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0062 ACRE HILL ROAD - Health
62 ACRE HILL RD.�� f 1"7 Commonwealth of Massachusetts — Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 62 Acre Hill Rd Property Address Ellen Bedard Owner Owner's Name information is required for every Barnstable MA 02630 3-26-15, page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: �-- t 67 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 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation b Local Approving Authority 3-26-15 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner_ and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how t e system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspe n Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 62 Acre Hill Rd Property Address Ellen Bedard Owner Owner's Name information is required for every Barnstable MA 02630 3-26-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in-310 CMR 15.303"or in 3`10 CMR 15.304'exist: Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and 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): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 t s Commonwealth of Massachusetts b W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,L M 62 Acre Hill Rd Property Address Ellen Bedard Owner Owner's Name information is required for every Barnstable MA 02630 3-26-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND'(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken 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): C), Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is faiiling to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 62 Acre Hill Rd Property Address Ellen Bedard Owner Owner's Name information is required for every Barnstable MA 02630 3-26-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 62 Acre Hill Rd Property Address Ellen Bedard Owner Owner's Name information is bl tae Barns , required for every MA 02630 3-26-15' page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. JvAny portion of cesspool or privy is within 100 feet of a surface water supply or ® tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply Elthe system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to.any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M $. 62 Acre Hill Rd Property Address Ellen Bedard Owner Owner's Name information is required for every Barnstable MA 02630 3-26-15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 [sins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 62 Acre Hill Rd Property Address Ellen Bedard Owner Owner's Name information is required for every Barnstable MA 02630 3-26-15 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No 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 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No 3-2015 Last date of occupancy: Date Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 62 Acre Hill Rd Property Address Ellen Bedard Owner Owner's Name' information is required for every Barnstable MA 02630 3-26-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 2014 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval.: ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts = W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 62 Acre Hill Rd Property Address Ellen Bedard Owner Owner's Name information is required for every Barnstable MA 02630 3-26-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1999 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2411 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. Septic Tank(locate on site plan): Depth below grade: 18"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" t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 62 Acre Hill Rd Property Address Ellen Bedard Owner Owner's Name information is required for every Barnstable MA 02630 3-26-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) 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. Grease Trap (locate on site plan): Depth belowi grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M— 62 Acre Hill Rd Property Address Ellen Bedard Owner Owner's Name information is required for every Barnstable MA 02630 3-26-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form " Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 62 Acre Hill Rd Property Address Ellen Bedard Owner Owner's Name information is required for every Barnstable MA 02630 3-26-15 City/Town/Town State i a e. Y Z Code Date of Inspection P9 P P D. System Information (cont.) ) 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 field. 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 c Commonwealth of Massachusetts m W Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 62 Acre Hill Rd Property Address Ellen Bedard Owner Owner's Name information is required for every Barnstable MA 02630 3-26-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4-Infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Infiltrator leach field in good working order with no sign of back-up into d-box or surrounding stone. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer . Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 62 Acre Hill Rd Property Address Ellen Bedard Owner Owner's Name information is required for every Barnstable MA 02630 3-26-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): r t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 62 Acre Hill Rd Property Address Ellen Bedard Owner Owner's Name information is required for every Barnstable MA 02630 3-26-15 page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately ---- t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 62 Acre Hill Rd Property Address Ellen Bedard Owner Owner's Name information is required for every Barnstable MA 02630 3-26-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ 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: Original design pains show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 V Commonwealth of Massachusetts W Title 5 Official Inspection Form fit Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M- 62 Acre Hill Rd Property Address Ellen Bedard Owner Owner's Name information is required for every Barnstable MA 02630 3-26-15 page. CityTrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information-Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Certified Mail#7065 1160 0000 0191 0171 � zr+ rota Town of Barnstable o� Regulatory,Services ao IWO&ir> aCOPY Thomas F. Geiler, Director �R 3sb79 . Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February 12, 2008 Ellen J. Bedard 62 Acre Hill Barnstable, MA 02630 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at 62 Acre Hill Road Barnstable,.MA,was inspected on February 8, 2008 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint. The following violations of the State Sanitary Code were observed: 105 CMR 410.450—Means of Egress. Observed room being used as bedroom within basement without proper second means of egress as required by 780 CMR 3603.10.4.1 of the Mass State Building Code. Furthermore, during this inspection there were three (3) other bedrooms observed within this home. This home is only permitted for three (3) bedrooms (permit#97-621). Therefore a bedroom in basement would bring bedroom count to four(4). You are directed to correct the violations listed above within twenty four (24) hours of your receipt of this notice by removing all beds from basement and ceasing and desisting from using any part of basement as sleeping quarters. Due to the fact this room in the basement does not have the proper egress it is not considered a bedroom by Health Division. Although it may not be used as a bedroom due to -septic restrictions. If you choose to.install an egress window in said bedroom you must pull building permits and may have to upgrade septic if eligible. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days.after'the date the order is served. QA0rder letters\Housing violations\Rental ordinance\56 Seabrook Road lower level.doc Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH o J as 4cKean, R.S., CH_ O Director of Public Health Town of Barnstable Cc: Timothy O'Connell, Health Inspector ti 4 .t QAOrder letterMousing violations\Rental ordinance\56 Seabrook Road lower level.doc t it zen Web Request �U �f_jage 1 of 3 + W-�, z * Oil -f XA a f _0 E . t x i e t Y 6 � .�*.- �, � x .F RO3:if l to us ..r's Search Re,-L;ests Cre to Rr vu:'.sF.s Fq7 2-Request Information Request ID: 21554 Created: 1/24/2008 3:24:45 PM Status: Assigned To Staff Assigned To: O'Connell, Timothy.- Health Office Anonymous: Yes Request Category: Chapter 170`: Housing Overcrowding.. edit Estimated 1/29/2008 Change Estimated Dec January�20W Feb Completion Completion Date: Date: Sun Mon'Tue Wed:Thu Fri Sat 30 31 1. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18119 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 .__.........._....._....._.__._..._ __..........._........-.....__...._...___.-....._._.___.___._.._..._.____..._....._...___...__.._........_._...--.--.._..._..._........---..-----......_............_........... Created By: Shea, Sally Priority: Medium edit Building Dept Citation Numbers: edit equestor Information Requestor _ Request DETAILS: LOCATION: 62 ACRE HILL ROAD Barnstable, Ma 02630 Request Parcel Number T 4 BEDROOMS REPORTED ON A 3 Map: 1297�"""�`"�`Block: 057 Lot: j000 BEDROOM SEPTIC Parcel_._Lookup Email: ,m . , http://issgl2/lntemalWRS/V,Request.aspx?ID=21554 1/24/2008 Citizen Web Request Page 2 of 3 _._.._..---_.__--..-.-.-.--- _.__..._...__......_...._..----..--.--._.....�__ Edit Requestor Information Track Request Progress Request Work History: Internal Note History: System entry on 1/24/2008 3:29:36 PM: Assigned to O'Connell, Timothy Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) 1 , i ti ' umu. ..... .......... ....._... __. ._ rv. i Spell gChe'ck6y� Spell C�lieck� i Add document or image link: _ . BrowseA ;` You can also type in a folder name to see everything in the folder Current Links: Time worked on request 'j0 Response time: 0,- T? e entries are in hours, Examples of time entries: 1, 5, 0,5, 0,75, 1, 3,5� 0,25, OAQ Response time: Measured from the creation date to your first actions on the request. Do not include nights, weekends, and holidays in 3responsc time for most departments. Save changes Check to notify town employee below to review this request. r, Save changes and notify citizen* Health Office • Agostinelli Joan Close request and notify citizen* - _. Brief message to reviewer: *notify works if email address ,;a givef Pr . .......... ... . ................................. ....... Update http:/hssgl2/InternalWRS/WRequest.aspx.ID-215 54 1/24/2008 Parcel Detail Page 1 of 3 p r� _ � v 1 � �Rp � nio IP .. €ogged In As: Par i Fein. Parcellnfo Parcel ID 1297-057 Developer°LOT 6 1 Lot; ___. .--------_..,,...w. ... .... .... . ..._. _...._ g a_ . . . _._ .. .._ ... ..,,__. Location(62 ACRE HILL ROAD Pri Frontage 20 � ......... � _.,. ...,.._.... .. _.,..._...�.:_...�_.._�_.x.�.__.�..__.�...,. .____ Sec Sec Road{ Frontage Village i BARNSTABLE Fire District BARNSTABLE Sewer Acct Road Index i 0005 R . Q l I'��" iWM �F r Interactive Map I - Owner Info __.._ _. _ _. _ _... .... . Owner BEDARD, ELLEN J Co-Owner. __... streets 162 ACRE HILL RD Street2 ............ ............. . ............ ..... C€ty'BARNSTABLE State,MA Zip 02630 Country US - Land In0�10V:S Acr Use,Single Fam MDL-01 Zoning RF 1 Nghbd }0106 . __..�.....Topograptreet Road Paved utilities Septic,Gas,Public Water Location.Rear Location Construction Info Building Year 1'1 Roof Ext .. -------- Bunt 11979 Struct Gable/Hip Wall,Wood Shingle Effect£__ _. Roof•..__.... ..�.�___._ �.._..._... _.......�. _.�..._..�._ __.... Area 12292 __ Cover Asph/F Gls(Cm Type None __...... . _ ..... Style Colonial wall.Drywall �� Roomy 4 Bedrooms ,.._. . ., _.._...� Int .._:.... �...w ....�___� Bath Model 1 Residential Floor Carpet _ Rooms 44 Full IHeat ___. _ ._. - Total _...._, __.._._:___. . _. Grade;Average Plus Type Hot Water Rooms ;8 Rooms http://issql/Intranet/propdata/ParcelDetail.aspx?ID=23743 2/8/2008 Parcel Detail Page 2 of 3 ut n Stories 2 StorieS Heat Oil LLJFound- Typical 1 - Fuel _ ation �� s Permit History _....._.... .......... _. ._ ........ . .. _ ......... ............_.........._. .. Issue Date Purpose Perm,it Amount Insp Date Comm 10/1/1994 B37080 $0 1/15/1995 12:00:00 AM BA PO 10/1/1994 B37165 $25,700 1/15/1996 12:00:00 AM BA ADI - Visit History Date ',-A!h o Purpose 9/14/2000 12:00:00 AM Martin Flynn Meas/Listed 6/15/1996 12:00:00 AM M - Sales History Line Sale Date Owner ook[Page Sale P 1 BEDARD, ELLEN J 2891/215 - Assessment History.._.________________________________ _._...... Save# Year BuiUng Value XF Value OB Value Land Value Total Parc( 1 2008 $229,800 $9,400 $500 $219,200 3 2007 $228,800 $9,400 $500 $219,200 4 2006 $225,200 $9,400 $500 $237,600 ; 5 2005 $204,800 $9,400 $500 $218,500 6 2004 $167,300 $9,400 $500 $161,500 7 2003 $148,900 $9,400 $500 $86,200 8 2002 $148,900 $9,400 $500 $86,200 9 2001 $148,900 $9,900 $500 $86,200 10 2000 $109,000 $8,400 $300 . $62,300 11 1999 $109,000 $8,400 $300 $62,300 12 1998 $109,000 $9,200 $300 $62,300 13 1997 $102,900 $0 $0 $50,900 14 1996 $82,600 $0 10 150,900 15 1995 $82,600 $0 $0 $50,900 16 1994 $85,700 $0 $0 $50,900 http://issgl/intranet/propdata/ParcelDetail.aspx?ID=23743 2/8/2008 y Parcel Detail Page 3 of 3 17 1993 $85,700 $0 $0 $51,600 '18 ` 1992 $97,400 $0 $0 $56,600 19 1991 $112,100 $0 $0 $90,600 20 1990 $112,100 $0 $0 $90,600 ; 21 1989 $112,100 $0 $0 $90,600 22 1988 $90,200 $0 $0 $33,100 23 1987 $90,200 $0 $0 $33,100 24 1986 $90,200 $0 $0 $33,100 Photos http://issql/Intranet/propdata/ParcelDetail.aspx?ID=23743 2/8/2008 t Town ofBarnstable �PesP%, . Public Health Division 9 5 �, 200 Main Street H�annlS,MA 0260 7 PITNEY BOWES `v $ 05.210 ' 1 7005 1160 0,000 0191 0171 , oz 1A .- _ � 0004606238 FEB 1 4 2008 MAILED FROM ZIP CODE 02601 st NOTICE- 7- WTIC rdama F?Iu"rURN TO SENDER 7fr'1 tJA►AML.E TO i"©R1dfaFfC, I e Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X ❑Agent M Print your name and address on the reverse ❑Addressee i so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery I ® Attach this card to the back of the mailpiece, or on the front if space permits. I D. Is delivery address different from item 1? Oyes 11 1. Article Addressed to: If YES,enter delivery address below: ❑ No I I 3. Service Type ®Certified Mail ❑Express Mail I ❑Registered M Return Receipt for Merchandise 6 ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes l a 2. Article Number r_ -- I (Transfer from service laben __ 7005 1160 0000 0191 01?.1 � 6 I 102595-02-M-1540I t t i 1't t I PS Form 3811,February 2004 Domestic Return Receipt I Certified Mail#7005 1160 0000 0191 0171 y� e r Town of Barnstable a ;.1 Regulatory Services i yBARN5TAHLi * ,nAs:; Thomas F. Geiler,Director Ar , a, Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February 12, 2008 Ellen J. Bedard 62 Acre Hill - Barnstable, MA 02630 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE'I'I ' MINIMUM STANDARDS-OF FITNESS FOR".HUMAN HABITATION The property owned by you located at 62 Acre Hill Road Barnstable, lV1A, was inspected' on February'8;2008 by'Tirriothy:0'Conrielh Health:Inspectorfor the Town of n .. Barnstable:',,`Phis inspection was'conducted''on the'"basis.of a.complaint The following violations of the State Sanitary Code were observed: 105.CMR 410.456—Means of Egress, Observed room being used as"bedroom within basement without proper second means of egress as required by_780.CMR 3603.10.4.1 of the Mass State Building Code: Furthermore, during this inspection there were three(3) other bedrooms observed within this home. This home is only permitted for three (3) bedrooms (permit#97-621). Therefore a bedroorn,in basement would bring bedroom count to,four(4). You are directed o correct the violations listed above_within twenty,four (24) hours of your receipt`of this notice by removing,all beds from.basement'and ceasing and " desisting from using any part of basement as sleeping quarters. Due to the fact this room in the;basement does:not have the proper.egress,it is.not considered a bedroom by Health Division. Although it may got be used as a bedroom due to septic restrictions: If you'cW669646 inst"all-an egress window in:.said bedroom you mustyylpull building perm><ts an'd may'have to upgrade sept><c if ehg><ble 1_i v'e, R You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) daysafter'the date th6:ordor'is served r Q:\Order letters\Housing violations\Rental ordinance\56 Seabrook Road lower level.doc Non-compliance will result in a fine of $100.00 per,violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH o as kA*cKe�anR.S'., CHO Director of Public Health Town of Barnstable --- r--cc: Timothy O'Connell;Health Inspector _ r _ Q:\Order letters\Housing violations\Rental ordinance\56 Seabrook Road lower level.doc TOWN OF B ABLE LOCATtt?N [55o2 G r c. ,'�� A SEWAGEVKLA # ASSESSORS AMP&LOT INSTALLERS NAM&PHONE NO' SEPTIC TANK CAFACiTX LEACHNG FACKM.: !/ (sue)_ 7` NO:OFBEDROOMs.. BtJi1.DER OI�:OWt1ER, � ' PER)AMATM: HATE:. i Soparatioa Distance Between the: . I iazintt#cq Adjostel Groundwater 61e. ble tothe 136tipiri of I;eacttitag Facility Feet Private WaW SuPPiY wing" loft (U*wells exist an'8"Iff V;oftihii 20D..*d of`Jsachssg f�ity) Feat . Edge of Wedandl and 3.eacWtrg; tY. any.�veflands exist raw, 0 feet of leaching' ` j � ..Feet; F.iiisbed by GlA ------------------ o � 55 s D- 96y Q-,D- P3 l i D 13 1 q�'✓�' m TOWN OF BARNSTABLE LOCATION °� f �012.E ��r /2(� SEWAGE # VILLAGE- �/av2 a-s•'�'3 '� ASSESSOR'S MAP & LOT . INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING;FACILITY: (type) Al F,X A,A i 04—r (size) Z x r'y X Z i NO.OF BEDROOMS BUILDER OR OWNER (`� 8 �A PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted.Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Gq?9� tI t i 6 fib'' t0 -CAT10 p S E E` PERMIT N0. V L'LAGE a ! INSTALLER'S NAME i ADDRESS p41 R I L D E R eAl/x T-,4A C F OR OWNER I FL,E/�-- a r DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 7-� s- - 79 :F , BARNSTA LE FIRE DEPARTMENT 's -- �� 3249 lain Street - P.O. Box 94 E g 27 ® Barnstable, Massachusetts 02636 '`4•' 4 �'` 508-362-3312 ' 0W.MIA FAX: 56$-362-5444 WILLIAM A.JOKES III,CHIEF GLENN 6.COFFIN, CAPTAIN UNDERGROUND STORAGE TANK REPORT FIRE PREVENTION Property Address: 62 Acre Hill Road, Ba,—►z-A-HL91e— Property Owner: Ellen Bedard Removal Date: September 15, 1997, 11551irs COMMENT: Witnessed the removal of a 500 gallon U.G.S. Tank from this location. The tank appeared to be OK, with no signs of leaking. The excavation site also had no odors of fuel or discoloration. The contractor was advised to remove the tank from this location and backfill the hole. William A. 6 es, III Fire Chief Make application to local Fire Department. Fire Department retains original application and issues duplicate as Permit. 7. jha�`�iinO01��ri�qe�exv� ��6e �74eVel2z4�a2 y APPUCATICOIN and PEnWIT F for storage tank removal and transportation to approved tank disposal yard in accordance with the provisto of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: ns "Ownerme (please print) Q 2� l Gnu. X Address ArE gnatore i apllying o�pe mit Sheet City e Stata Z", Company Name Print Co. or Individual Address r0 60 304. S r9G�✓�7Q7 Print Pant Address Signature(if . I ng for p rmit) Pint C/ � Signature(if applying for permit) XIFCI Certified Other ❑ IFCI Certified ❑ LSP —--_ Other . 7Dimensions a CSC t I L S,ee(hddress ----�__ city ����. Substance Last Stored. eter x length) ?( ---- Remarks: Firm transporting waste 12Cp— �' 5'�—�r Sta,e Hazardous waste manifest# E.P.A.n ApprdVed tank disposal yard _ 2 C _.S✓��c Tank yard. Gb Type of inert gas /�/ U G w Tank yard address CC�-^✓n L��r�J(_ City or Town i l l f FDIDn / l Permit; Date of issue Date of expiration • / Dig safe approval number: / l 4 v 19 a e oil Free Tel. Number 800-322-4844 Signature/Title of Officer granting permit f�, After removal(s)send Form FP-290R'signed by Local Fire ept.to U T egulatory Compliance Unit,One Ashburton Place Room 1310, Boston, MA 02108-1618. "-292(revised 9/96) TOWN OF BARNSTABLE - UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION V ©� MAP NO. �! / PARCEL NO. ®r7 TAG NO. /3J0 ADDRESS OF TANK: � c 11[le, Ll 2z w(,1 VILLAGE: Numbwr 6tr4040! MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : OWNER NAME: C� IV� rr PHONE: �LPc — J � e INSTALLATION DATE: BY: INSTALLER ADDRESS: *TANK LOCATION• ABOVE BELOW (D C O C"I a G T A N k L O C A T I O N W I T H "a O P Q C T T O n U I L D I N O) CAPACITY '7� TYPE OF TANK AGE YRS. FUEL/CHEMICAL TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE CONSERVATION [ ] CHECK IF N/A DATE BOARD OF HEALTH TAG NO. DATE PLEASE PROVIDE A SKETCH SHOWING THE. TANK LOCATION ON THE BACK OF THIS CARD TOWN Al BARNSTABLE - UN.DERGKUUND FUEL AND CHEMICAL STORAGE REGISTRATION v n TAG NO. �3/d � MAP NO. 'Z�� -. PARCEL NO. O�7 /ADDRESS OF TANK: C CC o WZ VILLAGE: s MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : OWNER NAME: K110, /fo (D'a A� PHONE: INSTALLATION DATE: /A67*_,;7_. BY: J/D G✓ /W7 " lo9 _t-1 C7 / * INSTALLER. ADDRESS: -CERT .NO. *TANK LOCATION ABOVE BELOW 4 (DCSEPit I-aC--TAN-IC V,Co AT ION W I ZN"piwwPQCT TO 'mLj I LD I NO) CAPACITY :> TYPE OF TANK:' > AGEY 'S. FUEL/CHEMICAL TESTING CERTIFICATION [ I PA C ] FAIL DATE LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION_ [ ] YES [ ] NO . DATE FO HE REMOVED FIRE DEPT. PERMIT ISSUED C ] YES ( ] NO DATE CONSERVATION [ ] CHECK IF N/A DATE BOARD OF HEALTH TAG NO. DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD ,+'fir--a...l�r.�' :�"�''.'"''" a:."`y" '�f:"�f''.v,..Tt.w•w�5�1'��'`'`"�'�1,;�"i "�!�wr"'"*'-''°#�+i�++�'�'` _ , , TOWN ,OF BARNSTABLE — UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION V 1 t tti i MAP NO. .; ,, � PARCEL NO. {''�" �` TAG NO. 310 ADDRESS OF TANK: ! "i �'' i / ,fir Cl�' VILLAGE: f/ •-�=s / ! t Numbwr Ylr map! MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : OWNER NAME: t ��I f�%�Y f ' ,` � PHONE: INSTALLATION DATES `"`� ;/ `�,!� BY: - ' g %�� % INSTALLER ADDRESS: {-"�' .� � ' t ,!i "-F CERT .iVO. *TANK LOCATION: ABOVE BELOW `,Alr x O CAPACITY Y TYPE OF TAN AGE ` `VRS. FUEL/CHEMICAL j r TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND ZbNE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE CONSERVATION [ ] CHECK IF N/A DATE BOARD OF HEALTH TAG NO. [ 1 ] DATE *. PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD -1 �F,\j .1q^:.q+{...-,Y--.wr...-' -. ..^".fi y++r...r...,.a,-y -�.. _ - ... ��'•Nm'9.e"!: r.�- _ r„ - -. TOWN OF BARNSTABLE — UNDERGRUUND FUEL AND CHEM I CAL STORAGE. REG I STRAT I-ON /^,, MAP NO. PARCEL NO TAG NO _ �� . ADDRESS OF TANK: d`- K'.�/C /'-i / l� /[ (L� VILLAGE: MAILING ADDRESS ( IF; DIFFERENT FROM ABOVE) : OWNER NAME t - PHONE:„ .� .5, �.' r BYs j71 INSTALLATION. DATE: INSTALLER .ADDRESS: �n 0 /r� �= 'CERT.NO... *TANK LOCATION ABOVE; BELOW`- tat 'T'ANFC 'LOQAT:ON W 2 T1-1� / CAPACITY TYPE OF TANK AGEYRS FUEL/CHEMICAL ` TESTING _C£RT.I F.I CAT I ON C -] PASS C -7 FAIL`: DATE- TESTING LEAK DETECTION [ ] CHECK IF ,N/A TYPE/BRAND =4 ":ZONE OF .CONTRIBUTION [ ] YES C ]G NO DATE TO `BE REMOVED, ;..FIRE DEPT. PERM.L:T ISSUED [ ] . KES [ ] NO DATE 777,7777 — d CONSERVATLON- CHECK IF N/A DATE r BOAR& OF HEALTH'. TAG N.O. [ 13 �� , ] DATE, # PLEASE PROVIDE A SKETCH.. SHOWING THE TANK 'L°OCATION : ON THE. BACK _OF :THIS CARD , s l eel)r� o t # a,v3 3 L Olt) 7--L Z `' 1 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: VYe PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Z(pplicatton "Repair � ozal *paem �tCon.5truction Verna Application for a Permit to Construct( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 6 /ARE 4/ 2 Owner's Name,Address and Tel.No. 13,OA,v57.4 Assessor's Map/Parcel brAl .//4A AS'7C� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. A2e.0 1 7 7 s 136 ',), Type of Building: Dwelling No.of Bedrooms —3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 0. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu d by thi Board Health. Signed Date -� Application Approved by Date Application Disapproved for the following reasons Permit No. 7 —0 zy Date Issued /©"Z -No. / G9 t� Y« ,�_ Fee ,f/ _ 'y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1 ' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSET;TS Zlppiication for Zli-g-pozat *pztem Conotruction Permit Application for a Permit to Construct(,1)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 4(i 4140 Owner's Name,Address and Tel.No. .V5 7,9 f Assessor's Map/Parcel A0, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. s Type of Building: Dwelling No.of Bedrooms - Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date ., M Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil t f _ Nature of Repairs or Alterations(Answer when applicable) �" r.. s , �� f/ /s9,✓s+ t L.7 Lao Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board Health.r�. 27 " Signed �:% '�. '' Date A CJ 7 Application Approved by Date 7 Application Disapproved for the following reasons Permit No. 9 7 —G Z Date Issued 7 - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by A R e H ._ at as been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this pe. ' shall not ee co strued as a guarantee that the sy •te~w4llll function as design d.G Date �� Qt�f Inspector �� 1', t � — —----------------------------e No. F e THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Miopozal bp5tem Construction Permit Permission is hereby granted to Construct(,-'R air )U gra�/e( )Abandon System located at vi v / E � / Cam` /}�.�r2./ -s 7,4 y F and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this t. D Date: /0 - Z P`9-7 Approved by (57 A• rL1 NOTICE: This Form is to be used for the Repair of Failed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated la 2 5 17 concerning the A,) property located at gl'a 4c-Re /-�iXi 1?410 meets all of the r following criteria: •�Thre no wetlands within 300 feet of the proposed septic system • There a no private wells within 150 feet of the proposed septic system • e observed groundwater table is 14 feet or greater below the bottom of the leaching facility ;ZThere ha is no increase in flow and/or change in use proposed re n variances r uested or needed. a o requested /011 SIG `r DATE: LICE SE PTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER' [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. I 1xis ' 1 j i �irR�t��S i No Fxz • THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 'I 7T0.CJ_A).................OF........ ................................. Appliration for llhipoiial Works Tomitrurtion firrutit Application is hereby made for a Permit to Construct (�or Repair an Individual Sewage Disposal System at: ..16 RXAZ'JUA.,?(�. .....................C-49.z!.....6.............................................. Location"s or Lot N.. /........... Owner Address \j E_-T 0 Z ,.............................. ......................... ............. .... ......................................................... Installer Address Type of Building Size Lot.5 -------Sq. feet U Dwelling—No. of Bedrooms__________.7..........................Expansion Attic Q1,10 Garbage Grinder (Aip) '4 114 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria PL4 Other fixtures .................................... < ems---------------------------------------------------------------------- ---------------------------- Design Flow.........1-1.40....................:..gallons per, per day. Total daily flow.............7.3.4P...............gallons. 1:4 Septic Tank—Liquid capacity/Oi?agallons Length.4!J��. Width.V�'4_"'Diameter................ Depth.!K.`&'.".' Disposal Trench—No..................... Width..................... Total Length..__.........._..... Total leaching area....................sq. f t. Seepage Pit No...... o........... iameter.....ic-9.. ..... Depth below inlet......6.......... Total leaching area..Q.,0.2 sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by... ....6-jAet'pff &Jr,Date...,AY/2_1.0...... Y `4 Test Pit No. I....4_z=..minutes per inch Depth of Test Pit__/._?:z�...... Depth to ground water...Aadev.&...... Test Pit No. _..minutes per inch Depth of Test Pit..f .......... Depth to ground water..",aou.e..... ............................................................................................................................................................ 0 Description of Soil............C2..=-.Id........... 9 M. ........4.W..,b......... .............................................. ------Sxy ................y /y ....................................................................................................................................................................................................... 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. Sig ........................................ ............................... Date Application Approved By.....-- ----------------------------------- .......Y..Ije....7.9 r......... Date Application Disapproved for the following reasons:............................................................................................................... ........................................................................................................................................................................................................ Date ............................................... Issued------7 c�(5-------*.... ............... Permit No.......... Date No................_....... FEB. ........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 70cj..N.................oF........ j. r�r. ._ -r l ':----__-----------_-_--------._---- Appliratiun for Disposal Works Toustrurtion rvornfit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at . ---••-----••--......4--p .....6............................................. Location-Address or Lot No. a ti !� ... = . 4�►. JZ.......................................................... Owner Address a UCTc�tz i n�a oS�............................:....:......... ...: (��. ST-+� E .................--•--•-••-----......--•- _------•--__--•- -- Installer Address d Type of Building Size Lot.5s>__f 54._._..Sq. feet aDwelling—No. of Bedrooms.......... ___________________________Expansion Attic (&,o Garbage Grinder (164 p., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) aOther fixtures ....................................d - 1�0� ----------- ---------_- ..._....... Design Flow______ .r�.40......................gallons per,pw�sRi per day Total daily flow............. y gal W _...._...._. Ions WSeptic Tank—Liquid*capacity_}!tpRogallons Length._ :_."�_ Width__. Diameter................ Depth___ri rr x Disposal Trench—No...................... Width.................... Total Length.................... Total leaching area............__.._...sq. ft. Seepage Pit No....___,�---------- Diameter._.__:_.Y.... Depth below inlet.......6.......... Total leaching area....sq. ft. Z Other Distribution box () Dosing tank ( ) Percolation Test Results Performed by.__,j"�4.AV.4__7)__ t a_...c j Y?2 __ Date....AL Pl Z L..... a Test Pit No. L.__4_�_minutes per inch Depth of Test Pit____1_l-__:_...... Depth to ground water....Att2!at_ ",... rX4 Test Pit No. 2.... -._._minutes per inch Depth of Test Pit..>.:;..._....... Depth to ground water..Aj.6A).4-!..... a .................................................. ..................................................................................................... D Description of Soil . ,2.. ,, Q__ �104—d !......... dlf. .........S! 27.VZ -------------- �!.�y"/� //a/.���y/ j�YM -----------------------•- ..__.._�.V-fI'..r�_._. _'f_... .�.,'a r•i }"� ..... I'�•i'-l.Y. _____________ .....fR'.___C___d_ -` .....�(._.� y-..._.... � ________ W Ww�����' UNature 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 LITIZ 5 of the State Sanitary Code— T-h'e undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued�by the board of health. Signed...................................................................................... ................................ Date Application Approved By......_.:f ilLx_ �� 'T Date Application Disapproved for the following reasons-------------------------------------•---------------------------------------------••------•---•-------••--_.._.. r r Date PermitNo....................................................=-.. Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............a.0..... ........0F.... N .►..!A!'t....................................... Tnrtifiratr of Tomplionrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (� or Repaired ( ) by......VJE!ca2_U ......�' �T.1 ...............................1.. .......................................................................................... Installer at.-------1,r�T ........ 2 .._. ..!-4...... + Q+�is2----.._.._ � �� has been installed in accordance with the provisions of F 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit N 7�... _______ ...... dated....... "7 . 9............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST UED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............. r� '�. Inspector....... . ---------------------•-.------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No......................... -..1. .0...............OF......��1�.�.1�'t�.l�---.....-----..................... FEE. :2�........... Disposal Morks C'Unnotrurtion Vprrmit Permission is,hereby granted.... ET C�t?lA!........_�b t .T_l F_R�-------------------------------------•--....------................._ to Construct ( or Repair ( ) an Individual Sewage Disposal System at No..... •, K.....t.'......... C.f.ZL...-•.i41......- c_'AD-.......bAZk5T-1 ZLJr-.................................................................. Street as shown on the application for Disposal Works Construction Pep* No __. _:._._... Dated._'__he"lj�_"_'�. .... . �` '� ----------------------------------� ard of Heal �� DATE=.................-•-------•-•---•--............................................. ' FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ,y },. �...:si•.:. ,.,.,,,...';:.r'r � ,,•.� � . 1 . _. - _ ,rL':g•' w'� , Rr w`C.r` -t'�„,v..j�•'r�.E..r'-,Y. .. . ...��.., TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION ADDRESS: (IC C E� 14 11 1C d MAP NO. r PARCEL NO. OWNER, NAME: VILLAGE: &•,;ln4s-r1 ,C/ r I NSTALLAT I ON DATE: ' ) BY: ADDRESS: CERT. NO. �_ TANK "INFORMATION"� < j '4 LOCATION OF- TANK: 4-1soo ' a CAPACITY 4DO YP r&' E �/ AGE :^-FUEL/CHEMICA'Lf r i. 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