The URL can be used to link to this page

Home My WebLink About1720 OLD STAGE ROAD - Health 1720 OLD STAGE ROAD, W. BARNSTABLE A=152-004 F' l r v II 1PI lfC�` 4. x `1 6 No. 4210 1/3 BLU Psnd (lianvo ' ESSELTE 10% . O O O i _ l owe Commonwealth of Massachusetts 1Sa 00zf—�y Ell -�� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1720 Old Stage ge Rd , Property Address �> Mike Brooks r' Owner Owner's Name : rr information is Barnstable MA 02668 6-7-19 required for every .L..L page. City/Town State Zip Code Date of Inspection a y 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. A. Inspector Information Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);I have personally inspected the sewage disposal system at theproperty address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 6-7-19 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26f2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 c~ Commonwealth of Massachusetts I Title 5 Official Inspection Form hi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1720 Old Stage Rd Property Address Mike Brooks Owner Owner's Name information is required for every W. Barnstable MA 02668 6-7-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and 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. ❑ Y ❑N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form .M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1720 Old Stage Rd Property Address Mike Brooks Owner Owner's Name information is required for every W. Barnstable MA 02668 6-7-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y El ❑ ND (Explain below): ❑ obstruction is removed ❑ Y El ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND (Explain below): 3) 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. a. 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: t5insp.doc•rev.7i26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 s Commonwealth of Massachusetts Title 5 Official Inspection Form .A rl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1720 Old Stage Rd Property Address Mike Brooks Owner Owner's Name information is required for every W. Barnstable MA 02668 6-7-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has a septic tank and soil absorption system (SAS) and the SAS Is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for 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. c. Other: 4) 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 water dt.re to art overloaded or clogged SAS or cesspool I,Sinap,dOG fCV..7/28l7.Q19 `firlq 5f)(6 ial i,-,pocti0,i re, i'.Sutr.-VirgcH gIwAgm r)irrgw Ai-yctgni..r ge 4 taf 18 Commonwealth of Massachusetts y Title 5 Official Inspection Form l� w-' i�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1720 Old Stage Rd Property Address Mike Brooks Owner Owner's Name information is required for every W. Barnstable MA 02668 6-7-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 '/2 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 water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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. 5) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection form C�'l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1720 Old Stage Rd Property Address Mike Brooks Owner Owner's Name information is required for every W. Barnstable MA 02668 6-7-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Wasthe facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts ,. Title 5 Official Inspection Form I,t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1720 Old Stage Rd Property Address Y Mike Brooks Owner Owner's Name information is required for every W. Barnstable MA 02668 6-7-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Well water 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 6-2019 Date t5insp.doc•rev./26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form r�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1720 Old Stage Property Address Mike Brooks Owner Owner's Name information is required for every W. Barnstable MA 02668 6-7-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner----`pumped 2-3 yrs ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts ,w Title 5 Official Inspection Form IQ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1720 Old Stage Rd Property Address -- Mike Brooks Owner Owner's Name information is required for every W. Barnstable MA 02668 6-7-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1995 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form C�'l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1720 Old Stage Rd Property Address Mike Brooks Owner Owner's Name information is required for every W. Barnstable MA 02668 6-7-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade:. 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12° Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts y, Title 5 Official Inspection Form r'I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1720 Old Stage Rd Property Address -- Mike Brooks Owner Owner's Name information is required for every W. Barnstable MA 02668 6-7-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form .� ws ibi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments g p Y rY 1720 Old Stage Rd Property Address Mike Brooks Owner Owner's Name information is require r every Barnstable MA 02668 6-7-19 d fo page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 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.): Good condition with water at working level and no sign of back-up from pits. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1720 Old Stage Rd Property Address Mike Brooks Owner Owner's Name information is required for every W. Barnstable MA 02668 6-7-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 2-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 s Commonwealth of Massachusetts Title 5 Official Inspection Form C�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1720 Old Stage Rd Property Address Mike Brooks Owner Owner's Name information is required for every W. Barnstable MA 02668 6-7-19 page. City/Town State Zip Code Date.of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pits in good working order with pit marked "4"filled to capacity at inspection. Pit marked "5" was holding 12" of water with stain lines at 36" below inlet invert. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts y Title 5 Official Inspection Form �wf' Fi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 1720 Old Stage Property Address Mike Brooks Owner Owner's Name information is required for every W. Barnstable MA 02668 6-7-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts �� Title 5 Official Inspection Form hl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 1720 Old Stage Rd Property Address Mike Brooks Owner Owner's Name information is required for every W. Barnstable MA 02668 6-7-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 Pi r i a q. f �d L r t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts p, Title 5 Official Inspection Form r Sri Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1720 Old Stage Rd Property Address Mike Brooks Owner Owner's Name information is required for?very W. Barnstable MA 02668 6-7-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database - explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. Lt5m.p.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 e Commonwealth of Massachusetts Title 5 Official Inspection Form �i. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 1720 Old Stage Rd Property Address Mike Brooks Owner Owner's Name information is required for every W. Barnstable MA 02668 6-7-19 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 - Joeyy� We Make Disasters DisappearV • ll . kej�� 1-800-675-3622 r C � i i 1 I I wan+6 Qdd U 0 0 ;F V I y 0 , i i I Strut. House# orkflow/P'rojeot Review Is [ s�rg 2s is Review Status: COMPkete �._ Revert�ssuancE [7LD STAGERflAC6, 172 v } Building-Rr iin Buitding-Inspector Cons�Erva an Fire TE, 4- r� Coax Menu 9 s 9e Permits 14 of 14 Fb----or�,$)Four 51,Vill y x u m Hilt y� �+gg+ �Y p e� /��',•./ IF 6 V OF. 'i..l:i iR«�E tisct gguffi-Line Tex} it it i X�, a•�y i Add- IS aTIM < B i9 83 e.,M.� r �' rB - a parztt title V 11D allowed: beyond 4BRs. 11 child.limit in da care A November 9Fd Y Y _ egend g lermit Setect ;F 2019 v t ShaiAllyae .. ,. ; Ow"muna 7, l FEE THE COMMONWEALTH OF MASSACHUSETTS SOAR® OF HEALTH ------------- .........._...---.....OF...................................... Appliratiun for Disposal Works Tonutrnriiun amit Application is hereby made for a Permit to Construct ) or Repair Disposal ( an Individual Sewage Dis ) g P System at: r_ .................. %....�'- ..................................... ....................... Q= ' - ......--•---.......---..........-•------- Location-Ad ress .... /� h' Owner Address �1'1.C. � �4�1 3xre tea-----Cole----- -•-••.--••-- .1 /"la�� AC!!►h__l i ---•--••.............•........._. „�................ Installer Address d Type of Building Size Lot............................Sq. feet Dwelling U No. of Bedrooms ............................Ex Expansion Attic — p ( ) Garbage Grinder (/dd , aOther,Other—Type of Building CQ !g_'Rl'2_..... No. of persons.......4.................. Showers ( ) — Cafeteria fixtures ....R._S m -------------------------------------------------------------------- -------- W Design Flow___..___._. . 9...................gallons per person per-day. Total daily flow.........._........_........................gallons. 1:4 Septic Tank—Liquid capacity`09.0__gallons Length.81.`1.. Width.A'!0"_ Diameter................ Depth..,Vst" Disposal Trench—No..................... Width...4'............ Total Length....................... Total leaching area....................sq. ft. Seepage Pit No--------/----------- Diameter..........?........ Depth below inlet.._............ Total leaching area..................sq. ft. Z Other Distribution box (X' Dosing tank ( ) ►-' Percolation Test Results Performed by.......................................................................... Date......... Test Pit No. l..��...._._minutes per inch Depth of Test Pit.... ..... Depth to ground water._. .wA't.L:E- (X4 Test Pit No. 2...............minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil-•--6-... `.....S$'.-q0— ... - -- - .. ........... W VNature of Repairs or Alterations—Answer when applicable............................................................................................... -------------------------------------------------------------•----------•------------------------•--..........•----•----- Agreement: The undersigned agrees to install the aforede'cribed Individual Sewage Disposal System in accordance with the provisions of TIT Z- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued`by the b and of health. j Signed--fit _. (�^j-'L. 71171 Qy -- ---•--• .......... ... Application Approved By----...;efollowing :.IL......................-------------------------------------------------------- a Eg 0 g at Application Disapproved for t reasons-----------------------••---...--•--------------:....------------•-----------•-------....._ D ....._.:....•--.•••--- •............................•----•-•--•-..........--------...----•-••••--•-----•••--•--•....------.......__....--•--•--•-----•-•--•----•-•-•---•----•---- ............................................. Date �� 7 . PermitNo........................................................ Issued........... z.- q.-� Date Fus............ .�..4_ - d THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -•.......................................,OF............................._..... Appliration' for Disposal Works Tonstrurtion Prrmit , Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at / ................. ...... .r; ........................................................ � Location-Adddress or Lot No. ---•---.�?:_.rY�... C�•:��_:::r'F� g--'::.5..t -•---' _ ..MLn_C__ I '— -��.Ox = -.. - -yj C -Addresss W CY�_!._��i ar c�.s.._3_c T......_ .�f?5...J�`"1<1 �_\.�. ..____1....__ �5.-\!�_!...� ..._ t i Installer Address `_ UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms......... .............................Expansion Attic ( ) Garbage Grinder (,iU) Other—Type T e of Building �" �� yp g ___.__._-_:_�_____________ No. of persons......._.................... Showers ( ) — Cafeteria ( ) Other fixtures ... W Design Flow.......... 7....................gallons per person per day. Total daily flow.......~_. _ _____________..........gallons. WSeptic Tank—Liquid capacity] :_._gallons Length c'_'r:'!_._ Width_`�__`.d(a __ Diameter................ Depth_C__'__4'.'�. xDisposal Trench—No_ ____________________ Width__(__"._.._.__.____ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......1............ Diameter........6.......... Depth below inlet______ ............ Total leaching area..................sq. ft. Z Other Distribution box (Y,,) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1..:P•_........minutes per inch Depth of Test Pit... 24.'_!....... Depth to ground water__I 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ t4 ._..-•-....-•••-----•--•----••-•._.........•••---•--••••---••----•••-•---.......•--•-•-------------......................................................... 0 Description of Soil-- ? �`�,' C ..�� -r.-.^ 1 50- 1,,=--,- - -----------•------------•---------------------••••••••••-••-•••------•-••--- p ----....-t-•--------. - (� - .........-•----------•••••...._...----• W ---•---------------------------------••---•----•••----••--•--...•••••--•-•-----••••---••••-••••-••----•••---••-----------........_••------•-••••--•••-•••-•-•-•_._.._..-•••••••--•-••••••-----•----.._. U Nature of Repairs or Alterations—Answer when applicable..................................................................._........................... --------------------------------•---•-•---------•---------••-------------------•----._...-•--•---------.._...------------•--------•-------- ----------------------------------••._..................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed_ . -------•---------- .... ._'�.�7 'F.�_ Date Application Approved By••--•••--•---11 ----•---------------------•--•--...••••- . TC•-�----------••---------------------•'-----------------.._......_..------ Date Application Disapproved for t following reasons---------------•----------------•----•-------•--------------•--------------..................................... .................••••-•------••-•'f•••-•-•-•-••••--•-•••---•------•--......-------...------....----...._..._....••-••-•-•---•-•-•--•-------•-••-•--••----••-•--•-••-•---•--••-•••-.. •••---••-••- -� Date 7/ PermitNo.....-•------....--••---- •------•-•-•-----••--_..... Issued-....................................................... Date t. .d- f ..THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF...... 1, ............................................................................... Trrtifiratr of Tompliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) " •.....:• . ..----------•..........................................................................•------ Installer � -------••-•-------------•---•--•••---...•-••••-••-•••-•- has been installed in accordance with the pr.'. isions of TITLE 5 of The State Sanitary Code as described in the . , u application for Disposal'Works Construction Permit'-'No.__.:__. �f,___?eel______________ dated_ ..-_w._.1._. V_TA,[_.._.________. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARA EE THAT THE SYSTEM WILL FUNCTION SATI FA T��jjORY. j DATE.... !07.. ? / == .:O:S __••-- Inspector........ -' .... ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OFIEALTH 7/c� lJ •. -... OF...........................•_..._............._... ............ sU !_. �y FEE.................... idµ �4'�b �Y,...•. ^~ � ,�'1k �,,� �I K C Permission'is hereby granted...... _:..... � . �* to Construct e .'l_ ` .Qa -------------•.••-••-._........---•-••-••••••-••--••-•••••-•••••••••.....••-----------...•-- ) or Repair ( ) an Individual Sewage ispos�l System at No......./.P.- - Street rv. 71y f shown on the applicati6h,for.'Disposal Works Construction Permit No...................... Dated.._, ��? - asp B/L1 f Health DATE __..____. ................... FORM 1255 A. M. SULKIN, INC., BOSTON ..u'..:+.�n� �'•w. ..saL..a.. -wryu. Y «w..w.+wwFt'.'i Al 1. r y TOWN OF BARNSTABLE LO .ATION act O� iJ S�-i4�r SEWAGE VILLAGE_ / •.d{s 6� ASSESSOR'S MAP LOT INSTALLER'S NAME PHONE NO.� �vL J he SEPTIC TANK CAPACITY 1 OQC) LEACHING FACI r LTY•tt • YPe) 2, 5 NO. OF BEDROOMS .jJ PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUE:):--� DATE COMPLIANCE ISSUED: VARIANCE GRANTER: Yes No l � � 33 * J f " No. NJ) 3 -'r� fq R �"��jr� Fee L .. BOARD OF HEALTH / TOWN OF BARNSTABLE l/ 2pplication _for Yell Cougtructiou Permit Application is hereby made for a permit to Construct( Alter( ), or Repair( ) an individual well at: 1^I Zo 01 A SLy, ,a. 1 152 U 0 0 y� Location-Ad ss Assessors Map and Parcel n W C�NMA r�C mI cs r 62 Owner Address Installer-Driller Address Type of Building / Dwelling �1 Other-Type of Building No. of Persons Type of Well 3 C1lt�p pJ C Capacity__ q Purpose of Well Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed I r ]�L Q/ Date Application Approved By �,,,, Itd� Y Date Application Disapproved for the following reasons: Date Permit No. 0 a-) Issued ? y Date ------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed( ), Altered( ), or Repaired( ) by Installer at U G, Q S , has been installed in accordance wi6fthe provisions of the Town of Barnstable Board of Health Private Well Prot ction Regulation as described in the application for Well Construction Permit No.W-o/V Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector 7 , No. �j )=.d`(y_-o�3 �`� Fee L �. BOARD OF HEALTH TOWN OF BARNSTABLE 01ppficatiou _for Yell Cougtructiou Permit Application is hereby made for a permit to Construct 4, Alter( ), or Repair( an individual well at: ZU tL ,Ups.rrS b �j2 , ci� 10 0 S Location-Add ss Assessors Map and Parcel Q 1 Owner ;� ` V Address ` �, Installer-Driller .j Address Type of Building Dwelling N t Other-Type of Building No. of Persons Type of Well 3 C\\titO f\((- Capacity StP� Purpose of Well 1 a Agreement: The undersigned agrees to install the afore described individual well in accoii�dance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed '1 Date Application Approved By R / / y Date Application Disapproved for the following reasons: Y 1 Permit No. a a Issued y Date 7 Date i BOARD OF HEALTH TOWN OF `BA-RNSTAB*LE (Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed( ), Altered( ), or Repaired( by - tInstaller at f Ui S C-49V has been installed in accordance w' f the provisions of the Town of Barnstable Board of Health Private We}d Prot ction Regulation as described in the application for Well Construction Permit No.(,j 2.0 f t/-Q.? 3 Dated l 1 7 f THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector BOARD OF HEALTH r TOWN OF BARNSTABLE Vern Cou5truction Permit No. h o (�� j Fee Permission is hereby granted to he5�,0 Installer to Construct(�), Alter( ), or Repair( an individual well at: No. . �6,L Street 7 as shown on the application for a Well Construction Permit No. JJ.of 4 - l Date Date -7/( 11 cl Approved By 2 k Massachusetts Department of Environmental Protection ' Bureau of Resource Protection Well Completion Reports Well Driller Please specify work performed: Address at well location: New Well Street Number: Street Name: 1720 OLD STAGE ROAD Please specify well type: Building Lot#: Assessor's Map#: Domestic Assessor's Lot#: ZIP Code: Number Of Wells: 02668 O City/Town: Well Location BARNSTABLE In public right-of-way: GPS G Yes C No North: West: 41.68787 70.37670 Subdivision/Property/Description: Mailing Address: IF click here if same as well location addres Property Owner: Street Number: Street Name: MIKE BROOKS 1720 OLD STAGE ROAD City/Town: State: Engineering Firm: ABINGTON MASSACHUSEffS ZIP Code: 02668 Board of health permit obtained: r Yes (' Not Required Permit Number: Date Issued: r.a W2014 023 7/17/2014 �c7'.11 ' C3 fn d� S roi Massachusetts Department of Environmental Protection LlBureau of Resource Protection—Well Driller Program Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock Auger Choose Bedrock-- WELL LOG OVERBURDEN LITHOLOGY From To(ft) Code Color Comment Drop in drill Extra fast or slow Loss or addition of (ft) stem drill rate fluid 0 20 Fine To Coarse Sand Brown OYES r NO r Fast r Slow Loss r Addition 20 40 Fine To Coarse Sand Brown 6 YES G NO I rd Fast ri Slow r Loss O Addition 40 60 Silt Brown G YES r NO11 r Fast 0 Slow r Loss r Addition 60 80 Fine To Coarse Sand Brown 0 YES r NO Car,r, Slow G4 Loss r Addition WELL LOG BEDROCK LITHOLOGY From Drop in drill Extra fast or slow Loss or addition of Visible Extra � To(ft) Code Comment Rust Large (ft) stem drill rate fluid Staining Chips Choose Code C?YES C NO tr Fast C_ Slow 0 Loss rr Addition Ye r Ye ADDITIONAL WELL INFORMATION Developed r Yes C,No Disinfected t: Yes C,No Total Well Depth 80 Depth to Bedrock Fracture Surface Seal Type None Enhancement CASING I�+Is Casing above ground? From: 1 To: 0 From To Type Thickness Diameter Driveshoe 0 76 Polyvinyl Chloride Schedule 40 4 r Ye SCREEN r No Scree From To Type Slot Size Diameter 76 80 Stainless Steel Well Point ---1 0.012 4 WATER-BEARING ZONES r DRY WEL From To Yield (gpm) 44 80 12 PERMANENT PUMP(IF AVAILABLE) 2 Wire Constant Speed Pump Description Submersible Horsepower 3/ f r Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Pump Intake Depth(ft) 75 Nominal Pump Capacity(gpm) 10 ANNULAR SEAL/FILTER PACK From To Material 1 Weight Material 2 Weight WaterBatches Method Of Placement (gal) Choose Material Choose Material (--C�hoose�One-- L__ WELL TEST DATA Time Pumping Time To Recovery (ft Date Method Yield (gpm) Pumped Level (ft Recover BGS) (HH:MM) BGS) (HH:MM) 8/612014 Constant Rate Pump 12 1:30 45 0:01 44 WATER LEVEL Date Measured Static Depth BGS (ft) Flowing Rate(gpm) 8/6/2614 7 44 12 COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. DESMON THOMAS E Monitoring[M] Supervising Driller Si III, Driller DESMOND III Registration# 764 gnature THOMAS, DESMOND WELL Firm DRILLING INC. Rig Permit# 023 Date Job Complete 8/13/2014 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. AsBuilt - Page 1 of 1 TOWN OF BARNSTABLE c LOCATION 112;�d oi.D -5- 4 e I�--�I SEWAGE # -- VILLAGE�� I,S .w D�sld d� — ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.T T �1'}y'�,-,yti�b�r Sv;-1 ,L-n c SEPTIC TANK CAPACITY 000 LEACHING FACILITY:(type) 5 (size)_Lo O d NO. OF BEDROOMS �PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER .� DATE PERMIT ISSUE'): DATE COMPLIANCE, ISSUED; VARIANCE GRANTER: Yes ?Jo 7 http://issgl2/intranet/propdata/prebuil.t.aspx?mappar=l 52004004&seq=l 7/17/2014 L 548 659 955 Receipt for Certified Mail No Insurance Coverage Provided 4T� Do not use for International Mail (See Reverse) 00 Se o 0, tStreet a No. l6 P. ,S to and ZIP ode C) Postage A ch a E Certified Fee O LL Special Delivery Fee C/) . ILFTAfrict`ed'D'e`llYer`y"Fee' '.F�ettirt'Re`cepT StirS�irS'g^ 1 � a { to Whom&Date Delivered U Return Receipt Showing to Whom, Date,and Addressee's Address TOTAL Postage $ &Fees til Postmark or Date ��;�� STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address a leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). m 5 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return M address of the article,date,detach and retain the receipt,and mail the article. rn 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed co ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. C 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY on the front of the article. E 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If ti return receipt is requested,check the applicable blocks in item 1 of Form 3811. n B. Save this receipt and-pi-send 1?-if you make inquiry. 105603-93-B-0218 `.� THE The Town of Barnstable 0WP� �w ITIM Department of Health, Safety and Environmental Services """ Public Health Division lop i639. `� �0 MAY M• 367 Main Street,Hyannis,MA 02601 Office 508-790-6265 Thomas A.McKean FAX 508-775-3344 Director of Public Health October 25, 1996 Chris and Joe Scanlon Jeff Komenda 569 Keolu Drive 369 South Main St. Apt. C Centerville, MA 02632 Kailua, HI 96734 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 1720 Old Stage Road, West Barnstable was inspected on October 9, 1996 by Christina Kuchinski, R.S. 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 Sanitary Code H were observed: 410.500: There is water leaking through the foundation wall in the basement in several locations. One area is near the oil barrel and several others are at the front and front right walls. 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 r C-� 36, 17,,Gov► Sf 5G� lCeo �v ��' GVLl4 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00. STATE SANITARY HABITATIU CODE tI MININIUM STANDARDS OT Tl TNESS TOR llUMAN N AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE ARIICLE 51 The property owned by you Iocated at f�,2e o(d 3 12�' /teas inspected on /11Pc I. --I)y C� Ilealth Agent for the Town of Barnstable because of a complaint. 'I'he following violations of the Town of Barnstable Rental Ordinance Article Slan d the Snnitny CoJc II were observed; ki Or �i You are directed to correct the violation of within 24 hours of receipt of this notice by Yon ore 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 leakh within seven (7) days a(ler the (late 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 fine of not more Ilia" $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. 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 f 11-6-95 MRVP(4:00pm) 11-13-95 MRVP Re-inspection(3:00 pm) 11-14-95 Tenant complained about debris in rain gutter and black color on electric outlet cover in 1st floor bedroom.(9:30 am) 11-14-95 Re-inspection of gutter and outlet that was fixed by realtor(3:30 pm) 1-20-96 Tenant called to complain of water in her basement but she didn't want to to make a formal complaint as she wanted to give the realtor time to fix the problem.It had also been an extremely wet season. She called the realtor Jeff Komenda who sent Service Master to pump the water out. Items in the basement that belonged to the landlord were water damaged and had to be removed from the site. Service Master had to respond to the house several more times over the next couple of months to pump out water.A copy of a fax that Mr.Komenda had sent to the health inspector on March 8, 1996 stated that Service Master felt that the flooding problem could be corrected by digging a shallow trench around the bulk head and filling with crushed rock and,by re- positioning a down spout.A copy of a letter sent to the landlord on February 22, 1996 was also faxed to the health inspector on March 8, 1996. It stated that a carpenter found the landscape timbers had rotted away around the bulkhead and that was why the water was coming in.He recommended that a mason rip out the old timbers and put up a masonry block wall and that a bulkhead be built at the top of the wall.Repair of the problem was to begin and be completed in March by Coutinho Masonry. 5-28-96 Housing complaint by tenant regarding no stairwell for basement bulkhead access(old stairs had been torn out by workmen during block wallibulkhead repair and not replaced),window screens provided that spring were too small, screeen door provided for sliding glass door in master bedroom wouldn't stay in track,torn screens,drain pipe broken on left rear of house and not draining water away from house.(9:30 am) 6-13-96 Housing re-inspection.All violations cited had been corrected. Window screen frame in child's bedroom was slightly bent due to tightness of screening material.Workman took screen away to fix.(11:00 am) 8-2-96 Housing complaint by tenant regarding water leaking from several locations in the basement(10:00 am).Inspector observed water seeping from right side of basement wall,condensation from water pipe near oil tank forming puddle, water supply line for washing machine dripping condensation from pipe and water from supply valve.(11:30 am) 8-14-96 Re-inspection of violations.showed workman that water was still seeping in from right side of basement wall and area of wall near oil tank. Workman said that he would notify the realtor and fix problem.(2:30 pm) 10-9-96 Tenant complained that the water was still leaking into basement in several locations.(9:00 am).Inspector observed water seeping through the foundation wall in basement near oil barrel and in 2 more locations at the front and front right walls.(1:30 pm) f FORM30 HOBBsB WARREN,INC.NOV.1979.1983 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY�W� W a DEPARTMENT #: ADDRESS TELOPAONE Address Occupant Floor Apartment No. No.of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling rooming units No.Stories Name and address ress of owner P 4 --�'� / /�.- /�-u 1`� s G ( e o�v b vZvk C Ct I v.<. (`r4^ 0 7��y Remarks Rag. Vb. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters,Drains: t O L) -te)64 Walls: Foundation: ' JAA Chimney: , - o BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑Y Q 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.: ❑ 116 ❑ 220 Fusin a,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors- Locks Kitchen Bathroom —Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent. Plumb.,Sanit'n.: Wash Basin Shower or Tub: UMestation Rats Mice Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL—BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED,UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR f "�" '� IT;TLE DATE 0// o� TIME CP,_ 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 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 GMR 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. (G) 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 4110.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.602 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. (R) 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. ( ) 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. t ', SENDER: C ■Complete items 1 and/or 2 for additional services. I also Wish to receive the r� ■Complete items 3,4a,and 4b. following services(for an y ■Print your name and address on the reverse of this form so that we can return this extra fee): d card to you. di • ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address permit. ■Write'Return Receipt Re uested'on the mail piece below the article number. a, P 4 a 2. ❑ Restricted Delivery rn ■The Return Receipt will show to whom the article was delivered and the date a delivered. Consult postmaster for fee. 0 3.Article Addrqssed to: 4a.Article Number a E 4b.Servi a Type n U `�—�i -1 ❑ Registered Certified ❑ Express Mail ❑ Insured c dl IM ❑ Return Receipt for Merchandise ❑ COD G 1 7.Date of Delivery t T Z /0 5.Rec I ed By:(Print Name) 8.Addressee's Address(Only if requested W and fee is paid) t g 6.Sign to e: ddr sse rAge ) X / - dl i `PS Form 3 11, December 1994 Domestic Return Receipt a IF UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 Print your name, address, and ZIP Code in this box • Board of Health "';' Town of Bamstabig P.O. Box 534 Hyannis, MaE,sachusetts 02601 Town of Barnstable Health Department I "":: } 367 Main Street, Hyannis, MA 02601 Office 508-794�265 Imomaa A. McKean FAX 508-775-3344 Director of Public Health August 7, 1996 Jeff Komenda 369 South Main Street Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00 STATE SANITARY CODE II MINIMUM STANDT� OF FITNESS FR RENTAL ORDINANCE ART ARTICLE 51 ION AND TIIE TOWN OF BARN The property owned by you located at 1720 Old Stage Road, West Barnstable was inspected on August 2, 1996 by Christina Kuchinski, R.S. 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 Sanitary Code II were observed: 410.500: Water was seeping from the bottom of the foundation wall on the right side of the basement. 410.351: Water was forming into a puddle on the floor of the basement due to large amounts of condensation dripping from a water pipe near an oil tank. 410.351: Water was dripping from the water supply line valve for the washing machine in the basement. Condensation was also dripping from the pipe and adding to the puddle on the floor. You are directed to correct the 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. r 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 4:�5np omas A. McKean Director of Public Health cc: Margaret Sexton 34.8 659 896 T Receipt for • Certified Mail No Insurance Coverage Provided AL STaIr-C s' o not use for International Mail fgST�L SEINICE (See Reverse) 0) Sent �_ t a t0 P tate a Code � Postage $ Cl) Certified Fee -� O � Special Delivery Fee e r fffd 4iU tidy �e� e urp;,.ecelp.'.owl n9 to Whom&Date Delivered Return Recei Showing t Date,and Add res TOTAL.[; &Fees Postm r o �09Z STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). a^i 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If fyou do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article, date,detach and retain the receipt,and mail the article. w 3. If you Want a return receipt,write the certified mail number and your name and address on a return receipte�ard,Form 3611,and attach it to the front of the article by means of the gummed ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. O O • O 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY on the front of the article. G9 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If U- return receipt is requested,check the applicable blocks in item 1 of Form 3611. 0- a 6. Save this receipt and prescnt it if you make inquiry. t 105603.83-e-0218 ko rr .p;,)I-z 3C,9 Sa 1 -6 C � l(,e, h' P9 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410,00, STATE SANITARY CODE ll, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND TILE 'TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 177 o Old s4-0-k6 Je;, was inspected on 09 PJFA by C ff-2, d c I lealth Agent for the Town of Barnstable because of a complaint. I he following violations of the Town of Barnstable Rental Ordinance Article 51 and the Sanitary Code II were observed: f are it cted to orrect he vi do of IN 24 urs of re t of this ;�tc e y You Are alfWirected to correct the r 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 after the (late order is received. However, 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 fine of not more than $500. Each 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 V 5.00 for each additional violation. 'Pickets 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 9` i r FORM30 Hoses&WARREN,INC.NOV.1979-1983 THE COMMONWEALTH OF MASSACH USE TTS BOARD OF EALTH CITY/TOWN DEPARTMENT 7 � n S 7 /� ati °t ADDAESS TELEPHONE 1� Address �`3`� Ut' �{&4z 2 Occup �T � =� h Floor Apartment No. No.of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No.Stories Name and address of owner o a. 36 % S o v (1 - th .S'fi�c'{ `P/h GYG!/( (�� / Remarks Rog. Vim YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation:, Chimney: BASEMENT Gen.Sanitation: r2A f pAn - Dampness: Stairs: Lighting: (AL STRUCTURE INT. Hall,Stairway: 02 K9 Obst'n.: 1 h/ Ax Hall, Floor,Wall,Ceiling: Hall Lighting: q 1 Hall Windows: P,e, -- IkA4,ezI HEATING Chimneys: G, I Central ❑Y ❑ N Equip. Repair �1 TYPE: Stacks,Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ST ❑ P Waste Line: H.W.Tanks Safety and Vents 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 Facil. Vent., Plumb.,Sanit'n.: Wash Basin Shower or Tub: Infestation Rats Mice Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED,UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR Al TITLE_ 74 /1`� ,��•� / A.M., DATE l a /Q.(� TIME �/ O �X 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 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. (G), 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 41'O.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.602 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. (R) 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. (r) 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 ;; SENDER: :C ■Complete items 1 and/or 2 for additional services. I also wish t0 receive the H ■Complete items 3,4a,and 4b. following services(for an y ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. 'd j ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address permit. ■Write'Retum Receipt Re uested'on the mail piece below the article number. d a, p 4 p 2. El Delivery � ■The Return Receipt will show to whom the article was delivered and the date .. delivered. Consult postmaster for fee. a o 3.A le A ss o: 4acl u�rlber cc E S 4b.Service Type CL coon 9 ❑ Registered Q!1 Certified °C at N j ❑ Express Mail ❑ Insured c c y ❑ Return Receipt for Merchandise ❑ COD Q J 7.Date of li .e zM5 >, z 5.Received By:(Print Name) 8.Addrdsdees Address(Only if requested LU and fee is paid)lZ r g 6.Signati ee or Agent) X sL H PS For 3811, December 1994 Domestic Return Receipt _ 1 r UNITEQrSTATES POSTAL SERVICE '74 R �Fist�as�`M17r�tlA U �' Postage&^F Paid P M s USP6 .Permit NO.,G--rd • Print your nanq,;a ress, and ZP-Gode in this=bo-x-•- Health Department Town of Barnstable P.O.Box 534 Hyannis,Mlassasht 1 faUX O 775331 i 13 June 3, 1996 Jeff Komenda 369 South Main Street Centerville, MA 02632 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 1720 Old Stage Road, W. Barnstable was inspected on May 28, 1996 Christina Kuchinski, R.S., 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 Sanitary Code II were observed: �fl 10.452: No stairwell or handrail was provided for basement bulkhead egress. 410.551: The screens provided for the first floor right side, front and left side windows were too small. ;-,�I f 410.500: The drain pipe for the left rear side of the house is not complete and ends at the deck, thus not directing the flow of water away from the house. 551: The window screen provided for the master bedroom had a small hole in the screening material. d OV4 10.552: The window screen provided for the master bedroom sliding glass door would not stay in the door track. 41W55L The window screen provided in the boys bedroom right side window had a torn screen material. You are directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. �r 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: Margaret Sexton, tenant I 11-6-95 MRVP(4:00pm) 11-13-95 MRVP Re-inspection(3:00 pm) 11-14-95 Tenant complained about debris in rain gutter and black color on electric outlet cover in 1 st floor bedroom.(9:30 am) 11-14-95 Re-inspection of gutter and outlet that was fixed by realtor(3:30 pm) 1-20-96 Tenant called to complain of water in her basement but she didn't want to to make a formal complaint as she wanted to give the realtor time to fix the problem. It had also been an extremely wet season. She called the realtor Jeff Komenda who sent Service Master to pump the water out. Items in the basement that belonged to the landlord were water damaged and had to be removed from the site. Service Master had to respond to the house several more times over the next couple of months to pump out water.A copy of a fax that Mr.Komenda had sent to the health inspector on March 8, 1996 stated that Service Master felt that the flooding problem could be corrected by digging a shallow trench around the bulk head and filling with crushed rock and,by re- positioning a down spout.A copy of a letter sent to the landlord on February 22, 1996 was also faxed to the health inspector on March 8, 1996. It stated that a carpenter found the landscape timbers had rotted away around the bulkhead and that was why the water was coming in.He recommended that a mason rip out the old timbers and put up a masonry block wall and that a bulkhead be built at the top of the wall.Repair of the problem was to begin and be completed in March by Coutinho Masonry. 5-28-96 Housing complaint by tenant regarding no stairwell for basement bulkhead access(old stairs had been torn out by workmen during block wall/bulkhead repair and not replaced),window screens provided that spring were too small, screeen door provided for sliding glass door in master bedroom wouldn't stay in track,torn screens,drain pipe broken on left rear of house and not draining water away from house.(9:30 am) 6 13-96 = Housing re-inspection.All violations cited had been corrected.Window screen frame in child's bedroom was slightly bent due to tightness of screening material.Workman took screen away to fix.(11:00 am) 8-2-96 Housing complaint by tenant regarding water leaking from several locations in the basement(10:00 am).Inspector observed water seeping from right side of basement wall,condensation from water pipe near oil tank forming puddle, water supply line for washing machine dripping condensation from pipe and water from supply valve.(11:30 am) 8-14-96 Re-inspection of violations.showed workman that water was still seeping in from right side of basement wall and area of wall near oil tank.Workman said that he would notify the realtor and fix problem.(2:30 pm) 10-9-96 Tenant complained that the water was still leaking into basement in several locations.(9:00 am).Inspector observed water seeping through the foundation wall in basement near oil barrel and in 2 more locations at the front and front right walls.(1:30 pm) f . Town of Barnstable �S Z Health Department 1 367 Main Street, Hyannis, MA 02601 As Thomas A. McKean Director of Public Health .t�= FA1C V vco(a4(owr Jeff Komenda 369 Solg*'Main Street CentervM6,kMA 02632 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 1720 Old Stage Road, W. Barnstable was inspected on May 28, 1996 Christina Kuchinski, R.S., 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 Sanitary Code H were observed: 0)0 410_: No stairwell or handrail was provided for basement bulkhead egress. dOv-'�- 410.551: The screens provided for the first floor right side, front and left side i windows were too small. aDvLa 410.500: The drain pipe for the left rear side of the house is not complete and ends at the deck, thus not directing the flow of water away from the house. doy-,t 410.551: The window screen provided for the master bedroom had a small hole in the screening material. doh 410.552: The v4Qw screen provided for the master bedroom sliding glass door would not stay in the door track. dDyv- 410.551: The window screen provided in the boys bedroom right side window had a torn screen material. You are directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. ;i r4Q 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. R IM 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 $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH ' 0 + mas A. McKean Director of Public Health cc: Margaret Sexton, tenant ,, a r.: a _ Town of Barnstable s z a O Health Department 1 367 Main Street, Hyannis, MA 02601 twoAP 4t 79pb2!►S Thomas A. McKean FA 50$=7 Director of Public Health F ; �7 75-3344 . F S tiy! •. June 3,1996 z' Jeff Komenda 369 South Main Street Centgrviff';MA 02632 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 1720 Old Stage Road, W. Barnstable was inspected on May 28, 1996 Christina Kuchinski, R.S., 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 Sanitary Code H were observed: 410.452: No stairwell or handrail was provided for basement bulkhead egress. 410,551: The screens provided for the first floor right side, front and left side Al _ windows were too small. 410.500: The drain pipe for the left rear side of the house is not complete and ends at the deck, thus not directing the flow of water away from the house. 410.551: The window screen provided for the master bedroom had a small hole in the screening material. 410.552: The vAv screen provided for the master bedroom sliding glass door would not stay in the door track. 410.551: The window screen provided in the boys bedroom right side window had a torn screen material. You are directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. t - 7 Al 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. AI * P. 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. N -PER ORDER OF THE BOARD OF HEALTH oMas A.McKean Director of Public Health cc: Margaret Sexton, tenant r u G L syy f • S i , t 17 ald ash s*a,Me r Mr./Mrs. NOTICE TO ABATE VIOLATIONS OF 105 CMR 410,00, STATE; 3AN&ARY CODE 112 MINIMUM STANDARDS OF FITNESS FOR IIVMAN HABITATION AND THE 'I OWN 0F BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 e2 The property owned by you located at 17a 0 was 1080ectad Olt +*94 by a441 r2--P Iiealth Agent for the Town of Barnstable because of a complaint. 'the following violations of the Town of Barnstable Rental Ordinance Article 51.and the Sanitnry Code 11 were observed: , h� A� /`4l ifs &,)o s-f w u-�t( nv )1 e�s'S rP1420y Sick w n e f^ S'(,�� a� '( ec� 1ktzr trot rke 46 f , J � ` Y e direct o corr c the vio ti of in urs oft i t of t n You are directed to correct the remaining Above listed violations within seven (7) days or receipt of this notice. You may request a hearing if written petition requesting some Is received by the Board of Ilealth within seven (7) days after the date order is received. however, 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 fine of hot more than $500. Each 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 s15.00 for each additional violation. 'rickets 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 4 5 FORM90 Hoeesa WARREN,INC.NOV.1979.1983 THE COMMONWEALTH OF MAS8ACNUSETTB ' BOARD OF HEALTH ' CITYROW ' W �t o DEPARTMENT Gt <.S" a, °tADDRESS 1 601 S _. LEPNONE �^ Address7a� 6, Occupan - /-o Floor S Ap 4mv : I No.of Occupants No.of Habitable Rooms No.Sleeping Rooms_�� No.dwelling or rooming units No.Stories _ Name and address of owner v r e ✓ ` :Sdt,-�G r w,(, �{ r ` Remarks Reg. Vb. / YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: (VIC aV Dual Egress:and Obst'n.: ( Yu?Gl ❑ B ❑ F ❑ M Doors,Windows: At Roof C4 Gutters, Drains: Walls: Foundation: ,, v, (,[p Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: m �a - �+ 46 A _16t t STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: f0ah ,t HEATING Chimneys: , , C 46 / Central ❑Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: v 1 ;;1 rm-VN _S' ( cr7 d PLUMBING: Supply Line: (`� pin 1. -{ ' r ❑ MS ❑ST ❑ P Waste Line: H.W.Tanks Safety and Vents ELECTRICAL Panels,Meters,Cir.: i i ❑ 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 Facll. 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: a Infestation Rats Mice Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR A kA Atj TITLE S o�f` TIME DATE I 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 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 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) 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. (G). 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 41D.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.602 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. (R) 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. .0) 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. Z 348 659 875 . Receipt for Certified Mail No Insurance Coverage Provided Do not use for International Mail (See Rev rse OVf Sent to Of t Str nd No y tv 2 P. tate de 10� Pbsragd T✓ �� A E Certified Fee /E O LL Special Delivery Fee ca fRegtr cted[Wiv_ery fFeo I tReturnFReceipt<SAowing- --- — _-� to Whom&Date Delivered r Return Receipt Showin o Wh Date,and Addressev§Addr TOTAL Postage y &Fees Postmark or Dat fA r c0,tom Z.4 Q! b. O 09� STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, ' CERTIFIED MAIL FEE AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). Q 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach and retain the receipt,and mail the article. 0) r 3. If you.want�a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. C 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, CO). endorse RESTRICTED DELIVERY on the front of the article. S 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If LLL II return receipt is requested,check the applicable blocks in item 1 of Form 3811. co ` a 6. Save this receipt and present it if you make inquiry. 105603-93-13-0218 Health Complaints 21-Oct-96 Time: 9:00:00 AM Date: 10/9/96 Complaint Number: 492 Referred To: CHRISTINA KUCHINSKI Taken By: CHRISTINA KUCHINSKI Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 1720 Street: Old Stage Road Village: WEST BARNSTABLE Assessors Map-Parcel: Complaint Description: Basement still leaking in several locations. Actions Taken/Results: CK observed water seeping through foundation wall in basement near oil barrel and in 2 more locations at the front and front right walls. Investigation Date: 10/9/96 Investigation Time: 1:30:00 PM 1 Health Complaints 16-Oct-96 Time: 10:00:00 AM Date: 8/2/96 Complaint Number: 332 Referred To: CHRISTINA KUCHINSKI Taken By: LYNDA SARGENT Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 1720 Street: Old Stage Road Village: WEST BARNSTABLE Assessors Map-Parcel: Complaint Description: Water in the basement from several locations. Actions Taken/Results: CK observed water seeping from right side of basement wall, water seeping from water pipe near oil tank(condensation from pipe), water supply line for washing machine dripping condensation from pipe and water from supply valve. Investigation Date: 8/2/96 Investigation Time: 11:30:00 AM 1 i Health Complaints 16-Oct-96 Time: 5/28/96 Date: 9:30:00 AM Complaint Number: 213 Referred To: CHRISTINA KUCHINSKI Taken By: CHRISTINA KUCHINSKI Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 1720 Street: Old Stage Road Village: WEST BARNSTABLE Assessors Map-Parcel: 152-004 Complaint Description: No stairwell for basement bulkhead access(old stairs that were ther had been torn out and not replaced),window screens provided for spring/summer are too small, screen provided for sliding glass door in master bedrom won't stay in the track, torn screens, drain pipe broken on left rear of house and not draining water away from house. Actions Taken/Results: CK observed 6 housing code violations(see file)and sent order to correct to property manager Investigation Date: 5/28/96 Investigation Time: 1:30:00 PM 1 T wnsy.. d SENDER: V ■Complete items 1 and/or 2 for additional services. I also Wish to receive the w ■Complete items 3,4a,and 4b. following services(for an d ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address 0 permit. d ■Write'Refurn Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery CO) r ■The Return Receipt will show to whom the article was delivered and the date a i delivered. Consult postmaster for fee. 0 3.Article Addressed to: 4a.Article Number 4b.Service Type o ��0 /t1`�/ otl Registered ® Certified �a W (� ❑ Express Mail ❑ Insured 9 ¢ ElReturn Receipt f f Merchandise ❑ COD a0& J 7.Dade Deliv ry. Z -� 0 p 5.Received By:(Print Name) 8.Addr ssee's Address(Only if requested W and fee is paid) t 6.Signature: (Addressee or Agent) � X y PS Form 811, December 1994 Domestic Return Receipt , UNITED STATES POSTAL SERVICE VOA Mq 0.0 ge P;vi Oil 0 Print your na /addr , and ZIP G Health Department j Town of Barnstable I �A P.O. Box 534 Hyannis, Massachusetts 02601 Fax(508)775-3344 Phony(508)790-6265 I I i I I I I No...V___-3� Fss. .-..30....Q9.:... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for DinVitial Workii TontitrurtWit Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ix)4 an Individual Sewage Disposal System at: 1.720...Old__S.tage..F,.oa _Test Barnstable . -------------•---...-----.................... Location-Address 1 or 1,o' No- Komenda_.Asa9C . . a..-k�� 1 Sta e 0.0........ .........................................Address Jr--..................................................... ---------------------------...----------------••-•----------------•--••-•----•----.............--- Installer Address Type of Building Size Lot............................Sq. feet ., Dwelling 4 No. of Bedrooms--------------3----------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------- - - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacitv-----------.gallons Length......... ...... Width....--.......... Diameter...-- .......... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.......----......... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter............-------- Depth below inlet.-....--.-.--.---.-- Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ): Percolation Test Results Performed by-------- --------------------------------------•--•----------------------- Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit........------.--... Depth to ground water........................ G% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...---......-..---...... P4 -------------------------------•---•----••----------------•-•--•-------------•-•-••-----•-----...---......................................................... O. Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------- v .............. and.-- &---Gravel W UNature of Repairs or Alterations—Answer when applicable.-.Add i ng 1"-1 0 0 0 ga 11 on leach p i t to-.an...exi.sting---tank &..Pi-t.�............................................................................---------- ------- ............................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n i, sued y the bo •d of health. Sign /, ... ... 3/9/.9.5........ Dare Application,Approved By .. ........ ............... .......--------- - Dace Application Disapproved for the following reasons: ..................-........................................................ .......... ........... ... ........................ ........ . ................................ ....... .... .......................................... . Dace Permit No. ..........(�� ....... -�� Issued .........................a .�p. s" r - 00 � 6C � 1. No..--1� �_. _.:� FEs. ..... .. .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratuan for Di_npwi al Workii Tomstrnrtiun rumit Application is hereby made for a Permit to Construct ( ) or Repair ((Xy). an Individual Sewage Disposal System at: 1.720...Old_.Stacic... oac3...West...Barnstable --------------------------•--•---•------------•---------------•--•-----._.....---•---•-••-...•---- Location-Addrrss ') or t No. Komenda Associates Re-at Esbat�.a.-_. 7 Sl)-._.Sony-!� - -•-----•_..... .-------- Owner Address aJ..P.AM:acomber-•-'fir-A----------- ---•-----------•---•-----------------••-- ---------------------------------...-•---.....--------•--••---------------------•-•--•--•--•------ Installer Address UType of Building Size Lot............................Sq. feet Dwelling X No. of Bedrooms______________3---------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------. Showers ( ) — Cafeteria ( ) dOther fixtures --------------------_---- ----------------------------------------------------- ---------•-------•----•--•-------•------•-•••----...•--•-... W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacitv............gallons Length---------------- Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width..._................ Total Length---------_-------- Total leaching area....................sq. ft. Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water..................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ..............................................................................................................................•..... •........ _... •••--•----- 0 Description of So il........................................................................................................................................................................ x Sand& Gravel v ------------------------------------------•--------------------------------------------------------------------------------....--------------...--------•-----------------------•-••••-•--•••...._..__.. Z.W U Nature of Repairs or Alterations—Answer when applicable._- _�?:� _--1- 1000 gallon 1Qae'� pit to an existinq tank & pit. __......_..-•---•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n i sued y the board of health. Signed ...... . . v..................... .... ....3./-9/..9.5.... ...... Dae B Yt � `APPlication,Approved f _.j..... ........ .. +- . l _. -------------------------- ........................................ Dace Application Disapproved for the following searonr: - ----------------------------------------------------------------------------- -----..-. ------------ .--....----- ------- -----------------------------..y.$".� ............. ...... ........................... .............. ...... ..................... .-............ Dace................ .. Permit No. ------- - ......... Issued ................ ....... !�. , 9 ----------- - ------ ---------- -------------1=------- ---------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH V TOWN OF BARNSTABLE (Iblertifirate of C11omplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX�) by -------.J..P MA_;ember. Jr Installer at ... 1720 Old Staae...-Road-...W at..-.Kann tahl-.e... . .............. ............ ..... .............................. ----------- ---------------- - has been installed in accordance with the provisions of TITLE 5 f The Sta5e nv onmental Code as described in the application for Disposal Works Construction Permit No. ."'�.( .. � dated ........................................_._ THE ISSUANCE OF THIS CERTIFICATE SH ALL B,NOT CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE .... .r... � .........._...._..... Inspec or.... .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH G — TOWN OF BARNSTABLE $ 30.00 No.... !.R,-•.... - FEE........................ ' Disposal Worb Towdrurti.oxn "unfit Permission is hereby granted_..__`7_'p_-_Macomber Jr. to Cons,rust ( ) or Repair (KX) an Individual Sewage Dispposal System at No.... ZO R Old Stage oad West :,Barnstable Street as shown on the application for isposal Works Construction emit No._ �__.._____,_�9 a ed_ ...___...___l?.._ _._._.._. . 1� .... t ------•- •• Board of H�alth DATE. --•---...r...................................... �. FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS t:umber: Bottle 4+ 01 Date: '/�= t BARNSTABLE COUNTY HEALTH DEPARTMENT SUPERIOR COURT HOUSE L� J �BARNSTABLE, MASSACHUS=S 02630 , • DRINKING WATER LABORATORY ANALYSIS "IA$g PHONE: 362-251 1 EXT. 331 Richardt'cealy collector• rred Clifford Client: . _ _ _. _ . Mailing Address: !'�,`LZat:e'°5e i;lL. L OrP. Affiliation: t� �'' ru "`+ + ur Time S Date of rivanins' 1'Li ULUU; - Collecti_on: /�4/�>*, 11 :00 a.�. Tple�hone: �!' - ty!! Type of Supply: �i'c; i .Water Sample Location: 11i `IL DLOUC `%'- Well Depth- c3+'li':Lov+:_ Date of Analysis: Parameter Sample Result Recommended Limits Total Coliform Bacteria/100 ml _ �' 0 PH - J•�� _ 500.0 Conductivity (micromhos/cm) - Iron (ppm) _ U.v: 0.3 Nitrate-Nitrogen (ppm) _ U ti` 1.0.0 Sodium (ppm) -` 20. >;^ Water sample meets the recommended limits of all above tested parameters. Water sample has higher than average levels of nitrate. Future monitoring is recommended ..(2-3 times per year) . . The low pH of the water Imay shorten the useful life of the house's plumbing. Water sample may present aesthetic problems due to Water sample has high levels of sodium. Persons on low sodium diets should consult `their doctor. --'Water sample is not recommended for human ,consumption due to Retesting is suggested. RErt4RKS: CC: 5 cL Lab Director l l;7/83 y —WN OF IBARNSTABLE . vrc;L,A�fi ll� ��;•5 6 ApEssowsaiV1A�'a LOTT.�._:�: .T.. 'INlSTAX,.Y. ti'S NAM&,PROM N0. 0 TANKCAPACITY Q� 4 ..... . LEACMG•I PA,CI l'I"Y: (qpe) Nb:;OF'�6t31�.00JNdS J .0�oM iiiR iTDATE Cell t.,�F►I+iG'l 1DA'`E: ' �S�p�uatta�11�i�P�n�a B�Ev�seta t�ci: Maximum t}ust tf Cn'au►tdv✓�tet TebtsEo ti<e Bt�ttornofLuaWng Pocility. Pity +,' at r Supply Vlt fli td d pahing I?AcMY iwy wolf$exist at e�tss oc:�r�tl�in 00 feet of loaeCuo►g f ctkty) Fail F.cl fWnch an Le Aalnlns>F�c�iEy:(f"y:wetlands exist wltlais� Up feat of leashing f, ty) Lr oe ��ttrnlshod by � �,4 ::• � �Q Coy er y �je ` C-j i31 ' h � Y TOWN OF BARNSTABLE LOCATION dad 01-D 5-b4� c, I�� SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME ,i PHONE NO.j-� \ liaumber so Pt Z-mc SEPTIC TANK CAPACITY LBO O LEACHING FACILITY:(type) S (size) Io O d NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUE:):' DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 4. iii ` � �y �� C � �i ._-- '. -- � � \ x �. CO CATION 17ao SEWAGE PERMIT NO. V-1LLAGE � INSTA LLER'S NAME a ADDRESS R U I L D E R OR OWNER ' DATE PERMIT ISSUED Q DATE '' COMPLIANCE ISSUED Z g 1 �9 �9 13Y o, _--- - �— ----w solL LOG Np -1F, T � �t�• - alb �' �%-'' .a �� ,. r � _ COVER 11Rrr WASHED SCONE 2 —3IS 1 � r t : i STONE f 1 314 1 1l2 WASHED , o IESI7,1» x x � TEST ` � t F. TH e I �I,R� eet 2 D,EP RATR �i y j no LEACHING PIT SIH TNESSIAt'''3 41 ! o PRECAS., No.: qN� SIZE•� *� F a�w� .� �.� r , �q®•(J . i � •i�r/:�. ��,Y�. _.� ., ..fir _. r �;�yrrt l}�M�„aLs,�(r �t y s�,s°�r°K �.x s< c r4 t f �0VA'., 1 f �I�flI tt�} } Pprfr # �� r sW Jy 4 4 o kp 71 43 f�a iF lvj AF IVO r v i 4 _ t ,P 7 fi o z I OAy GARF Q lo D I L IV G ►eaax PROPOSED FOesr FCMR 720 OLD SAGS rRO4Z) sWIZ* V46 T BAN.STA BLE i-lA OZ6C8 �� B-6 b � b t AMCrp �.1 WALKIWO CL05E? c01 a . h 19-gN IN - - - 14ALL oArr sPAcc- ,1 t I a 1NMX --I DEMoc.i rroN PR POSE D SEcdNn hoop" NEW WAU. 1720 OLO SI"AGE P,0 40 ICAtE' w6ST QRRNSTAt3» MR OZ668 �.25 I TT 6€D 2 I � - - - - - - ovENsPAC.E ATTICEA I I - -- - -- - -- I ATT/G - - - - - FX/ST/Na sccoaJD FLook 1720 Ot-D STAGE P-OA O SCAB€ wEST sgRrvs TAB LE-MA O Z 66 R f Y � a01L LOG N0. 1 O N0. 2SITE PLAN - 2 _.__. 4 .5A NO 5 TOP Of FOUNDATION El : f 6 �� _ f38• o G 1 • - r„ 810 r- ,` ••, - i °•• IN [I . =� l 1 1 ---------� I N E l. 8�` 6 ..��, N.E I. 85. 4 —_ �d -=r •• -�- -- 2 COVER 1/8 - 3/8 WASHED STONE ' 12 •^Y IN.EI.�'�. IN.EI. ° IN Et �5, / o`�o�;'o° ' n° 3/4 1 1/2 WASHED STONE 13 •� DtB Wi 6 SUMP _ C • 4' LIQUID LEVEL15° ° ° ° " ° 14 ° `^ C ' � on o •o' O � " J d C e --- °�. 6" E F F. DEPTH -� r b �- --- 15 PERC TEST RESULTS PRECAST SEPTIC TANK WITH PRECAST LEACHING PITS PERC RATE : 2 — o Cv D • n Jc °�' � `� p GoDo o�f_r. x .. ,�,, , WITNESSED BY: CAST IN PLACE INLET AND EL. y. _ _--_— ` ° NO.: SIZE : _ _ -�— • _�� BOARD OF HEALTH OUTLET T "S PER TITLE �-- �� D I A . --�--1"--� �f- s f�� DATE: SIZE : �000 �.��G o•`/ — _ n � �� • L OnlG X -9io-�io� x �-;�..o�-�,�� i----- �" D I A . PROFILE OF PROPOSED SEWAGE SY(%3TEM SYSTEM DESIGNED BY THE TOWN OF - ___— —__ REGULATIONS AND T11T1: T ! T[ 11 FOR SUBSURFACE DISPOSAL OF SEWAGE . SCALE 1,4 = 1 0 - - I1 N . B . 1 . All PIPES SHALL BE SCHEDULE 40 P.V.C . SEWER PIPE 14 °3 2. All PIPES SHALL BE SLOPED 1/4 " PER FOOT EXCEPT FOR FIRST 2 FEET OUT OF THE D / B WHICH SHALL BE LEVEL �� '' q �'� �' ` �� THE F �.� � ,��.�4,g.-� BEDROOMS AT 110 GALDAY PER BR. _.--_= = GAL/ DAY 3. DESIGN FLOW ___ __ {�K _ ll EPTIC TANK SIZE - -3c2 X i•�- _== _- GAL . USE J G Al. W GARBAGE DISPOSAL �'/T35 g �� LEACHING SYSTEM : U S E (�% _ T E ,� 'p,.:a x G ELF �.�f�,�.i� ,��?,�L,gs;-L �.��:.-�, � •fi � fir w//- o ,srw✓F .qr..G. .�i.4vu,v� r / 3�• o � � EFFECTIVE AREA : SIDE _t-x 77 �A�. BOTTOM X$Z-4 x/ = so G.•oc/or— y�!- -�� 't/��.� 1 TOTAL FLOW --- TOTAL I REQ 'O FLOW -s3y X /a = 3o WI o�T GP,R9AGE, DISPOSAL o RESERVE FLOW _ 0� 7- �-30s 9 z GAL/DAY - - wo 7"� + _ REFERENCE PLANS : oAR/ S77"4t)5`z-,�5 co�Nry •��E-�� -��' y.� A N := 07 i _ APPROVED BY : BOARD OF HEALTH DATE : .___ SITE AN :ll SEWAGE PLAIN PROPERTY OWNER : r FOR _rr BEDROOM S06LE FAMILY DWELLING ' SON LOT : --— - e ft. -14500 a ., D A T E �1 - =�� ,y •� DOYLE A SOClATES FALMOUTH , MASS. jq � c