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1815 FALMOUTH ROAD/RTE 28 - Health (2)
1815 FALMOUTH ROAD Centerville A= 189 - 055 No, 53LOR Il/1 lIII UPC 1593 ISY- HASTINGS, LIN TOWN OF BARIrSTABLE L0CAU0N M,5 k+t 2 S 9)-DC "W' ua(l� 14i.'ISEWAGF-# Zoay-5e6 VILLAGE_C e-b±-C�t Yt 1 ± ASSESSOR'S MAP& LOT 19' LS� LNSTALL.ER'SNAMEdr.PHONENO._Anyis, N• OjALPr O4-3b2-y'y1 SEPTIC TANK CAPACITY Zda LEACHING FACILITY: (type) g S15oc7 a.E cltnw wt h.Q yS r ' (size) .76 X fl.$ X 2 NO.OF BEDROOMS a � ���� AS5ctk{z2 BUILDER OR OWNT-R H011-1 PERMITDATE: /Q � O COMPLLANCE DATE: I0 21 0° Scpara6on Distance Between the: Nlaxilmum Adjusted GroundwaterTableto the Bottom of LeachingFaciiity Feet Private Water Supply Well and Leaching Facility (If any wells exist ��(', on site or.within 2QO feet of leaching facility) tJt f' +�� Feet Edge of Wetland and Leaching Facility(If any wctlands exist within 300 feet of leachin facilityk WQ fvdlo w-l' Feet Fumished by, � TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet ofileaching.facility) Feet FURNISHED BY 9-2S26a1C.7 4Viacx- C, H. S'1e14C g� 0c-�5 'y��Np51� 4k v Q°t 35=�. 3xo d.o71 qo�( 1 *�a00Cl ¢f arepn35t e 1 aW� 601 la(r„Y cP r t (3 U rL r7 i M c., A 77' 1 No. c,,;Locq— J THE COMMONWEALTH OF MASSACHUSETTS FEE < CC BOARD OF HEALTH (� OF c�i LIG APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair N Upgrade ( ) Abandon ( ) - ❑Complete System 00ndividual Components &Pk 115 Location Owner's Name Map/ParceA Address Lot# Telephone# Installer's Name Designer's N e z.� Yr`A-y►C_�� sr -Pa � OY- Lam' q1 5 ►.0 S T Q> Address Addre w. X3 50T 367,U Telephone# Telephone# Type of Building: �' Lot Size,•k joa,`G __.S, . e Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Q Design Flow(min.required gpd Calculated design flow W gpd Design flow provided gpd Plan: Date -al I,, ° Number of sheets I Revision Date Title T!!TJ4-�-4 y 2W 4-- B A- t�L/ Description of Soil(s) O- ~ A `' 3(. LS ��-,v � ►.[ED S 1'L -1 bar M�i Soil Evaluator Form No. Name of Soil Evaluator PA D W.c.Ilr Date of Evaluation q-j o DESCRIPTION OF REPAIRS OR ALTERATIONS Of mac►LAC 14 KV e The undersigned agrees to install the above described Individual Se age Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date /O L( D / LB (o 0 Inspections FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 ..sn.,.... J';r,._+..i"f'6y'^r,1'.. C."Ss..� ::;� .,�.T•..� ......,+u`i+'. .. F.+.r . �f' tiG�;.,«.,r.tir M`re7i, ...,;:`e-x' `r!!": _ ,,.. "sr•s No. =: GQ F� THE COMMON WE I:LTH-O•F-M-ASSACHtUSETTS FEE �0U : BOARD ,OF" HEALTH - f OF I R t�( i G� lit lam. f µ APPLICATION FOR DISPOSAX^SYSTEM CONSTRUCTION PERMIT I Application for a Permit to Construct ( ) Repair N Upgrade ) Abandon ( ) - 0 Complete System Individual Components lia Location Owner's Name Map/ParceA Address f ' Lot# Telephone# A L/�— t tNt- �A �c tt� — Cr ' `►1 t,. Installer's Name Designer's N e �,..•�^ 2- \ hn A L 4 �T VC, ' uX (•'IM,N i ` '` ?2 t Address f Addre w. �0.r Ms-tG�lt sod �4 y91 -SLR �t� 1 Telephone# Telephone# t Type of Building: �� ' Lot Size,•\ A4 .Sqrfgef"� Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures . Design Flow(min.required) geo gpd Calculated design flow �Leo gpd Design flow providedl h gpd Plan: Date\ A v- Number of sheets ! Revision Date _ I ti Title =i 2� it ( D I' 77 -71n 'A, L L,- -Description of Soil(s) o- U o IA , (,)"- 7 1'S I 3 - '13 b &A �• Soil Evaluator Form No. Name of Soil Evaluator 1'7A O IAA A-K Date of Evaluation 1-1 o'-�• DESCRIPTION OF REPAIRS OR ALTERATIONS a: �+ • r' or I.i�C�✓� \,' 'Nf ,t� h 1 t rThe undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Boa4al"Health. Signed'. Date Inspections tad 1 FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 fi NO. cad I' J�9- -T E COM w�IVWEALT,H#OF?MASSACHUSETTS�����' �W FEE U �r ' BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: Ij Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired X,Upgraded( ),Abandoned( ) by: Irtn Q 1�t h at 1S LC Alr,I _RL41 1i'f has been installed in accordance with the provisions of: 10r C R 15.00 (Title 5) and the approved deli Tans/as-built plans relating to application No. (� 1 iodated U Approved Design Flow(gpd) Installer Aro t. G+ Designer: 4TA f9 1 C, Inspector �� Date D a 1 J The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No. QCC�14 - 5C-KP THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ) Repair ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at `` 6 \� \ as described in the application for Disposal System Construction Permit No. dated /O/a 14`f Provided: Construction 7", 11�Date �U /� -I be completed within three years of the date of this-permit.�Al-11 local conditions must be met. Board of Health, ,�J FORM 2 - DSCP DEP APPROVED FORM 5/96 'J FORM 1255 (REV 5/96) H&W HOBBS&WARREN TM PUBLISHERS- BOSTON Town of Barnstable Regulatory Services a� Thomas F. Geiler,Director BAEUMA"B Public Health Division i I i639 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601.__...-- --' Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Assessor's Ma �Parcel�l�5�/ S� Date: �� �D� Sewage Permit# '�7�°-CP P Designer: LA C Installer: ` Address: Address: M4d� T pp On z06 G� G(e, (Q was issued a permit to install a (date) (i staller) septic system at L(J i l/ -3(�9 Abased on a design drawn by �����'-P °�' � �p (address) t docuilC l u datedAv/o (designer 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 or 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. \kNE H.v9cyG (Installer's Signature) 011ALA a CIVIL No 30792 ( igner's Signa ) (Affix D ' Brier's p Here) CPLEASE VRET TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc TOWN OF BAR]tiSTABLE LOCATION SIa {� t 2 S C3� ",4` Ka{{� { +IIS1rV,'AGE# 2DD�—.SE6 0 0 3 VILLAGE �r eeY Vim_ ASSESSOR'S MAP R LOT 0 ]INSTALLER'S NAME&PHONE NO. A W k t-I• U 3 A•L Pr 3 SEPTIC TANK CAPACITY• O ty Q b LEACHING FACII.ITY: {type) g 22cz Q� c"a wt h-Q y5 (size) 74 f A11.0 r7r 2 F ro NO.OF BEDROOMS Ce��� v�ti� A4'S-cc�ftS 'D BUILDEROROWR'ER H011"1 Mana,-. *%"%r S Yt urns t�n� {/ 3 _ }?E}ZI+4TI'I�ATE: .�� �L.Y COMPLLa1NCE DATE; !B z! � I � Scpamion Distance Between the: Max;=m Adjusted Groundwater Table-to the Boticm of Leaching FaciIitV Feet Private Water Supply Well and Leaching Facility (If any wells exist f , on site or within 20(1 feet of leaching facilit;') tJ f G �qe+Q Feet Edge of Wedand and Leaching Facility(U any wetlands exist � within 300 feet of leachin facility-) 1AIQ wet/o wk Feet X Famished by -fin-• o m m w to m m m 3 m r RJ N N m W ' 3 T A FROM :down cape engineering inc FAX NO. :15083629880 Mar. 01 2011 03:14PM P5 St DcrS All�hfpskA 4L 77 VS-L 390 gao71 yob Zda0cl of f arf vu}St�Q r r4�{ w� eprnp�°5 i 41 (3 U IL 0 N C, �k i ~E�� -ItjTOWN OF BARNSTABLE . LOCATION rf 4 qWAGE# ��e �VILLAGE 1/y lip- ASSESSOR'S &PARCEL 2 INSTALLER'S NAME&PHONE NO. 1 SEPTIC TANK CAPACITY -12�60 G>g1_ okl S LEACHING FACILITY:(t*)(1 ..50 - (size) 1 f L NO.OF BEDROOMS / ✓�` OWNER 1 [ PERMIT DATE: Z/6 COMPLIANCE DATE: a Separation Distance Between the: oueoU10 Maximum Adjusted Groundwater.Table to the Bottom of Leaching Facility. A10 4$6 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 any etlands exist within 300 feet of leaching i ty) j Feet FURNISHED BY („ /J 4 5 3 NGrt � No. D Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 4plitation for Disposal 6pstrm Construetiott permit Application for a Permit to Construct( ) Repair( ) Upgrade(✓) Abandon(� Complete System ❑Individual Components Location Address or Lot No. //,OZZ Owner's Name,Address,and Tel.No. fle/, j.4 O1/ ICY �NiF4i>//e-f4A Assessor's Map/Parcel Installer's Name,Address,and Tel.No. s p�� �c� o� Designer's Name,A ress,and Tel.No. So 8 7,7 6F (,IJEL�L•� f-SUCIIYi�' );1019 &0,z-Vd6ab5T AAI Type of Building: Dwelling No.of Bedrooms /off Lot Size sq.ft. Garbage Grinder( ) Other Type of�uildin �) /1!`of No.of Persons Showers( ) Cafeteria( ) Other Fixtures -� Design Flow(min.required) gpd Design flow provided e) Plan Date f ;9_c QDry Number of sheets a 0'— l Revision Date 01 Title r� Size of Septic Tank �.s00 z5W L Type of S.A.S. � "!�00 �awlT—_ �t/,eC r: kyn!n C Description of Soil C? )�� 46/MY SA Ud {R 7"- 3/" /_�mY 1509AH 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 Cod not to place the system in operation until a Certificate of Compliance has been issued by this Boar of He 1 i e Date Application Approved by Date Application Disapproved b - Date for the following reasons Permit No. 'r Date Issued C_, f All � l No. P� THE Fee'� Cd MONWEALTH OF MASSACHUSETTS Entered mcomputer: Yes PUBLIC�.HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS VZIPpitlation for isposal Opstrut Construction Permit Application for a Permit to Construct( )`-,Repair( ) Upgrade( ) Abandon('f Complete System ❑Individual Components r tccation Addressor Lot No. //GLL Ownei Name,Address,and Tel.No. L41 ses s ap c �i/J `l_/ �'E N%C,e wAe-10A CC-Y71 � - ? Installer Szi,4 e,Address,and Tel.No. 7�j ay6�5 Designer's Name,A dress,and el.No. 5�8 T� G735 r: e/ 't ` '6 °Vdc , �/</ �f��./�/� 1 4K o Addz i7 Cam! -,rvi�� /�✓ r- Type of Building: S t m{ (' Dwelling No.of Bedrooms / Lot Size sq.ft. Garbage Grinder( ) Other. Type uildin G C — No.of Persons Showers( ) Cafeteria( ) 4 - Other Futures f Design Flow(min.required) , //O gpd Design flow'provided 0 / _ dl �+ Plan Date ) 2, " 04 d Number of sheets S P- 1 Revision Date l Title Size of Septic Tank 1/$fin /'A L Type of S.A.S.�� $a0 &7!LGAI l-Cl1 1 1 Description of Soil }, d� G Nature of Repairs or Alterations(Answer when applicable) 1 x 1 Date last inspected: •agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system im ` accordance with the provisions of Title 5 of the Environmental Cod an not to place the system in operation until a Certificate of Compliance has been issued by this Boar of He 1 i ed 1 ,i% �•�— ✓J ,--� Date Application Approved by f /�� U G // , Date r! Application Disapproved b Date for the following reasons Permit No. "'� =� " Date Issued a - - .--------------------- ��, ( J 41 y JJ1 THE COMMONWEALTH OF MASSACHUSETTS ,;..� BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On.-site S wage Disposal system Constructed( ) Repaired X UpgradedAbandoned( )by i . at has been constructed in accordance r with the provisions of Title 5 and the for Disposal S}stem Construction Permit N . " dated Installer Designer #bedrooms Approved design flow_J ? A gpd The issuance of this permit shall not be construed as a guarantee that the system will cti(lo desi ed. Date ��'+ 1 Inspector No. �* �35THEFee COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MispoBal */( ) Construction Vermit Permission is hereby granted to Construct ) Rep Upgrade ) Abandon( )ca System located at s G and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Con ctionpst be completed within three years of the date of this permit. II Date Approved by 4 . Town of,Barnstable °pVE r ' Regulatory Services Thomas F. Geiler, Director BARNSTASLE, *M Public Health Division .� ASS. 163q• �0 '°TEor,�ra Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: ic5"-// Sewage Permit# Z4:�'//-4'S.:5rAssessor's Map/Parcel Installer& Designer Certification Form Designer: -�� �� Installer: v � Address: CJ �CL �U f ° C Address: G fU -7 ,6 6 _117 aAda Ul 11ce 6755 q ks F 4&10/9. On, -Z -/:�,- /` was issued a permit to install a (date) (installer) l J septic system at (l based on a des gn drawn by (address) CEMEX- 1�14- a dated C'Il (designer). /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. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State& Local Regu_ a, s Ian revision or certified as-built by designer to follow. Stripout (if required) s\ sp;ez nd the soils were found satisfactory. q�y off' ARi'.EN G`Pc� Vv No. 1140 (Installer's Signature) 'o FGfST�R VA , ` (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:\office forms\designercertification form.doc Town of Ba"rnsl�We P# Department of Regulatory Services Public Health Division Date �ArE1 39.��� 200 Main Street,Hyannis MA 02601 Date Scheduled L / i Time _ Fee Pd. lad" y r • Soil Suitability Assessment for Se age isposal Performed By: e,C 1 4-f C /�.S�CI Witnessed By: J �, �`v 1 LOCATION& GENERAL INFORMATION Location Address Owner's Name � ddress y",f,,L>;t.7J J ,s�yA,L,.,G - •'f Assessor's Map/Parcel: Engineer's Namer� NEW CONSTRUCTION REPAIR Telephone# 3" Land Use Slopes(95) Surface Stones Distances from: Open Water Body ft Possible Wet Area fit Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit FAce Estimated Seasonal High Groundwater DETIER-AI 44ATION FOR SEASONAL HIGH WATER TABLE' Method Used: ; Depth Observed standing in obs.hole: in. Depth to soil mottles: Depth to weeping from side of obs.hole: in, Groundwater Adjustment fr. Index Well# Reading Date: _ Index Well level—.,- Adj.Factor— Adj.Groundwater Level -e Observation PERCOLATION TEST D te one Hole# 1 Time at 9" f0 60 iL Depth of Pert Time at 6" Start Pre-soak Time @ l Time(9"-6") End Pre-soak Rate MinJInch ` 1/1 t- Site Suitability Assessment: Site Passed_ ) Site Failed: Additional Tenting Needed(YM) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:ISEPTICIPERCFORM.DOC l i p a d DEEP.OBS]ERVATION HOLE LOG Hole# I _ +a Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) _ S C Q®CO (USDA) (Mansell) Mottling (Structure,Stones;Boulders. o sistency,%'Graven V— Itov' ,I DEEP OBSERVATION HOLE LOG Hole# 2- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) jj+po � � (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency,% ravel ttl 4� 2,S- 7/ 1' " DEEP OBSERVATION HOLE LOG Hole# �. Depth from Soil Hon n Soil Texture Soil Color Soil Other Surface(in.) It Sn;i F (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gra DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency. a rl l Z 'I Af-C—SG11 C /0 37 Flood Insurance Rate M10: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes Within 100 yearflood boundary No. Yes Depth-of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervl us material exist in all areas observed throughout the area proposed for the soils absorption system? Ve5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on ic'' r (date)I have passed the soil.evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the requir edAraining,expertise and experience described in 310 CMR 15.017. Signature �rU Date Q:\.S.EPTIGIPERCFORM.DOC e q TOWN OF BARNSTABLE LOCATION/9/Sr t 49_ SEWAGE# VILLAGE SSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. iwtZ5 .5 6-FS0— CI SEPTIC TANK CAPACITY : :57� LEACHING FACILITY.(type) 4Wf1-t19Z---- (size) �t %tam NO.OF BEDROOMS s OWNER � '��L��� PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: `L 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 Qtd� ` d 9 No. Fee VYes HE COMMONWEALTH OF,MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS x 2ppfication fur 30isposal *pstem construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(Abandon(/) 2KComplete System ❑Individual Components Location ddr s or t No. Owner's Name,Address,and Tel.No. �� / Assessor's Map/Parcel I t Installer's Name,Addrep and el. o. m g a5-3 Designer's ��,and Tel.No. Type of Building: Dwelling No.of Bedrooms I of Size sq.ft. Garbage Grinder( ) Other Type of Building )�o.of Persons Showers( ) Cafeteria( ) Other Fixtures 6i�� 80 1JUI Q Design Flow(min.required) %lQ gpd Design flow provided / j�� �f�I T gpd Plan Date 4), Number of sheets �� p 7 Revision Date Title Size of Septic Tank ® Type of S.A.S. 600 094c"x1 ✓IV Description of Soil C �,�_ 3,P- 5/:�wd 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 Zndace the system in operation until a Certificate of Compliance has been issue his Board of Health Date Application Approved by ® Date Application Disapproved by Date for the following reasons Permit No. i Date Issued y V lid 1 s No. ! `` ` Fee t i HE COMMONWEALTH OF MASSA HUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS : d; application for Al spovar bpstP:tn Cons trUctlon,pPrinit i Application for a Permit to Construct( ) Repair(,,) Upgrade( A6andon( ) 2 Complete System ❑Individual Components Location Address or_Lot No. //} /5�J/ �)p� s Owner's Name;-Address,and Tel.No. , t�/5 1 ,6�ov !' erv�l Assessor's Map/Parcel e. (f5AJ 1—c- lC r/ 11� uGC ft-? Installer's Name,Address,and TelvNo`. Designer's ame,Address,and Tel.No. G ,es ��rS14 Type of Building: G S 7 } Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 1 g)'g ice , 4o.of Persons Showers( ) Cafeteria( ) Other Fixtures k'.1 U/b///I Design Flow(min.required) /A) gpd Design flow provided /Ll / / gpd Plan Date < '�� �i!�/ Number of sheets J Revision Date Title Size of Septic Tank SoQ L Type of S.A.S. re. Description of Soil A �" 7 r �G /7�-Vj-�p,�:l d 4r ii {, C " Nature of Repairs or Alterations(Answer when applicable) ; { r r Y 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 Certificate of Compliance has been issue khis Board of Health ed Date Application Approved by , Date Application Disapproved by Date r for the following reasons i Permit No. Date Issued ra THE COMMONWEALTH OF MASSACHUSETTS S!,p f r BARNSTABLE,MASSACHUSETTS , it - ��� },p, bR�; ivt4 Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewa Disposal system Constructed( ); epaired( Upgraded( ) Abandoned( )by at / has been cons cted in acco Banc with the provisions of Title 5 and the for Disposal System Construction Permit No 'o ted I Installer Designer #bedrooms . Approved de i�flow,A 7 2 U gpd The issuance o frmit shall not be construed as a guarantee that the system wil function as desii need. (� Date Inspector �VI✓ > 1" ____________________ _______________________________________________ No l! ` Fee . THE COMMONWEALTH OF MASSACHUSETTS `\ oPUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS b1p; MispoSal 6pste ConstCUCtlon 30Prnilt ` Permission is hereby g d o Co struct ) Re ai ( U grade( ) A andon( ' ,r System located at f 1 � i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with i Title 5 and the following local provisions or special conditions. Providedjdsction ust Pe completed within three years of the date of this permit. Date Approved by Town of Barnstable °F'THE Regulatory Services ti Thomas F. Geiler,Director BARNSTABLE, " Public Health Division 9 MASS. 1639. Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: -2 Sewage Permit# Zca/ -C>v Assessor's Map/Parcel/�� Installer & Designer Certification Form Designer: Installer: Address: ,cam le4-iL9 917 Address: R IP On ®Zr/��-� � �g,r��.S ��� was issued a permit to install a (date) (installer) �— r septic system at/6'/S Q 44,,,?6 waZly�'G�� hh�r /�fased on a design drawn by (ad ress) GJ4-5le-e 4 dated /0_C)"V-ZAca. (designer) _Izi 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. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & L tions. Plan revision or certified as-built by designer to follow. Stripout (if ected and the soils were found satisfactory. D R ,---- ` � Na. 1140 (Ins all 's Sign �® RFGI S?DEL q 1 SANITAR\P� 1 �� Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN ' BQJRNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice forms\designercertification form.doc 1 r / TOWN OF BARNSTABLE eUf/dam y D LOCATION T/�/�/5'/�/�,�/Jr WAGE# __2o 051 VILLAGE /` G`! ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. cC,- SEPTIC TANK CAPACITY I SU LEACHING FACILITY: (type �ThQ�!^� (size) NO.OF BEDROOMSA OWNER PERMIT DATE: ��� C����a/��` COMPLIANCE DATE: S T Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) /" Feet Edge of Wetland and Leaching Facility(If any ands exist within 300 feet of leaching 7)/ i'ty )r Feet FURNISHED BY i � � � � ; , 'rl �- �� � �� � b �� 9` I/ C�.� -0lo/a No. I l Vi,.l i D Fee t? 1 THE CGi ONWEALTH( F MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftpliCAtion for Vspo8AY *ps'tpul Construction vermIt Application for a Permit to Construct Repair(�UPgrade '*Abandon ❑Complete System EIndividual Components Location Addres Map/Parcel P� /s Lot No. Assessor's M '/B X o, Owner's Name,Address,and Tel.No. 5279 75✓' -�,� lS'5 S5 �1/1 �IC d9`77 1 Installer's Name,Address and Tel.No. SOS?_ 7.;k5——�LP6,r Designer's Name,Address,and Tel.No. , aFr 77.-O7,3S Type of Building: ' ' Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building V ilk of Persons Showers( ) Cafeteria( ) Other Fixtures t Design Flow(min.required) 6 11e 0 gpd Design flow provided �(p 5,. � gpd Plan Date — 03 a 0// Number of sheets — Revision Date Title r V Size of Septic Tank 15,1170 Type of S.A.S. & '°^'.5 40 Description of Soil o-7044 — .1A -MY 6!9A . OR-In y, Nature of Repairs or Alterations(Answer when applicable) 6'. ! T _,rLao QRZL.aAjF 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 Certificate of Compliance has been issued by this Board of He Signed Date /-217 It Ap plication Approved by Date/t Application Disapproved y I Date for the following reasons Permit No.20I I , 051 Date Issued 3�/ar'11 V. ( is No.6D 1 I — OS-( t V( Fee 9 THE1Cfi►,M IV F MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -JOWN'OF BARNSTABLE, MASSACHUSETTS Yes 0(ppIication' for Disposal 6pstemXonstruction Permit r ; ^/ Application for a Permit to Construct( ) Repair(,/�Upgrade-( Abandon('- ) ❑Complete System 211,dividual Components Location Address or Lot No. //G�� //�,�f�/ v, �r Owner's Name,Address,and Tel.No. s6� 7J� 9�/ Assessor's Map/Parcel l /(� �'(� j �j %GC'L1 //C—� 1-??4- Installer's Name,Address,and Tel.No. soe_ 5 Designer's Name,Address,and Tel.No. ��'U� 77 KA/ f�W,4 .1-W6 U , n/ 4 Z,G 0,4/F:5 5 /--,g .v�r{•`'d Type of Building: Dwelling No.of Bedrooms j Lot Size sq.ft. Garbage Grinder( ) Other Type of Building y / x o.of Persons Showers( ) Cafeteria( ) k Other Fixtures / Design Flow(min.required) (0/�T gpd Design flow provided //„S gpd Plan Date 0-3 0/! ""`'Number of sheets ' r Rev1is`ion,�Date r Title t,l ' Size of Septic Tank '/` t Type of S.A.S. to ---J o0 ?,,91ZcAj �iE�C•-C/1-zr Description of Soil ri /yl'/ /I/!y �JOQA.& Nature of Repairs or Alterations(Answer when applicable) Ate_�- ���'/ /� 0/ T Qj5�J 6,1-,Z2 UA,l , 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 Certificate of Compliance has been issued by this Board of Heal Signed } Q Date Application Approved by . S , Date- 3//0/ /T t Application Disapproved y Date for the following reasons Permit No.20 1 — O Date Issued 3�/a�l 1 _ . ------------------------------------------------------------------------------- ---------------- --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(K) Upgraded( ) Abandoned( )by i,.ia I fl Pie& at ( _��, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No2Oil-OS 1 dated T11 1 Installer GJAQR4+j PWA Designer r #bedrooms 6 Approved design flo 6��. 3 gpd 11 The issuance of this ermit shall not be construed as a guarantee that the system w' nct n as deli, ned. Date /, Inspector - ---------------------------------------------------------------------------------------------------------------------------------------- No. 2011— 051 Fee$l06 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at 16/6- 7N Ql) "1D" 73LAILTIA4 C4 iy-7�-re v/LL[: 11411 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date 31 �/( Approved by� � Town of Bgenstable ti Regulatory Services Thomas F. Geiler, Director MAS& Public Health Division 9Q i6 q. a Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 �Ls��-, ,� Fax: 508-790-6304 Dater-z/-i/ Sewage Permit# 20/ OS/Assessor's Map/Parcel c? 5_5 Installer & Designer Certification Form Designer: Installer: e � Address: Address: C� -2 v c 0 9,3 %66 695 7 �1 On /V _ _was issued a permit to install a (dat (installer) t `,t Ile septic system at Yc�Y Aw /&5 Jk/'j VJVC based on a design drawn by (address) dated / (designer) 1/ I certifythat the septic stem referenced above was installed substantially according to P Y l g the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. _r. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & L.ocaLReg ulations. Plan revision or certified as-built by designer to follow. Stripout (if requir- nspected and the soils . were founds actory. �A OF 4fq sgc-s �o DARREN M. (Installer's Si ature) MEYER N No. 1140 `. G/ TES S4 IT 1PN / (Designers S'gnat �r ure) (Affix De ramp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL. NOT BE ISSUED UN '°B0T—H" T}IIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice fonnsWesignercertification form.doe I J/TOWN OF BARNSTABLE LOCATION 1411 VILLAGE ASSESSOR'S MAP&PARCEL /� S INSTALLER'S NAME&PHONE NO. -A— � IA p7 S SEPTIC TANK CAPACITY J5G0 ma-pNs LEACHING FACILITY. (type) (size) 1 �� NO.OF BEDROOMS % OWNER CCW7C-C 1 G A4?2�— - PERMIT DATE: 9ACCII /00�'/ COMPLIANCE DATE: Separation Distance Between the: /� Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility r-`� Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) I Feet . Edge of Wetland and Leaching Facility(If any wetlands exist within f 300 feet of leaching facility /Y Feet FURNISHED BY IdaY Iding �Vi'0(lk Fee (30 OMMONW ITH OffMASSACHUSETTS Entered in computer: Yes ION -TOWWOF BARNSTABLE, MASSACHUSETTS 'd Oisposal *pstrm Castration permit it to Construct( ) Repair( ) Upgrade( ) Abandon( [�Komplete System ❑Individual Components Location Address or Lot No. l kj//y 'f �Jf��� Owner's Name,Address, {and Tel.No. JAG,' 7 5 3J Assessor's Map/Parcel Installer's Name,//Addre and Tel.No. Designer's Name,Address,and Tel.No. �W /W Type of Building: Dwelling No.of Bedrooms Id. Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 7 VAJ/1-5 "Oo.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 1320 gpd Design flow provided ,l 2J t g gpd Plan Date '�' Number of sheets 3 Revision Date T Title n Size of Septic Tank ' 6/l(q 20AWRZOWbe of S.A.S. /d.— 5,no of -, _w Description of Soil 0-7 16hoy -99Xjtt -7-- 3/ 3 kOW y $P6W ,3/ IV /h SAS 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 Certificate of Compliance has been issued by this Board of Health. Signed QDate Application Approved by hN t L.. Date aD . Application Disapproved by Date for the following reasons E Permit No. I V Date Issued 1 o "".+►1..,J!! ' �'• �s� 'n"" �ad.�p i�c.. 'a ^� �.".:f�; '� �� `'�' ,ff�,/�_�<-x�'"q._,gY`, x I� 1.+r �'��'T �/1 �� G �"1',�..5 No. _ t Fee THE COMMO WE'r'L H'r j MA A HUSETTS Entered in coaiputerf SS C I�� Yes i �PUBL'IC HEALTH DIVISI . N - TOWINx0FABARNS�TABLE, MASSACHUSETT. 4' Zipplitation for is oral * stem Construttion Permit Application for a Permit to Construct`O Repair( ) Upgrade:( ) Abandon(� Complete System ❑Individual Components Location Address or Lot.No. 1!;%/1 H Owner's Name,Address,and Tel.No. Fk.L�i Assessor's Map/Parcel' q pr)p ( '6 X)7K ? Installer's Name,Addr`es and Tel.No. Designer's Name,Address,and Tel.No. f \ /9 Alew 0-s 7 "—L Type of Building: l Dwelling No.of Bedrooms /rah n Lot Size sq.ft. Garbage Grinder( ) Other Type of Building �~j/J,C�/js !'fi ,A 1o.of Persons Showers( ) Cafeteria( ) Other FiAres Design Flow(min.required) / , gpd Design flow provided gpd Plan Date Number of sheets 5 Revision Date Title Size of Septic Tank2p2jF&Pe of S.A.S. is,3 r- 7'00 (',F3 CL�t% ,�ieC—C ') /�s�y jf)6 l L y 9 Description of Soil 0-7 m y -,�Qv d t! '17r�17//�l►.SAS 'Nature of Repairs or Alterations(Answer when applicable) i ! i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in } accordance with the provisions of-Title 5 of the Environmental Code and not to place the system in operation until a Certificate of . Compliance has been issued by this Board of Health. / _ Signed Date j Ap plication Approved by V" ►'W�` enei_"2,L y2Cj Date (� w Application Disapproved by Date for the following reasons Permit No. 6 D, Date Issued J - - - ------------------------------- ------------------------------------------ �lnr THE COMMONWEALTH OF MASSACHUSETTS '7 BARNSTABLE,MASSACHUSETTS Certificate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded Abandoned( )by 0014 , at as been constructed in accordance ,with the provisions of Title 5 and the for Disposal qyqtem Construction Permit No. 01 U 1- dated V a It Installer W &zz A~L Designer ✓ #bedrooms pL Approved design flow _� / �o� gpd The issuance of this jermit shall not be construed as a guarantee that the system will ctio J as�lesigned. r Date Inspector / ) —No. ����— Lo� Fee �— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MispoBal 6pstem Construction Permit Permission is'hereby granted to Construct( ) Repair( vy", Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constrijction must be completed within three years of the date of this permit. Date U Approved by ��►+� Regulatory Services Thomas F. Geller, Director y MAS& = Public Health Division 9�i0t16 9..�s � Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 1�(��c ' ' / Fax:. 508-790-6304 Date: — Z/// Sewage Permit# oo��Assessor's Map/Parcelj Installer & Designer Certification Form Designer: Installer: - Address: 9 ��7 Address: zw On i was issued a permit to install a (dat (installer) //� septic system at 1 /�.,+Q IS I��,_9LA�,�d�h.�Wd d on a design drawn by (address) dated (designer) y 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. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with mayor changes (i.e. greater than 10' lateral relocation of the SAS or 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. Stripout (if required T `s inspected and the soils were found satisfactory. �I A of MASSge ///Od)ov-, DARREN ti a In taller's 'gnature) MEYER No. 1140 (Designer's ignature) (Affix mp Here) 4N�ke.,— Ate. PLEASE RETURN 'TO BA STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTI. ROTH-THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignereertitication form.doc t No. / 171 Fee THE e0MM'6NWEALTH OF MAS;�,AjP j SETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTAUe-E,'MASSACHUSETTS RppliLation for ]Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(Vr"Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.1-61,5' J;7 f. Qwner�s�Na g,A ress,and 1.No. Assessor's Map/Parcel / — � ��7 �D, 5 t, 14 Z2,VVI-5 Y� Installer's Name,Address,and Tel.No. ,OV &80 Designer's Nam ,A d�d Tel.-Icy, qVt . Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Buildings No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) `7'7® gpd Design flow provided d=sAld70 � gpd Plan Date �—�l Number of sheets 3 Revision Date Title /� p p Size of Septic Tank j��. �}C5��5��,��cq Type of S.A.S. �, '°Cx� �°�� �—b D% D' Description of Soil 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 Certificate of Compliance has been issued by this Boar of Health. gned Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued sir No. ± ... Feed/ x ! a '` ' '" i► Entered in computer: THE4d MMONWEALTH OF�IIIAS1j&&+ 1SETTS Yes '- PUBLIC HEALTH DIVISION - TOWN OF BARNI$9 MASSACHUSETTS _ { Zfppliration for MIsposal 6pstem Construction Permit i Application for a Permit to Construct( ) Repair(VIlu"pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.1_51 j' Fq j, �h �g Owner's Nam ,Address,and Tell.No. ' Assessor's Map/Parcel � `�y MV, 5 V1 Y"1 i Installer's Name,Address,and Tel.No. Designer's Nam ,A d s and Tel,�.10 u>r—l(�S� �I4 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(min.required) -7"70 gpd Design flow provided �rD gpd Plan Date �—s)r—I j Number of sheets Revision Date y .I Title s N-�d Size of Septic Tank add Exf"-, i� Type of S.A.S. Description of Soil ` Nature of Repairs or Alterations(Answe n.applicable) ✓ <3W x Z&5A I• Date last inspected: t 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 Certificate of Compliance has been issued by this Boar of Health. Signed 10 Date Application Approved by CAJ Date Application Disapproved by Date for the following reasons i Permit No. l�"" /; Date Issued 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 AQ at , has been constructed in accordance I�is with the provisions of Title 5 and the for p�osal System Constriction Permit No.r�//—/3 dated t Installer Designer #bedrooms Approved design flow gpd i The issuance of this permit shall/not/not be dons trued as a guarantee that the system all f ncfi esigned. Date ��1( ` Inspector ---------------- ------------------- ---------------------------------------------- ------- ---------------------------------------- No. r 3 4 , Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNS.TABLE,MASSACHUSETTS f Misposal *pstem Cons trurt on permit Permission is hereby granted to Construct( ) Repair( } U grade-( ) A1bandon System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date H / I (� ,e Approved by'� I N /� / + Fee THE COMMONWEALTH OF MASSACHUSETT& Entered in computer: Yes PUBLIC HEALTH @IVISIO'N - TOWN OF BARNSTABLE, MASSACHUSETTS 0(ppiicatiou for 30isposal *pstrm Coustrurtiou Permit Application for a Permit to Construct( ) Repair(4-1�Upglade( ) Abandon( ) ❑Complete System ❑Individual Components Locatioq Address or Lot No. / Owner's e, ddress d Tel.No GJrvcP.(Z g'�c� ) C2�1�c � a °h�"-cS �,cJ�, Assessor's Map/Parcel —15- 7 Ma Installer's Name, ddxeAss,and Tel.No.�j8-�—C)03`? Designer's Name, dress,and pl. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building s No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3e� gpd Design flow provided f4:97, 7 gpd Plan Date !�— ( Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alter tiions(Answer when applicable) ail-AO ;L ® 1' L poc ,, N B �-`? . . T *7 _Fx_" GR( 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 Certificate of Compliance has been issued b oar f th. Signed 1 Date, Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ,) Date Issued - - - - ----------------- "171 C:v No ....- \ Fee 16, S THEpCOMMONWEALTH OF MASSACHU, Entered in computer: ETTS� Yes PUBLIC HEALTH DIVISIGN -TOWN OF BARNSTABLE, MASSACHUSETTS ` Zipplitation for ]Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(grade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. � � v Owner'sj4ame, ddress and Tel.No. Assessor's ap/Parcel _ .t!� 29 Installer's Name,Address,and Tel.No.��Z& -cc3`2' Designer's Name,Address,and el.No. Type of Building:. Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other 'Type of Building Q- No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) f gpd Design flow provided 4 gpd 1I Plan Date �- �- / / Number of sheets Revision Date Title _ Size of Septic Tank GC Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 9 r. N(3 -9 0 7 s!n G,f— Okv t& 2, s Date last inspected: Agreement: 1 . c 'E- -- 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 Certificate of _ Compliance has been issued by t 's�BoardHgl�tSigne Date �- Application Approved by Date Application Disapproved by Date for the following reasons Permit No. !)o JJ / Date Issuedi f 4 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 at has been constructed in accordance 1 h with t the provisions of Title 5 and the for Disposal System Construction Permit No.. dated _ P P Y � " 1g / 1 ' Installer" g� r� g s Designer elf 6a #bedrooms Approved design flow Q gpd i The issuance of this permit shall not be onstrued as a guarantee that the system willrfuncas esi Date Fj f Inspector --------------------------------------------------------------------------------------------------------------------------------------- No.r-tF/ '". Fee / ! THE COMMONWEALTH OF MASSACHUSETTS —� PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Ns posal bpstem Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at g1 �, ,� Oj QA 7 i v and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty tc comply with Title 5 and the following local provisions or special conditions. r Provided:Construction must V co Iplleted within three years of the date of this permit. Date �^ /� /�f � ')�1 / � Approved by°\ i r Town of Barnstable oFt r Regulatory Services ti c� Thomas F. Geiler, Director >MASS. Y Public Health Division y Muss. � 1639. 6�0 � Thomas McKean Director ED rytpV 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 10- Sewage Permit# �� �� Assessor's Map/Parcel �91- Installer & Designer Certification Form Designer:' ` � Installer: Address: ` �. ��� Address: On was issued a permit to install a (date) (installer) 17L D7 septic system at %keK® _ based on a design drawn by (address) �� -; Ssofsl 4`�125 dated (designer) 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. Stripout (if required) was inspected and the soils were found satisfactory. ' I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Lo e. ations. Plan revision or certified as-built by designer to follow. Stripout (if pected and the soils . were found satisfactory. (I aller's ) Si nature o. 114 g T igner'sfigature (Affix Designer's Stamp Here) PLEASE RVTURN TO RNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc No. l Fee u THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 1 Yitation for Nsposal stets Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components Location Address or Lot No. / f"q[' c9p O ner' Name a , ddres and Tel-No. C viClc V'/lec� C�� vt��. � i �5,�►-��°..a Assessor's Map/Parcel ° _ ( Installer's Name,Address,and Tel.No. Designer's Name,Address,and fbl.No.. at�`ts �S61�0-C_Q�� Type of Buil mg: 1 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building A PIZ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided (® gpd Plan Date l Number of sheets Revision Date Title 8-� Size of Septic Tank ��©® GF��e o�S. .S. [l(`(QtZ�s Description of Soil ° Nature of Repairs or Alterations(Answer when applicable) v12 © 6 j 1� ram' b —51 <gql vo 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 Certificate of Compliance has been issued by this Boar of Health. i a Date I Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued No. ( E.a.. . Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: a Yes PUBLIC HEALTH.DIVISION - TOWN OFBARNSTABLE, MASSACHUSETTS i .ltJYicat101C fDr Mii �posal *pstem Construction Permit Application for a Permit to Construct(,;) Repair(Upgrade( ) Abandon(. ) ,❑Complete System ❑Individual Components Location Address or LotNo. Ow_ner�' �N�am�e,�ACddres and Tel No. Assessor's Map/Parcel - /UO 1' 4 N! G Installer's Name,Address,and Tel.No. Designer's Name,Address,and tbl.No. i q Q, Type of uil ing: Dwelling' No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) ,Other Fixtures Design Flow(min.required) gpd Design flow provided (B gpd Plan - Date ���"' ) Number of sheets Revision Date Title - H : Size of Septic TankCatMQF�jSe o .S. Description#of Soil f ' ` NaEure of Repairs or Alterations(Answer when applicable) ✓� � {'� j µ`' `�L� ael Y ` Q -n-- — <g<z ::i yk. 'd Date last inspected: Agreement: • i The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in ccordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar of Health. i Sig ed ,,, Date f Application Approved by /' I /, Date V � Application Disapproved by / I Date for the following reasons Permit No. Date Issued -------- ------------------------ A7 THE COMMONWEALTH OF MASSACHUSETTS r BARNSTABLE,MASSACHUSETTS ST - Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded,( ) Abandoned(p )bye at i -- as been con,structed in accordance with the provisions of Title's•and the for Disposal System;Construction Permit No. dated /. Installer t;Designer (��' (g • #bedrooms `�. Approved des�i n flow "7; ='�j gpd The issuance of this—permit shall pot Ve construed as a guarantee that the systerrlwill functio de ' ned. Date /� �1 Inspecto t -- - - - - ------------- ----------------------------------------------------- No: � Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH,DIVISION-BARNSTABLE,MASSACHUSETTS 30isposar 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) U ade r ) Abandon;( (� ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with 1 Title 5 and the following local provisions or special"conditions. • Provided:Construction must be om leted within three years of the date of this permit. c I Date Approved by � '4ft Town of Barnstable oFTHE Tp�, Regulatory Services ti o„ Thomas F. Geiler, Director + BARNSTABLE, * Public Health Division MASS. s639. A`0 Thomas McKean, Director Ep�p`l 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: to-Z,7A Sewage Permit# Assessor's Map/Parcel Installer & Designer Certification Form Designer: 'Installer: Address: SP::;, 417 Address: On ���—�( � was issued a permit to install a (date) (installer) ". k septic system at181<_ Pq based on a design drawn by (address) hub(4A L-; dated (designer) 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. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical tion of any component of the septic system) but in accordance with State & Lo s. Plan revision or certified as-built by designer to follow. Stripout (if r ted and the soils were found satisfactory. RREW 99 (Install is Signature) i �,* vv� �41)esigpe 's Signature) (Affix Designer's Stamp Here) PLEAS RE URN TO BLNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc I' TOWN OF BARNSTAB11 LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type) _5�111n a NO.OF BEDROOMS Y`•s OWNER PERMIT DATE: COMPLIANCE DATE: 1 'Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility_ (If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY p F �A g" 7 0101 �3 =6-7 ' BOARD OF HEALTH TOWN OF BARNSTABLE Application-*r Veil Confitruction permit Ap cation is ere-by made fo ermit to Construct \ *4' Alter L t' Address Assessors Map and Parcel Address Cj iyns a e nstaller — Driller Address Type of Buildi Dwelling {]t6er ' Type ofBuilding No. of Persons TypeofWell Capacity '-' " oe- ------- VV Purpose ofeD-�������u Agreement: The undersigned agrees to bz$oU the afuredeocribed individual well in accordance with the provisions u6The Town f Barnstable Board ofBealUh Private Well Protection Regulation undersigned further agrees not to � place the well in by the Board of Health. Sn lej J,Application Approved�pndate Application Disapproved for the following reasons:----- a*" Pernnit No. Issued aat" ' ' ' '-- ' -----'--' ' ' '-' ' '--' - ' ------ -------- ---' -- — ' ' - ooAnoopHEALTH � "����� �� �� l� Q� �& Q� N� 4��� �& Q� � U� � TOWN =�� u BARNS TABLE � �����'�' ���m ���� Compliance � �����u���~°�� ��rK ���.°.n~u��uu�� THIS j&,—,-FCr CERTIF at the lndiv�dual Well Constructed (-��Altered or Repaired ~� - _'-_-_'----_-'__--_'-_'__---' ' Installpr at-- --- ______'-___' '---'----- � has been iootuDedio accordance with the pnov�ionsof6, Top,00fBaro$a�e Board ofBeaJUxP�vaue Well Protecdoo Regulation as described in the application for Well Construction Permit No- ------- ---------—------Dated-- -----------'---' TBE ISSUANCE C)FTHIS CERTIFICATE SHALL NOT 8E CONSTRUED AS A GUARANTEE THAT THE WELL � SYSTEM WILL FUNCTION SATISFACTORY. DATE---- -----------------'------ -------------- -----__---- Inspector-- ------------------------------------------_----------- _'__--- - hh� No. v --_ �' Fee-------------------- BOARD OF HEALTH TOWN OF BARNSTABLE - Application`ArVell Construct ion Permit Ap lication is hereby made for permit to Construct ( /l", Alter ( "), or Repair ( )an individual Well at: / ` 5 '---- - --— ------�- _�s`S Location — Address Assessors Map and Parcel - --- ---- -- -------------------------------- ---------------------- wner Address nstaller — Driller Address Type of Buildi Dwelling----—----------------------------------------------------- I Other - Type of Building ------ No. of Persons ---------------------- Type of Well--C�`S&C-/------�---_---------------- Capacity-----���------�-�-�--�L----------- —' „ F Purpose of Well--- --n -' ---- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation The undersigned further agrees not to - place the well in operation until-�a Cer i 'cate .of P/ ,ph, -n as been issued by the Board of Health. l� )ate s w f Application Approved, ------- --------------------- --- date ` Application Disapproved for the following reasons:---------------------------------------------------------------- ----------_--_-_-_--_- ___----_----_ ---__--_----_-__--- I; date 1 'I PermitNo. ------------------------- ---------------- Issued ---- -- ------------------------------------------------------ date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS.T-(fY CE I at the Individual Well Constructed (—), Altered ( ), or Repaired ( ) by- , gd ---------------------------------------------------------------------------------------------------------- Installer ° - t has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ------- -----------------Dated---------------------- i` THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- --- — - —---------------------------- — -- Inspector-------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE i Vell ConstructiouPermit No. ----------------- Fee----q-------- ! Permission is hereby granted --- - to Construct ( Alt r ( ), or Repair ( ) an Individual Well at: jNo. - 1� �-- ------------—------------------------------------------------------------------------------------ I — street as shown on the application for a Well Construction Permit No. ------------------------ -- ---- ----------—------— - - k d--— - -- - -- - -DATE ---------- Board of Health --------�---�- � ----- I i �I .. r TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: Z �^e- `� ���`� ce��.,�- Mail To: BUSINESS LOCATION: �glg�c.�rv.c,�i'h rza Board of Health MAILING ADDRESS: saw Town of Barnstable P.O. Box 534 TELEPHONE NUMBER: Ong 7_� 9_ I V 9 9 Hyannis, MA 02601 CONTACT PERSON: V,r -Z O o 1- EMERGENCY CONTACT TELEPHONE NUMBER: Sa -779 1 (/ 9 F Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES - NOf This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) - Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) nT `P\/L Cj Other cleaning solvents vc G Iv- Bug and tar removers Household cleansers, oven cleaners S ' White Copy- Health Department/ Canary Copy-Business TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: Mail To: BUSINESS LOCATION: i g l<_F,.ar y"o,,t-K �� � _ v �� ,4 Board of Health - Town of Barnstable MAILING ADDRESS: 5�• - P.O. Box 534 TELEPHONE NUMBER: 150 S -7 7 9- 1 Y 9 9 Hyannis, MA 02601 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: f119 J79 / 1 5 T Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES - NOC_ This form must be returned to the Board of Health regardless of a yes or no answer. Use the ' enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your l mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: .''-,Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants __•_�-__�_.- Motor oils/waste oils.:=:� �.:,���:----` - -- - = a --alite) . . - - - �_,T- --- Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) _J , r-r '?V(- C( e Other cleaning solvents r\ '?Yc. G Ivc _ Bug and tar removers Household cleansers, oven cleaners psS White Copy- Health Department/ Canary Copy-Business r l t 9 � 1 FoRM30 �I�W HOBBSBWARRENTM THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH kbto CITY/TOWN 0 DEPARTMENT ADDRESS ] TELEPHONE Address OS ccupant_- Floor Apartment .- - Z No. of Occupants U No. of Habitable Rooms- No eeping Rooms Z-- No. dwelling or.rooming units No.Stories 'Z Name and address of owner vi(It 455 Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish s 41 fry o-4 bra 4_ ' bS&�Ktt -f- 64109111 Containers: /L Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: S4,tp ,4 1 Dual Egress:and Obst'n.: Vk ❑ B ❑ F ❑ M Doors,Windows: A/®- (-11-- 4"t C.e Roof d cde f% @ &to -f I iv•� l Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : tvtaA-0 — 1aSt�tf rt.-C// STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: 3014 ew+wd : et @ wali t 33' Hall Lighting: Hall Windows: HEATING 610 Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: 1/ Stacks, Flues,Vents: PLUMBING: Supply Line: li s- ❑ MS ❑ ST ❑ P Waste Line: ,T— H.W.Tanks Safety and Vent(s) --�k ELECTRICAL Panels, Meters,Cir.: ^-vK V110 ;6-220 Fusing,Grnd.: AMP: tm 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, I Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink / 7 cF .73 Stove (( "a t/ /ec/O-,-lr. Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Vltin,-- (ijol0e mlj& / f- 0A, - Pike Wash Basin,Shower or Tub: �✓b d vrct174 ve r10 to k a L, S'I Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: L3 --&o ® J 1 General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR TITLE A.M. DATE ( ✓ s TIME A.M. THE NEXT SCHEDULED REINSPECTION P.M. ~'^�'=°�°`~ . — . + . . 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found m exist in residential pr�miaeo. oh�i be deemed conditions which may endanger or impair the he�dh. oruadgy and w�|'0oinq��upomoonrpomonx occupying the premise u. This|ieUngio composed ofthose items which are deemed /o always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter||. 105CMR41O.1O0 through 41O.O2O state minimum mquiromonts/of fitness for human habitgmn, any other violation has the potential to fall within this category in any given specific situation but may not d000 in every case and th*mhuro 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 orcorrection of such vio|skinn(y) pursuant to 105 CIVIR 410.830through 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 asupply of water sufficient in quantity, pmonuno and tempomturo, both hot and oo|d. to meet the ordinary needs cd the occupant in accordance with 1O5CIVIR410.18O and 410.18O for a period of24 hours orlonger. (8) 'Failure V» provide heat ao required by 105CMR410.201 orimprnpoF venting or use ofa space heater or water heater au prohibited by 1O5CMR4102O0(B) and 410202. (C) Shutoff and/or failure Vz restore electricity orgas. (D) Failure k/provide the electrical facilities required by 105CMR410.250(B). 410251(A). 41O.253 and the lighting in com- mon aearequied by 105CMR410.254. � (E) Failure to,pmvidaa safe supply ofwater. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 41U150(A)(1)and 41U.30O. (3) Failure to provide adequate exho, or the obstruction ofany-exh 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 and41O.452. (M) Failure V»comply with thoaoourhy�quimme�oof1O5C�R41O.4O0(D). ' (|) Failure to comply with any provisions of1O5CMR41O.O00. 410.6O1 o/410.6U2 which results in any accumulation ofgar' bago, rubbioh, filth m other causes of sickness which may provide afood source or harborage for rodents, insects orother pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of|eadbaood paint ona dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control,'10,5 CMR 460.000. (See M.GL. o. 111 6D@) 1Q0through 109j (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\o health orsafety. ' (L) Failure to install e|ootrioa|, p|umbing, heating and gas-burning facilities in accordance with accepted p|umbing, heahng, gas-fitting and electrical wiring standards or failure to main'tain such facilties as are required by 105 CIVIR 410.351 and41O.352. ooaoVo expose the occupant oranyone else tofire, bumo, ohook, accident or other danger or impairment to health or safety. (�) Any defect in asbestos material used as insulation or covering on pipe, boiler m furnace which may result inthe release of asbestos dust orwhich may result inthe release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR410.358. (N) Failure to provide aomoke detector required by 105 CIVIR 410.482. (0) Any of the following conditions which remain uncorrected for period of five or more days following the notice to or knowledge of the owner of said condition orconditions: (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 0z provide a washbasin and shower m bathtub an required in 1O5CMR41U.15O(A)(2) and 41O.150(/)(3)orany 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 p|umUing, hooUing, gasfitting, or electrical wiring otondardothakdo not create an immediate hazard. � (4) Failure to maintain anafe handrail or protective railing for every stairway, porch ba|oony, roof orsimilar place as required by 1O5CMR41O.503(A)and 410.503(B). . (5) Failure to eliminate r6donts. 000kn000hem, insect infestations and other pests aorequired by 105CIVIR 410.550. P)' Any other violation of1O5CMR41Ci00O not enumerated in 105C |R41O.75OV\ through (0)shall bo deemed Vzbeacon- dition which may endanger or materially impair the health o/safety and wm||'Uoing of an occupant upon the failure of the owner to remedy said condition within the time 000rdered by the Board of Health. � � . ` � | ! _ ^ a t v H HoessawnaReN'" THE10 MMONWEALTH OFMASSACHHUSETTS FORM 30 C y� ` BOARD OF HEALTH, —or. CITWTOWN f 1�4c DEPARTMENT ADDRESS gwy M �U '1 4 6 I I o, / TELEPHONE ° Address /Q 1 r-— v - tJtk tl'►'��� jccupant_— _ --_--- - ; Floor Apartment N.o. _ No.of Occupants No.of Habitable Rooms f- —Na Sleeping Rooms 7— No. No. dwelling or rooming units-_-/'—___ No.Stories Name and address of owner fe f t.�,�4ii l G� — SS — �� Remarks Reg. Vio. YARD Out Bld s.: Fences: a Garbage and Rubbish 13pt,s s(., ev+back. tH bS&-%'t 60 ►7` Containers: Z .Ir Q AV,, + Drainage ti, Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: ate, , S4ow 1 o v5-t. tFr2 '>C- , Dual Egress:and Obst'n.: ❑B ❑ F ❑ M Doors,Windows: a S (✓� f .e.k a.r• t� Roof a, ,L" f K Gutters, Drains: ode it re ems.S'c v, ctoo r-- SL bC Walls: Foundation: Chimney: BASEMENT Gen. Sanitation: Dampness: Stairs: Li htin : i-51h it, . j laSr"y S4kirwtd � STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling oi tt!i n @ Wp f rt 3Sl HallLighting: Hall Windows: ° HEATING 6-*4 Chimneys: f Central , ❑ Y ❑ N Equip. Repair TYPE 'Tffr _ Stacks Flues,Vents: o , PLUMBING: Su I Line: T .H. Gr e- ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) - ELECTRICAL Panels, Meters,Cir.: —OK i&110 . J6220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen t Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.. en.,Gas, Oil,Gl ' Stacks, Flues,Vents,Safeties: Kitchen?Facilities r Sink - —(w m4e^ Qd / F-,` =r 33 0)C' StoveA t ve t-%p 4 M�, 6vo,, , Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: (/-C&n 4 IhD P a rabke ril. 1-jOL ©f,✓;k Wash Basin,Shower or Tub: c/ de'a 4k teq (ve 0 eo k a )$"Z Infestation Rats, Mice, Roaches or Other.- Egress _ Dual and Obst'n: Ye> - vo D 3 i General Building Posted Locks on Doors: ' ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." f _ INSPECTOR `. TITLE a �k DATE ` + Z Z �/ TIME Z ' _ A.M. THE NEXT SCHEDULED REINSPECTION P.M. a 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or impair the heaith, 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. (N) Failure to provide a smoke detector required by 105 CMR 410.482. uncorrected for period of five or more days following the notice to or (0) Any of the following conditions which remainp y g 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. 5 HOLLY MANAGEMENT & SUPPLY CORPORATION 297 North Street Hyannis, Massachusetts 02601 (508) 775-9316 FAX (508) 775-6526 Novektb 3 , 1997 Ms . Jodie Stringer 324 Bumps River Road Osterville, MA 02655 Re : Holly Hill, Unit F-2 Dear Ms . Stringer`':.., As you are probably aware, we were not able to remove the cat "stench" from the carpeting in the referenced unit . Please be advised that we were successful in masking the odor on the plywood subflooring throughout the unit . It took approxim w yam, five weeks with four applications of Kilz . We saved .at lease $1, 000 . 00 by not ripping up the plywood subflooring throughout t e unit . Not only were many expenses incurred in the renovation of this unit, but also ,rent was lost because the unit was uninhabitable . Enclosed please find a complete itemization of the bills for renovations of the unit you occupied at Holly Hills in Centerville . Copies of invoices are also enclosed. If we do not hear from you within 10 days, this will be referred to an attorney for collection. This will only cost you more money in legal fees . Please note that I have pictures which are in the process of being developed. Respectfully submitted, acv,�.V� I Aaron Bornstein for Centerville Associates, Inc . AB jk cc : Paul Stringer CC : John Durant, Facilities Manager ✓cc : Donna Miorandi, Health Inspector, Town of Barnstable CC : Attorney William Enright CERTIFIED MAIL; RETURN RECEIPT REQUESTED 5 1 i 1 Itemization of expenses to renovate F-2 lost rental income necessitated by renovations September 15 - October 31, 1997 @ $750 . 00/mth. $1, 125 . 00 rip up and dispose of urine stained carpet, padding, and linoleum: 2 men @ $30 . 00 each X 7 hours 420 . 00 installation of new subflooring for kitchen & bathroom 150 . 00 chemical applications to plywood subflooring 250 . 00 16 yds . of new linoleum @ $10 . 00/yd. 160 . 00 new carpet & padding ($553 . 68 + $250 . 80) 804 . 48 installation of carpet, padding & linoleum 510 . 00 rip up and install new heating ducts 545 . 00 10 screens re-screened at $15 . 00 each 150 . 00 (it appears as if an animal tried to claw its way out) re-install kitchen cabinet doors 25 . 00 Total $4, 139 .48 OF INEJ � r.. 0011 Town of Barnstable i U.S.POSTAGE>>PiTNErBOWES Public Health Division • BARNS ABLE. • �// 7 MASS. g 200 Main Street 1 `%I�/ OJED MP'�p• Hyannis,MA 02601 _ 1 //�_J A `'x ZIP 1VV $ 000.440 02 1YV 0001.3614.75 JUL. 2.7. 2011. Gina Apostolopoulous 1815 Falmouth Rd APT# C2 Hyannis,MA 02601 i J i YCEXIE 029 DE 1 00 091021111 11 RETURN TO SENDER NO SUCH NUMMER UNAGLE 70 FORWr.aRD ESC: 021e 0,1400200 ` 0969—0som_`.9--.27—40 - _ ,,-� .�; i --_. i _.�. .,R t _� � � ;'� � S �� J ' '1}} ��w ' �� � 4` 1 F 1t � i �r ,I F ;4�/�y I� �� t { ' ' 7 ,� �w^� // / i ��� 1 �! ` �. • 1MPLE'11-THIS SECTION ON DELIVERY :. ■ Complete items 1,2,and 3.Also complete A. Sig t e item 4 if Restricted Delivery is desired. Z;J� Agent ■ Print your name and address on the reverse Addressee so that we can return the Card to you. Received b Printed Name) C. Da of Deliv ry ■ Attach this card to the back of the mailpiece, l or on the front if space permits. kkmefg //)#7 7/-2--7/// D. Is delivery address different from item ❑ e 1. Article Addressed to: If YES,enter delivery address below: ❑No -. w^ Centerville Associates alr;s � 297 North Street Hyannis, TEA 02601 M ,3. Service Type A.Clertified Mail ❑Express Mail J ❑ Registered urn Receipt for Merchandise .❑, Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2..Article Number I `-- "(Transfer from service laben �►f i ;,7 0 0 6 10810 0000' 3525 i:6 3 3 7 I I �� I PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSq1 (iSfEt W tE ff-f!t tcttt (t t f( ! it .f(ttl{1 t( First-Class.Mail Postage&Fees Paid ` USPS Permit No.G-10 I • Sender: Please print your name, address, and ZIP+4 in this box • I I T,. Town of Barnstable Health Division 200 Main Sheet i Hyannis,MA7 02601. 2 Certified Mail#7006 0810 0000 3525 6337 Town of Barnstable Regulatory Services sARvsrnsM KAS& $ Thomas F. Geiler,Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 25, 2011 Centerville Associates 297 North Street Hyannis, MA 02601 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 1815 (C2) Falmouth Road, was inspected on July.15, 2011 by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis a complaint. The following violations of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Pipes within basement were observed to have large amount of condensation dripping from them. This may be contributing to source of chronic dampness within basement. You are directed to correct the violations listed above within seven (7) days of your receipt of this notice by ensuring all sources of chronic dampness are eliminated from said basement. 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. 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. -ORDER HE BOARD OF HEALTH omas A. McKean, R. HO Director of Public Health Town of Barnstable Cc: Gina Apostolopoulous, Tenant QAOrder letterMousing violations\Rental ordinance\1815 QFalmouth Road B 7-25-11.doc Citizen Web Request Page 1 of 4 Zr atu+�Sr [s� a ' Logged In as: . Citizen Request Management Monday;July zszoii TOWN\oconnelt Route to Users Search Requests Create Requests Request Information Request ID: 35269 Created: 7/22/2011 11:35:59 AM Status: Assigned To Staff Assigned To: O'Connell,Timothy Health Office Anonymous: No Request Category: Chapter II : Housing Substandard edit Routine work: No Estimate: No edit Date scheduled: edit Estimated 8/5/2011 Change Estimated Jul August 2011 Sep Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri I Sat 31 1 2 3 4 5 16 7 8 9 10 11 12113 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 Created By: Parvin, Lindsay Priority: Medium edit Health Office Citation Numbers: edit Requestor Information Requestor Request Parcel Number F189-1 1--' F"�"" Requestor reports that the ceiling Map: �189 Block: 055 Lot: 000 i in her bathroom is covered with mold. She also reports that the Parcel Lookup furniture she has stored in the basement is covered with mold. She reports an overwhelming smell of mold in the basement. Email: http://issgl2/intemalwrs/WRequest.aspx?ID=35269 7/25/2011 I Citizen Web Request Page 2 of 4 Edit Requestor Information 0 Track Request Progress Request Work History: Internal Note History: Entered on 7/25/2011 7:55:19 AM System entry on 7/22/2011 11:35:59 AM: by O'Connell,Timothy Last modified on 7/25/2011 2:59:58 PM Assigned to O'Connell,Timothy On 7-22-11 went to said apt at said address. I met with two occupants. One was person who filed complaint and the other stated to be her mother. We went into the basement.There I observed a dresser and a couch with what appeared to be a mold like substance.The basement was very dry in comparison to others that I have been in with serve mold like problems. I did observe condensation on a group of pipes within said basement. I did not observe any other areas within basement that had similar types of growths. I tried to explain to said occupants that Health Div can only enforce chronic dampness which may lead to mold like growth. I also explained that there are not ordinances or laws pertaining to air borne mold within the state of Massachusetts. I informed them they may hire a mold expert if the choose to, but this would have no bearing on what Barnstable Health Div does in regards to this complaint. I told them I would have owner address the condensation on pipes but other then that,there is not much the Health Div can do. During this explanation both occupants became frustrated in what I was explaining and could not grasps why the Health Div couldn't do more, such as provide the occupants with a FREE Dehumidifier. I explained they should either clean mold like substance with a store bought mold retardant product or use a water and bleach solution; or discard the said items, along with running a dehumidifier. It would be hard to determine if said items were brought into basement already damp which could of caused mold like substance to grow. Later that day,the person who originated said complaint called 200 Main st and asked for me. During our phone conversation she informed me that her pediatrician informed her that Black Mold is very toxic to young children. I told her I could not confirm or deny that said mold exist within that dwelling. We do not have that type of expertise within the Health Div. I ask her how she could confirm such a substance exists,without the proper education. She said she saw"Black Mold" in basement. I told her that there are many types of black mold and not all are toxic. As the conversation continued she became irate and began to use profanity and then hung up. I then talked with management of said unit and they have a work order to fix condensation on pipes which will occur on 7-25-11. I will send out order http://issgl2/intemalwrs/WRequest.aspx?ID=35269 7/25/2011 r Citizen Web Request Page 3 of 4 letter ASAP. update delete Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) ;z Spell Check Spell Add document or image link: Browse.... *You can also type in a folder name to see everything in the folder Current Links: QAOrder letters\Housing Violations\Rental Ordinance\1815 Falmouth RoadC24.doc Removez 7-25-11.doc Time worked on request: 1.50 Response time: 1.00 *Time entries are in hours. Examples of time entries: 1.25, 0.5, 0.75, 1, 3.5, 0.25, 0.10 * Response time: Measured from the creation date to your first actions on the request. * Do not include nights, weekends,and holidays in response time for most departments. r Save changes ❑ Check to notify town employee below to review this request. Save changes and notify Health Office citizen* __.._ __.__ ...........-- Crocker, Sharon (� �>Close request Brief message to reviewer: C7 Close request and notify citizen* *notify works if email address was given Update Sp l Check ,' Public Use: Printer Friendly Version Internal Use: Printer Friendly Version http://issgl2/intemalwrs/WRequest.aspx?ID=35269 7/25/2011 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town [which you must do by M.G.L. it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: y 3 Fill in please: r I APPLICANT'S YOUR NAME/S: ' El t. USINESS YOUR HOME ADDRESS: 1 P 1 a L-Moy-rr-f --R 12 ` 08 S 3 y 9 32-0 TELEPHONE # Home Telephone Numberro NAME OF CORPORATION z NAME OF NEW BUSINESS TYPE OF BUSINESS 'P-9'i i�Mr. Cg IS THIS A HOME OCCUPATION? DES NO GIN i.0 f22 • a 1 ADDRESS,OF BUSINESS .i d 1S r- t'<.,r w. -� :-1Z v�.L MAP/PARCEL NUMBER I D: � (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally.operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH MUST COMPLY WITH ALL This individual ha be for d of the permit requirements that pertain to this type of business. - I , . r, HAZARDOUS MATERKS RECULATIOW Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual ha e formed of the licensing requirements that pertain to this type of business. Auth�o('i� a /Si n'i1t�y�re* COMMENTS: �� ��CIILG �l�.11�d ) TOWN OF BARNSTABLE Date:5/ TOXIC AND HAZARDOUS MATERIALS / NAME OF BUSINESS: SIL-V` r &K F4ii✓ -1NA1 G BUSINESS LOCATION: INVENTORY MAILING ADDRESS: 1815 Est e- u rt �,ti t Ecq��,r �� L� , TOTAL AMOUNT- TELEPHONE NUMBER: <;'CR `50 5 4 9 �Zy CONTACT PERSON: hnd ti CID C M,1 QAA-V LLi EMERGENCY CONTACT TELEPHONE NUMBER: ��c t `�3ZJ MSDS ON SITE? TYPE OF BUSINESS: YA'LA c , Ad G INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month re uires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) i f{ C- A 17 c� i E IAI 'P-t E- Spot removers &cleaning fluids (dry cleaners) ( Al LSC Lo Cyr►rU V\ fl Other cleaning solvents Bug and tar removers Windshield wash ' WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS Applicant's Signature Staff's Initials r •i "' . 9�� Xr4 y ^ fir • -� (No y ;R,3 By 9� 67 zp q� rr ID Fs Cll G2 N �u•1LDIN6 G GS 1 1 .b'--'�-N � � is w_�� ♦R IVe Assessor's offioe (1st-Jfloo6: Assessor's map and lot number Board of Health (3rd floor): 666 i0 Sewage Permit number .......:........................`........,............: HASit9T11DLL. i Engineering Department (3rd floor): F.. B moo N & t' House number .e&- f C r..�` Q .0 7 �aV ale ... ,,,,// .... .. APPLICATIONS PROCESSED 8:30-9:30 A.M�aFS�1:00.2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR S / - 9 APPLICATION FOR PERMIT TO ............... /5 Lca s I TYPE OF CONSTRUCTION ........................On-9--and...Two...J•tonyn .-W-OGEE...�.���.��:,...z"I'1'EA�••Lr�u•Fr...3ti. ..............Cep�t2-mhr e -.2.T19..87' TO THE INSPECTOR OF BUILDINGS: 4 The undersigned hereby applies for d permit according, to the following inform�atfon: Location ....•..............S.Q.,Abwe-Ot...c-0rnP,-r...Rt.o....FA..and...C.1.d...5.ta-ge...Rd.i-gentervil-le........................ Proposed Use ...........XLII.t.1-.F. .mil}i...Rc si.dPllti.4.�.:I'; ............................... ................... ... ZoningDistrict Fire District .. . el e 'UJ Vie Ge" tery:1. � .................. Name of Owner ..RQ.1 ly...Hill...Realty...Trust.......Address .....B( ;2 0-7: 3 4 Naive of B_uilde,r �` Jahn...S.tan.�Stanley..................................Address .1 Bax...4 3.....Cumm -t id.....,..©Z•6•3?;;......... Name of Architect AR.Q...A.SS.O.C1a P.,S; ..... '.................... Address .......4 ..... a:Pilp...St,-; iIy�1Y1T1Ts 0�2 �iQ1 i $ 00. `................:...,. ....Fou:ii 1 i Number of Rooms dation -- i )tx ed...Con-creed;e................................. , A Exterior .............V.aCA.... l. p-...Shinglas.....................Roofng ...............Asphalt................................................... Floors ' Car p.et-.Ui•ny1........................................ ............ - Heating _} �C�G ,7.�.� t ..................Plumbing. •. .....,.. • i Fireplace ............N-A...............................................................Approximate Cost ........:; ........... Definitive Plan Approved by Planning Board ------------------------_-------19________ . Area -- , ........:.... �;�� Diagram of Lot and Building with Dimensions g g Fee ..�. `,,,�..�---.... .. .. .... i SUBJECT TO APPROVAL OF BOARD OF HEALTH Sewage permit Vs # living units Building 1 Building 2 ---t --�_ -` Building 3 `7 a Building 4 Building 5 Building 6� - --'7 Building 7 Building cg COtIMUNITY - �b p BLDG. - — ---- — -? a I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS. I hereby agree to conform to all the Rules and Regulations of the To o'Bar s. bl gardin /th-e above construction:` Nae �J.O}�n. • sut-an•1.ey............ .................... Construction Supervisor's License ...& :3.2 J6.................. - � I 041 bs. . n Or' ro r r l - +� "i;t •C � �2r1 v J ••V I ff cj 41, OK ` P 5 car t �3i.; h. y 'S .q• ..{ v .. '`1 ,�'`` `�•i`,ram,"+>1'sy,�r �'� � _ � ; � � � v� Qp . y `a -+aim 'H3 K X •�'. � �' � � '. ou €y`• �t .,.. ?' `v 1 � � , y` _ _t�� PI' s1j�/ :*Sr'.. ,,... __. .t ._--___�1� _\�F ..._ `i McKenzie, Marybeth To: tbusby@hollymanagement.com Subject: Holly Hill apt. Hello Aaron, Per your request 1 have looked into all the systems on the Holly Hill property and you will need both the as-builts and engineering letters for the buildings listed below to get building permits signed off by the health department: Building F permit#2011-135 Building H , Permit#2011-141 Building I, permit#2011-134 Building E, the community building, the septic was not updated You also left your building permit application on the front counter so I am leaving it with the ladies up front. Regards, Marybeth McKenzie R.S. \ l r YOU WISH TO OPEN A BUSINESS?,. For Your Information: Business certificates (cost$40.00 for 4 years), A business certificate ONLY REGISTERS YOUR NAME in town [which yo must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyai� ' Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. - DATE: r Fill in please: APPLICANT'S YOUR NAME/ BUSINESS YOUR HOME ADDRESS: Lff)a 1 1 C 12 �11 l L �IF TELEPHONE # Home Telephone Number �- i e ,F,T.r, :er NAME OF CORPORATION: NAME OF NEW BUSINESS GLC (N _ k A CZS. ' " TYPE OF BUSINESS CC�r\I t tlUd,, IS THIS A HOME,OCCUPATI N? lYE NO ADDRESS OF BUSINESS 1�Qf,� C.S-C� �� VI�LMAP PARCEL NUMBER f �?q zS j�(_I(1(�la / (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of.the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd: & Main Street) to make sure you have the appropriate permits and licenses required to legally operate our business in this town. 1. BUILDING COMMISSIONER'S OFFICE MUST COMPLY WITH HOME OCCUPATION This individual has b ' formed of ermit requirements that pertain to {�styy$ +Wu�r�l#ATIONS. FAILURE TO t r.:�OMPL.Y MAY RESULT IN FINES. - ho ¢ed Signature* COMMENTS: 2. BOARD OF HEALTH This individual ha been ' me pf the permit requirements that pertain to this type of business. MUST COMPLY WITH ALL HAZARDOUS MATERIALS REGULATIONS Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: / TOWN OF BARNSTABLE Date:113/1 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS:7rC. C6EAA)I N C, ` VICGS BUSINESS LOCATION: )' JS F-W lYW+-" --#G�;- Cjl� -TrZM, INVENTORY MAILING ADDRESS: S�OVr-�_ TOTAL AMOUNT- TELEPHONE NUMBER: (SUP)ag`} — /I0� CONTACT PERSON: r A(, 17% 'P4�XC lei EMERGENCY CONTACT TELEPHONE NUMBER: `7-7� ��l-/�33�g MSDS ON SITE? TYPE OF BUSINESS: C GAL 1NG, INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt&roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Ali Windshield wash , WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS licant's Sig Staff's Initials �>a YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00, for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. it does not give you permission to oj5�ral-e. ou mus. first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 sr FI., 367 Main St., Hyannis, MA 02601 (,Town Hall) and get the Business Certificate that is W(JUired by law. Y DATE: y Fill in lease: 3 APPLICANT'S YOUR NAME/S: �/�'C_/��� ��i✓71� p BUSINESS YOUR HOME ADDRESS: 1,915 f,9L 14 o ci (So�3)28o u6,6 0,6 3e2 TELEPHONE # Home Telephone Number So 7 3610 NAME OF CORPORATION-- 7� V a i it ti ' NAME OF NEW BUSINESS TYPE OF BUSINESS. .. rA G IS THIS A HOME OCCUPATION'? YES NO ADDRESS OF BUSINESS !;M J; f AGM ob-01 R D A P' MAP PARCEL NUMBER t/w' OSS / (Assessing): - When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO_200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally opera a your usiness in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. c�S Authorized Signature** r COMMENTS: 2. BOARD OF HEALTH This individual has been r d of the permit requirements that pertain to this type of business. MUST�XMPLY WITH ALL l� Vl HAZARDOUS MATERIALS REGULATIOPrS Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: W / TOWN OF BARNSTABLE Date: �/ TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: filalu IS ?19)-k iili6 BUSINESS LOCATION: 1915 f9LM�yU-fN p�Pfi �3 aWj1NVENTORY MAILING ADDRESS: all& 19t; YhLMOG�P go APy- 6.3 cEti-eiz&i11C- oiG;ayTOTALAMOUNT: TELEPHONE NUMBER: 1 :5joa) !7gg69r5 r/ CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: Sr)F3 0 9Q t/ 9 ,5 9 MSDS ON SITE? TYPE OF BUSINESS: 1at0o '-,r) 90 i tz'1 i/N G INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes T- Uzilj -Le ol- h^C,"� Laundry soil &stain removers 5 (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$4D.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessaiy signatures on t is Orin a. 00 Main St., Hyannis. Take the coml:)Ieted form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE:04 13 /Z'j/_C Fill in please: APPLICANT'S YOUR NAME/S: B � as. BUSINESS YOUR HOME ADDRESS: I-v- vvQ,:1d k0 -3 v L TELEPHONE # iHnme Telephone Nurn,14er Z akf ahS� Pir� Rnn - (1 > 1:>-W . NAME OF CORPORATION;,,,, �;:�; NAME.OF NEW BUSINESS ! `TYPE OF BUSINESS.. "r+ 1-� i IS'THIS A HOME OCCUPATION-. YES NO ADDRESS OF BUSINESS .= = MAP/PARCEL NUMBER /�.J� �IS�'S [Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 20113 Ndain St. - (corner of Yarmouth Rd. &Main Street) to m e sure you have the appropriate permits and licenses required to lega y operate your buss ss in this town. 1. BUILDING CO ISSI ER'S OFF E SNIUST COMPLY WITH HOME OCCUPATION This individu e nTnfor e of ny er t r quirements that pertain to this type of busines RULES AND REGULATIONS: FAII-URE TO Aut on d ignatu (;OI!!IPI..Y MAY RESULT IN FINES OMMENT 11 1r V i � .. 2. BOARD OF EALTH This individual has been i r -ed of the per i�equi m is that pertain to this type of business. onzed Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been--informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: Ha,za,rdous Materials Inventory Sheet Checklist Date Physical Street Address-Check database to ensure it exists Working Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials-no blanks) Storage Information -location of storage, how long is storage for? If none, note that. Disposal Information -where and who? If none, note that. _Applicant Signature -understand what is listed and noted Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and explain it . Attach the Business Certificate with your-sign off and comments '**The inventory.form.should explain what the'business:consists of and:the procedures they are doing.: Notes need to be left to explain what you-discussed with them. YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 yearsL.A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. -it does not give you permission to operate.) You must first obtain the necessary signatures on this form a.l. 200 Main St., Hyannis. Take the completed form to the Town Clc�rl<'s Office, 1 st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and Set the Business Certific:ale that is required by law. ap DATE: 2- Fill in please: � APPLICANT'S YOUR NAME/S: /� 'G;V c4 . Bpp INEpSS (� YOUR HOME ADDRESS: /tZ/S ,�f}Zc?t+� T L i Il II i r11I '{ ul't ily Ili �OO 1f EPHONE # Home Telephone Number I of of 7 n,ni.t_6I iuys ii;y. NAME OF CORPORATION: NAME OF NEW BUSINESS G/4-erAiAYS C P14E C/ -1 . TYPE OF BUSINESS C-i IS THIS A HOME OCCUPATION?T YES NO ADDRESS OF BUSINESS MAP/PARCEL NUMBER � (i'S`-5 (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street-) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE 1 This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual ha been informed he p i r quire nts that pertain to this type of business. Authorized Signa re** MUSTi;OMPLY WITH ALL COMMENTS: 15AZAR110I IS MATERIALS S I 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) N0PS{t1 This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: _ 4 — y TOWN OF SARNSTASLE Date:3 / 2/ i 2- TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: C-'J/t T -�r'�G' .S Cfwkj A,�)-IV-6r) BUSINESS LOCATION: 191-3 F7MO-uW T* P—_6 A--P7' )3 INVENTORY MAILING ADDRESS: C.t'1NfPFXV tkE TOTAL AMOUNT: TELEPHONE NUMBER: C50 9) 01$0) - 21 t?l,©l CONTACT PERSON: AAA-Ff� b/k EMERGENCY CONTACT TELEPHONE NUMBER: "1$ 9 ' 21 MSDS ON SITE? TYPE OF BUSINESS: _ ?P1C;VJ 16 C-4 C-1 INFORMATION/RECOMMENDATIONS: kL , M,q L-QE Fire.District: 57VnC ftT 714-�e I wC.*-- o N o1V z�A SI-M, Ayr j b UA,jlt, Nor 1-~Xc. y 9 C-,/mo"`-C Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) fl/'T 3 e. /✓O /1/C� S iG,uS Spot removers &cleaning fluids (dry cleaners) �aT sro�E �� y�r.,I�• 4Pq�9r�rau,-r�uic.��ia1G. c°v�Rcor,1iq,e9 Other cleaning solvents �,a. �r MR-3 sAf�pu.8.4e-y � Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS plica *igre Staff's Initials EXPRESS -Customer Copy Label 71-8, March 2004 M15'L III III hIIIIIIIIIIIIIIIIIIIIIIIII��II���Ih' �II�I�I�I,IIIIIIIIIIIIII UNITED STATES POSTAL SERVICE® Post OfficeTo Addressee JIIII . . o 458868246, US Delivery Attempt Time ❑AM Employee Signature PO ZIP Code Day of Delivery Posts a Delivery.Attempt Time ❑AM Employee Signature q Next ❑znd ❑a,d Od.Day $ y Mo. Day PM Sche uled Date of D ry Return Receipt Fee Delivery Date Time ❑AM Employee Signature, �'Mo. rDate Accepted ) - -Month /Day $ Mo. - Day ElPM Day Year Scheduled Time of Delivery COD Fee Insurance Fee • • Time Accepted lI--II PAYMENT BY ACCOUNT '�WAIVER OF SIGNATURE(Domestic Mail Only) ❑AM- Lrl Noon ❑3 PM $ $ Express Mail Corporate Acct.No. Additional merchandise irrsurance is void if ?customer requests waiver ofsignature. ' Military Total Postage.&Fees I wish delivery to be'made without obtaining signature r� d PM of addressee or addressee's agent(rf delivery employee \ (� Federal Agency Acct.No.or, judges that article can be left in secure location)and I Flat Rate C�or Weight ❑end Day ❑3rd Day J Postal Service Acct.No. ;authorize that delivery.employee's signature constk. Int'I Alpha Country Code' Acceptance Emp.Initials 'valid proof ofdelivery.. lbs. ozs. * /x NO DELIVERY ❑ / */ '•///�// Weekend Holida ❑ Mailer Signature FROM:(PLEA ,/� SE PRINT) PHONE( h�g) " •+ TO:(PLEASE PRINT) PHONE (,AIR�) 0— � �,���lC. i��„A-�"rl L��!Vi5►1�+'"� .r JLtS �P�+.(-Gf'lAl'P'�✓ �J(.�,,,, may, ZIP i 4(U.S.ADDRESSES ONLY.DO NOT USE FOR FOREIGN POSTAL CODES.)-1 F1 El D - FOR PICKUP OR TRACKING F FOR INTERNATIONAL DESTINATOffE COUNTRY NAME BELOW. Service Guarantee:Express Mail international mailings are not covered by this service agreement.Military shipment•,.delayed due to customs inspections are also excluded. If the shipment is mailed at a designated USPS Express Mail facility on or before the specified deposit tirije.for overn elt or.second delivery day delivery to the,addressee,'delivery to the addressee or agent will be attempted before the applicable guaranteed time.Signature of the addressee's aC rirt or;deli66ry;employee is required uporj delivery.If a'delivery attempt is not made by the guaranteed time and the mailer files a claim for a refund,the USPS will refund th cistage u�pss.the delay was,caused,by:proper detention for law enforcement purposes; strike or work stoppage; late deposit of shipment,forwarding, return incorrc address o incorrect ZIP code delay or cancellation of'flights; governmental action beyond the control of the Postal Service or air carriers;war,insurrection,or civil disturbance;breakdowns of a substantial.portion'of the LISPS transportation network resulting from events or factors outside the control of the Postal Service or acts of God. A notice is left for the addressee when an item cannot be delivered on a first attempt.If the item cannot be delivered on the second attempt and is not claimed by the addressee within five days of the second attempt,it will be returned to sender at no additional'postage. Please consult your local Express Mail directory for noon and 3 p.m.delivery areas and for information on international and military Express Mail services.See the Domestic Mail Manual for details. Insurance Coverage:Insurance is provided only in accordance with postal regulations in the Domestic Mail Manual(DMM)and,for international shipments,the International Mail Manual(IMM).The DMM and IMM set forth the specific types of losses that are covered,the limitations on coverage,terms of insurance,conditions of payment,and adjudication procedures.Copies of the DMM and IMM are available for inspection at any post office and online at pe.usps.gov.If copies are not available and information on Express Mail insurance is requested,please contact postmaster prior to mailing.The DMM and IMM consist of federal regulations,and USPS personnel are NOT authorized to change or waive these regulations or grant exceptions.Limitations prescribed in the DMM and IMM provide,in part,that: • The contents of Express Mail shipments defined by postal regulations as merchandise are insured against loss,damage,or rifling.Coverage up to$100 per shipment is included at no additional charge.Additional merchandise insurance up to$5,000 per shipment may be purchased for an additional fee;however,additional insurance is void if waiver of the addressee's signature is requested. • Coverage extends to the actual value of the contents at the time of mailing or the cost of repairs,not to exceed the limit fixed for the insurance coverage obtained. • Items defined by postal regulations as"negotiable items"(items that can be converted to cash without resort to forgery),currency,or bullion are insured up to a maximum of$15 per shipment. • For international Express Mail shipments,insurance coverage may vary by country and may not be available to some countries.Indemnity is not paid for items containing coins,banknotes,currency notes(paper money);securities of any.kind payable to the bearer;traveler's checks;platinum,'gold;and silver(manufactured or not);precious stones,jewelry,and other valuable or prohibited articles. ' • Items defined by postal indemnity regulations as"nonnegotiable documents"are insured against loss,damage,or rifling up to$100 per shipment for document reconstruction, subject to additional limitations for multiple pieces lost or damaged in a single catastrophic occurrence.Document reconstruction insurance provides reimbursement for the reasonable costs incurred in reconstructing duplicates of nonnegotiable documents mailed.Document reconstruction insurance coverage above$100 per shipment is NOT available,and attempts to purchase additional document insurance are void. • No coverage is provided for consequential losses due to loss,damage,or delay of Express Mail,or for concealed damage,spoilage of perishable items,and articles improperly packaged or too fragile io withstand normal handling in the mail. _ , COVERAGE,TERMS AND LIMITATIONS ARE SUBJECT TO CHANGE.Please consult Domestic Mail Manual and International Mail Manual,both of which are available at pe.usps.gov,for additional limitations and terms.of coverage. Claims:Original customer receipt of the Express mail label must be presented when filing an indemnity claim and/or for a postage refund. 1. All claims for delay,loss,damage,or rifling must be made within 90 days of the date of mailing;for international,call 1-800-222-1811. 2. Claim forms may be obtained and filed at any post office. 3. To file a claim for damage,the article,container,and packaging must be presented to the USPS for inspection.To file a claim for loss of contents,the container and packaging must be presented to the LISPS for inspection.PLEASE DO NOT REMAIL.THANK YOU FOR CHOOSING EXPRESS MAIL. COMMONWEALTH OF MASSACHUSETTS SUPERIOR COURT BARNSTABLE, SS. CIVIL ACTION NO: 08-00674 CYNTHIA JOHNSON, q T Plaintiff ®� 9UE qN®o�N,S P gTIFS VS. ) F9FS CFS T M.R.C.P. RULE 30(a) & RULE 45 q�A�FR HOLLY MANAGEMENT AND ) N SUPPLY CORPORATION AND ) CENTERVILLE ASSOCIATES, INC., ) Defendants ) TO: Keeper of Records: Town of Barnstable Board of Health,200 Main Street,Hyannis,MA Greetings: YOU ARE HEREBY COMMANDED in the name of the Commonwealth of Massachusetts in accordance with the provisions of Rule 45 of the Massachusetts Rules of Civil Procedure to appear and testify on behalf of the defendant before a Notary Public of the Commonwealth, at the office of Lynch and Lynch, Attorney Susan E. Sullivan, No. 45 Bristol Drive, South Easton, MA 02375, (Phone: 508- 230-2500) on Monday, the 20`h day of April 2009, at nine o'clock a.m., and to testify as to your knowledge, at the taking of the deposition of the above-entitled action. NOTE: BY PROVIDING THE FOLLOWING REQUESTED DOCUMENTATION TO LYNCH & LYNCH AT THE ADDRESS STATED ABOVE PRIOR TO THE DEPOSITION DATE YOUR APPEARANCE WILL NOT BE REQUIRED "And you are further required to bring with you any and all reports of inspections of any type pertaining to Unit C-1, 1815 Falmouth Road/Rte 28, Centerville, MA from 1/1/03 through the present, owner: Aaron Bernstein,President,Centerville Associates,Inc. Hereof fail not as you will answer your default under the pains and Ipenalties in the law in that behalf made and provided. Dated: March 23,2009 AYE p P� �SYION' U 2 La U otary Public * ti ARY / M41ONWEP�( /�N/SSA File No.: 17.20370 /mab COMMONWEALTH OF MASSACHUSETTS SUPERIOR COURT BARNSTABLE, SS. CIVIL ACTION NO: 08-00674 CYNTHIA JOHNSON, ) Plaintiff ) VS. ) NOTICE OF TAKING DEPOSITION HOLLY MANAGEMENT AND ) SUPPLY CORPORATION AND ) CENTERVILLE ASSOCIATES, INC., ) Defendants ) TO: All Counsel of Record Please take notice that, at 9:00 a.m., on Monday April 20, 2009, at the offices of Susan E. Sullivan, Esquire, Lynch and Lynch, 45 Bristol Drive, South Easton, Massachusetts 02375, (Phone: 508- 230-2500), the defendant(s) in this action, by their attorney(s) will take the deposition upon oral examination of the Keeper of Records, Town of Barnstable Board of Health, 200 Main Street, Hyannis, MA, pursuant to applicable provisions of the Massachusetts Rules of Civil Procedure, before David Laplante, Notary Public in and for the Commonwealth of Massachusetts, or before some other officer authorized by law to administer oaths. The oral examination will continue from day to day until completed. You are invited to attend and cross-examine. Respec S�u�sa .. Sullivan for the Defendant(s) CERTIFICATE OF SERVICE I, Susan E. Sullivan, hereby certify that on March 23, 2009, I served the above notice on the plaintiff, in the above entitled action by mailing a copy thereof, postage prepaid, to Graham N. Wright, Esquire, MORGAN&MURPHY, 528 Pleasant Street, Brockton,MA 02301. la� � I Susan y,. Sullivan Att ey for the Defendant(s) File No.: 17.20370 /mab • Town of Barnstable -T"E TO`�ti Regulatory Services Bar "5 Thomas F. Geiler, Director AL-AmericaCity $^RNSTAB MASS. Public Health Division p a 1639• ��� Thomas McKean, Director lFDMA�A ^llC)7 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 } April 16, 2009 Susan E..Sullivan, Esquire 45 Bristol Drive South Easton, MA 02375 RE: 1815 Falmouth Rd/Route 28, Unit# C-1, Centerville Dear Attorney Sullivan: Enclosed you will find the complete records of inspection for the rental unit# C-1 at 1815 Falmouth Road, Centerville, MA. The rental registration program became the end of 2006. There was no rental inspection in 2007 as there was difficulty in reaching a tenant and the new program was going through its start-up trials and errors. There has been only one inspection of any type pertaining to the above address from the Public Health Division during the given time period of 1/01/03 through the present. The inspection took place on October 28, 2008. The inspection report and our paperwork are both attached as requested. All of the aforesaid statements are true to the best of my knowledge. Sincerely, Sharon Crocker Administrative Assistant ' Keeper of Records ' Enc. Q:\Legal\Rental 1815 Fal Rd Unit CI Cent Apr2009 lawyer-DOC � J FORM 30 CAW HOBBS&WARREN m THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN > DEPARTMENT ,WH Sey,� ADDRESS TELEPHONE Address Occupant s J��11� '�ql Floor 1 Apartmen No. No. of Occupants No. of Habitable Rooms No.Sleeping Rooms { No. dwelling or rooming units_ __No.Stories `�- Name and address of owner_ , ^ Luc/�- -v %�fl✓/C L l�I�s Remarks Reg. Vio. YARD Out Bld s.: Fences: Garba e and Rubbish Containers: Drainage Infestation Rats or other: A L- U �% STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress: and Obst'n.: 71,E 7U J -j�_ u c CrC ❑ B ❑ F ❑ M Doors,Windows: Roof ------- Gutters, Drains: Walls: r' Foundation: (, i` Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Su ply Line: ❑ MS ❑ ST P Waste Line: H.W.Tanks Safet y 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. Sv`Ten.,Gay-9iJ l lect.. Stacks, Flues,Vents,Safe Kitchen Facilities Sink U Stove a � Bathing, Toilet Facil. b`18anit'n.: P. Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted S Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH r} MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE C,Jj< OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE U AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF-PERJUUR f r INSPECTOR d/ / TITLE f (-Z, /�DATE k--6 r TIME U -S P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health,or safety and well-being of a person or persons occupying the premises. This listing is composed of 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. (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 ( ) e pests as required b 105 CMR 410.550. P q Y f (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= ' t 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. l YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates.(cost$30.00 for'4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give;.yqu permision to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: dGf Fill in please: APPLICANT'S YOUR NAME/S: PIS ; n ri BUSINESS YOUR HOME ADDRESS: I I S' Jcc(I�Ui c f l C'i✓1 b Nll4 �a �f = TELEPHONE # Home Telephone Number O - S7� NAME OF CORPORATION: NAME OF NEW BUSINESS n t5 0- r)d C 't L_5 6,4 0-1d IVQ vt fYPE OF BUSINESS I p v) — im_actUCaj PS IS THIS A HOME OCCUPATION? ES NO f4N�_je-S d&-y S Gt r)of G t" ,� ADDF#ESS OF BUSINESS Ir<IS VY) t -~ C( v'Il(Q W MAP/PARCEL NUMBER L`S J' D _ (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town'of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to.make sure you have the appropriate permits and licenses,required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. . Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual has e n infor d of the rr�t re irerrtents that pertain to this type of business. Authorized i nature** '' COMMENTS: ' 3. .CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has b f rmo of licen ing requirements that pertain to this type of business. Authorized Signa re* . COMMENTS: HOLLY MANAGEMENT 297 NORTH STREET HYANNIS, MA 02601 508-775-9316 fax 508-775-6526 August 6, 2009 Town of Barnstable Thomas McKean Public Health Division 200 Main Street Hyannis MA 02601 RE: 1815 Falmouth Road, Apt A-4, Centerville MA 02632 Dear Mr. McKean, Enclosed please find a copy of the Notice to Abate Violations which we received regarding the above apartment. Please be advised that our Maintenance Department inspected the apartmen?-and found�at three smoke detectors had been taken down and one was missing. We replaces the missing and had all three installed and tested. ; { Q -n Sincer y, 70 - � 03 kA yi�M q cke KatkyvnKolka Property Manager Enc. Certified Mail#7005 1160 0000 0190 9229 Town of Barnstable Regulatory Services MASS. Thomas F. Geiler,Director ��`rFo ems' Public Health Division Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 29, 2009 Centerville Associates 297 North Street Hyannis,MA 02601 NOTICE TO ABATE VIOLATIONS bF 105 CMR 410.000, STATE SANITARY CODE II —MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 18.15 Falmouth Road A4,was inspected on July 29, 2009 by Timothy O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Twn of Barnstable Code. The following violations of the Town of Barnstable Code were observed: 1� 70-10—Smoke Detectors and Carbon Monoxide Alarms. Inoperable smoke detectors throughout unit. I I � . You are directed to correct the violations listed above within twenty-four (24) hours of your receipt of this notice by repairing or replacing inoperable smoke detectors. 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. 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 e wn Health Division and ask to speak with the inspector who performed t ection. ORDER F THE OF HEALTH M ean,R.S., C O Director of Public Health Town of Barnstable QAOrder letters\Housing violations\Rental ordinance\1815 Falmouth Road A4.doc Hdzardous Materials Inventory Sheet Checklist Date Physical Street Address-Check database to ensure it exists Working Phone,Number Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials) storage Information - location of storage,how long is storage for? If none, note that. Disposal Information -where and who? If none, note that. 1,�Applicant Signature - understand what is listed and noted Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -provide a vehicle washing policy and explain it- note that it was given Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures thev are dolna. Nnfpq np_pri fn ha loft to ovninin%Aihn+vni, r1 cri won 1...7+k +4...— YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. Fill in please: Date: APPLICANT'S NAME: yl.,7A RGOS py7Au•a"t P a YOUR HOME ADDRESS: /,R /S jgL-.v-)vTN P-.D is G 14 - L EN�E��� L-t-�, M-A - 0..2 3Z BUSINESS TELEPHONE # 5,0g 69(� 6 S S HOME TELELPHONE #: NAME OF CORPORATION: NAME OF NEW BUSINESS S 1 L V E FOX P�3 I N I I A/ 65 TYPE OF BUSINESS A'tA1 i IA) 6., IS THIS A HOME OCCUPATION? _ — NO r ADDRESS OF BUSINESS 1131 5 FA C �: '1" (L9 tT � �I MAP/PARCEL NUMBER! � (Assessing) N �r / •� - ©1G3� When starting a new business there are several things you must do to be in compliance with the rules and regulations of the Town of Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to ega y o era a your business in town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** L COMMENTS: 2. BOARD OF HEALTH This individual hsFZben info d f e e (t requir ments that pertain to this type of business. Authorized Si ature** MUST COMPLY WITH ALL COMMENTS: R82ARMUS MATERKS R n ern�;e 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: ly Date: S_ / 0// 0--? TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: QI I-Ve? V:::0X P� 1/V T 1 NCB BUSINESS LOCATION: 1 $ 15 FA LM'g%)T -I p V # LI INVENTORY MAILING ADDRESS: SA M E TOTAL AMOUNT: TELEPHONE NUMBER: 509 057 6 S S CONTACT PERSON: 1"AKcMS MRC-HAD 47 EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: Ri41 AI T I n1 6 INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's �ains tains y Other chlorinated hydrocarbons, Lacquer thinners I (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels r Pain varnish remover , deglossers Z GIs . (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Deparlrnent of Ilcallh,Safely, andinvirounicnial Services d�nert INiblic llealth Division Date ml' , " 167 Main Sirecl,I lyannis'MA 02601 f RARNW,leM t IAA—Date Scheduled �'2 (° rime__( Fee Pd. � CP Soil Suitability Assess»ient for Sewage Disposal Performed By: R&rr&4, k, Witnessed fay: 4 00 0 illb LOCATION & GENERAL INFORMATION Location Address Owner's Name C-,@�'ts7Cu/c.tc-'_ /�SJre'rG i.v1L' Address Z97.ue >i� Il /f'Ky/�.�J.al'� Assessor's Map/Parcel: Engineer's Name & G<: pe f NEW CONSTRUCT ON __ REPAIR Telephnne a Land Use% '.DEu "A4,f_ Stones(%) Surface Stones Nonnces from: Open Wntcr Ilody7 n Possible Wet Arca e'�'eSiZ n Drinking Water Well n Drainage Way 7 x 25� n Property Line n Olhcr _n SKETCH: (Street name,dimensions of lot•exact locations of test holes k pare tests.locate wellands in proximity to holes) 3 Parent material(geologic)�}����A'L O��uypl Depth to Bedrock IC/� Depth to Groundwater: Standing Water in I tole: �� Weeping from Pit Face Estimated Seasonal I Iigh Groundwater - i DETERMINATION FOR SEASONAL `NIGH WATER TABU Method Used: _ Depth Observed standing in obs hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: i in. Groundwater Adjustment R. Index Well N_ Reading Date:_ Index Well level Adj.factor Adj.Groundwater Level_ t PERCOLATION.TEST DA49 L vTime & :vb Observation Tole rY _ Time at 9" Depth of Perc Time at 6" Start Presoak Time Qa �/=1cti 44S3 Time(9%6") End Presoak Rate Min./Inch Site Suitability Assessment: Site Passcd—j.r� ;Sile Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back—� Copy: Applicant JON III)IA" Ilule ll / Depth Isom Soil I lorizon Soil'fcxlurc Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Doulderes. Consistency,%Of ayeh b-�Y 92 N .v C> -�, DEEP OBSERVATION HOLE LOG Hole# Depth from I Soil Ilorizon Soil'Tcxture Soil Color Soil Other Surface(in.) (uswk) ;"Aunsell) M.-Itling (Structure,Stencs,Ioulderes. e Lip 15W"U10 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil ItoN-111n Soii Terhue Soil Color Soil t0ther Surface(in.) (IISDA) (Munsell) Mottling (Structure,Stones.Doulderes. Consistency • DEEP OBSERVATION HOLE LOG Hole# Depth from Soil I Iorizon soil'fcxture Soil Color Soil Other Surface(in.) (I ISDA) (Munsell) Mottling (Structure,Stones,Doulderes. e Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes' ^� Within 500 year boundary No es Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not what is the depth of naturally p I y occurring pervious material? Certification I certify that on (date) I have passed the soil evaluator examination approved by the Department of En it met al Protection and that the above analysis was performed by me consistent with the required traini xpertise and experience described in 310 CMR 15.017. Signature Deparinlenl of Ilenllh,Safety,and I;nvironn►eolnl Services Public Health Division Date .67 Main Slrcct.I lyannis MA 02601 RARNRfARIA MARK i°» •� halt Schcdulccl I L 'I imc _/`^ Fee Pd. Un �EOIMKI� Soil. Suitability Assessment for Sewage Disposal Performed Ilya.�'— I e Witnessed ny: LOCATION & GENERAL INI+ORMA'FION Location Address / Owner's Namc Address Z��/►/aiL7� % (^/ ''/�c•�-�;fig/Gc. �,�'�'� G Assessor's Map/Parcel: 4 _ _ + - Engineer's Name Z-0 (2�X /;0 Nf W CONSTRU(:TION RITAIR DD jj��J ' /►� Land Use ^�S ' �L_ Slopes("/") V_ _ Surface Stones�nlll�W Distances from: open Water Clod r l�J Il Possible WC1 Awn Z,0V_.n Drinking Water Well Drainage Way J 1&U n Properly Line n (nher_ It SKETCI I: (Street name,dimensions or lot,exact locations of test holes&pert tests.locale wellands in proximity to holes) Parent material(geologic) (YingWiterinlIo1c: Depth to Bedrock Depth to Groundwater•. St Weeping from Pit face Eslimalcd'Scasonal I ligh Groundwater l�E1'I�, tiyNtNA iON FOR SEASONAL HIGH WATER TABLE Method Used: DcPlh Obscry d standing in ohs.hole: in. Depth to soil mottles: in. Depth to weeping from side of ohs.hole: in. Groundwater Adjustment n. Index Well N_ Reading Dale:_ Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST note Time Observation - i1 1_ i lolc N Time at 9" Depth of Pcrc 4�-6 ! _- Time at 6" Start Pre-soak Timc a Time(9"-6") 2b End Pre-soak _ Role Min./inch Site Suitability Assessment: Site Passed_ '� Site failed: Additional Testing Needed(Y/N) Original: Public health Division Observation Hole Data To Be Completed on Back Copy: Applicant DEEP OfiSEAWATION 1101,1!, LOG, IIole# Dcplh from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (I ISDA) (Munscll) Mottling (Structure,Stones,I)oulderes. — -- 5�41�S.lsI�I.Gy-%Gu+YGII_ o'er'! A I- 5 __i Uy �A-1� t� � DEEP OBSERVATION HOLE LOG Hole# Depth from I Soil Ilorizon I Soil'lcxlure I Soil Color Soil Other S '1!�!`^.) ;"�::r.,c!!) M.Illin SInrct!!re.Stones,Bouldetes. t.rfacc(in., � g (•• t istenGy.%Gravel) t t.l -- DEEP OBSEKVATION HOLE LOG llole # Dcpth from Soil I lorizon 'nil 1'exture Soil Color Soil` Olhcr Surrace(in.) (Munscll) Mottling (Stntcture,Slones.I)ouldcres. �� Consisteimy.° Gravel) DEEP OBSElf I ION IIOLE LOG 1101c # Depth from Soil I lorizon Soil •xhue Soil Color Soil Olhcr Surface(in.) (115DA (Munscll) Mottling (Structure,Stones,Boulderes. Floud insurance Rate tNUIj: Above 500 year flood boundary No_ Yes Within 500 year boundary No_! Yes Within 100 year flood boundary No Yes Depth of Naturally ccurring rv'ous Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? �L S If not,what is the depth of naturally occurring pervious material? Certification 1 certify that on (h ' l(date) I have passed the soil evaluator examination approved by the Department of Cnviron ental Protection and that the above analysis was performed by me consistent with the required trr. m expertise I d experien I:describ d in 310 CMR 15.01 ;��_f M (7� 11 ►, I I I/111 UCI►111'1111C11t or IIC111111,1111cly,HIM 111,11•n lrnmanun..a. ...a.. d ) Public 11csilth Division Date j� 307 Main Street.I lyamik MA 02601 RARMANUL MARK. Dale Scheduled LLLl 'Time__ j /`^ Fee Pd. o" Soil Suitability Assessment for Sewage Disposal Performed Ily: I G Witnessed Ily:_Dii-r/„ IN JT/.^JL.,-—ex LOCATION & GENERAL INFORMAT[ON Location Address Owner's Name ,A / ZO) /•'�e7—, Ax Address z ✓a/17/f� �% (►�� 1 y - ` //Y0#AJ A.#S !ar//i� C%��*C•j/ O\ 1. or Assessor's Map/Parcel: �' G linginecr's Name Z,v c,—e-c(0e M?W CONSTRIAON REPAIR e-� Telephone N 2 /� Land Use R s (Nl`�]JijL_ Slopes(%) l,� Surface StonesM111-0 1►islances 1iom: (►rep Writer 11(,d Z Vd 11 Possible Wc1 Arcs C.'Ot) 0 Drinking:Water Well Drainage Way. J _ �U n Property Line � I Q_Il Other n SKETCH:(Street name,dimensions of lot,exact locations of Icsl holes&perc Iests.locate wclland5 in proximity to holes) Parent material(geologic) z( t&,( Vas Depth to Bedrock Depth to Groundwater: Stan mg Water in I Iolc: p Weeping from Pit Face iistim;;cdSc�smlaiitigtrGlx,uudNa€cr=�-- :�v,(:�- _ I) E TLt' MINATIOiV FOR SEASONAL NIGH WATER TABLE Method Used: Depth Ohscry d standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of ohs.hole: in. Groundwater Adjustment Il. Index Well N_ Reading Dale: Index Well level Arlj.factor Adj.Gtoundwater Level_ PERCOLATION TEST note Titne Observation ' I tole N _ Time at 9" Depth of Peru `i'D—4� t! 'Tine at G' 2Z Start Prc-soak'rime a, & time(9"-6") End Prc-soak 1 2 b Rate Min./Inch Zrkl t� �,� Site Suitability Assessment: Site Passed Site railed: Addilinllal Tcating Hcedcd(Y(N) Original: Public licalth Division Observation Hole Data To Ile Completed on Hack Copy: Applicant DEEP OBSERVATION HOLE LOG Hole# Depth limn Soil I lorizon Soil Texhuc Soil Color Soil Other I.SwAnce(in.) (USDA) (Munscll) Mottling (.Structure,Stones,Boulderes. S.-4ltils1cnU.%Gt"dL_ -111-31 i1 ('./ ip DEEP OBSERVATION HOLE LOG Hole Depth from I Soil I lorizon Soil Texture I Soil Color Soil Other Surface(in.) (l1 M:111!ng (S(roct►c.Stones,Boulderes. Cons istcricy.e Gravel I DEEP OBSErtVATION HOLE LOG Mole# I)cptl►from Soil I lorizon nil feMore Soil Color Soil Other Surface(in.) ( )A) (Munscll) Mottling (Stricture,Stones,noulderes. e �T 1) E EP OBSEI' 'ION HOLE LOG Hole# Depth from Soil Ilorizon SoilrI'•rlurc Soil Color Soil Other Sur!',ce(in.) (USDA (Munscll) Mottling (Structure,Stones,Boulderes. e Flood Insurance hale Mm Above 500 year flood boundary No_ Yes Within 500 year boundary No J Yes within 100 year flood boundary No v Yes Depth of Naturally Occurring r gus Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? _ If not,what is the depth of naturally occurring pervious material? Certification I certify that on fh (dale)I have passed the soil evaluator examination approved by the Department of Environ ental Protection and that the above analysis was performed by me consistent with the required trait>,ing„expertise 011d,expericn�c described in 310 CM I5.01 1. 1 Deparhncnt of I Icalth,Safety,and Fuviroomental Set-vices Public llc:>Ilth Division Dale /°b I G 367 Main Street,I lyannis MA 02601 RARMARt$ MAML Dale Scheduled J �/-/�Via\'I'imc__ I /`^ Fee Pd. d" Soil Suitability Assessment for Sewage Disposal �} j Pullormcd Ily: �Oxfftn, G Witnessed Ily: Qi1/„ i LOCATION & GE.NEItAL INFORMMION Location Address / Owner's Name A /�/`J ��L-s�G'cJ� /�L� (�' Z�Y) c:-E,�/7�'G Li/•7�C,�� �Z ^,2� Address Z� Assessor's Map/Parcel: Engineer's Name e,v GH Q' /;0 ASay \ NI:W CONSTRt TION REPAIR 41-11 '1'cicOumc I! ' r'- QQ Land Use ^�S `hj�l---- Slopes("/") �- �� Surface StonesL'f 1)Blnnccs Cron: Opro Wnler 11mly LuJ Il I'ossihlc N'cI An•n Z ov 0 Drinking Walcr Wcll Drainage Way J _ �U 0 Property Line ] I Q II Olhcr n SKF,TCI I: (Street name,dimensions of lot,exact locations of Icst holes&pert Icsis.locate wcllands in proximity to holes) parent material(geologic) ( ,tw{ V W�S I Depth to Bedrock Depth to Groundwater: Stan mg Water in I lole: qq Weeping from Pit face Estimated Seasonal I ligh Groundwater L4—. I)ETE t I'A MINATiON FOR SEASONAL HIGH 'WATER TABLE Method used: ki Depth Obscry d stand ing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of ohs.hole: in. Groundwater Adjustment Indcx Wcll H_ Rending Date:_. Index Well level. Adj.factor Adj.Groundwater Level_ PERCOLATION TEST DAIe Time Observation Itole N _ Time a19" Depth of Pere `to"'47 I rl time at 6" Slam Prc-soak'I'imc a, Time(9"-6") 2b End Prc-soak _ Me Min./Inch Site Suitability Assessment: Site Passed_ Site failed: Additional Testing Needed(YIN) Original: Public licalth Division Observation Hole Data To lie Completed on Back Copy: Applicant LOG DEEP OBSERVATION IIOLi, LO(. Hole # Depth limn Soil I lorizoo Soil Texture Soil Color Soil Other Surface(in.) (1ISDA) (Munscll) Mottling (Structure,Stones,noudderes. _ _ S�Qp�i.SlCllrwy.%Gply�J_ A i 5 i oy aIVI —7'1-3 I _ 3 L DEEP OBSERVATION HOLE LOG Hole All Depth from I Soil I lorizon I Soil Texture ( Soil Color Soil Other Surface(in.) M.-tiling (S(nictme.Stems,Boulderes. e ON 41 - 5 ('3G ---- ---- ----� - ----- --f-v4 DEEP MIMI.ItVATION HOLE LOG Mole # Dcplh From Soil I lorizon oil fexturc Soil Color Soil Other Surface(in.) ,' )A) (Munscll) Mottling (Structure,Stones.Houlderes. i " 1 DEEP OBSEiMM'ION HOLE LOG Hole # Depth from Soil I lorizc)n Soil rpirc Soil Color Soil Other Surface(in.) (1ISI (Munscll) Mottling (Structure.Stones,Boulderes. Consistency.%Gravel) Flood Insurance Kale Map: Above 500 year flood boundary No Yes Within 500 year boundary No J Yes Within 100 year flood boundary No`� Yes Depth of Naturally Occurring rv'ous Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Vp J If not,what is the depth of naturally occurring pervious material? Ceti I certify that on d (date) ! have passed the soil evaluator examination approved by the Department of rtivirontnental Protection and that the above analysis was performed by me consistent with the required tra.'�in expertise�I cIAcxperien c desa ib d in 310 CMR 15.01 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: $ 1 b Fill in please: a APPLICANT'S YOUR NAME/S. St��v iIV� Cil-u >3i►�f BUSINESS YOUR HOME ADDRESS: IS IG 17&L Moyt1+ l2p CE►� �o.i�r u F ; iM A Q 32 Y' TELEPHONE # Home Telephone Number a—52(- lb 71 NAME OF CORPORATION: NAME OF NEW BUSINESS Artrz i2,lte TYPE OF BUSINESS V PrC, IS THIS A HOME OCCUPATION? --';- __YES NO ` ADDRESS OF BUSINESS Ni 5 T-_ftmoyn_� AD 45 , C' f,i MAP/PARCEL NUMBER (Assessing) When starting a new business there are several things you must do in order•to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature" COMMENTS: 2. BOARD OF HEALTH This individual has be i ormed of ermi quirements that pertain.to this type of business. MUST COMPLY WITH ALL 6thorized Signat OUS MATERIALS REGULATIONS COMMENTS: /1/C� �'���e"� ��� 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. KW Da 44U Ll.— Authorized Signature COMMENTS: OFFICE ONLY -No letM1j COMPLETE • ■ Complete items 1,2,and 3.Also complete A. Sig ature item 4 if Restricted Delivery is desired. 0 Agent ■ Print your name and address on the reverse &4y X ❑Addressee ssee so that we can return the card to you. B. Received by(Printed Nam) JC. Dae f livery ■ Attach this card to the back of the mailpiece, O or on the front if space permits. D. Is delivery address different from item 1? Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No Centerville Asso.ciates i 297 North.Street 1 3. Service Type Hyannis,MA 02601 i�certified Mail ❑Express Mail ❑Registered Il etum Receipt for-Merchandise❑Insured Mail C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number { 7008 3 2 3 M 0'D 02;'S 17 7{ 9 4 8`0;,! }t (Transfer from service fal ; , , PS Form 3811,February 2004 Domestic Return Receipt S W 902595-02-M-154U " I UNITED STATESPM111 r x,: • -s„�. cup. Fjtl ..Sd • Sender: Please print your name, address, and ZIPWIn this box • I I �d�''O. Town of Barnstable °"' Health Division 200 Main Street I Hyannis,M:A 02601 Certified Mail#7008 3230 0002 5177 9480 VE r ti Town of Barnstable P �• Regulatory Services BARNSTABLE. "", Thomas F. Geiler, Director ArFaMa' Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 26,2010 Centerville Associates 297 North Street Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170 The property owned by you located at 1815 (134) Falmouth Road, was inspected on August 25, 2010 by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.552- Screens for Doors: Front entrance door not provided with screen door as designated by above code. 105 CMR 410.351 —Owner's Installation and Maintenance Responsibilities. Wires within light fixture in second floor hallway are exposed and frayed. 105 CMR 410.100 - Kitchen Facilities. Cabinets within kitchen are not properly secured to wall. They are not in good repair and in every way fit for the use intended. You are directed to correct the violations listed above within thirty.(30) days of your receipt of this notice by replacing or repairing screens within kitchen; by installing screen door in front entrance door; by replacing light fixture. 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. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. R OF THE BOARD OF HEALTH cKean, R.S., CHO Director of Public Health Town of Barnstable QAOrder letters\Housing violations\Rental ordinance\1815 Falmouth Road 134.doc I Certified Mail#7008 3230 0002 5177 9480 T" ram,, Town of Barnstable Regulatory Services A1AS S c Thomas F. Geiler, Director t63� �$ �rFnMa' Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 26, 2010 Centerville Associates 297 North Street Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170 The property owned by you located at 1815 (H5) Falmouth Road , was inspected on August 25, 2010 by Timothy B. O'Connell, R.S.,!Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.5517 Screens for Windows: Window's within kitchen area had large holes in them. 105 CMR 410.552- Screens for Doors: Front entrance door not provided with screen door as designated by above code. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by replacing or repairing screens within kitchen; by . installing screen door in front entrance door. 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. Non-compliance will result in a fine of$1.00.00 per violation. Each day's failure to comply with an order shalt 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. R THE BOARD OF HEALTH omas cKean, R.S., CHO Director of Public Health Town of Barnstable Q:\Order letters\Housing violations\Rental ordinance\1815 Falmouth Road H5.doc 'I I �� TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date GU Time: In Out Owner c OL • �'" Tenant Address Address �4 Compliance Remarks or Regulation# Yes NO Recom endations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities •r- 7. Lighting and Electrical Facilities 8.Ventilation � ,e � 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 QQ 19. Number of Tenants Observed l p� �l N 2-- PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition 22 Number of Bedrooms Number of Vehicles Allowed (max) J Number of Persons Allowed (max)Person(s) Interviewed InspectorR0,0 Lj ' . If Public Building such as Store or Hotel/Motel specify here TOWN OF BARNSTABLE BOARD OF HEALTH 44 ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date 0 f U Time: In Out Owner r �'� Tenant Address a Address Compliance Remarks or Regulation# Yes NO Recom ions 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8.Ventilations 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 22 19. Number of Tenants Observed ( p� rJ �. N �t� 3 ( �Z-- PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms. �-- Number of Vehicles Allowed (max) Number of Persons Allowed (max) U C -�- . Person(s) Interviewed Inspector <� - If Public Building such as Store or Hotel/Motel specify here � TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date t5 Time: In Out Owner � Tenant Address Address 4 5 Compliance Remarks or Regulation# Yes O Recommendations 2. Kitchen Facilities 3. Bathroom Facilities Vr 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation Q 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 f� 18. Driveway Width 19. Number of Tenants Observed ll PART II f 01 i(oU 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms 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 TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date t5 0 ' l U Time: In Out Owner As � Tenant Ikil Address T' /"" Cy�'` '\ Address S Compliance .Remar"kstor Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply t klz 5. Hot Water Facilities 6. Heating Facilities Ir 7. Lighting and Electrical Facilities 12 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 IV 18. Driveway Width 19. Number of Tenants Observed PART 11 t 6d 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms ' Z- 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 Postal Q- n co .. • in nly;No Insurance Coverage Provided) � I For delivery informatin visit our website at ,� m Postage $ �'a,N�S "W o OCertified Fee O Return Receipt Fee NOV P H`168 (Endorsement Required) C3 Restnoted Delivery Fee rl (Endorsement Required) co C3 Total Postage&Fees $ USPS —0 p Sent To r_ . } � .................... 3oYri PeO dCN0.etp Box No. C- "State ZIP+4 67 &Z Certified Mail Provides: A mailing rec 1es�aney)ZpoZ eunf'006e u�J Sd ent ■ A unique identifier for your mailplece :m A record of delivery kept by the Postal Service for two years bnportant Reminders: ■ Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. is Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■for an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. i • For an additional'fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". 0,If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and.affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and PPOs. SENDER: COMPLETE THIS SECTION qOMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. gnature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X' ❑Addressee so that we can return the card to you. B, Received by(PH ame) C. Date of Delive ■ Attach this card to the back of the mailpiece, 1 ✓/, or on the front if space pe its. l/ D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No i L� © � ' I � Q0 (�.2 3. Service Type LYE %Certified Mail ❑Express Mail r,vcw 1 ❑Registered ❑Return Receipt for Merchandise - / `� 3 ❑Insured Mail ❑C.O.D. �'� 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number i (transfer from service late/)} r 7 0 "6 0 810 y PS Form 3811,February 2004 Domestic Retum 0 3521 8 8 0 9 32595- -M-1540 _�� UNITED STAT�%SLLt.;. FTO;E411A.02—.S,-; . as es 07 NOV 2-008 PM • Sender: Please print your name, address, and ZIP+4 in this box • I I Olt Town of Barnstable Health Division 200 Main Street Hyannis,MA 02601 I . «1;„i:�:';� iilrrtti�e�r/trt'�rrrrrr�)rlrrf��)irrllttutlr�flrFr7�:rrrlfr�s� [1 'J Town of Barnstable BARNST"LE, ; Regulatory Services v$ 1 MASS. �•� Thomas F. Geiler,Director ArFD��A Public Health. Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 1,1041- � NUMBER OF PAGES TO FOLLOW: TO: FROM: �41 K A sue.; M F_ CA e)O-T PH,ON PHONE: (508)862-4644 FAX HOME: FAX PHONE: (508)790-6304 cc: RRk x eo o re�ieW'' RepA NOTES/COMMENTS: ILA 1�. l..�\' �vOCL i—�iA�\C1� t-i2t� ti� 7' v� —T® i K 1-e p,��S A �� � •►.S QAFax Form.doc a Town of Barnstable Barnstable P � Regulatory Services De artment A�-AmmicaCity 1 Ii R,RAFLNS'CAE3LE, ` � f " 39 i6Ch Public Health Division °\ .� W oIFoMA3a, 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 568-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL 7006 08 10 0000 8809 November 5, 2008 Louise Cintron 1815 Falmouth Road, Apt. G2 Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE I1- MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property rented by you located at 1-8mouth,Road;`Apt:G2, Centerville, was inspected on November 4, 2008 Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.190—Hot Water. Gas was turned off at the time of inspection. Hot water not held between 110°F and 130°F. 105 CMR 410.750 ( C ) - Conditions Deemed to Impair Health and Safety. Gas has been shut off because of failure to pay utility bills. You are directed to correct the violation listed above within five (5) days of your receipt of this notice by restoring the gas and providing hot water. The occupant has stated that no one is residing at the dwelling. As the conditions present at the dwelling have the potential to impair the Health and safety of the occupants, persons are not authorized to reside and/or sleep at this dwelling. You may request a hearing before the Board of Health if written petition requesting same is received within ten(ten) days after the date the order is served. 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. momasAMcKean,'R.S., questions regarding the above violations, please contact the Town sk to speak with the inspector who performed the inspection. HE BOARD OF HEALTH , R.S., CHO Director of Public Health Town of Barnstable CC: Centerville Associates, Inc. ` Town of Barnstable OF THE T T Regulatory Services Barnstable Thomas F. Geiler,Director ;mericaCity Public Health Division ' I * BARNSTABLE, "� MASS. �, Thomas McKean, Director 2007 i639' A`0 200 Main Street FD MA't Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 September 4, 2007 Louise Cintron 1815 Falmouth Road, Apt. G2 Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II-MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property rented by you located at 1815 Falmouth Road, Apt. G2, Centerville, was inspected on August 27, 2007 by Meredith Morgan, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.190 — Hot Water. Gas was turned off at the time of inspection. Hot water not held between 110°F and 130°F. You are directed to correct the violation listed above within five (5) days of your receipt of this notice by restoring the gas and providing hot water. You may request a hearing before the Board of Health if written petition requesting same is received within ten (ten) days after the date the order is served. 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 Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable CC: Meredith Morgan, Health Inspector FORM 30 c&w HOBBSS WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN W C-7H DEP RTMENT TA JUL ADDRES M 5ey`a v1 y�A G(�'t/-/ a`"' TELEPHONE Addre Occupant 0Lj Ci le-or) Floor ` Apartment No. 6a9— No. of Occup No. of Habitable Rooms_1 _ o.Sleeping Rooms C-- No. dwelling or rooming units_ _ No.Stories._ Name and address of own r ! N Ted 4 J//LC-JE ��C.lV o 4 V/6 L,f 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: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: 210 Hall, Floor,Wall,Ceiling: C= f- rQ N(. 1.0 Hall Lighting: !L- Hall Windows: HEATING Chimneys: Central ❑Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: \0 PLUMBING: Supply Line: V,�IL-- 'Iv t,3 ❑ 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 ff2E Bedroom Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,V Safeties: Kitchen Facilities Sink AJ Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF P RJURY." INSPECTOR TITLE ��' S 110 A.M. DATE "� TIME /r 00 A.M. THE NEXT SCHEDUL D REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of 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(8)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. i (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. FORM 494 - SUMMONS WITH OFFICERS RETURN DUCES TECUM REVISED DEC. 1971 HOBBS & WARREN. INC PUBLISHER!g BOSTON. MASS, JAN I ZA BARNSTABLE /7 ......................................................... EEE Barnstable Board of . .......................0..................................... Health, 200 Main Street, Hyannis, MA ---- - _ - I .......................................... .................................................................................................................. ................................................ ..................................................................... .......... ................ ....................................................................................................................................................greeting. jou art 4trelig rquirrb. in the name of 'The Coln 11jon wealth of Massachusetts, to appear before the...B.ar.ns.t.ab.l!�...D.i.s.t.r.i c.t...............Court . .... .... . .... .. .......................................... bulden at Barnstab e ..................... .........vithin and for the county of.....Barnstable on the...........1.7.t.h................................................day of.....��!�uary, 2008 ........................................................at 9:00 . ..................................0 clock in the....fore noonj and froin da-j, ............ to day thereafter, until the action hereinafter named is heard by said Court, to give evidence of what you know relating to an action of...summaxy...px.Qc.ess....thcn and there to be heard. and tried 1,etween Centerville Associates, Inc. .......................................................................................................................................Plaintiff an d Brian Misiaszek, et al ....................................................................... ...........,.Defendant and you arc further required to bring with,you.... ..from..Ja nuar 1 , ......**.. ..............y.... 2 00 7 t o dat e wit h re s pe ct to p rem i s es at 1 8 1 5 F a lm 6u t h R o'a d u n i t .. . .. ...... .. ...... .. .... . .... .... .... .. ...... . .. .... .... .. . . .. .. . .... .... . .. ...... .. . .. . .... Centerville, MA Occupied by. Br ian Misiaszek and Melissa Gipe 7 .................................................... ............ .............................................................................. ............. .................... ................................................................................................................................................................ ................................................................................................................................................................ .........................................................................................................................................I....................... ............................................................................................................................................................... ijertat fail not, as pit will ansiver your default under the pains and penalties in the law In that behalf made and provided. 4qDaub it ....e.. ..........................................the....... .......................\........day o A. D. 19 ............. 0�,� - 4� ... -*...***.......... Notary Public**—-"J'U*$'t ice of the PeaLc 80 14�- "Iry o a 4 A �� - ,' c, '� <;, y � y i 4 •. _4 1 4 k �� . :j., r. i r 4. '�' �1 � t '1 i 1 '.:\ .. i 1 � , Town of Barnstable °FTHe, Regulatory Services ti Thomas F. Geiler, Director sA ASS.�.M � Public Health Division ' 9 MASS. g 4' i639. s`0 Thomas McKean, Director p�FO N1P� 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: Sewage Permit# Zoj 13 Assessor's Map/Parcel Installer & Designer Certification Form 1I11 k Designer: �JSDC-IP1`1_5'_S Installer: Address: Address: On was issued a permit to install a (date) (installer) septic system at t$ls qt u. - ?--i. (;Eu. g JtuAg &A based on a design drawn by (address) dated (designer) 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. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &. ulations. Plan revision or certified as-built by designer to follow. Stripout inspected and the soils were found satisfactory. JDAB 1� ( stallex's Signature) o. 110 ( i ne ' ire) (Affix Designer's Stanip He e) PLEASE RE URN TO BA STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY ■ Complete items 1,2,and.3.Also complete A. Sig ture a Rem 4 If Restricted Deliv6iy Is desired. �` ❑Agent ■ Print your nameand address on the reverse X ❑Addressee so that we can return the card to you. eceived by,(Pnnted ame ' C�. Date'of Delivery ■ Attach this card to the back of the mailpiece, l/J111�UU or on the front if space permits. l D. Is delivery address different from item 1? Yes! 7 1. Article Addressed to: \ If YES,enter delivery address below:1 ❑ o, CjE'n\ 11��1EjS©C�cvS � � I nn`t 7 ®2 O 3. Service Type I U Certified Mail ❑Express Mail ❑Registered ®Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number �; € 70UuO710 "0005 5;82Dtt74�41 (Transfer from service Iabeq F t l i t i 1 r,t,t( \c u l t t t t 1 PS Form 3811,February 2004 Domestic Return Receipt 10265-02-10-1540 UNITED STATESP ��11 €RYIC. .>,w IT ,1v �; f=irst��ts t4 ' f e& s Paid `^?}.fieit N04' �gl ar 'Iw,Rt • Sender: Please print your name, address, and2ZIP+4 in this box • OTown of Barnstable F Health Division 200 Main Street I —� HA,pinnis_vMA_02601 —J i�lfFlilli�l��ilki41ili1Illtilii�l!llliisi3l}ill'.11iiIiliil�=.4 Copy Certified Mail#7007 0710 0005 5820 7441 P,oFjNF r,-wti Town of Barnstable r� Regulatory Services 4 nARNSl'ABLE. . MASS. m Thomas F. Geiler,Director Opp i639• �� rFD MAt A Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 December 18, 2007 Centerville Associates 297 North Street Hyannis, MA 02601 NOTICE TO. ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 1815 Falmouth Road H6 Centerville, was inspected on December 7, 2007 by Meredith Morgan, Health Inspector for the. Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.351 — Owner's Installation and Maintenance Responsibilities. Open outlets in upstairs and downstairs hallways. 105 CMR 410.500— Owner's Responsibility to Maintain Structural Elements. Leak in kitchen over stove with peeling paint on ceiling. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by repairing all outlets so they are wired properly; by repairing leak, removing peeling paint and repainting. 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. QAOrder letters\Housing violations\Rental ordinance\1815 Falmouth Road H6.doc r 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 whoperformed the inspection. PER ORDER OF THE BOARD-OF HEALTH s A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Meredith Morgan,Health Inspector t QAOrder letters\Housing viol ations\Rental ordinance\1815 Falmouth Road H6.doc P FoRM30 C&w HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS ti BOA OF HEALTH C TY/TOW d a r D ARTMEN� #T Mao DRESS 41M SVOy`e� --If--� LEPHONE Address /g/� '`�"-- Occupant YN fo"'T-" Floor Apartmentn1 o._H No.of Occupants.. No.of Habitable Rooms No.Sleeping Rooms__ No. dwelling or rooming units. Np t nes ..►►-. /� Name a d add ess of wne V I f�J%/''it .w - �(,J s t P 00 1 Remarks Reg. Vio. YARD Out Bld s.: Fenc ' 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: f Chimney: d &A BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 0 220 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 INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTFFE &.' _ INSPECTORTITLE /�/� DATE TIME �VD P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of 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 inIevery 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. COMPLETE • COMPLETE THIS SECTION ON DELIVERY ■ Complete items,P 2,cnd'r3.Also complete A. Signature item 4 if Restricted Delivery is desired. X J ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received (Printed Name) C,p to of�Jellv ■ Attach this card to the back of the mailpiece, t� _ r 1 or on the front if space permits. D. Is delivery addr6s different from Item 1 T 1. Article Addressed to: If YES,enter delivery address below: fy\A 02(s O\ 3. Service Type y 1 ®Certified Mail ❑Express Mail ❑Registered 0 Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number jj 7003 1680 00'041 54.58 i 554'S '0I (riansfer from service labeo PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540. UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid u-TPS :' M Permit No.G-10 • Sender. Please print your name, address, and ZIP+4 in this box • I I "Town.o.('.[rarnstable I Hyannis,_MA. !.)260i I I �It?FB??f3ifi}!Fi1Ff?FFi�iili?{iiFiBli4IF?fIBi�33??�I?BF?�iI?[ � Certified Mail#7003 1680 0004 5458 5545 IKE TO�ti Town of Barnstable Regulatory Services • BARNh-rABLE. v� M A SM ,�� Thomas F. Geiler, Director MAMA Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 September 12, 2007 Centerville Associates 297 North Street Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II— MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 1815 Falmouth Road Unit I1, was inspected on August 31, 2007 by Tim O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Chronic dampness throughout home; bedroom window does not open; mold observed at bedroom window. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by preventing chronic dampness and mold by ensuring all doors and windows are weather-tight; by repairing window in bedroom so it opens and closes as intended. 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. QAOrder letters\Housing violations\Rental ordinance\1815 Falmouth Road Il.doc c 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 HE RD OF HEALTH <oma cKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Tim O'Connell, Health Inspector QAOrder letters\Housing violations\Rental ordinance\1815 Falmouth Road ILdoc FORM.30 Cl+W HOBBSE WARREN M THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H L CITY/TOWN � F ARTMENT ' ADDRESS GSM 5 By`aW TELEPHONE h Address I a Occupant Floor Apartment No. No. of Occupants No. of Habitable Rooms No.Sleeping Rooms2___ No. dwelling or rooming units No. tories .. Name and address of owner ,, emarks 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: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin � STRUCTURE INT. Hall,Stairwa : 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 , d Bedroom 2 t (l Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: ,AijQks, Flues,Vet eties: Kitchen Facilities Sin ove 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. ee Over) "THIS INSPECTION REPO T S SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES PERJU INSPECTOR TITLE A.M. DATE TIME `� I P.M. f A.M. THE NEXT SCHEDULED REINSPECTION ` P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are,deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the 41 2 minimum requirements of fitness for occupants or the public. Because Chapter II, 105 CMR 410.100 through0 6 0 state q P 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. in on a dwelling or dwelling unit in violation of the Massachusetts Department of Public (J) The presence of leadbased paint g g p 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. O Y An other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- I 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. SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si ature Item 4 if aestricted belivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return 4he card to you. B. Received by(Print Name) C. D to of D live ■ Attach this card to the back of the mailpiece, - I Iq or on the front if space permits. D. Is delivery addr6ss different from item 1? ❑Y 1. Article Adddress--ed,,to: If YES,enter delivery address below: ❑ I 3. Service Type 0 Certified Mail ❑Express Mail ❑Registered ■Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2-Article (rmnsfer frromeserWce iabei) ► 117 0 013 016'8 0; 0 g 0 4 s 5 4 5 8 ',5 42 2 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 i UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LJSPS Permit No.G-10 • Sender. Please print your name, address, and ZIP+4 in this box • Tows:of Barnstable Health Division "< 200 rdain Street Hyannis,MA 02601 i L� 3 Certified Mail#7003 1680 0004 5458 5422 Town of Barnstable .� �. Regulatory Services • IiARNSfABLE. 9$pi aMASS. g Thomas F. Geiler,Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 31, 2007 Centerville Associates 297 North Street Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 1815 Falmouth Road A3, was inspected on August 29, 2007 by Tim O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.484—Building Identification. No building ID affixed to dwelling unit. 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Front storm door lacking handle; torn rug throughout apartment in need of replacement. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by affixing unit number to dwelling; by providing handle for front storm door; by replacing rug throughout apartment. 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. 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. QAOrder letters\Housing violations\Rental ordinance\1815 Falmouth Road A3.doc 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. PE RDE TH BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Tim O'Connell, Health Inspector Q:\Order letters\Housing violations\Rental ordinance\1815 Falmouth Road A3.doc ° FORM30 CEw HOBBSB WARREN'M THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEAL W CIT1:/ 7 ' c atPEORTMENT �G1M SVBy`0 ADDRESS � T EPHONE � Address Occupan Floor Apartment No. No.of Occupants � No.of Habitable Rooms No.Sleeping Rooms— No.dwelling or rooming units No.St s a ,�.- _ Name and address of owner 9- l 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.: N-0 ❑ B ❑ F ❑ M Doors,Windows: CzrL Roof o �" 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 l Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: S _ ks, Flues,Vents Safeties: Kitchen Facilities ink _ ve Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General BuildingPosted Locks on Doors: ONE OR MORE OF THE VIOLATIO S 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 REPORAISGRNED AND CERTIFIED UNDER THE PAINS AND PENALTIES WER UR�" INSPECTOR TITLE /� A.M. DATE V TIME , 6 . P.M. THE NEXT SCHEDULED REINSPECTION 1 P.M. c 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. III COMPLETE •N COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature Rem 4 if RestriJted Delivery is desired. ■ Print your name and adJress on the reverse X ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. ate f Delivery ■ Attach this card to the back of the mailpiece, i l l � or on the front if space permits. l D. Is delivery address different from Item 1? OQ 1. Article Addressed to: If YES,enter delivery address below: ❑ I 3. Service Type 6 Certified Mail ❑Express Mail ❑Registered 18 Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number �abeq 7 0 0 7 710 0005 5821 2476 (rmnsfer from service PS Form 3811,February 2004 . Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • I • Sender: Please print your name, address, and ZIP+4 in this box • I I I I Town of Barnstable ' Health Division 200 Main Street I L�__ Hvannis rM.A:02601.___--__ -J «r: R Certified Mail#7007 0710 0005 5821 2476 �OpIHE ro Town, of Barnstable �. Regulatory Services IIA RNSTAIILE, + 6 SS. `gym Thomas F. Geiler, Director 39 Ar 1 MAW N., Public Health Division Thomas McKean,Director r ) l v 200 Main Street, Hyannis, MA 02601 G Office: 508-86274644 Fax: 508-790-6304 November 7, 2007 Centerville Associates 297 North Street Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 1815 Falmouth Road A4, was inspected on October 9, 2007 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the Town of Barnstable Code were observed: 1§ 70-10—Smoke Detectors and Carbon Monoxide Alarms. Inoperable smoke detectors throughout unit. You are directed to correct the violations listed above within twenty-four (24) hours of your receipt of this notice by repairing or replacing inoperable smoke detectors. 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. 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. QAOrder letters\Housing violations\Rental ordinance\1815 Falmouth Road A4.doc 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 OARD OF HEALTH �T McKean R.S. CHO Director of Public Health Town of Barnstable Cc: Timothy O'Connell, Health Inspector Q:\Order letters\Housing violations\Rental ordinance\l815 Falmouth Road A4.doc FORM30 C&w HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD �FTH CITY�TOWNI 4 d a DEPARTMENT � ADDRESS GSM svey`e TELEPHONE Address A 1 — Occupan Floor Apartment o. No.of Occupants No.of Habitable Rooms No. beeping Rooms— No.dwelling or rooming units__ nits No.Stories Name and address of owner 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: I VJ2Z Iiin �( Walls: �1 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 Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 11220 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 1IOU Bedroom 2 160 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: . ks, FI s V afeties:. Kitchen Facilities Sin Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other.- Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION O T IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTTE OF JU i INSPECTOR TITLE 1 DATE ©�� ` L TIME I _ A.M. THE NEXT SCHEDULED REINSPECTION P.M. f n 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 4110.830 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 Ieadbased 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. Town of Barnstable IKE t � Regulatory Services t kBA$N'CABLE, Thomas F. Geiler,Director sNASS. g Public Health Division A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 October 9, 2007 Attn: COMM Fire Health Inspector Timothy B. O'Connell conducted a rental inspection in accordance with Chapter 170 of the Town of Barnstable Code. In accordance with the State Sanitary Code, 105 CMR 410.482, the Health Department is required to notify the Fire Department if there is a smoke detector violation, or possible smoke detector violation. The following property had possible smoke detector(and\or CO detector) violation(s): _1815 Falmouth Rd. Ant. A4 Centerville,Assessors Map-Parcel: (189-055): No working smoke detectors within unit. Meredith E. Morgan -Health Inspector QAOrder letters\Housing violations\Rental ordinance\\Fire ViolationsTIRE TEMPLATE.doc COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,.4nd 3.P:so complete A. Signa item 4 if Restricted ISCIvery is desired. ❑Agent ■ X Print your name and address on the reverse ❑Addressee.. so that we can return the card to you. B. Received by(Printed Name) C. ate of Delivery ■ Attach this card to tha back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1 ❑jP�Q(� 1. Article Addressed to: If YES,enter delivery address below: ❑�r�IJl 1 3. Service Type ED certified 13 maji mail ❑Registered $Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number to Tq 0 7 710 i 0?;0 5 4 5 8 21 2 48 3 (Transfer fromservlcelabe!) t; x E PS Form 3811,February 2004 Domestic Return Receipt 10259M2-M-is4o i UNITED.STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 I Sender. Please print your name, address, and ZIP+4 In this box I I I I I � � I Town of Barnstable 03 Health Division M 200 Main Street To Hyannis.MA 02.601 —..,— 1 ! tt i 1} 4} . 1t?sisi:tB114E4't::.'.{; i �t=� 1I11? ia �� ?'i3i7ii f - .Y ti Certified Mail#7007 0710 0005 5821 2483 �OpSHE T�wti Town -of Barnstable I Regulatory Services 7 :AS' ,�� Thomas F. Geiler, Director ArfD 9. MA'S� Public Health Division Thomas McKean, Director . 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 7, 2007 Centerville Associates 297 North Street Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II— MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 1815 Falmouth G5 Centerville, was inspected on November 7, 2007 by Meredith Morgan, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received by the Health Department, as well as in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.351 —Owner's Installation and Maintenance Responsibilities. Inoperable stove burners; broken kitchen cabinet; electrical outlets in front bedroom are inoperable. 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Water damage and chronic dampness observed throughout apartment. 105 CMR 410.501 —Weathertight Elements. Window in front bedroom leaks. The following violations of the Town of Barnstable Code were observed: 1� 70-10—Smoke Detectors and Carbon Monoxide Alarms. Smoke detector on first floor is damaged due to leak. QAOrder letters\Housing violations\Rental ordinance\l815 Falmouth Road G5.doc You are directed to correct the violations listed above within twenty-four (24) hours of your receipt of this notice by replacing smoke detector. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by replacing water damaged carpet; repairing water damaged walls and ceilings; replacing or repairing front bedroom window so it is weathertight; replacing broken cabinet; repairing stove burners; repairing inoperable electrical .outlets. 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. 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 TH OARD OF HEALTH as cKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Meredith Morgan, Health Inspector QAOrder letters\Housing violations\Rental ordinance\1815 Falmouth Road G5.doc FORM30,., HOBBSB WARREN TM THE COMMONWEALTH.OFMASSACHUSETTS r BO D OF H ALTH CITY/ OWN b 6DEAP RTMENT c, AD SS GSM 5 6 u �,/,, TELEPHONE J V'� /Address _ OccupantB r k's'l•s a 6 k, 4 Floor Apartment No. && No.of Occupants__ Ma-'j65 (3-1v .Q No.of Habitable Rooms No.Sleeping Rooms__ No. dwelling or rooming units No.Storie, Name /and 2address /o�f,/o�w,neer ✓V 1 �1� OC. �'7 T /Vv1�`d'�, I v I(JIV �Q Remarks Reg. Vio. YARD Out Bld s.: Fen es: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: U y I Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: N Foundation: Chimney, BASEMENT Gen.Sanitation: Dampness: RTI Stairs: Y bJQ✓ Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: 4AJ Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: a ❑ 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: DWELLINO 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: Jn 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: 4 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 I SPECTI PORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENAL S F R U ' INSPECT0 TITLE aQ4)0eP V DATE � D TIME 130 P• A.M. THE NEXT SCHEDULED REINSPECTION P.M. - H 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(sf 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. 1 CMR 410.482. N Failure to provide a smoke detector required b 05 O P q Y (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 n (2) Failure to provide a washbasin and shower or bathtub as required i �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. SECTIONSENDER: COMPLETE THIS COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4.if Restri671ed Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you.■ Attach this'card to the back of the mailpiece, B. Receiv In MANU' ted ame) C.19 ate of Delivery or on the front if space permits. � D. Is delivery address different from item 1? 1. Article Addressed to: If YES,enter delivery address below: Vk—t c.�,st S f M fR OZCa-p \ 3. Service Type ®Certified Mail ❑Express Mail ❑Registered D Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes s. ((rrmnsfer from sendce kbeo .rot i i i r ,p 0 3 1`6 8 0 Vb 0,0 4 5 4 5 8 j 5 5 5 11 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 1 i UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USP§ Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this bok• ,fide s Town of Barnstable _: c Health Division \` ��°Mp�� 200 Main Street Hyannis,MA 02601 il. !!!!!lit!11H11!ii!:i6l:1!! s!! 1i!i!il!llii!!II!!ie r !1 f t u+d `rS Certified Mail#7003 1680 0004 5458 5552 SHF A Town of Barnstable r Regulatory Services r + BARNSCABLE. 9� I b q 1�g Thomas F. Geiler,Director ""AYA Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 September 12, 2007 Centerville Associates 297 North Street Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 1815 Falmouth Road H4, was inspected on August 31, 2007 by Tim O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Peeling floor in kitchen. You are directed to correct the violations listed above within thirty(30) days of your receipt of this notice by replacing peeling kitchen floor. 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. 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. QAOrder letters\Housing violations\Rental ordinance\1815 Falmouth Road H4.doc PER ORDER OF THE S RD OF HEALTH Thom a A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Tim O'Connell, Health Inspector QAOrder letters\Housing violations\Rental ordinance\1815 Falmouth Road H4.doc FORM30 C&W HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAJ�H C Y/TOW W DEPARTME T 4 ADDRESS GSM sey`e T LEPHONE 94 Address ' — Occupant_ Floor Apartment No. ALA No.of Occupants__ No. of Habitable Rooms 102, No.Sleeping Rooms_ No.dwelling or rooming units J�o.St s� Name and address pof o ner 9` l Remarks Reg. Vio. YARD Out Bld s.: Fences: pz 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.: t - 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.: _5tqcks, Flues,V ts,Safeties: Kitchen Facilities Si love 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 V101 8TIONI 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 REP IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJUR INSPECTOR / TITLE i r DATE_ r 1 TIME ` vy 7 A.M. THE NEXT SCHEDULED REINSPECTION � P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises,shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of 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 Jiolation(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. SENDER: C•MPLETE THIS.SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si ure Rem 4 if Restricted Delivery Is desired. ❑Agent ■ Print your name and address on the reverse X' [3 Addressee so that we can return the card to you. oeived by Printed N C. ate el' ry ■ Attach this card to the back of the mailpiece, V'�\ or on the front if space permits. D. Is delivery address different from item 1? s 1. Article Addressed to: If YES,enter delivery address below: o E0/e f \Nl- ciC "4 3. Service Type 13 Certified Mail ❑Express Mail ❑Registered Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (rmnsfer from service fabeq 7 0 3 16 8 0 4 5.458 537 8 1 j I; PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 ll— I I I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 I I I • Sender: Please print your name, address, and ZIP+4 in this box • I I Town of Barnstable Health Division 1 200 Main Street Hyannis,!VIA 02601 i .K Certified Mail#7003 1680 0004 5458 5378 VE r, Town of Barnstable o� Regulatory Services BARNS-rABLE. 9 MASS g Thomas F. Geiler, Director 1639. �prED MA'S A,� Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 27, 2007 Centerville Associates, Inc. 297 North Street Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 1815 Falmouth Road I3 Centerville, was inspected on August 27, 2007 by Meredith Morgan, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.351 —Owner's Installation and Maintenance Responsibilities. Broken bathtub faucet; electrical outlet in upstairs bathroom not properly affixed to wall. 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Peeling paint and chronic dampness observed in upstairs bathroom and around perimeter of ceiling. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by removing and repainting peeling paint; by repairing or replacing broken bathtub faucet; by properly affixing electrical outlet to wall. 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. QAOrder letters\Housing violations\Rental ordinance\1815 Falmouth Road 13.doc I I t 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. ORDER OF E BOARD OF HEALTH T o as A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Meredith Morgan, Health Inspector QAOrder letters\Housing violations\Rental ordinance\1815 Falmouth Road 13.doc FORM30 C&w HosBs&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS • B RD OF HEALTH CI /TOWN W o XPARTMENT iS D c, 0061 RESS 4�M svoy`0 6V)&8?' _W4XI tELEPHOXf _ ,Address Occupan Floor Apartm n No. No.of Occupants "� No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No. ories _ Na��r�ad res�f owner ��i� 1(A'!f�S off-' 00 Remarks Reg. Vio. YARD Out Bld s.: Fence 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: I/ Hall Windows: HEATING Chimneys: i1/ Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: r ❑ 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, Flu s,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 Buildin 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 PORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENAL O VU . INSPECTOR TITLE DATE U�Ia IUT ���w TIME P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of 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. (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. CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT 1875 ROUTE 28 s. CENTERVILLE, MA 02632 (508) 790-2380/FAX*(508) 790-2385 _ r OIL/HAZARDOUS MATERIAL RELEASE FORM F.A.* 1? - '- LOCATION: ADDRESS OF RELEASF/-,CV I a ,f j Ik s" fM�� 1�I f h,v-ry.t ✓,i , MA DATE OF RELEASE: 1+ /1 1 �. PRODUCT RELEASED: '_ s -ESTIMATED QUANTITY: 5'-.10 CORRECTIVE ACTION TAKEN BY RESPONSIBLE PARTY: CVDNL &-' -Mv/Wit/ 72) Fj� fr fe ;5 NOTIFICATIONS: FIRE DEPARTMENT: YES(VT NO( ) DATE: 11 Zfj J20,1) TIME:_iWl-,to �., 8&7 A, NATIONAL RESPONSE CENTER YES(�f NO( ) DATE: L&-, , IME: r" ' Pfxtf 5� DEPT. OF ENVIRONMENTAL PROTECTION YES(X NO( ) `DAt u: TIME: OIL SPILL COORDINATOR: YES( ) NO( ) DATE:!I TIME TOWN BOARD OF HEALTH: YES( NO( ) DATE:�_TIME: zgA Tom M�d(�-ter, TOWN HARBORMASTER: YES( ) NO( ) DATE: � TIME: OTHER AGENCIES: ST-A-r-f.01 ... COMMENTS:- i l s a•- 4-1-0 4-p n rA rdn..r1 g_ u de l/ S n..) 1 .lc C 1, f /ln /4t �✓! / L J1, A/ IL,s ar Art A, a x 44,MA,Al,n.i,- / L -PA-1,l)r,rril 0AJ 1 x, .t AP REPORTED BY: �' A lax-rr DATE- lz WHITE COPY—FIRE DEPARTMENT YELLOW COPY—D.E:P, PINK DOPY—BOARD OF HEALTH C-O-MM FORM *58 i F ♦ s V J V�"'�'Y �1 IWUL�1 1V=VM11-NL r. ✓ Date — Physical Street Address-Check database to ensure it exists Working Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials-no blanks) Storage Information - location of storage, how long is storage for? /If none, note that. V Disposal Information -where and who? If none, note that. Applicant Signature - understand what is listed and noted /Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and explain it Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. .., YOU WISH TO OPEN A► BUSINESS? J? ' For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: J L L Fill in please: 7. r•'y1:r' r - r:::rrr�.r:r �I APPLICANT'S YOUR NAME/S: ( 'll BUSINESS YOUR HOME ADDRESS: 191S Egkrg0,)-rH RJ -114-211 C - CE�I/T� 12c/ CCE -IYI� TELEPHONE # Home Telephone Number 0 r il 611.1 Moll C-_D 1 S S i L v F}nl I Q m ai 1 dco 4 NAME OF CORPORATION: NAME OF NEW BUSINESS C S Pr I yT i uQ TYPE OF BUSINESS ` A- ✓✓ IS THIS A HOME OCCUPATION? YES NO M ADDRESS OF BUSINESS ) 15 F 45 o uTN IZ> - (4 -Ce NTfRVILLE MAP/PARCEL NUMBER (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFF. This individual has been inf of any er it requirements that pertain to this type of business. i Aut orized Signature** COMMENTS: r` 2. BOARD OF HEALTH This individual has been Rfor ed of the permit requirements that pertain to this type of business. n oW Authorized Signature** MUV_COAIit N W ITH ALLY COMMENTS: u-A-40 t ft.j'AAi=M Aram e3fre��u i nia[+ 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: TOWN OF BARNSTABLE Dater- /fig /9-' TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: 1 P.S P,1 NTI A✓G7 BUSINESS LOCATION: 191E FKV100i1 R-�i) INVENTORY MAILING ADDRESS: fi r%- G6 jt.jj-FV?LLE —M A TOTAL AMOUNT: TELEPHONE NUMBER: 44-y�08 6Bq. CONTACT PERSON: Eb I Son/ EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: ?IA-lWT]VC`l - INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: j RIB SkV- ATA- i-oru Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Wi0°r /P 14-1 AIT' 7r-1n/VF--f— Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives(creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ""NEW ikUSED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers 0 Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signal re Staff's Initials_ N DEEP OBSERVATION gv rLE LOGS ` PIPES TO BE LAID LEVEL FOR ,n - - INSTALL R15ER5 COVER5 TO J DATE: 04-14-201 1 P-I 324G WITHIN G" OF PIN15H GRADE 2'-OUT OF D15TRIBUTION BOX u_j TEST BY: D. MEYE , R5 C:R (SEE PLAN VIEW FOR LOCATIONS , I,_, Q WITNESS: D. STANTON, HEALrH AGENT WATER TEST D-BOX FOR 2" LAYER OF PEA5TONE OVER Q PERC RATE: < 2 MIN. i INCH LEVELNESS FLOW 3/41' 1 %2 DOUBLE WASHED 5TONE EQUALIZATION m DEEP OBSERVATION BOLE#I EL. 54.0 �2€ -- 28 '..:. Q FROM 501E DEPTH 501E SOIL c>LOR 501E OTHER EL. 57.5 EL. 57.5 EL. 57. 'JIE O HORIZON TEXTURE (MUN.ELL) MOTTLING _ -. - - - LOCU5 SURFACE m411 o�L _ g SANDY LOAM I OYR'C/6 4" SCH 4 SCH TOP @ EL. .5 O 6 O PVC 40 PVC z 6 - 1 68 C I MEDIUM COARSE SAND 2.5`r//3 I 40 PVC ILI :.::.:. 500 GALLON PRECAST DRYWELL5 4 BOTTOM EL. 51 .75 .... ;.' � INSTALL GAS BAFFLE 54:30 5 . I3 O° Q IN OUTLET TEE 54.65 53.75 :: (EXIST:) DEEP OBSERVATION HOLE#2 EL 54.0 DB-9 -�- INSTALL TANK� D-Box NOTE: ALL NEW STRUCTURES TO BE H-20 LOADED DEPTH SOIL SOIL SOIL CL.OR SOIL ON 6" LAYER OF CRUSHED FROM �:_, OTHER SURFACE HORIZON TEXTURE (MUN5fL_Q MOTTLING - EXI5TING,2000 5TONE 0" 168" C I MEDIUM-COARSE SAND 2.5Y.7/3 GALLON .PRECA57 SEPTIC TANK BOTTOM OF TE5T HOLE @ EL. 40.0 i DEEP OBSERVATION HOLE#3 EL. 56:0 DEPTH SOIL SOIL 501L C6LOR SOIL ---- - OTHER 54 -------------'"-_-- SUROM HORIZON TEXTURE (MUN5I:LQ MOTTLING ------ ` 0" _ 3 B LOAMY SAND I OYR�>JC 56 _I -------------------------- \ 3 - 36" CI MEDIUM-COARSE SAND IOYR(>/4 3G" - 1 5G" C2 MEDIUM-COARSE SAND 2.5Y7/3 l 56.9 56.� 1 \\ DEEP OBSERVATION HOLE#4 EL 56.0 DEPTH OIL OIL GO.OR _ SOIL - SOIL 5 5 + F 1 / _. _ cm FROM � _:. __ 1 _ 1 TEXTURE MURk_.� MOTTLING _ ' HORIZON ( 7 _ 1 _- 57.9 SURFACE i- 1 5G.3 Th 0" _ 411 B LOAMY SAND I OYR(,/6 1 1 - 57.9 1 I . MEDIUM-COARSE SAND I OYRr:,/4 ------------------- #2 C I -• -•-"" �" I VENT T r- 37" - 156" C2 MEDIUM-COARSE SAND 2.5Y%`!3 '----_ 1 I • • • • i TN #1 , t 55. 1 i ---- ---- #3 I 1 ?Z,,-- LP- THE + LP BUILDING E NOTE: NO GROUNDWATER ENCOUNTERED IN ANY OBSERVATION HOLE -'` - #4 53.2 F"s T.O.F. @ EL. 5 3.8 ' I • + \ 53.5 -. BUILDING F r ; !1 55.8 + {' T.C .F. @ EL. 58.8 * EXISTING, - _ 1 O � 2000 GAL: SEPTIC TANK _ ' ET'NG SAS i _ ' - f �' x fir. / ✓ - 54.9 ! -- fx. � BUILDING H \ .. T. .F. EL. 54.8 54.5 r 0 @ , r; ---- --------- \ : BUILDING G �' \♦ . L I \ 1 ------------------ \ \ \ ----------------- / f r ----- ------ ---- \ i �2' I a.69 9 _ 1 --_ 1 76, , - _ -- - / 63.90 - -� i \ � I -,�,,, 387•g4 SITE SEWAGE PLAN FOR BUILDING F DE51GN DATA GENERAL'NOTES HOLLY HILL APARTMENTS -BUILDING F I . SEPTIC SYSTEM IS TO BE IN-•ALLED IN ACCORDANCE WITH 181 5 FALMOUTH RD., CENTERVILLE, MA DAILY FLOW: (8) 5EDROOM5 x 110 GPD = 880 GPD 880 GPD x 200% = 1760 GPD 3 I 0 CMR 15.00: TITLE V PREPARED FOR SEPTIC TANK: 2. TH15 SEPTIC SYSTEM 15 NOTD E5IGNED FOR THE USE OF A U5E: EXISTING 2000 GALLON SEPTIC TANK GARBAGE DISPOSAL. �L.rAPF q s CENTERVILLE ASSOCIATES, INC . 3. THI5 PLAN I5 NOT TO BE U5�D FOR PROPERTY,LINE DETERMINATION. �? q SCALE: 1, 1 DATE: DRAWN BY: DISTRIBUTION BOX: a E 1 _ 40 05-05-20 1 I TMW USE: DB-9 9) OUTLET D15TRIBUTION BOX 4. CONTRACTOR SHALL PROVID: 48.HOUK NOTICE TO DE51GN HAPPY CINCO DE MAYO ENGINEER FOR"ANY REQUIRED INSPECTIONS. c, =M. JOB NUMBER: REVISION: SHEET NUMBER: SOI L ABSORPTION SYSTEM: MEYr✓R 5. CONTRACTOR TO BE RE5PO�51BLE FOR THE LOCATION OF ANY No. 1140 1 0-040 5P-8 USE: (7) 500 GAL: PRECAST DRYWELLS LINED UTILITY, ABOVE OR UNDERGFOUND,PRIOR TO ANY EXCAVATION w/4' OF DOUBLE WASHED STONE ALL AROUND OR CONSTRUCTION. � c��z'�� WELLER ASSOCIATES G. EXISTING LEACH PITS TO'BE ,'UMPED DRY REMOVED, ALONG SQNl7AR�PN CAPACITY: WITH ANY CONTAMINATED 501L. I G45 FALMOUTH RD., SUITE 4C -�- P.O. BOX 4 17 CENTERVILLE, MA 02632 51DEWALL: I G I x 2 x 0.74 238.3 GPD P 2 WINDY WAY, #232 NANTUCKET, MA 02554 TELEPHONE * FAX: (508 775-0735 BOTTOM: 13 x 67.5 x 0.74 = 649.4 GPD ' TOTAL: 887.7 GPD EMAIL: tn5wcIIcr@comca5t.net REGI5TERED LAND 5URVEYOR5 ENVIRONMENTAL CON5ULTANT5 NOTE: ALL NEW STRUCTURES TO BE H-20 LOADED 7 Traverse PC ----------- ----------- DEEF OB5ERVATION t�, ,OLE LOG5 Ln PIPE5 TO BE LAID LEVEL fOR -14-201 1 P- I 32?rG DATE: 04 2' OUT Of D15TRIBUTION BOX Lu TEST 5Y: D. MEYER, R5 CS-k,�- IN5TALL R15ER5 GOVER5 To NOTE: VARIANCE 15 RIEQUE5TED TO 3 10 CMR 15.221 -(7) WITNE55: D. STANTON, HEALT;,-I AGENT Lu WATER Tf-5T D-BOX fOR 2" LAYER OF PEA5TONF OVER 7'0 ALLOW SYSTEM COMPONENT5 TO BE MORE THAN PERC RATE: < 2 MIN. INCH WITHIN G" Of IFIN15H GRADE < 3 LEVE LN E55 IF LOW /4" 1 V2" DOUBLE WA5HED 5TONE G` bELOW fIN15H GRADE. (L (5ff- PLAN VIEW fOR LOCATION5) 3 EQUALIZATION 5EKVATION HOLE#I EL. 54.0 DEEP OB ........... ---oFrTh-- ........... 501L 501L 501L 501L CX)LOR E- OTHER �28 f ROM TEXTURE (MUW"1-Q MOTTLING FL. 53.0 EL. 53.0 0 HORIZON EL. 54.0 4" 5CH In SANDY LOAM PVC - 50-7 LOCUS 0 5URFACE 011 G11 4" 5CH 40 40 PVC TOP @ f,1 -H A0 Pile- Z 0 G" - G811 c I MEDIUM-COAP,5E SAND 2.5Y7,13 41' 5( IT: 110 14" 500 GALLON PRECA5T DRYWELL5 a- LLJ GO 50 1301'� EL. 48-00 50. 7 IN5TALL GA5 BAFFLI/ L 50.00 f < IN OUTLET TEE 51 .05 (EXIST.) D13-9 DEEP 055ERVATION HOLE#2 EL. 54.0 INSTALL TANK D BOX NOTE: ALL NEW 5TRUCTURE5 TO DEPTH 501L 501L 501L CO,�t-OR 501L OTHER EX15TING 2000 �R Of CRUSHED H-20 LOADED. FROM LQ MOTTLING HORIZON TEXTURE (MUN STONE 5URFACE GALLON PRECA-9T M-COAR5E SAND 2.5Y-4�/3 011 1 G811 c I MEDIU 5FPT,IC TANK BOTTOM (�f TIff-5T HOLE @ EL. 40.0 DEEP 055ERVATION HOLE#3 EL. 5G.0 DEPTH 501L 501L 501L CQ�-OR 501L 54 ----------- f ROM OTHER HORIZON TEXTURE (MUN5f�LL') MOTTLING ------------------ 5URffACE 5G 011 - 311 B /G LOAMY SAND I Om" 3 - 3G11 IMEDILIM-COAR517 SAND I OYP,4'/4 C2 MEDIUM-COAP,5E SAND I 3G11 - 15G" 2.5y 7/3 0 'JG.2 VAT(ON HOLE#4 EL. 5G.0 DEEP 055EP 52 G DEPTH FROM 501L 5011-2 501L CCLOR 501L OTHER HORIZON TEXTURE (MUI`Z5�11-) MOTTLING i I ---- Vf NT rr 5UPFACF +57.9 +�G.3 Th Lel 011 - 411 LOAMY SAND I Oyp'g/G L:---- ---- -I- 57.9 #2 MEDIUM-COAP,5E SAND I OYR,�/4 411 - 3711 ci MEDIUM-COAR5E SAND 2.5Y + TH 37" - 15G" C2 TH 58. 1 EX15TING #3 LP 2000 GAL. NO GROUNDWATER ENCOUNTERED IN ANY 01551J",�ATION HOLE THo LP NOTE #4 05EPTIC TANK BUILDING I T.O.f. @ EL. 53.8 .5 BUILDING f + 53.5 55.8 T.O.f. @ EL. 58.8 0 +57.5 54.9+ --r- --A 5G.G U) BUILDING H 54.5 T.O.f. @ EL. 54.8 --------------------- '0 > BUILDING G 4 --------------- T.O.f. @ EL. 5G.8 ------------------ Al Z, ---------------- - 40 ---------- 0) --------------------- -- 0) (V .......... ........................................ 149.70 413 .30' ........... ............. N ------ ....... 3&7.9-41 51TE 5f-WAGE PLAN fop, 13UILDING I DE51GN DATA GENRAL NOTE5 HOLLY HILL APARTMENT5 - BUILDING I 1815 FALMOUTH RD., CENTERVILLE, MA DAILY f LOW: (7) BEDROOMS, x I 10 GPD = 770 GPD I . SEPTIC SYSTEM 15 TO BE 115TALLED IN ACCORDANCE WITH SEPTIC TANK: 770 GPD x 200% = 1540 GPD 3 10 CMR 15.00: TITLE V PREPARED FOR 2. TH15 SEPTIC SYSTEM 15-NCF DE51GNED FOR THE USE Of A U5E: EX15TING 2000 GALLON SEPTIC TANK GARDAGE DISPOSAL. CENTERVILLE A550CIATE5 INC . D15TRIBUTION 13OX: USE: D13-9 - (9) OUTLET D15TRIBUTION 13OX 3. TH15 PLAN 15 NOT TO 13E':U�ED FOR PROPERTY LINE DETERM I NATION. 5CALE: DATE: DRAWN BY: 4. CONTRACTOR SHALL PRO�51f'48 HOUR NOTICE TO DF-51GN I = 40' 05-05-201 1 TMW 501L AB50RPTION 5Y5TEM: ENGINEER FOR ANY REQUIRD-INSPECTIONS. MEYER JOE, NUM5ER: REV1510N: 5HEET NUMBER: USE: (G) 500 GAL. PRECAST DRYWELL5 LINED CONTRACTOR TO 15E RE5P(N5115LE FOR THE LOCATION Of ANY INO. 1140 -PP 5P-Co W/4' Of DOU13LE WA5HED 5TONE ALL AROUND UTILITY, ABOVEORUNDER(ROUND, IORT0 ANY EXCAVATION OR CONSTRUCTION. -'a I s-T WELLER A550CIATE5 SAWN G. EX15TING LEACH PITS TO,151 PUMPED DRY REMOVED, ALONG CAPACITY: e) 51DEWALL: 144 x 2 x 0.74 = 213. 1 GPD WITH ANY CONTAMINATED !OIL.' I G45 FALMOUTH RD., SUITE 4C - P.O. 13OX 417 CENTERVILLE, MA 02G32 2 WINDY WAY, #232 NANTUCKET, MA 02554 50TTOM: ' 13 x 59 x 0.74 = 5G7.G GPD TELEPHONE * FAX: (508) 775-0735 TOTAL: 7,50.7 GPD EMAIL: tri5wellar@comca5t.net NOTE: ALL NEW 5TRUCTURE5 TO 5E H-20 LOADED PEG15TEPffD LAND 5UR.VEYOR5 ENVIRONMENTAL CON5ULTANT5 oi- Traver5e PC ----------- ------ l I _....... DE EP OB SE RVAT ON HO LE LE LO G5 :: . IN STA LL R SE R5 COVE ' PIPE B RST ST E O O LAID E DAT - L VEL FO R 04 142011 P. .. I 2_ 3 46 M NOTE AVARIANCE w I S REQUESTED TO 3 I M i W TH N 6 OF FINI O C R 5.221 7 ,. .rGR ADE 2 ;TEST O T F ch 5 BY D. MEYER,M D STRIBUTI B U EYER RS � C5E ON OX .> T ALLOW Y: :• O LLO 5 TE S M C MP NE - O O NTS TO BE MORE THAN nC SEE P H w VIE W OR l A O C T ON WITNESS: S NE 55 D. STANTON,T ANT 5 ONHEALTH T11 L AG ENT G NT .. .. .. " - w P _ 36 BELOW FNSH GR ADE PE RC <R 2 MIN. INCH C/ A Q WATER TE R STDB X 2 O F LAYER R F_. . O PEASTONE OVERa WALLS m Ls E tl 1 ` L VELNE a _ I SS �'FL OW h DO UBLE WASHE : m � DST ONE' e m DEEP OB ERVATIEQUALIZATION s oN H #I • D A INLET QDEPTH SOIL..... �L SOIL SOI 9IE L CO.OR SOIL FR OM OTHER O HORIZON O ER T IA EXT RE is o LOC U usE L.M 54 O ( UNSELL MOTTLING I SURFACE / T E O L3. __ OUTLET _ _ L. 54.0 S o LE EL. z , In o� � - y O 5 NDY LOAM 6 B 10 YR 6/6 ' 4 5 ,• TEE r _ CH z 0 4 S_ C N_ . . _ 40 M P _�. EDIUM VC C A 6 i 6 O RSE AN 8 CI S D 2.5 Y7 3 f 40 Q PVC' �J TOP E w w C SEE TA 7 -6. �. w. NK N" _ ......... Soo 00 A a�LO N P E...... RCA 1 STD 3 _ 49.8 0 DtTAI L .. .... RYWE s� 48. BOTTOM , E 5I . 50 49 0046 00 t i S l A 4 9. 4 0 � 4 55 48.0 0 t L ou c F E X'lrtF F�L F DEEP .....:.::...:::..:::.:.::::::':::>::::::::.:::::::::::::-:::::r::>.:::::..: LEVEL jl DEFT E OBSERVATI HO LE OLE#2 EL. 4.5 0 DB 9 H SOIL ' 501 N L I STAL TAN L TANK X I o 6 FR OM SOLC OLD R 50 L 0 45 0 A , OTHER. GALLON) HORIZON I NOTE ALL STRUCTURES TEXTURE MUNSEI� ON 6 LAYER OF CRUSHED TO H 20 LOADED ' SURFACE ( ) MOTTLING _ 2 COMPARTMENT -. sroNE 11 - - ( R NT _ ME - C I DIUM COARSE AN 5 D 2 O .5 68 Y7 P E R CA T S S PTIC TANK ; I 2 nZPARTI\1El�T SE 4 0 GALLON PRECAST T CO SEPTIC TAN K _ OG C S T B TT O OM F E T H O S HOLE E T L 40.0 @ H 20 DESIGN DEEP ATI OBSERV N H #O HOLE 3 EL: 56.0 I DEPTH 50 L SO L i 50 L OL FROM C bR 50 L OM ----- H IZ OTHER HORIZON _TEXTURE M N _-- -- U E S L( M TT O LN _ A _5 RF E U C _ _ 54 _ _ _ 11 � � is - LOAMY _ O O MY SAND -__ 3 B OYR6 5 6 - ' M _ I _ EDIUM COA 3 36 I RSE SAND _C Y O R6 4 _ F n _ MEDIUM- / 36 I 6 O R5E SAND _ __-- 5 C2 2.5Y7 3 -- _-- 0 R _ D _ O - T DEEP O _ 1 EE B VA I5G.0M- O SER T N H _O HOLE#4 - EL _ , L F _ 6.2) DEPTH _ 5 I _ - 569 SO L - OI 5 L SO L COL SO L _52 FROM _ 6 , RO THE __ �,.: .._. O R i \ HORIZON .; �- TFXf RE ._..U _ M N U SEL i M /( OTTLING _ �- F P URA E 5 C _ L _ 1 1 _ _ I 1 II 5 . O LOAMY SAND _ 7 9 4 -B- OYR6 G _ _ r 1 i " }- n 1 _ 56.3 _ M _ EDIUM C A E A _- O RS S ND TH '4 37 CI _ \ Y O R6 4 57.9_ o MEDI - 1- UM COA RSE SAN D _37 I56 C2 #2 2 _ .5 3 , _ 58 T _- N 1 0 _ 1_ 1 Tf9 .. 58. 1 NOTE: NO GROUNDWATER _ENCOUNTERED N T COUN ERE I Y D N AN OBSE _RVATION HO LE _ TH _ 3 . _ r _ a _ `BUi L D NG i • _ . _ f _ 53.2_ _ VENT/ _T _ r 1 _ 1 _ T f F O. ._ E 53 8 1 - r _ _ _ t I _ _ 53.5 B I DI _ NGF _ 55.8 -_ T` , EL. 58 8 _ _ I f_!5 7.5 _ .. LP _ 1 O S O _I r , l S S _ • r 1_ 54. � Q 9 / P P • r _ 56.6 Ro ose� r _ I r I 4500 GAL. � o I r n _ VJ ti r I C MPA T O R MENT \ I 1 5EPTIC TAN -7 f K BUILDING 1 1 55.9 L NG H , r 54.5 . . 'T. F E I L 54.8` _ t / i rn , 1 r r _ 1 r 1 / r" 1 I / r ^ i e 1 \ _ r r : � r 1 D r r 1 r , C7 _ / 1 i _ BUILDIN r \ _ G t 1 ' ---- \\ _ T.O.F \' E_ _ 5 \I 6 8 1 _ / _ 1 .'. .• _ / \ N \ t 10 ------------ ------------ _ 1 _ ..._ I' I_ _ 1 _ _ 9_ _ 2 1 \ 7 _ 1 _ S .. 1 -I .. 6 _ r 9 ;7 / 4 \ � r I I 9 8 r I / 3 _ 3 f I O I , 8 7. 9 3 •� E y Cr f: S i S g Ti A'yTv o C6AI /Z o 12, i E P _ a --d r ' S1TE SEWA GE PLAN BUILDING H DESI N DATA Fo G A R GENE T ,� GENERAL NO ES HOL LY HIL L AP A T R ME NT S BU ILDING LI W: I BED DN GH DAILY FLOW. 2 OOM x R 5 0 GPD 2 3 P( ) OG D I SEPTi C SYSTEM IS T OBEIN IN STALLED LLED IN ACCORDANCE WITH I81 5 FA LM OUT ti D R E C NTE RVI L E L M _. . I P _ A SEPTIC TANK 320 G D x 200% 2640 GP i D 31 O CMR 15.00. TITLE V - P N P PREPARED FO R R USE 4500 GALLON 2 COMPARTMENT TMENT R SEPTIC( ) TANK 2. THIS SEPTIC SYSTEM 15 NOT D ES GNED FOR THE USE OF A is ' D STR BUT ON BOX GARBAGE DISPOSAL. ' CE N TE V R LLE A SS OCI ATE S NC. ` 3. THIS PLAN IS NOT T _: - �• O TO USED FOR PROPERTY LINE.DETERMINATION. , .USE. . DB-9 -�-' (9) OUTLET DISTRIBUTION. BOX s , I �� DAT . _ E DRAWN BY. 4 CONTRACTOR I , n t O TRACTOR SMALL _LL PROVIDE HOUR _48 UR NOTICE TO DESIGN _ 05 O I AB PTI N SYSTE 5 20 50 L SOR O M ,' I 40 T MW ENGINEER OF G E F A N R OR ANY REQUIRED ED INSPECTIONS.I Z M R Q R NS E T N ° HAP CI NCO O S. HAPPY_ q CO DE MAYO 2 AL. PRECA T DKYWEL S USE I 500 G 5 LS LINED 'N D F3'`' � JOB NUMBER. 1 a O 5. CON REvt I TRACTOR TO BE E N 5 oN R SPO SIBLE FOR THE LOCATION OF ANY SHEET n , 1 y UMBER O 1 w OF DOUBLE WASHED STONE ON R �4 SID .. ES , S 0 0 0 � 040 / Zo UTILITY ABOVE OR UNDERGROUND, I N /R ROUND, PRIOR TO ANY EXCAVATION / _ 2 ON EN S o SP 7 � D OR CONSTRU CTION. ON. G. EXI5TIN ER WELLER A I ; G LEACH PITS TO BE PUMPED DRY� REMOVED, ALONG No. 1140 SSOCIATES CAPACITY: I c ,W TH ANY CONTAMINATED SOIL. 0 F 16 ..,45 FALM c OUTH _ a RD. SUITE 4C P. rs a O. BOX 417 CENTERVILLE M SIDEWALL. 230 x 2 x 0.74 - 340. .G T _ q 02632 4 PD s 2 WI Nr to WINDY WAY #232 NA i x - rAR NTUCKET, MA 02554 BOTTOM 3 x 06 0.74 _990.9 GI'D . . , ;. TELEPHONE _ l L HONE � FAX. 508 775 0 TOTAL. 1 33 I .3 GPD D ( ) 735 EMAI . L trisweller c m A _ @ o cast.net NOTE ALL STRUCTURES TO BE H 20 LOAD ED RE G STERED LAND SURVEYORS ENVIRONMENTAL"CONSULT ANTS02 Traverse PC _ y DEEP OBSERVATION HOLE �LOGS N � U) DATE: 1 1-1 8-2010 P-1 3 1 15 •,: J TEST BY: D. MEYER, R5 4 C5E uj WITNE55: D. 5TANTON, HEALTH AGENT j m U PERC RATE: < 2 MIN./ INCH r LLJ Q s QDEEP OBSERVATION HOLE#I EL.56.5 SDR ACE HORIZON TEXTOURE 5/IU O OR MOTTLING OTHER (� 0' -7' A LOAMY SAND 1 0YR4/3 D_ 7'-3 I" B LOAMY SAND I OYRG/S ALL 31' - 132" C MEDIUM SAND 2.5YG/r. O 2 NO GROUNDWATER ENCOUNTERED __ ---- -------------- _ LOCUS O ------------- - co _ _--- ------- G 8 � Z O DEEP OBSERVATION HOLE#2 EL 57.0 -- t. � DEPTH o SOIL SOIL SOIL COLOR -SOIL �f FROM OTHER IL W HORIZON TEXTURE O"-8" A LOAMY SAND (nI0YR4/3> MOTTLING 59.6 w � � SURFACE + { Q � v { \. N Q 8"-36" B LOAMY SAND I OYR6/8 R 36"- 1 32" C MEDIUM SAND 2.5Y6/6 NO GROUNDWATER ENCOUNTERED _ ` I NOTE: TEST HOLE #3 WITNE55ED BY DAVE STANTON - 150 (NO GROUNDWATER) ` - TOP OF MHB 0.2' ; { ,+ - 59.5 BUILDING D -"�--- ,�- -- �- 2 58.7 ! _ PROPOSED SAS Q I O BUILDING B �Tr• .�6, BUILDING LD I N G A ----�\ \ o ♦♦ Z 1 _ PROPOSED SA EXISTING SA5 \ o \ rn 58.7 I U) 58.7 of \ ,r • / / BUILDING RMAw ! D r �, / L NG C „WA1E +i 56.9 � EXISTING SAS _ r _ ! rn ♦ _ WATER ` #3 \ �` ; SERVICE � EXIST, LEACH PIT / .'' ♦♦ - TO BE REMOVED �,/ ♦♦ 00#7EXIST. LEACH PIT +58,4 Cam,. ♦\♦ 70 O + -- AT \ I ------- ---- N \ ♦ - I 0 ♦ 55.5 •' 58.3 _-__ _ TO BE REMOVED ! W ---------------- _-- / BUILDING B \ -' --- --_ / \♦ \ - -- _ 8"WATER MAIN -� ' 8.69' 11` - , , - =-- ------ 6' a __ I i _ .. r _ w.a : :> x aw�: a 1 GENERAL NOTES DESIGN DATA 1 SEPTIC SYSTEM 15 TO BE INSTALLED IN ACCORDANCE WITH 3 10 CMR 1 5.00: TITLE V 2. THIS SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A DAILY FLOW: 12 BEDROOMS x 110 GPD = 1 320 GPD SEPTIC TANK: 1320 x 200% = 2G40 GPD GARBAGE DISPOSAL. I 3. THIS PLAN 15 NOT TO BE USED FOR PROPERTY LINE DETERMINATION. USE: 4500 GALLON PRECAST (2) COMPARTMENT SEPTIC TANK 4. CONTRACTOR 5HALL PROVIDE 48 HOUR NOTICE TO DESIGN 1 ST COMPARTMENT: 3000 GAL. 2ND COMPARTMENT: 1 500 GAL. DISTRIBUTION BOX: ENGINEER FOR ANY REQUIRED INSPECTIONS. U5E: DB-9 -� 9 OUTLET DISTRIBUTION BOX-- �H-zo 5. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ANY _ - ( ) � UTILITY, ABOVE OR UNDERGROUND, PRIOR TO ANY EXCAVATION INSTALL R15ER5 COVERS TO PIPES TO BE LAID LEVEL FOR 501L ABSORPTION 5Y5TEM: OR CONSTRUCTION. WITHIN G OF FIN15H GRADE 2' OUT OF DI5TRIBUTION BOX- r USE: ( 1 2) 500 GALLON PRECAST DRYWELLS LINED w/4' G. EXISTING LEACH PITS TO BE PUMPED DRY ' REMOVED, ALONG (5EE PLAN VIEW FOR LOCATIONS) OF STONE ON 51DE5 2' OF STONE ON THE ENDS WITH ANY CONTAMINATED SOIL. WATER TEST D-BOX FOR 2" LAYER OF PEASTONE OVER CAPACITY LEVELNE55 * FLOW 3 .!! I /4 I /2 DOUBLE WASHED STONE EQUALIZATION ALL AROUND 51DEWALL AREA: 238 x 2 x 0.74 = 352:2 GPD BOTTOM AREA: 13 x I OG x 0.74 = 101 9'7 GPD EL. 58.5 EL. 57.0 : T.O.F. @ - - - - - 4, 5cH - - __.- - - - - - - -- - - - - -EL. 57.5 TOTAL: 1371 .9GPD EL. 59.0 4 SCH 40 PVC 1 500 40 PVC TOP @ EL. 53.2 GAL 4 SCH 40 PV:: / 10" 3000 - J/1 500 GALLON PRECAST DRYWELL GALLONS 53.33 BOTTOM @ EL. 50.50 �_55.0 54.75 _ 53.50 INBrALL6A5 54.50 52.50 BAFFLE 51TE /�wI SIEWAGE PLAN fop, INSTALL TANK 4 D BOX G.G! 50TONELAYER OF CRUSHED BUILDING B 4500 GALLON PRECAST HOLLY HILL APARTMENTS, 1 81 5 FALMOUTH RD. , CENTERVILLE, MA- (2) COMPARTMENT SEPTIC TANK BOTTOM OF TEST HOLE #3 @ EL. 43.9 PREPARED FOR CENTERVILLE A550CIATE5 , INC . SCALE: DATE: DRAWN BY: 111 40' 03-03-201 I TMW SEPTIC 5Y57 N PROFILE - IHAOF&f S. JOB NUMBER: I 0-040 REVISION: p „Zoe/ SHEET NUMBER: 5P-3 C' t a D RREN ��, W. WELLER ASSOCIATES RU SA T91 0. 1140 I G45 FALMOUTH RD.., SUITE 4C P.O. BOX 4 1 7 CENTERVILLE, MA 02G32 NfTAR\A 4 2 WINDY WAY, #232 NANTUCKET, MA 02554 W TELEPHONE * FAX: (508) 775-0735 EMAIL: trl5weller@comca5t.net : _ REGISTERED LAND SURVEYORS ENVIROMENTAL CONSULTANTS � Traverse PC Yam. is DEEP OBSERVATION HO' BOGS •t,.; DATE: I 1-18-2010 P-13 1 18 TEST BY: D. MEYER, RS CcaE W WITNESS: D. STANTON, HEAL T 1 P/SENT Sjr Cn U PERC RATE: < 2 MIN./ INCH ' W Q C� Q n DEEP OBSERVATION HOLE#I EL. 56.5 DEPTH SOIL 501L 5011 COLOR 501E OTHER SURFACE HORIZON TEXTURE (MUNSELI) MOTTLING S 1 m 0"-7" A LOAMY SAND I OYP,4/3 7'-3 1" B LOAMY SAND I OYRG/£5 Q 31"- 132" C MEDIUM SAND 2.5YG/6._.. O NO GROUNDWATER ENCOUNTERED ___---- --_ - - LOCUS 0 Ln _---------- m IV Z O DEEP OBSERVATION HOLE#2 EL. 57.0 cw J 0 DEPTH SOIL SOIL St 1 xop, SOIL ------ FROM OTHER ---- \ u ~ W SURFACE HORIZON TEXTURE (M�iv�CsLL) MOTTLING + O"-8" A LOAMY SAND i OYR&!c'i 59.6 O Q 8'-36" B LOAMY SAND I OYRt/Fs R _ \ 36"- 132" C MEDIUM SAND 2.5YG/E; ` NO GROUNDWATER ENCOUNTERED \ NOTE: TEST HOLE #3 WITNE55ED BY DAVE 5TAN ON 15G" (NO GROUNDWATER) _ \ TBM EL. 58.4 TOP Of M H B �r 0% 2' �I e P° *59.5 _ SAc _ �`\gyp ' BUILDING D - PROPOSED 5A52�0�' O 58.7 I TO BE REMOVED" - _ o EXIST. LEACH PIT • Q I BUILDING B �i �i \�6' O EXISTING 1500 ' BUILDING A ----�\ \ PROPOSED SAS \\\ , GAL. 5EPTICTANK CJ ,3T r,i TOP @ EL 56.6 1 ,- --_ EXIT I Ilv.g 5A5 \ �� \ • �� BUILDING C \' S"WA���MAI�.�e . 56.9 EXISTING 5A5 - r -, ------------------ I V , .'' `\ i \ - T.H. / \�.- � i I ,WATER ry.� � Irn #3 / i 11 58.3 I ; SERVICE \\\\ \ \ y T.H. #I + \ / \ ;�� \\\\ ✓ 58.5 +58.3 i ---------------------- RMq/N \\\ \\\ \\\ _- /�' --------------------- \ \\ \ G 13 - - \� 8"WATER MAIN ��� \\ 72 9 11 \ ___ - 149•7 I 9 x. v 387•g4 GENERAL NOTES DESIGN DATA 1 . SEPTIC SYSTEM IS TO BE INSTALLED IN ACCORDANCE WITH 3 10 CM R 1 5.00: TITLE V DAILY FLOW: G BEDROOMS x I 10 GPD - GGO GPD 2. THIS SEPTIC SYSTEM 15 NOT DESIGNED FOR THE USE OF A SEPTIC TANK: GGO x 200% = 1 320 GPD GARBAGE DISPOSAL. USE: EXISTING 1500 GALLON SEPTIC TANK 3. THIS PLAN 15 NOT TO BE USED FOR PROPERTY LINE DETERMINATION. 4. CONTRACTOR SHALL PROVIDE 48 HOUR NOTICE TO DESIGN ENGINEER FOR ANY REQUIRED INSPECTIONS. DISTRIBUTION BOX: 5. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ANY USE: DB-G - (G) OUTLET DISTRIBUTION BOX UTILITY, ABOVE OR UNDERGROUND, PRIOR TO ANY EXCAVATION PIPE5 TO BE LAID LEVEL FOR SOIL ABSORPTION SYSTEM: OR CONSTRUCTION. USE. (G 500 GALLON PRECAST DRYWELL5 LINED w/3 _ w r 2 OUT OF DISTRIBUTION BOA _ G. EXISTING LEACH PITS TO BE PUP�fiPWP D;CY P.Ew1 _y� ALONG _ _z , OF STONE ALL AROUND iNSTALL RI5ER5 COVERS TO WITH ANY CONTAMINATED SOIL. WITHIN G" OF FINISH GRADE WATER TEST D-BOX FOR 2" LAYER OF PEA5TONE OVER CAPACITY: LEVELNE55 * FLOW 3/4" _ I /2 DOUBLE WASHED STONE (SEE PLAN VIEW FOR LOCATIONS) EQUALIZATION ALL AROUND 51DEWALL AREA: 1 3G x 2 x 0.74 = 201 .3 GPD BOTTOM AREA: I I x 57 x 0.74 = 4G4.0 GPD i EL. 58.7- _ - - - -- EL. 58.5 - - - - - - - - - EL. 58.5 T.O.F. @ 4° 5cH TOTAL: GG5.3 GPD TOP @ EL. 54.7 EL. 59.5 40 PVC 4" 5CH 40 PVC 14" 500 GALLON PRECAST DRYWELL IIIIIIIIIIAl 54.58 - za BOTTOM @ EL. 52.00 54.75 BA EGAS 55.25 54.00 I�I SITE --- SEWAGE PLAN DB G�o� INSTALL D15T. BOX 8. I , FOR LAYER OF CRUSHED 55TONE BUILDING D 1500 GALLON PRECAST HOLLY HILL APARTMENTS, 1815 FALMOUTH RD., CENTERVILLE, MA SEPTIC TANK (EXISTING) BOTTOM OF TEST HOLE #3 @ EL. 43.9 PREPARED FOR CENTERVILLE ASSOCIATE@ , INC . SCALE: DATE: DRAWN BY: 11� = 40' 03-03-201 1 TMW SEPTIC SYSTEM PROFILE - c OF A�q JOB NUMBER: REV1510N: SHEET NUMBER: a °yam 10-040 c>3-09 2oi1 SP-4 �4 SR A y A'. 114 y No. WELLER ASSOCIATES 781 �'F �,; �'P~ 11 1 AR\ I G45 FALMOUTH RD., SUITE 4C P.O. BOX 4 1 7 CENTERVILLE, MA 02G32 q�asu1j�11 2 WINDY WAY, #232 NANTUCKET, MA 02554 s t% TELEPHONE * FAX: (508) 775-07735 �.K EMAIL: tri5weller@comca5t.net REGISTERED LAND SURVEYORS ENVIROMENTAL CONSULTANTZL Traverse FC / DEEP OBSERVATION HOLE LOGS In DATE: 09-22-2010 P-I3068 < TEST BY: D. MEYER, R5 i C5E J ! W MTNE55: D. MIORANDI, 1EALTH AGENT m U PERC RATE: < 2 MIN./INCH W QDEEP OBSERVATION HOLE N I EL. 56.0 - 0- DEPTH SOIL SOIL n 1 FROM S -COLOR SOIL OTHER co ,ACCHORIZON TEXTURE (:v IN5ELL) MOTTLING `�, A LOAMY SAND )YR3/2 t / 1 8'-37" B LOAMY SAND I )YRG/8 / Q 37'- 138' C MEDIUM SAND 5Y6/6 _ l� ` 54 ------------- 2 1 52 _---- --- Z DEAON H . . - J Z _ �, -- ` Q cn U� 56 _� - - - - e J DEPTH OBSERVTI OE�2 EL 560 SO:L 50_ COLOR 501ELLJ FROM 5URPACE -ORIZON TEXTLRE %".SELL) MOTTLING OTHER �� O' -8' A LOAMY SAND — �YR312 / �. Q- ",` _ 8'- 37' B LOAMY SAND 1YR6/8 ' 1 N �O r ` _______--- / - I ♦ 1 38' C MEDIUM SAND 5Y6/6 n n O V 1v 1 Nq GROUNDWATER ENCOUNTERED ( -r 52 ` _ 58I 1 I 5 8— + I --- 59.4 t 1 I _ 1 i - _ • _EXIry PIT TM ill I EXIST. / \♦♦ I _LEACH PIT J I �J ♦ I o I -_l♦ I � \ I I \ V I 1 Il ^ WATER /// ♦♦` I rn 1 ♦ ' SERVICE ♦♦ I 56 - ♦♦ \ I _ kqr ' ♦ ♦ I \ 3kI fR M ♦ ♦ I 0 C \ I qUV , t \ co 4 `\ \-_ / I TBM = EL. 56.75 __---- TOP OF EXITING ---- --------------------- \\ ♦;\ ` \ _ __________ ______ / FOUNDATIONki`` '---_ _- """" ` ♦. ' \ I ♦` ` - -------------------- -"" - t 1 5..7G� I1 I I - --- --- - / --- 63.90, ' I \ i 357.9 a' R I E GENERAL N I DE51GN DATA I . �Ef TIC SYSTEM IS TO BE INSTALLED IN ACCORDANCE WITH 10 CMR 1 5.00: TITLE V DAILY FLOW: 12 BEDROOM5 x I 10 GPD = 1 320 GPD 2. THI5 SEPTIC SYSTEM 15 NOT DESIGNED FOR THE USE OF A SEPTIC TANK: 1320 x 200% = 2G40 GPD GARBAGE DISPOSAL. ti USE: 4500 GALLON PRECAST (2) COMPARTMENT SEPTIC TANK 3. THIS PLAN 15 NOT TO BE USED FOR PROPERTY LINE DETERMINATICN. !' 1 5T COMPARTMENT: 3000 GAL. 2ND COMPARTMENT: 1 500 GAL. 4. CONTRACTOR SHALL PROVIDE 48 HOUR NOTICE TO DE51GN DISTRIBUTION BOX: ENGINEER FOR ANY REQUIRED INSPECTIONS. 4 USE: DB-9 -- {9) OUTLET DISTRIBUTION BOX UTILITY, CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ANY UTILITY, ABOVE OR UNDERGROUND, PRIOR TO ANY EXCAVATION INSTALL RISERS COVERS TO PIPES TO BE LAID LEVEL FO 501L ABSORPTION SYSTEM: OR CONSTRUCTION. WITHIN 6" OF FINISH GP.ADE 2' OUT OF C'ST�JEUTION 6�.' USE: ( 1 2) 500 GALLON PRECAST DRYWELL5 LINED w/4' i 1: G. EXISTING LEACH PITS TO BE PUMPED DRY REMOVED, k,1_01;G 1` (SEE PLAN VIEW FOR LOCATIONS) — OF STONE ON SIDES t 2' OF STONE ON THE ENDS WITH ANY COIJAMINATED SOIL. I� WATER TE5T D-ECX FOP. r— 2" LAYER OF PEA5TONE OVER CAPACITY: (E LEVELNESS FLO'�"✓ 3/4" - I V2" DOUBLE WASHED STONE EQUALIZATION ALL AROUND SIDELh/ALL AREA: 238 x 2 x 0.74 = 352.2 GPD BOTTOM AREA: 13 x I OG x 0.74 = 1 01 9.7 GPD l I — — — — EL. 55.5 E.L. 55. 3 TOTAL: 137 1 .9 GPD EL. 56.0—T.O.F. 4° scri - - - - - - - - - - — I 4" 5Cr 4o Pvc 150 TOP @ EL. 52.3 EL. 56.75 GA� o Pvc 4 scH 40 FI c o' 3000IA " 500 GALLON PRECAST DRYWELL �_53. 15 52.50Y GALLONS �°'� BOTTOM EL. 49.50 �52 I 52.00 @ I „ 7 2.25 51 .50 51TE --- SEWAGE PLAN DB-9 INSTALL TANK 4 D-BOX 51 FOR ON 6" LAYER OF CRU5HED 4500 GALLON PRECAST STONE (2) COMPARTMENT SEPTIC TANK HOLLY HILL APARTMENTS, 1515 FALMOUTH RD. , CENTERVILLE, MA BOTTOM OF TE5T HOL @ EL. 44.5 PREPARED FOR °A ; sTE ENw. CENTERVILLE A550CIATE5 , INC . 0 4EYE{2 N ' R BA SCALE: DATE: DRAWN BY: NO. 1 400 N 3 91 'I — 10-04-2010 TMW SEPTIC SYSTEM PROFILE . �o i SqN TAR P� �qH su J05 NUMBER: REV1510N: 5HEET NUMBER: I 0-040 5P- I WELLER * A550CIATE5 I G45 FALMOUTH RD., SUITE 4C — P.O. BOX 4 1 7 CENTERVILLE, MA 02G32 2 WINDY WAY, #232 NANTUCKET, MA 02554 TELEPHONE * FAX: (508) 775-0735 EMAIL: tri5weller@comca5t.net REGISTERED LAND SURVEYORS * ENVIROMENTAL CONSULTANTS 7r.aver5e PC } ••.•--••.. :i'>..wnrM44-.'�-•.Fi.i4h..: ,..:TL9-dG-9)-?a£'•4":i-V iTA"' ".IDR.'9tr'Yw'tR9S"!.'^i'I9'.':..,1'%iS3M� =9iL+...T'.;';'Y:xunc'N . -':.i^a m a— '+.C.2+3-.s.e ...• : .h:"_ :5:: ,C.a'-.SZS@T'R1— vAY'ft' I DEEP OBSERVATION HOLE LOGS (� DATE: 1 1-1 8-20 10 P-1 3 1 15 J TEST BY: D. MEYER, R5 4 CH 's' W WITNE557 D. 5TANTON, HEALTH AG`"-NT O U PERC RATE: < 2 IN./INCH W CZi QW DEEP 055EPVATION HOLE#I EL. 56.0 W DEPTr1 SOIL COLOR 501E FRO ACE HORIZON TEXTURE (MUN5ELL) MOTTLING OTHER 5URF C m 0'-7' A LOAMY 5AND 10YR4/3 W 7' - 3 1' B LOAMY SAND I OYR6/8 ?c Q 31'- 132' C MEDIUM SAND 2.5Y6/6 54 �iV O 52 - --------------------------- - LOCU5 O I ----------- ------- - - ZQ DEEP OBSERVATION HOLE#2 EL. 56.0 5 6 D_PT i J (f� SOIL SOIL SOIL COLOR I SOIL / _---_-- _ ----- — ` I F W ROM HORIZON TEXTURE OT FR - � SURFACE HORIZON ' �'OTTLI�JG � 0' - 8' A LOAMY SAND I OYR4/3 I ` I Q 8' - 36" B LOAMY SAND I OYR6/8 FO C - A� Ov / 58 36 - 132' NO GROUNDWATER ENCOUNTERED / I (I /f — 52 `\ +59.4 4 1 • / Tti #2 ` P1T • J - � l / 1 �QC!1 • \( I + 5 7. I , - • ` 2 \ Ex ST. - + 6' _ LEACH PIT— I , roe lot ` + 59.2 ' ► I + • _, ------------ ` - f1 #I , - ,' \\ ,1 WATER `\ 55.2 +56.5 ` - , • SERVICE ` tt CY ---------- ------------------- / ` --------------------------- \ BUILDING IIG" ; `v TBM = EL. 5G.75 TOP OF EXI5TING DATION EXI5TING � WATER 5ERVICE-�* - - ----- -- /-`` ''/ , ------ 63 90 BUILDING 11C11 - - v TBM = EL. 57.50 TOP OF EXI5TING 387.�4' FOUNDATION GENERAL NO--CS DESIGN DATA i . SEPTIC 5Y5TEM IS TO BE INSTALLED IN ACCORDANCE WITH 3 10 CMR 1 5.00: TITLE V DAILY FLOW: 12 BEDROOM5 x I 10 GPD = 1 320 GPD 2. Tt�15 SEPTIC 5Y5TEIJI 15 NOT DESIGNED FOR THE U5E OF A SEPTIC TANK: 1 320 x 20070 = 21640 GPD GARBAGE DISPOSAL. U5E: 4500 GALLON PRECAST (2) COMPARTMENT SEPTIC TANK 3. TH15 PLAN IS NOT TO BE USED FOR PROPERTY LINE DETERMINATION. -f. C ONTRACTO 7, 5r—IALL FROV'ID� 48 I-IOUI R NIOTICE TO DE5iGN 15-� COMF'AR�i PJENT: 3000 GAL. 2ND COI�PAP.TMENl-: 1500 GAL. ENGINEER FOR ANY REQUIRED INSPECTIONS. D15TRIBUTION BOX: 46� �� 'F B- -� o OUTLET DI TRIBUTION BOX 5. CONTRACTOR TO BE RESPONSIBLE FOR THE LCCATION OF ANY r USA. D 9 (� ) 5 , � I SOIL ABSORPTION SYSTEI�f: UTILITY, ABOVE OR UNDERGROUND, FRIOR TO ANY EXCAVATION I INSTALL R15ER5 COVERS TO PIPES TO BE LAID LEVEL FOP. �Q�n. o `' � I O". CONSTRUCTION. II. WITHIN G" OF FINISH GRADE 2' OUT OF DISTRIBUTION EO � 1 �� �'u �'� U..,E. ( 1 2) 500 GALLON PRECAST DRY�1� ELLS UNED v./14 6. EXISTING LEACH PITS TO BE PUI�./iPED DRY REMOVED, ALONG (5EE PLAN VIEW FOR LOCATIONS) ` �I 1�� OF STONE ON SIDES � 2' OF STONE ON THE ENDS WITH ANY CONTAMINATED SOIL. WATER TE5T D-BOX FOR c� "l 11 f_` 2 LAYER OF PEASTONE OVER CAPACITY: LEVELNE55 � FLOW l� '�u 3/4 - I %2" DOUBLE WASHED STONE EQUALIZATION ' ` ALL AROUND 51DEWALL AREA: 238 x 2 x 0.74 = 352.2 GPD BOTTOM AREA: 13 x 106 x 0.74 = I 0 19.7 GPD (�0 EL. 56.5_ _ _ — _ Ei, 56.0 _ _ — _ _ _ _ _ _ _ EL. 56.0 _ TOTAL: 1371 .9 GPD T.O.F. @ oo TOP @ EL. 53.2 0 SCH EL. 57.50 4" scrl 40 Pvc o Pvc `' 10' 300 4" 5CH 40 PVC 54.50 54.00 GALL N 500 GALLON PRECAST DRYWELL 53.65 53.48 BOTTOM @ EL. 50.50 e5 G� 3.75 52.50 51TE SEWAGE PLAN DB-9 I NSTALL TANK t D-BOX 6 3 r f O R 4 �0 ,�n �I ON 6i' LAYER OF CRU511ED - T, BUILDING "CI'qq 4500 GALLON PR�CASJrh„ b( E o �Lt HOLLY HILL APARTMENTS, 16 15 FALMOUTH RD. , CENTERVILLE, MA (2) COMPARTMENT SEPTIC TANKIlk BOTTOM OF TE5T OLE @ EL. 44.2. \ �n PREPARED FOR R4��..�/.,`° ` ' CENTERVILLE ASSOCIATES INC . 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'g' rr ~ , �'�y O '�•S'.:1 J3 '10u Vat YO 7 i� /� Q, X � a `.��" .. � �,.. .ruww+r.... \` -•' •� � � '•C,L.. y�,A i' r �.r: {� 7 j .{ y S 116<Q { � F.` mac' y� i --- it _r'-7" �r✓ 4, �j' IV :'� /, ;�F+`�tr'i � ;.�� `,.� .r.. 7� �- "iYl) ��1�;?�/ 3x�G ' -- "- S T � � � _��ZO 'SC' . f• -�3. ,�' .•�.�. y _ .W/ .-ant $fir .• `/� g$ Cc 7 ;P o v- B.R.8. ' s�.3 r �M a. �. �"- z+w' '� y y0 �w- , c 9�, •.. s i ^ / • / r ,('X .y' �'I r (�• �. I 4. 0 i 17 r T -. 1/ Q. 'Jr ! '►al h /'i ., Y _ - —:5,'47 .fii� t ` lb -Y.fitif VVI J 1� , � FTE 48 20 r• o q /N FEB'T I /apt �'�9 R�j� �a iq U l; i 1 � RECT CRO56 R4�US f/OUS/mc IIgii T/14roo? Sly'rr"!� 'F v .�sw.o �iRriat►bes $c,4c,�: /".- qp ' �'usT l i+, /9!9' 7 _ /1 Gr 1✓ z.s F✓ y7I1.y'at< a v /g 7 Kam• , ,E. �_ fy�r7 �`-. I I TOP FNDN. AT EL. 59.3' SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN 6" OF FINISH GRADE D.A. OJALA, SE ACCESS COVER (WATERTIGHT) TO ENGINEER: MINIMUM .75' OF COVER OVER PRECAST /� WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 58.0' WITNESS: DAVID STANTON, IRS EL 58.0' RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE DATE: 9/21/O4 I o FOR FIRST 2' < 2 MIN/INCH EXISTING 2000** c 3' MAX. PERC. RATE _ GALLON SEPTIC 56.6't* 55.0 CLASS I SOILS P# 10 g 1 _E - ME 28 TANK (H- 10 ) GAS nn 1..d r�•�b o BAFFLE 55.70' -E- 55.53' O a O �;J 0 C og $ 0 54.17 EDM 6" CRUSHED STONE OR MECHANICAL MPACTION. 15.221 2 0 2' a a o 0 0 O O C7 o� 52.17' 0" Q 57.9' DEPTH OF FLOW = 4' (4.5i.; SLOPE) (3.5t% SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE LS TEE SIZES: > INLET DEPTH = 10„ _ 14,. 6„ 10YR 3/2 LOCATION MAP NTS T - OUET DE PTH L i FOUNDATION EXIST. SEPTIC TANK 20' D' BOX 39' LEACHING LS ASSESSORS MAP 189 PARCEL 55 FACILITY (MAX) 5.57' 2.5Y 7/8 36 54.9' *THE INSTALLER SHALL VERIFY THE " LOCATIONS OF ALL UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS C1 PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM PERC MED/COS 10% GRAVEL - 9 46.6' 28 -�'� � 72" I 51.9' 59 OU YYY +57.7 3 3 R705 56, C2 L 101 � I MS / / +57.6 I +57.7 2.5Y 7/2 WALL CAUTION: SPRINKLER SYSTEM IN AREA. G s FLAG DAMAGED LINES; REPAIR BY OWNER 136" 46.6' &i (N.I.C.) Ss NO GROUNDWATER ENCOUNTERED 57.4 i t7.7 NOTES: _I- 67 +�+ 3 +5 8 � � SEPTIC DESIGN: (GARBAGE DISPOSER Is NOT ALLOWED ) 7.9 h 1. DATUM IS ASSUMED BENCH MARK - CTR OF I � y 58.6 (FAIL 56.9 f DESIGN FLOW: $_ BEDROOMS ( 1 10 GPD) = 880 GPD C.BASIN EL. 77.2 I ,�se3 +57.6 880 EXISTING 582 s&7 ,+<s/as 57.5 , I USE A GPD DESIGN FLOW 2. °MUNICIPAL WATER IS -- UOTIr _Tnn+t.___.Fi8G_:_ _p r__�_ �____ 1760 3. MINIMUM PIPE PITCH TO BE 1 8" PER FOOT. 590 0 ( Ep _ T o n u_ 10 58.7 : LP 2000 ** 4. DESIGN LUAEJINh I uK ALL L r t�ti,AS I viviTS TC �E ,ti tiSHO +sus 5.8 0 se APPROX. USE A 2000 GALLON SEPTIC TANK (RE-USE EXISTING) 5. PIPE JOINTS TO BE MADE WATERTIGHT 5&7 ; 5$ 584 , LOCATIONS ONLY **INSTALLER TO CONFIRM SIZE AND CONDITION OF EXISTING 6 +s77 (vIF) SEPTIC TANK. CONTACT ENGINEER IF OTHER THAN 2000 GAL. 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. TANK. PROVIDE REQUIRED TEES AND GAS BAFFLE AS ENVIRONMENTAL CODE TITLE V. \ BUILDING A ` 585 �� \`� 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT �ses � � �� s7.6 NECESSARY ti (a BEDROOMS) 85b.5 TO BE USED FOR ANY OTHER PURPOSE. \ 5&5 '\ ' \+58.3 P LEACHING: 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. _ TOP FNDN = �� 5&4 ( OT FAILED) 2(76 + 1 1.8) 2 (.74) = 259 ' 573 59.3' /use SIDES: 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT / 6 76 x 11.8 (.74) = 663 INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED NO WATER AT REAR OF / ASPHALT WALK BOTTOM: / FROM BOARD OF HEALTH. 58., 922 UNITS PER WATER DEPT. �� �/ TOTAL: 1246 S.F. GPD 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) FAILED LEACH PITS 58.3 58.s USE (8) 500 GAL. LEACHING CHAMBERS (ACME OR 5 58.4 BUILDING 6 5" BUILDING WITH 4' STONE AT ENDS AND 3.5' AT SIDES N.) \ S / s -LEGEND TITLE 5 REPAIR PLAN s f 100.0 PROPOSED SPOT ELEVATION OF BUILDING A ,,HOLLY HILL" 1815 RTE 28 f 57.2 573 + 56.0 EXISTING SPOT ELEVATION IN THE TOWN OF: 100 PROPOSED CONTOUR CENTERVILLE BARNSTABLE ( ) 100 EXISTING CONTOUR PREPARED FOR: HOLLY MANAGEMENT NOTE: OTHER BUILDINGS ON THIS SITE NOT SHOWN V.I.F. VERIFY IN FIELD 30 0 30 60 90 ,. BOARD OF HEALTH MA SCALE: 1 „ = 30' DATE: SEPTEMBER 21, 2004 APPROVED DATE f _ off 508-362-4541 7 4 fox 508 362-9880 OF l Ags6 ��ZN Or ligSs9 down cape engineering, inc, o� ARNE H ti� y �o� ARNE cGs o OJALA H. CIVIL ENGINEERS CIVILcn i No. 30 92 ALA LAND SURVEYORS �o �� �o 447 No,2 8 G zz o� 939 Main st, yarmouth, ma 02675 R P 04-287 OJALA, .S. DATE I