HomeMy WebLinkAbout3655 MAIN ST./RTE 6A(BARN.) - Health 3 5 Main Street RTE 6A
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Barnstable
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AsBuilt Page 1 of 1
TOWN OF BARNSTABLE
ff 37
LOCATION .s h m 4 l hset ac*A& SEWAGE#
VILLAGE ASSESSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO, [sl i is &b✓�r'C�nS'�
i SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size) 2_0
l NO.OF BEDROOMS S"
OWNER C'141ZL ®L'��SO�
PERMIT DATE: COMPLIANCE.DATE:
j Separation Distance Between the:
1 Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200-feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If:any wetlands exist
within 300 feet of leaching facility) °' Feet
FURNISHED BY
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tttp://issgl2/intranet/propdata/prebuilt.aspx?mappar=317040&seq=1 8/31/2012
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TOWN OF BARNSTABLE 372
LOCATION 3-b-S.5' m Gr{h 9a01-610- SEWAGE# _
VILLAGE ASSESSOR'S MAP&PARCEL -O O
INSTALLERS NAME&PHONE NO. IS11'l8
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size) L ty'
NO.OF BEDROOMS
OWNER CA0_/_ 70 44A.1so�.
PERMIT DATE: ! 02— CO COMPLIANCE DATE:
Separation Distance Between the: .
Maximum Adjusted Groupdwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) `''' Feet
FURNISHED BY
Llf �I
lqpr- .
2 �,-�
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-3"I
G,'1 t
I Fee
THE`COMMONWEALTH Of MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS
Application for �Digool *p5tem Conztruction Virmit
Application for a Permit to Construct( )Repair% v Upgrade( )Abandon( ) I�Complete Syster ❑Individual Components
Location Address or Lot No. 3&SS `21l--619 Owner's Name,Address and Tel.No.
Assessor's Map/Pazce/3.;/4 V-0-,/
30 36j'g Awry Sd- kj` .,4 13a,9 5�
Installer's Name,Address,and Tel.No. v 69 Designer's Name,Address and Tel.No. 3 C; 4;(4
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 I f Sw gallons per day. Cal ulated daily flow s� gallons.
Plan Date P/ SAA Number of sheets Itevision Date
Title
Size of Septic Tank LOe, Type of S.A.S.S S ,i�-Yam, L-e
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) £'0
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 of to place the system in operation until a Certifi-
cate of Compliance has been iss e by this Board
Signed =` Date �n2
Application Approved byu4kilt�tQej Date
Application Disapproved for th following reasons
Permit No. 200 Date Issued C1 —f,Z—a�,.-
` THE COMMONWEALTH OF MASSACHUSETTS Entered rn computer: ✓r
-� _PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTIS ` Yes
Application for Mizpozar *pgtem Com5truction. P.Rermit l
Application for a Permit to Construct( )Repair(k)Upgrade( )Abandon( ) . Complete Sys �O Individual Components
Location Address or Lot No. 4&s� o i- �9t� Owner's Name,Address Nand Tel.No. 3 a — 7
i Assessor's Map/ParcE f S/ �./ ` �5 r 1
vh m 3/ yrrt i 3(" 149,%, Q /3711 51/�G3%t
Installer's Name,Address,and Tel.No. J-- 3 a- Designer's Name,Address and Tel.No.
C1c,,.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building f — 'No.of Persons Showers( ) Cafeteria( )
r .
Other Fixtures
Design Flow 1 l 0 X f-= S Sc ~� gallons'per day. Calculated daily flow t�^ s� gallons.
t Plan Date cF-/Is/,, Number of sheets t� Revision Date I/ " �?
Title
Size of Septic Tank OG Type of S•A.S.S ' S Cc-�� / L0,4
Description of Soil 'A" i
t
Nature of Repairs or Alterations(Answer when applicable)
Date last,inspected: w �,
— Agreement:
r- The undersigned agrees to ensure the construction andmaintenance 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 iss ed by this Board kf e,th.
Signed Date
Application Approved by w✓. Date �` -06
Application Disapproved for the following reasons
Permit No. . 00 Date Issued C� f•� -
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
g,, Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (X)Upgraded ( )
Abandoned( )by t_z l 1-f fa<b)>Y r f 6 :z Sd-'
at 3ti S l n A t- has been constructed in accordance
with the provisions of Title 5 and the for i�isposal System Construction Permit No. D Ob - 3 5 7 dated 9 0--0 G
Installer 1, j /3/'oJ�va f C-n Q. Designer
The issuance of this permit s-al not a construed as a guarantee that'the ystem wi f neUi as esigned.
Date " � .M" x Inspector
No o4 ' 3°I:7 Fee ky -
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
i5o5aY*pgtem Construction Permit `
Permission is hereby gra led to Construct( )Repair( )Upgrade( )Abandon
System located at SS h-►h i n Sd qt G/2
and as described'in the above Application for Disposal`System Construction Permit.The applicant recggnizes his/her duty to
comply with Title�5 and the folio wirig local provisions or special conditions.
r Provided: Co struction must be completed within three years of the date of this
Date:_ I o2/�6 ApoXov'ed by • t � IJV 1?5
*' ,LL ' w
FROM :down cape engineering inc FAX NO. :15OB3629880 Nov. 09 2006 09:52AM P1
Town of Barnstable
Regulatory Services i h
• : Thomas F.Geiler,Director
>: '""s; ' Public Health Division
Thomas McKean,Director
200 Main$treet,Hyannis,MA 02601
Office: 508.862-4644 Fay:: 508-790-6304
Installer&ftiianer Certification Form
Date'. 111� Sewage Permit* 2-0 0 "`3 52 Assessor's Mapwarcel 3 2 40
Designer: ( 0 vJ✓1 L q,,r Installer
Address: Iv . Address:
pz* 7s Ud4
On O ll i�.f 0 ro r l l vS �3 Co4"'�was issued a permit to install a
(daft) ( ler)
septic system at IPo 'rL �� based on a design drawn by
(address)
k- dated
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS q�any vertical relocation of any component
of the septic system) but in accordance with State &Local Regulations. Plan revision or
certified as-built by designer to follow.
� tN OF ,��
^ ARNE H V
am`
` 4 OJAIA j
(Installer's Signature) C CIVIL .A
No 30792
w�
�0 -FG�STE�`�v�'i •'
1SS�ONAL
Designer _ Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH RMJS QN CERTIFICATE_Ot
C MPLIANCE WILL NOT -ISSUED UNTIL TH THIS FORM AND AS-BUILT A
RECEIVED BY THE BAR ST LE PUB C HEAT plVISIO& THANK XQU.
Q:H AWVSepdar)esigner Cenifieation Form 3-26-04.dk-
Bldg 1 - enter Village
Apprx. location of blockage on both occasions.
1st-Back up in 6 was slight,toilet did not overflow.
Back up in 8 was greater but wax seal on toilet was shot.
2nd-Back up in 8-6 in Florida with no back up.
NO OTHER UNITS EXPERIENCED ANY BACK UP.
DISCHARGE PIPE O O
6 8 10 12 14 16 Tank Pit
Murphy Smolkowicz Mullin Shechtman Bell Scanlon
Grade
17" Inlet
WATER LEVEL Highest-18"Feb
Date Fr Grade Fr Inlet
Dec 16, 04 41" 241' Water Level
Jan 05 No test-10-12'snow over pit
Feb 15, 05 35" 18"
Mar 16, 05 36" 1911
PIT
NOT TO SCALE
i
j
1a
s Page 1 of 1
Subj: Fwd: Building#1 Pit Levels
Date: 3/24/05 11:39:24 AM Eastern Standard Time
From: Bobl-3418
To: Huntingest
-----------------
Forwarded Message:-
------------------.
Subj: Building#1 Pit Levels
Date: 3/24/05 10:48:46 AM Eastern Standard Time
From: Bobl-3418
To: Huntingest
The Chairman of our Sewer/Septic Committee is in Florida and will not be back until March 30. He has kept the
official log of the pit levels. During his absence I have been taking the monthly readings. The level is measured
from the ground level to the top of the water in the pit.
The inlet pipe to the pit is 17 inches below ground level. Here are the readings for the last three months:
Date Water level Distance between inlet and water level
12/16/05 41" 24"
2/15 35" 18"
3/16 36" 19"
There is no reading for January because the plowed snow was at least 10=12 feet over the pit. It was impossible
to take a reading.
Robert Lassell
Committee Member
a
4 -
Thursday, March 24, 2005 America Online: Huntingest
ti ..
1
A&K Pumping and Inspections
Invoice
Division of Kerrigan&Axon, Inc
565 Carriage Shop Road Date Invoice#
East Falmouth,MA 02536 3/24/2005 731
508-540-6706
Bill To Job Location
Huntingest Management Center Village
40 Industry Drive Bldg 1
Marstons Mills,MA 02648
Terms Due Date Service Date
Net 15 4/8/2005 3/16/2005
Description Rate . Amount
Used video camera to determine there was a clog in the pipe and used water snake 728.00 128.00
from roof stack to clear the clog
It's been a pleasure working with you!
Total $728.00
r
Town of Barnstable
NAM
Board of Health
P.O. Box 534, Hyannis MA 02601
Office: 508-862-4644 Susan G.Rask,RS.
FAX: 508-790-6304 Sumner Kaufman,MSPH
Wayne Miller,M.D.
May 6, 2005
Mr. John MacEachern
71 Captain Cook Lane
Hyannis, MA 02601
,� "SY � a�
� E �Ce ter T/lla e r.Condoitdml=ailedrSepttc Syse1 � °
K.._.. �. g�Q ,..,..� r .�.� .r , �,
Dear Mr. Curtis,
You are granted temporary approval, on behalf of Center Village Condominium
Trust, to continue to utilize the existing "failed" septic system which is connected
to Units 6, 8 , 10, 12, 14, and 16 at Building #1, 6 Captain Cook Lane, Hyannis.
This temporary approval is granted with the following conditions:
(1) The failed leaching facility component shall be inspected monthly.
(2) The system shall be pumped immediately by a licensed septage hauler as
soon as there is any back-up of sewage into the building or as soon as there.
is any overflow of sewage onto the ground. ,
(3) Once such a back-up or overflow event occurs, the+condominium
association shall report the incident to the Health Agent, Thomas McKean, in
writing within seven days of the event.
(4) The condominium association is responsible for keeping the system
pumped, daily if necessary, to ensure there is no additional back-up or
overflow of sewage onto the ground.
(5) This approval may be revoked anytime,.unsanitary conditions are observed
in regards to the failed leaching component.
• fi
(6) In one year, on or before May 1, 2006, the condominium association-will
have the following options: (a) install a shared innovative/alternative pressure
dosed nitrogen reduction system for the entire condominium complex, or (b)
Q:WP/CenterVillageExtension2
apply for a variance or for an extension for an additional year before the
Board of Health, or (c) connect the condominium complex to town sewer if
public sewer becomes available at that time. This approval expires on May 1,
2006.
This temporary approval is granted because the Department of Public Works has
informed us that public sewer lines are planned to be installed along Old
Strawberry Hill Road in front of this condominium complex, sometime in the near
future. Funds have already been expended for designing engineering plans for
this purpose. The applicant testified that the "failed' system has not caused any
back-ups into the building or any overflows of sewage onto the ground in the
past; it has not been a public health hazard or nuisance to date. It is the opinion
of this Board that it would not be cost effective and would not be reasonable to
require the applicant to install a new septic system at this time in view of the fact
that public sewer lines are planned to be installed at this location in the near
future.
Since e y yours
Wqyne iller, M.D.
BOAROr OF HEALTH
TOWN OF BARNSTABLE
Cc: Robert Burgmann
James Daley
Peter Doyle
E.
Q:WP/CenterVillageExtension2
��
'
r
1 TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
� �� - ice
Date � Time: In Out
Owner cook. Tenant
Address 36 ,55 ram, Address
Complian a Remarks or
Regulation# Yes VNO Recommendations
2. Kitchen Facilities
3. Bathroom Facilities f '�
4. Water Supplyv
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural t
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal 5 jam(
17. Temporary Housing
18. Driveway Width
19. Number of Tenants Observed
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Number of Bedrooms Number of Vehicles Allowed (max)
Number of Persons Allowed (max) �1
Person(s) Interviewed Inspector
If Public Building such as Store or Hotel/Motel specify here
4
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date to) ���' r y Time: In Out
Owner 6%7s Tenant
Address 36 SS ' cJ Address 3 0 ,--- \
Complia Remarks or
Regulation # Yes ZNO Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service ry
11. Space and Use
12. Exits ---
13. Installation and Maintenance of Structural Cat
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
18. Driveway Width
19. Number of Tenants Observed C2
PART II
37. Placarding of Condemned Dwelling; 02 SU . f,z
Removal of Occupants; Demolition
Number of Bedrooms I Number of Vehicles Allowed (max)
Number of Persons Allowed (max)
Person(s) Interviewed Inspector
If Public Building such as Store or Hotel/Motel specify here
�
UIS�O�C—f"1 d V P"
cp5s V✓lal S4
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5
FORM 30 C&w HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
"5AI2 t1 S T'A SL6
t CITY/TOWN
kA
DEPARTMENT
1A-g k-4& 0z_&01
ADDRESS
SS•U (O 2— 14 el
TELEPHONE—
Address Uo�5� t�AOJ S'�• f AAN$U5 occupant ?A" G—LA, IG c " SjLt_
Floor Apartment No.6e'r't4c-L No.of Occupants
No.of Habitable Rooms 3 No.Sleeping Rooms 1_
No. dwelling or rooming units / No.Stories
Na e and address of owners At2L. —S v)A r.t Soil 14 SCPS,S MA-i N
'-AN Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers.-
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
/ Gutters, Drains:
V Walls:
Foundation:
Chimney: \ vl
BASEMENT Gen.Sanitation:
Dampness: V
SG/a b Stairs:
Lighting:
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central Y ❑ N Equip. Re air,��
TYPE: " Stacks, Flues,Vents:
PLUMBING: Supply Line:
ElMS ElST ' Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen.Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pantry
Den
Living Room
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4
Hot r Facil. Sup.Ten., ct.:
Stacks, Flues,Vents, es:
Kitchen Facilities Sink /
Stove
Bathe oilet Facil. Vent., Plumb.,Sanit'n.:
Waslq ower 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 O PERJURY."
INSPECTOR TITLE AAALZY T,4'S.4,QLTO�
DATE 116 O TIME 2- P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION 4 P.M.
410.750: Conditions Deemed to Endanger or Impair'Health or Safety
The following conditions,when found-to exist in residential premises,shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
s, I
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable. '1 `
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
��
FORM 30 CH W HOBBsE WARRENTM THE COMMONWEALTH OF MASSACHUSETTS
BOAR OF HE TH
%AI TOWit �}
W
ARTMENT
TELEPHONE
Address�� la�� Occupan
Floor Apartme t No. No.of Occu ants
No.of Habitable Rooms No.Sleeping Rooms
No.dwelling or rooming units N S��Qries I LA
Name and address of owner_ 1�J5OY7 Wd;k, c,-+ 'Iros
Remarks Reg. Vio.
YARD Out Bld s.: Fences: Aly
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:
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N E ui . Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen.Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pantry
Den
Living Room
Bedroom 1
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 INS EC 10 REPO T IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTI O R '
INSPECTOR TITLE YA X NJ
//ll
DATE TIME � 1.� P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
I
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises,shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the,legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by.105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
�- PA I-Op, e) =�
Fim
/ THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
!
Appliratioat for Disposal Works Tonstrurtioat Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal
System at:
N , y:;L(AdSss nH.► or`t N=:
....---•--••••.`+"' - t.-••--......................•-•--••-•----••...._._.... ...................................................$ .._.. -•--
r-- )wner,- - Address
W J . Lput,� flet 1nL, �'�+�{wicl, �!`! -.....''"mt''- ,
................................................................................•••-• -------------_. ... ••.............----•--•;._.......;....=
Installer Address O
Type of Building Size Lot__5i________________Sq. feet.
Dwelling—No. of Bedrooms............................................Expansion Attic -F—f' Garbage Grinder-E—}
P4 Other—Type of Building reS! 01A... No. of persons._.__y' ---------- Showers ( t ) — Cafeteria^ —r-
Otherfixtures ......................... s-- - ....`3, -y------....__3_.....':......-------------------------------------•---.._......__..
W Design Flow.................... ....C�..._.._________..gallons per person per day. Total day flow___ gallons.
WSeptic Tank—Liquid capacity=loP`'_gallons 11ength____5_______._ Width----I........... Diameter________________ De th_____ ____.Q___
x Disposal Trench—No_____________________ Width....�.a.......... Total Length____ ............ Total leaching area_1. A __s `
Seepage Pit No-------t............. 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_______________________.
Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
--------•---------------------------------------------------------------•-------•---••••••-•-_-••---.........................................................
0 Description of Soil-•-------•..................:.....................................•----------•------------------------•--------------------------------------------------------------...
x f
x -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•••-•-=
U Nature of Repairs or Alterations—Answer when applicable._.. ___1. ��4��._ -" _0�1.., L:__�i ::_.gam;____..
_______________•-----=---4�-------�'-- � CX 1'1 ......_._...
-------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'lI'PL!Lj 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. q
Signed--- .tAA . .-......... ----------- ••-•-- -----------------
� a �
Q Date
Application Approved By-- -- ------------------------------- % ��
Date
Application Disapproved for the following reasons______________________________________________________________---•-----------------•----- ------_.___._
....................•-•-•------------.._......_.....------------•------••-------------......_...........-•-----------------------•-----•--•--------------•-----•--•-----•-----••-----------------•._._..
�i
Date
PermitNo............b.-`J_--6067 Y------------------- IssuecL.......................................................
Date
y s'
•ta
�.- p_-`-'.! FRB..........................._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Ap, plira tiun for Disposal Works Toustrurtion Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal
System at:
..........��..G.�_�....�R� �-..��:..... �:��f� -----------=----------------------------- -------------........----•--.......
•,j,ocation-Address or Lot No.
......................_ .-.......-�15is...................................... ••----•-------------••••-.....---••-_----- ••-------•---•---•------••----................
Owner Address
W
1.4 Installer Address
dType of Building Size Lot............................Sq. feet
U DwellingNo. of Bedrooms______________________________ _.___Ex Expansion Attic
a — _________ p ( ) 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 capacity............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. 1................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 Soil_________________________
x
U -----•-----------•••-•-----•-•--------••-...---•-------------•---------------.....•---------------------...-•--•---------------••••--•--•-----•••--•...................................................
W
x •--•--•---••----------------••------------•------••-•'---•-•------••----•----------••-•-•-----•-------•-------•-------------•------•------••••-•--•---•----•-••-----••.................................
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 TITLL 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------------- ---------------------......_•••------••-•-
Date
Application'Approved By....--- 4 �- :_.� :S_ ........................................ `
Date
Application Disapproved for the following reasons:................................................................................................................
h. .. -•----------- __--� ------------ ---------------------------------._... --------_____----------------•-------•--•------------------------- ---•---•--•--------
e� .p
♦�.•+�+.'. ate
Permit No.................................L
........................ Issued.......................................................
s:
Date
THE CO SSACHUSETTS
SAIL S I BOARD OF HEALTHY
............................... oF....................................................L.............._........1 .. 'c r�,,sP- 0 � --
Trrfifirtt#r of Tomplianrr s
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by-------------------- k-:a K%Ift a, ......-----------..._....--•----- -------•------------•-------•-----•-•-•--=................................................
at _ �?.`�? l,-5--•--• ±.. . ----_... f.�1_-Installer------er--------------•-----------•-----------
-has been installed in accordance with the provisions of TI`; 5_q -h State Sanitary Cod a described in the
application for Disposal ��lorks Construction Permit Iv'o________________________________ t,_. ,.______
4s T. HE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONqT.DYED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCT ON SATISFACTORY.
.. ' or.......--
DATE i......
. . f � Inspect --------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......OF.................... ._...___-__._............ l ` )
No......................... FEE._:
Disposal Yorks Tonstr iota rruti#
Permission is hereby granted._._.__ hL t! .._._....__._______.......... ..................................................
to Construct (� ) or epair'( an Individual Sewage Disposal System �'
atNo..-•••••'3 to. �.... P fj..................................................................................................................
Street
as hewn on the application for Disposal W91ks Construction Permit No.._________��'�L Dated....... �� ............� ___._.___
Board of Health
DATE._`,.-R. ----- -- �-•----•- ............................
FORM FORM 1255 A. M. SULKIN• INC.. BOSTON
J
HOUSE TOP FNDN. AT EL. 42.3' SYSTEM PROFILE NOTES eti�°e
Leo °�
COTTAGE TOP FNDN. AT EL. 42.4' TO WITHIN " OF FIN. GRADE NOT TO SME) t. DATUIuF IS APPROXIMATE NGVE1
ACCESS COVER .fi
ACCESS COVER (WATERTIGHT) TO ACCESS COVER TO WITHIN 3' OF FIN. GRADE 04,16.6
40;0' MINIMUM 75' OF COVER OYER PRECAST /� WITHIN 6" OF FIN. GRADE 2. MUNICIPAL WATER IS EXISTING q
2X SLOPE REQUIRED"OVER' SYSTEM 36.0'-37.0'
�40.3' (A) INSTALL INLET RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. �'oufe 6q
•40.6 (B) TEE 11'r INVERT
FOR FIRST 2' OR GEOTEXTILE FABRIC ,
1500 3 MAX. 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO
4/ !PROPOSED
ON SEPTIC TANK 38.V H- l O
34.0' O� oo 0
(H-10) GAS �� 33.58' 11 5. PIPE JOINTS TO BE MADE WATERTIGHT. A�
0
BAFFLE 33.75 Q Q Q = Q t LOCUS
33.2' 00 � o a 000 � o'
6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH ,o �
A= ( 14 X SLOPE) �s CRUSHED STONE OR MECHANICAL O O � 0 0 0 0 0 MASS. ENVIRONMENTAL CODE TITLE V. Bro99s a
4 COMPACTION. (15 221 [2)) 2� 0 Q 0 0 "0
6= ( X SLOPE) � 31.2' bane
DEPTH OF FLOW 4 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO
TEE $17FS, 3/4" TO 1 1/2" DOUBLE WASHED STONE BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE.
INLET DEPTH = 10" Rovfe 6.
( 15 X SLOPE) ( 2 X SLOPE)
OUTLET DEPTH = 14" 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
FOUNDATION A=16� SEPTIC TANK 29' D' BOX 19, LEACHING 6.7' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED SCALE: 1 �� = 2,000'±
B=57 FACILITY WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION ASSESSORS MAP 317 PARCEL 40
OBTAINED FROM BOARD OF HEALTH.
LEGEND *THE INSTALLER SHALL VERIFY THE 10. CONTRACTOR SHALL B E RESPONSIBLE FOR CALLING LOCUS IS WITHIN. FEMA FLOOD ZONE "c"
LOCATIONS OF ALL UTILITIES AND ALL AS SHOWN
0 100.0 PROPOSED SPOT ELEVATION DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION
BUILDING SEWER OUTLETS AND BOTTOM TH-1 EL 24.5 ON COMMUNITY PANEL #250001 001 D
ELEVATIONS PRIOR TO INSTALLING ANY OF ALL CEMERG OF W 8e: OVERHEAD UTILITIES PRI4R`T0 DATED JULY 2, T992
+100.00 EXISTING SPOT ELEVATION PORTION OF SEPTIC SYSTEM COMMENCEMENT OF WORK.
_ LOCUS IS WITHIN AP OVERLAY DISTRICT
100 11. EXISTING SEPTIC SYSTEM SHALL BE -PUMPED AND- FILLED
PROPOSED CONTOUR WITH CLEAN SAND OR PUMPED AND REMOVED.
- - 1 pp - - EXISTING CONTOUR .r 12. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE
5' REMOVAL of UNSUITABLE SOIL REMOVED 5' BENEATH AND AROUND THE LEACHING FACILITY.
REQUIRED AROUND PERIMETER. OF
W EXISTING WATER LINE LEACHING FACILITY, DOWN To
SUITABLE SOIL LAYER. REPLACE WITH
CLEAN MEDIUM SAND. �h� ��� SYSTEM DESIGN.
G EXISTING GAS LINE NOTE VARIABLE DEPTH OF REMOVAL / //
(SEE TEST HOLE LOGS)
\ os GARBAGE DISPOSER IS NOT ALLOWED
LP EXISTING LEACH PIT � le� 4)1 �1,9
DESIGN FLOW: 5 BEDROOMS ® 110 GPD 550 GPD
ExtsrnvG NATURAL GAS U14E IFt AREA � USE A 550 GPD DESIGN FLOW
OF PROPOSED NEW SEWER LINES AND
COMPONENTS. USE EXTREME CAUTION
DURING INSTALLATION. /
4� // / / /40 SEPTIC TANK: 550 GPD (2) 1100
TEST HOLE LOGS � // ?�s� /�~. ` z , � � •' � �p�, USE 1500 GAL.. SEPTIC TANK
6 LEACHING:
ENGINEER.• DAVID FLAHERTY, R.S. it I i / / �' SIDES: 2 (47.5 + 10:83) 2 (.74) = 172 GPD
WITNESS. DAVE STANTON, R.S. ! ///� f / 3 '�so- BOTTOM 47.5 x 10.83 (.74) = 380 GPD
AUGUST 10, 2006 / / -� f CDR BULKHEAD TOTAL: 747 S.F. 552 GPD
DATE: �/ / i'�F; 1 ELEV = 41.4'
PERC: RATE _ < 2 ivtlfif INCF+ pry/ t\ A) E�STTIRNG If i USE (5) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL)
I 11410 ��� / i WITH 2.5' STONE AT ENDS AND 3' AT SIDES
CLASS. SOILS P I I f- / r DWELLING
ELEV. z ELEV. r I CI I I f k1lelti w , 1.79 ACRES±
/ 4 78,016 SF±
on 38.0' ON
38.2 I i I i MA
APPROVED DATE BOARD OF HEALTH
A A � i 20.62
LS LS
10YR 4/2 10YR 4/2 �% h• I E
10" 37.2' 13" 37.1' \ I TITLE 5 SITE PLAN
B I I 11 } B 2 BRG �� ,�
B r � � / f COTTAG OF
i
Ls LS 3655 MAIN ST. MT. 6A)
„ .
10YR 4/4 348' 10YR 4/4 �� =•" � g
38 36 35.2' BARNSTABLE, MA
C 1 C 1 P*VED i
REPLACE EXISTING 1000 GAL 1, DRIVE ; PREPARED FOR
SILT LOAM SILT LOAM sEPTICTANK WITH PROPOSED
100 10YR 6/3 29.7' 10YR 6/3 s ME LOCATION GAL TIC TANK IN
62" 33.0' ��,,�� CARL JOHNSON
GAi?AGE DATE: AUGUST 15, 2006
e2 C2 REVISED DATE: SEPTEMBER 7, 2006 (TANK, WATER)
MS MS
PERC 2.5Y 6/3 2.5Y 6/3
off 508-362-4541
� ZH OFs� (H OF,{f� 9 fax 508 362-9880
c
o� ARNE H ARNE yc�,
162" 1 124.5- 132" 27.2' H.
CIVIL OJALA y Own cape en gin e erin g, in c.
NO GROUNDWATER ENCOUNTERED r No. 30792 No.26348 CII/IL ENGINEERS
"= ° a/ST`° eE�o``�``�' _ t'� oEssNO
Scale:1 30' S ONA LAND SURVEYORS
7l 939 Main Street - YARMOU THPOR T, MASS.
DCE #06-192 0 15 30 45 so 75 FEET DATE ARNE H. OJALA, P.E., P.L.S.
06-192 JOHNSON.DWG (DDF)