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HomeMy WebLinkAbout0113 ANGUS WAY - Health 113 Angus Way Centerville A=251 —039 I i i I I 5 M E A 0 No.2-153LOR UPC 12534 amead.com • Made In USA roz). 0 n Mar 28 13 07: 55a John Lyons i 508-778-2276 P. 1 Department of Public Health-Childhood Lead Poisoning F evention Program Deleading Notification Pleatte complete all section%ofthis form cleariy.Incurrtplctc or illegible forms.will be returned. Lead Paint Inspector Paula Prior License 4 3986 inspection DOW 01113/2013 Property Owner Gale Klun Property Owner's Address PO ox_S75'Crentervslre Ma Zip Code 02632 — Authariagtl perw performing work: John P_Lyons Lic#/Anth.4 001912 Address ofauthorimd ctron 72 Hi M Crowell Road W-Yarmouth Ma _Zip Cods. 02673 Telephone Number 77 _)-4Ubb - Addr=where the work will be done: Building Namc(if tarv) Floor -- Str 113 Angus ay —Apt No.cct Address p City Hyannis-- - Zip Cods. 02632 The property is a—multi-family X single family. Deleadipy Methodt'sl: a Making paint intact(high risk) o Making paint intact(moderate o Applying vinyl siding on Merior a Demolition risk) Q Component removal(low risk tX Scraping a, Liquid cnCapsulax..t components) as. Component removal/rcplaccutent o 'Covering a Other. a Dipping a Cappingbascboards The work will begin on W 5I13 and will finish by W 9/133.The work will be done in the X am_pm or_weekends. In vase of EmcrgcnCy Contact_John P.Lyons Daytime Phone 774-353-6235 Evening Phone_ 508-775-4066 The Property Owner must complete and sign the following information: I certify that only authorized persons who have complied with the training mquirernews of the Massachusetts Lead Poisoning Prevention and Control Regulations, l M CMR 460.000,will conduct dcicading work.l further certify that the authorized person(s)will not exceed the scope of his/her authority and will be performing only those activities indicated above.All of the information contained in this document is true and c ct to the best of my knowledge and belief. Dale 03/27/2013 SiBod The following peopMlagencies must he notipcd ten days before beginning work: i_ Occupants ot'the dwelling unit Jason Sander`s 508-280-4336 2_ All other occupants of the residential premises.if ate work will be dose in the common arras 3. Childhood lmd Poisoning Prcvcntion Program,DPH,, Fax(781)774-6700 MWRHO S Randolph Street,Carlton.MA 02021 '* 4. Asbestos and Lead Program,DLS 19 Staniford St, 1*Floor,Boston,MA 02114 Fax(617)626-6965 5_ Local Board of Hoalth/Cok:Enforcement Agency Barnstable Fax 508-790-6304 "if the hnmo im m the 5tete Register of I-H!aoric Places,call the NMI[Lacrical Camminion at(617)727-8470. H. : TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date ( � ZD Time: In Out Owner V l R 1 NI a I4L-t1j Tenant Address BUY 5� Address � � 3 W P(j 7 Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 1�M R Rnri1 4. Water Supply 5. Hot Water Facilities ✓ O p 6. Heating Facilities L7T�YVI0 S ; srj 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities. 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 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 112— Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed A�l�r Inspe or If Public Building such as Store or Hotel/Motel specify here i TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date ! U Time: In Out Owner\,19C)M A LAW Tenant ! „ Address tl 1�y,, 1 �y//�1� IT)L�- 1'-� Address u-o 16ul"Ll j Mft Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities t Qr(lm � w 6. Heating Facilities 77 7. Lighting and Electrical Facilities ,✓ 8. Ventilation ✓ 9. Installation and Maintenance of Facilities 10. Curtailment of Service '✓ 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. SeWage'Disposal V., 17.Temporary Housing P\ 18. Driveway Width Of l0 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms '9— Number of Vehicles Allowed max) Number of Persons Allowed (max) Person(s) Interviewed -��A�1T Inspector ie;111� Tj/;"", If Public Building such as Store or Hotel/Motel specify here TOWN OF BARNSTABLE / \ LOCATION c/ SEWAGE # �""/ 7 0 nv VILLAGE L011tif td/I Z�, ASSESSOR'S MAP & LOT TALLER'S NAME & PHONE NO. �� �� �G(}Crr ��U y�cS U'� 4kt G- 4 S 'PTIC TANK CAPACITY LEACHING FACILITY:(type) P/,T (size) /ii G 'L .?4TO. OF BEDROOMS PRIVATE WELLOR PUBLIC WATER B'60GR OR OWNER DATE PERMIT ISSUED: '' G DATE COMPLIANCE ISSUED:' VARIANCE GRANTED: Yes f No �d j 1 v O A < r No - v N � C v ` v a � N � � I 0 a v t• � ©© 2 S ZCk� S1� �� � � - � �`' �. /rD �� P � � ��� - � � THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE � 0 Appliration for Disposal Works Tonstrnr#iun jhrmit Application is hereby made-for a Permit to Construct ( ) or Repair (XX)Xan Individual Sewage Disposal System at: .11 Angus .Way..aen he x-u i- aa...---...-•---•--------- Philbrick Location-Address or Lot No. Owner Address aJ..P_.-Ma c omber_...Js_................................................... Installer Address Q Type of Build' Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................. .Expansion Attic ( ) Garbage Grinder ( ) 2 aOther—Type of Building Resident..a•_ ._ A o. of persons_...•....................... Showers ( ) — Cafeteria ( ) QOther fixtures ----------------•-------------------------•----------.••-•--------•-•--••••--•••-•-------•-••--•---•--••••--...._...------------.........__....------ W Design Flow............................................gallons per person per day. ( otv daily flow............................................gallons. W Septic Tank—Liquid'capacity........_.__gallons Length................ Widths-------------- 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....................................................!_.._ W --...----- Date Test Pit No. 1................minutes per inch Depth of Test Pit._._._ .:'....... Depth to ground water..__-...__.._-_.__..._.. fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -----------•-----------------••••---•••.........--------------•--••---------•--•...----•-..._....--......................................................... 0 Description of Soil.......... . W9arid-_.Se__G_ra;ve-i----•-----------------------------------------------------------•------------------•--•----------------•---•---- U ----•----•----------------•---------•---------------•-•--------•----------------------•-------------.-.----------------•---•---------------•------------•----------------------------------------------- W U Nature of Repairs or Alterations—Answer when applicable........................................................ 1-1000_..gallon tank,l-1000 gallon leach---pit-. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli nce has beef i"byoard o health.g -... . ........................................4/30/91 Signed ... " Date Application Approved BY C� V ------------------------- ------------------- ------ Dace Application Disapproved for the following reasons- ........... ------------------------.......................... ................................................................. ---------------------------------------------------------------------------------- ---- --- -- ------------- ----------------------------------------------------------------------------------- -....................................... qq►� Date PermitNo. ------..?1-..'---1 0............................ Issued -------------------------------------------------------------- Date No._-1-�- 7 Fps.......3....0 1. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH- p TOWN OF BARNSTABLE! Appl ration Jor Disposal Works Tonstrur#ion Prrnti# Application is hereby made for a Permit to Construct ( ) or Repair (XX}Xan Individual Sewage Disposal System At: 113 Angus Way Centerville ............ __....__.....-•- -•- • -• ............................ ...................•-•--...---...... Ph i lb r i e k Location:Address or Lot No. ......................_.......................................................................... ..........•--•-•-•---•-----•-------••--......•--•--........................................_..... Owner Address J..P:MacQMhPr Installer Address Q . Type of BuildingSq.2 Size Lot--------------•_-_-•---.__ q. feet U Dwelling—No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( ) � Residentia� G p, Other—Type of Building ---------------------------- No. of persons._..._._..__......_......... Showers ( ) — Cafeteria ( ) al Other fixtures ............................ WDesign gallons Septic Tank—Liquid Liquid capacity s P L negth.. per day daily ... gallons Widt ................ Diameter _--__-----_ Depth•__ : x Disposal Trench—No..................... Width.................... Total Length-----:�............ Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet......`........... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ►-' Percolation Test Results Performed by........................................................................... Date........................................ W . Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_-___-_-_____-_______-_. (14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------------------------------•--......--•--•-•---•-•----------.................__............_......................................................... 0 Description of Soil........................: - , x Cana de---liYaV't51"-----•--........ W VNature'of Repairs or Alterations—Answer when applicable•_____________________________........................ - 1-1000 gallon tank,l-1000 ga1].on::leacl^i:_pit:. Agreement: The undersigned agrees to•.install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasf been)issued by the oard.,health.-' �( • 4/30/91 Signed .. .. .....................'� �..�.....� - ........... --------------------------------------- Dare Application Approved BY � .::-----------------�-.... c .�.. 'e� ✓------ Application Disapproved for the�bll�owinreasons: .... t.....-.- - ------ -------------------------------------------------------------------------------------------------------------- ---------- ........... ................................-.................. ---------------- ...------------------ Date Permit'No. pl.- �1?(�---------------^` - Issued �e THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (gertifirate of Q-Tomplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX ) byJ.P.Macomber Jr. - - ---------------------------------------------------------------------------------------------------------------------------------------------•---•----- ------------........----- Inst,aller at .113...Angus Way Centerville has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .......... .._......... .. . .......... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B ONSTR ED AS A GUARANTEE THAT THE SYSTEM WILL FI�,,NCTION SATI�,S+FACTORY. r DATE-------------------°. .. ��..f, ...................................... Inspector ..................................................................................------ THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH TOWN OF BARNSTABLE No...9.YL=J.;&.. ', FEEA..30.00.. Disposal Works Tons#rudion utit � J P Macomber Jr. Permission is hereby granted.... --• ...........................I---....................------•-----............................................................ to Construct n�us ROf ��p�t tad YI.j Tij:,jjV1 Sewage Disposal System atNo-------- -----•-----......-•••••.......••---•---•••----.......-•--•--••-----.............--•---•-•-• --•--•-•--•-•-••••••---•-•---......----•••••-•--•--•----•---•-•••-••--.............. Street as shown on the application for Disposal Works Construction Permit Noyll_- _ ... Dated.......................................... .............................. • Bbard-of Health DATE............ ........................................... FORM 36508 HOBBS h WARREN.INC..PUBLISHERS