENC0VX7ERED DURING THE EXCA VATION OF THE SOIL ABSORPTION SYSTEM,, THAT DIFFER NOTABLY FROM
• L = 50.03'
THE DEEP OBSERVATION HOLE LOG, CONTACT THE ENGINEER BEFbRE PROCEEDDVGal .
P3 DOp.. �AC7VR 70 VERIFY �TION OF ALL UNDERGROUND U77L1T ..
0� '
DESIGN DA TA
21, 820� Sq. Ft. ��`��' � � � , \ DEEP OBSERVATION
I Number of Bedrooms: �- HOLE LOG
Garbage Grinder. ,NO Test Hole #f
(EL = 132.0
\ \ 82 s7 Design Flow. 2 Z a
I _ Q a ° ` xvxcr.
TBM EL — (� 1 (110 Gal/BR/Day z Number of BR (�') i11-11i
I � )
TTAATT /�► Rim
; Septic Tank- / , o c7 , i � v It ��.✓d7 /OY2 y�3
I IY a ter Gate R112'l (Minimum = Design Flow x 200%) '� -:5 3 78.8 Lo A �D Ya S�b 1.
Leaching Area: Cco O c i o�� �k
3g - �y�,. 7u.o �Ilwr�1
� Sidewall:
q Approx. Tre e Lin e
PROPOSED LEACHING PA CILITY Z \\ (Z Sidei+raus s z Z ) Dip pb
» �ZJ (Z Endwalla z t Z . Ft'z _fit / Z Cntneee.d soil tor. E 5r o A� .�
O 'TWO 4 x 8 x - 24 Dee Con cry t o � ' r�,Z pwy Rat ���'°N�.��
P ��,�� f Bottom: sou Surrey nesoription• CARVER
I I �
_..__.
Chambers (or similar) RIM 4 ' sto_ne _ e0 00' g 3o s Depth to stance later. AA
• Depth to Weeping Watm- AA
Long Term Acceptance Rate (LTAR): o. 74 at sen.ona] High GX NA
' on sides ` (cham bets shall � be 1�Zd - L - Zz 81 �,`'' � ,�'�``�°'°�.'. NA
.�� Proposed _
W ' Total Dimensions = 16 x 12 ti P Leaching Area Design Capacity: Z Z `-{
� g g , �a����t �A
I Vent I (Side"Kall Area + Bottom Area) x LTAR 6 7 D
I EXIS't1n�' .
I ' o
Test o
. 12 Wa ter Line
�'b Pit
Location ySK �+s
I 23 -
2 20 Min °
Prop o��rye d
I O I L .C. d,�(�o rT
D �9 I '� �{v PBOJE(:T LOCATIO.Ar !.�^'`e- d
I D`-`-Ho c^ I �`� �-.c s {atiJs !`�►,l is , /4,4
` �j l t
I $ p b I ,SAS MAP /0 3 LOT--.!:--'
i 1 Q W ��.��- �2r� g , `�
Area ./ ti 44
Min O o � I �` � S dam- � �� r� 5
wrood ed A L `
(b, s�
I I PRE k?-ED BY
CO A & M Land Services
4 f'o O S E'r� 1, J OO 15 Sunset Drive
p ti
J • �O p ti�' Tank
(H-10)
" _ South Yarmouth, MA 02664
(508) 394-2723
a CnJST ��fi✓ � I ,� f'l
I ' - SCALE. % /v DATE.• 9 f z�/0 Z
l G
rj
s� REV.
,t� is LOCUS MAP
r ,
O o a (9
i oO vJ � __,_._____. __ _._ .____._____ .__,u_.._.._._ • - DRIG. .+VOA 301 o SHEET 1 OF
I
i j�� sT��rS MI S „ MA .
f