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0015 GINA COURT - Health
15 GINA CT.', CENTI RVILL A = 210194 .00 -------------- oCO UPC 12134 NOT153LOR HASTINd8, UN t� ` � _ ���,� �d� �� � �, �� F Town of Barnstable CE TFIE T Regulatory Services Barn do Thomas F. Geiler,Director A*4mericaCity Public Health Division w BARNSTABLE, 9 MASS. g Thomas McKean,Director zoos �Ar i639. s`� 200 Main Street fD MA'S Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 8, 2009 CERTIFIED MAIL 7007 3020 00013429 8301 Mikayel Hakobyan 15 Gina Court Centerville, MA 02632 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable Health Division. According to our records, you own rental property (Room Rental) at 15 Gina Court, Centerville. Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at www.town.barnstable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2008 fees included. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4644. Thank you in advance for your cooperation. O. / I /1 G�z Jaime A. Cabot. R.S. Health Inspector Health Division Direct#508-862-4651 i TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date , 2- O G Time: In l ;q C Out 2°�UOP Owner. Nl.iP LC& ,k, }Ap y-o f tipA Tenant c/ u 4 N-.-� e-,o _S Address S . C ) KJ.4 C'��c„2'( Address Co C,✓L? C,F Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities --ti 2 ,�, ® (.L, -C �•. ti 3. Bathroom Facilities 4. Water Supply U C/vl/& /a Sod 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 71 8. Ventilation f G P-7/2 4110 9. Installation and Maintenance of Facilities S; it C--Cd 10. Curtailment of Service 11. Space and Use (Lop CA L- 12. Exits 13. Installation and Maintenance of Structural Elements 400 S?a Iz- 14. Insects and Rodents Rco jzU v �I 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal I V4 7,E_ 17. Temporary Housing 18. Driveway Width 19. Number of Ten served PART II 37. Placarding of Condemned Dwelling; A-AL Removal of Occupants; Demolition Number of Bedrooms 2 ? Number of Vehicles Allowed (max) y Number of Persons Allowed (max) Person(s) Interviewed Inspector a dz• S, If Public Building such as Store or Hotel/Motel specify here Citizen Web Request 3;00 6G Page 1 of 2 f1�7 P.LL�iTRlil a',I �I Citizen Request Management - Internal Use Request ID: 25915 Created: 6/26/2009 11:28:48 A Status: Assigned To Staff Assigned To: Cabot, Jaime Health Office Chapter 170 : Housing Overcrowding Anonymous: No Category: Chapter 170 : Housing Overcrowding - Night Only E.C. Date: 7/13/2009 Created By: Wadlington, Ellen Citations: Health Office Time Worked: 0 Response Time: 0 Requestor Details: Email: , Vo Request Location: 15 GINA COURT Centerville, Ma 02632 Parcel Number: Map: 210 Block: 194 Lot: 000 Request: Overcrowding and operating a business out of house. Lots of commercial vehicles, i.e. - vans (3 or 4) -Request Work History: —Internal Note History: System entry on 6/26/2009 11:28:48 AM: Assigned to Desmarais, Donald System entry on 7/2/2009 8:44:48 AM: http://issgl2/IntemalWRSiWRequestPrint.aspx?ID=25915 7/2/2009 Citizen Web Request Page 2 of 2 -Please Review- email sent to Cabot, Jaime System entry on 7/2/2009 8:45:54 AM: Assigned to Cabot, Jaime http://issgl2/IntemalWRS/WRequestPrint.aspx?ID=25915 7/2/2009 Postal CERTIFIED MAIL,. RECEIPT D. Only; O m For e CO . E37 F1 1 AL USE tti Postage $ m yPNNIS 2! Certified Fee a , Postmark 9 O Return Receipt Fee p ✓ Here N (Endorsement Required) /� Restricted Delivery Fee U� n o 0 0 (Endorsement Required) �1J J O Total Postage&Fees $ G m Spy Sent To - t k ( L' A I.k�_i�_�___AA o«ae�Apt.moo.; 5`C,- -- �f or PO Box No. ------ ---------"----------------- 0 --- T6'lg - City,Sta IP 4 J _ 6�� Certified Mail Provides: ■ A mailing receipt • A unique identifier for your mailpiece • A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mall may ONLY be combined with First-Class Mails or Priority Maile. ■ 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. ■ 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°. ■ 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. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 i SENDER: COMPLETE THIS SECTION COMPLETE THIS SfCTIOIv ON DELIVERY .■ Complete items 1,2,and 3.Also complete A. Sign re item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Rec&e y(Print e) C. Date of Delivery ■ Attach this card to the back of the mailpiece, r or on the front if space permits. 1. Article Addressed to: D. Is delivery g6dress different fn3d i3 em 1? O Yes If YES,enter delivery address below: ❑No 3. Service Type OCertified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mali ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number "" 70`07 t3020' 000'D 3429 18301 it (Transfer from service label) _ PS Form 3811,February 2004` Domestic Return Receipt 10259e-02-M-1e40 UNITED STATES POSTAL SERVICE post aid •'�..t:�Cv3+''.t. s.n���� 7+"'aS:¢s�i•Kai,�....".tt" w: ,�`�'"4c;.ar:� d. • Sender: Please print your name, address, and ZTFfitl this box E ,�. Town of Barnstable 4 Health Division 200 Main Street , Hyannis,MA 02601 t I 1 g ,t Zoio ,, t x� r • 4 I P�°pSHETp�y Town of Barnstable Barnstable Regulatory Services Department caC j BAR, STABLE. MASS. Q 639 Public Health Division 90p i ,�� ArfD M 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO October 29, 2009 Barnstable District Court Clerk's Office P.O. Box 427 Barnstable, MA 02536 Re: Mikayel Hakobyan, 15 Gina Court, Centerville, Ma 02632 BAR# 76709 To Whom It May Concern: On October 9, 2009, I issued a one hundred dollar($100)Notice of Violation of Town Regulations for failure to register rental property as required by the Code of the Town of Barnstable Code Chapter 170: Rental Properties, Section 170-4. This Notice of Violation was sent by first class mail to the 15 Gina Court, Centerville address. This violation was as a result of no response to a letter of request to register rental property, sent by certified mail; # 7007 3020 0001 3429 8301 and signed for on July 17, 2009 by Mikayel Hakobyan. A determination that the property had a room rental violation had been made during an inspection made by this Inspector on July 2, 2009 and a subsequent inspection made on July 8, 2009 while accompanied by Zoning Inspector Robin Anderson. Respectfully Submitted, . 4 Jaime Cabot, R.S. Health Inspector Town of Barnstable NAME OF OFFENDER i � _—. --.,--^ ------ ;'�` �'` 'g �„� f �'�y, } h `iJ1 'md III 9 ADDRESS OF OFF ENDER 66 Mr - T'�WN OF •� -� j� A _ CITY,STATE,ZIP OE DATE(JLFJBIRTH OF OFFFNDER'BLE _ ,M n.�3 s• �'J' i ti.,. ' yyt11F Iqi,. MV OPERATOR LICENSE NUMBER '- MV/MB REGISTRATION NUMBER i.� OFFENSE„ y i h•'NAkI>•7Aa1! �qN,[�, A�'.,0•1� �..,.� 14°" tl,..F M�,{:..{',� fir., '�1'� i ��: t.,,P �J Ix� f��l w\., t t \. i a.�:.� ,m t.: Lyj a iA79 t +fit. to Aud ILti,.k 'j la, Mti TIME AND PATE OF VIOLATION a LOf/ATION OF V10LATION 6 NOTICE.OF P M.;o , f-` �r "' 20, r + (s^t• F I �'�. ^ y ,.,l..ti. " r f;UH SIGNATU OF ENFORCING PPERSON'i ,,,. �:, ENFORCINGP. EPT i e 't BAD�.E NO. W t , 1/1;OL '1TION `, _:.I�: .� S ,a`� r•. �t".)``�. _ o . tl LU OJF,DOWN I9EREBY ACKNOWLEDGE RECEIPT OF CITATION X k` . `ORDINANCE Unable to obtain si Hall re of otfenAer. 1 ' •a•'. 9,.1 tilre• o , THE NONCRIMINAL FINE FOR THIS OFFENSE-IS W ' �rA Date mailed — �' ua W ORr YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a. DISPOSITION WITH NO.RESULTING CRIMINAL RECORD. :` N REGULATION v p v V pp Monday through 9 P w yl (t)You ma elect to a the above fine,either by appearing In person between 8:30 A.M.and 4:00 P.M.,Monde throw h Friday,le of holidays exce ted, t before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,orb mailingg a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, (Y Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. f, ' 6"y 2)If you desire to contest this matter in a noncriminal proceeding,yyou may do so by making written.request to DISTRICT COURT DEPARTMENT,FIRST ' �ARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this 2irA r citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at they v c�flat hearing to be due,criminal complaint may be issued against you. n ,t r. ❑ I HEREBY ELECT the first option above,confess to the offense charged and enclose payment in the amount of$ r Signature e sit rvrFa� ".t 4 s' ..N KN r a d ^+'.1• cyty dt � .A h ' �a aArys,,� ,a'9 .. yeti a -ra e�' t " 4 t I'ix y 4 � ' a�t a s 'L tr `rv, ^.• ntL!'� M £ } w f a a h Ar vLr1 y x+g m �y^-'� ��* n a5f' �� - C 't_.� b� is`4' .f r•� j I :'�' W y e ai Fi'['�r � t i iL -vt G h, •xs ..a x r "� �t x Aa»pn i"'a fi1y)r .y7t�' a �.}. � ;{.,r,+" Health Master Detail Page 1 of 1 WLA ,..:..:s:',.'� &:zam_M.W...-'}�.. CGeS , =,s. "irl`>y•i..,,.c;r lHeallth lvlaslter Deta.. ii is Parcel Septic PeT Parcel: 210-1 4 Location: 15 GINA COURT, CENTERVILLE Owner: HAKOBYAN, MIKAYEL Business name: Business phone: Rental property: _.. Deed restricted: .„ Number of bedrooms .F 3 Contaminant released: Fuel storage tank permit: Save,Parcel Changes Return to Lookup Parcel Info Parcel ID: 21.0-194 Developer lot: LOT 9 Location: =a GINA COURT Primary frontage: 107 Secondary road: Secondary frontage: Village:CEN1 ERVILLE Fire district:C-0-MM Sewer acct: Road index:0602 Asbuilt Septic Scan: 2-10194_1 Interactive map Town zone of contribution:AP (Aquifer Protection Overlay District" State zone of contribution:OUT Owner Infra Owner: ;lAKOBYAN, MIKAYEL Co-Owner: Streets: 15 GINA COURT Street2: City:CEN 1 ERVILLE State: MA Zip: 02632 Cc Deed date: .2/3/200U Deed reference: 23294/163 Land Info Acres: 034 Use: Single Fam MDL-01 Zoning: rrRC Neighborhood: 0 Topography: 'evel Road: Paved Utilities: Public Water,Gas,Septic Location: Construction Info E;:: `mx "';;Year Buii Effecti r=<A ne alr e ,r'.,:,1i ��,.]tE ... ..w � 1 1981 1560 3 Bedrooms 2 Full Buildings value: `>51.28,600.00 Extra features: 111,300.00 Land value: $73,500,00 http://l ssq l/intranet/healthMaster/HealthMasterDetall.aspx?ID=210194 3/4/2010 TOWN OF BARNSTABLE LOCATION j 5 (f6o i?-T SEWAGE# r r ® VIL'tAGE Cel1f2f V r �C ASSESSOR'S MAP&PARCEL )�[® ll t INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY 1000 LEACHING FACILITY.(type) (size) NO.OF BEDROOMS . OWNER 1)0 5 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 of leaching facility) m Feet FURNISHED BY E c® - TcGH - &h 5 Aecf�v", (�pc,1 1`1,ZQ08 LEACHING GALLERY 3Q D-BOX LOCATIONS A B - 2 1 24 FL 40 FL TANK SEPTIC® 2 28 FL 42 Ft- 3 34.5 FL 46.5 FL A EXISTING DWELLING # 15 W Z J W F- 4I . G I N A COURT NOT TO SCALE Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 15 Gina Court 's l Property Address FILHO, IVO DOS SANTOS & DOSSANTOS, JOSSANAN P � ' I-t`1 Owner Owner's Name information is Centerville MA 02632 April 14 2008 required for p , every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the computer, use 1. Inspector: only the tab key to move your David D. Coughanowr cursor-do not Name of Inspector use the return key. Eco-Tech Environmental Company Name OQ 43 Triangle Circle Company Address Sandwich MA 02563 fe"0/ City/Town State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority • 25 April 14, 2008 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5-2907.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 � . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Gina Court Property Address FILHO, IVO DOS SANTOS & DOSSANTOS, JOSSANAN P Owner Owner's Name information is required for Centerville MA 02632 April 14, 2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed t5-2907.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M y 15 Gina Court Property Address FILHO, IVO DOS SANTOS & DOSSANTOS, JOSSANAN P Owner Owner's Name information is Centerville MA 02632 Aril 14, 2008 required for p every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5-2907.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 15 Gina Court Property Address FILHO, IVO DOS SANTOS & DOSSANTOS, JOSSANAN P Owner Owner's Name information is required for Centerville MA 02632 April 14, 2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. t5-2907.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Gina Court Property Address FILHO, IVO DOS SANTOS & DOSSANTOS, JOSSANAN P Owner Owner's Name information is Centerville MA 02632 April 14, 2008 required for p every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5-2907.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 15 Gina Court Property Address FILHO, IVO DOS SANTOS & DOSSANTOS, JOSSANAN P Owner Owner's Name information is required for Centerville MA 02632 April 14, 2008 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5-2907.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 15 Gina Court Property Address FILHO, IVO DOS SANTOS & DOSSANTOS, JOSSANAN P Owner Owner's Name information is Centerville MA 02632 April 14, 2008 required for p every page. CitylTown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 240 gpd 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5-2907.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 15 Gina Court Property Address FILHO, IVO DOS SANTOS & DOSSANTOS, JOSSANAN P Owner Owner's Name information is required for Centerville MA 02632 April 14 2008 every page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Age: 7+years. Certificate of Compliance issued 71512000(Board of Health permit#2000-363) Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-2907.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Gina Court Property Address FILHO, IVO DOS SANTOS & DOSSANTOS, JOSSANAN P Owner Owner's Name information is p required for Centerville MA 02632 April 14, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): No evidence of leakage or backup into dwelling was observed. Septic Tank (locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5 ft x 5 ft x 5 ft(1000 gallon) Sludge depth: 8 in Distance from top of sludge to bottom of outlet tee or baffle 26 in Scum thickness 6 in Distance from top of scum to top of outlet tee or baffle 7 in Distance from bottom of scum to bottom of outlet tee or baffle 11 in How were dimensions determined? As built card t5-2907.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 15 Gina Court Property Address FILHO, IVO DOS SANTOS & DOSSANTOS, JOSSANAN P Owner Owner's Name information is required for Centerville MA 02632 April 14, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is recommended at this time and maintenance pumping is recommended every two years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): t5-2907.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Gina Court Property Address FILHO, IVO DOS SANTOS & DOSSANTOS, JOSSANAN P Owner Owner's Name information is Centerville MA 02632 April 14, 2008 required for p every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert At outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box appears structurally sound with no evidence of leakage in or out. Some solids in sump. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-2907.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 15 Gina Court Property Address FILHO, IVO DOS SANTOS & DOSSANTOS, JOSSANAN P Owner Owner's Name information is required for Centerville MA 02632 April 14, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 1 ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soils above leaching gallery appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. A bucket of water was poured into the distribution box and was observed to pass through in a rapid and unobstructed manner, and could be heard splashing down into the leaching gallery. t5-2907.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 15 Gina Court Property Address FILHO, IVO DOS SANTOS & DOSSANTOS, JOSSANAN P Owner Owner's Name information is Centerville MA 02632 April 14 2008 required for P every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15-2907.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Gina Court M Property Address FILHO, IVO DOS SANTOS & DOSSANTOS, JOSSANAN P Owner Owner's Name information is required for Centerville MA 02632 April 14, 2008 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. LEACHING GALLERY LOCATIONS 3 ❑ D-BOX A 8 z 1 24 Ft 40 Ft SEPTIC 2 28 f t 42 ft TANK o 3 34.5 Ft 46.5 Ft 1 B A EXISTING DWELLING # 15 W Z J x W H 3I GINA COURT _ NOT TO SCALE t5-2907.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Gina Court Property Address FILHO, IVO DOS SANTOS & DOSSANTOS, JOSSANAN P Owner Owner's Name information is required for Centerville MA 02632 April 14, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: 15 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: Barnstable GIS Department records You must describe how you established the high ground water elevation: Town of Barnstable GIS Department records indicate that the property is 15 feet above groundwater table. t5-2907.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable OfTHE 1� Regulatory Services mmsrABM ; Thomas F. Geiler,Director v$ 1MAS& `erg Public Health .Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862 4b44 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts,Department of-Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future not does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. I No. �e��� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS 2ppYication for Migpogar *pgtem Congtruction Permit Application for a Permit to Construct( . )Repair( grade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No.�S n COO�� Owner's Name,Addressand el.No. �a f— U1.B� J iS Assessor's Map/Parcel Q/0 ^ , S.a�►�► Installer's Name,A*91 W U lNCO Designer's Name,Address and Tel.No. 350 MainiASllttreo */A W. Yarm Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 33 o gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank t o as Type of S.A.S. Description of Soil S v Nature of Repairs or Alterations(Answ r when applicable) ~ F ,+& 1 Date last inspected: -- ; Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Heal Signed rJ Date �o •/�7 • 00 Application Approved by Date ' Application Disapproved for the following reasons Permit No. Date Issued en No. ram°' Fee v THE COMMONWEIMTfif"0F MASSACHUSETTS Entered in computer: Yes Ct- `ft PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipaprtcation for Mie;poogal *p0tem Congtructio.n Permit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./5 C,..1 ( ice Owne ' Ne,Address and el.No. vUap , JrSK f Assessor's Map/Parcel a 10 j 4 �'A^-i � Installer's Name,Address,Ad&VOCANCO T Designer's Name,Address and Tel.No. 350 Main Street �� NIA , W. Yarmouth, MA 02673 ., Type of Building: 7 Dwelling No.of Bedrooms Lot Size \ sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons, Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 33 gallons. = Plan Date Number of sheets Revision Date Title Size of Septic Tank /Ono Type of S.A.S. Description of Soil �R Y N ture of Repairs pr Alte tion (Answ r when plicable) S� y gA f, �e r r'� e'hft ti& `S 1-0 G/ Sfoyt.-e Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Heal '. i� C,o Signed Date Application Approved by i Date Application Disapproved for the following reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS 1 Certificate of Compliance THIS IS TO CERTIFY,that th A On-site Sewage Disposal System Constructed( )Repaired( Upgraded( ) Abandoned( )b I., at ti�7 Ou 2 fP6�tP1 v�� ha en constr�ctp�,accAnce with the provisions of Title 5 and the for Disposal System Construction Permit Nc 11 dated llvv / Installer A Designer r`•. �l #� � � n�, r5 r v The issuance of this permit71 6 6)shall not be construed as a guarantee that thetsyiten will.•funetio,r�i�as c�esi ned. + Date / Insectors (/ p ��� — � — /3------------------- ------Fee ~� No. E' THE COMMONWEALTH OF MASSACHUSETTS 21U-19� PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS ;Miopota[ Opote✓,onotructton Permit Permission is hereby granted to Cons t( )Repair( Upgrade( )Abandgx�-( ) System located at �5 C� `.. U`' (- //r, and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constryc�'on st be completed within three years of the date of ' t. Date: G/ '/ c Approved b /`G 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated •/ -o 0 , concerning the property located at it e� �a_z, 2 meets all of the following criteria: The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. �• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system ,• There are no private wells within 150 feet of the proposed septic system �• There is no increase in flow and/or change in use proposed There are no variances requested or needed. /• The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] /• If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) -i B) G.W. Elevation d3. ` +the MAX.High G.W. Adjustment.�_ DIFFERENCE BETWEEN A and B SIGNED : V �c..., _ DATE: ( • O U [Sketch proposed plan of system on back]. q:health folder:cart • 4 FLCa, f TO OF BARNSTABLE G o C e LOCATION f SEWAGE #07= C VILLAGE i-e9 ASSESSOR'S MAP & LOT D- INSTALLER'S NAME&PHONE NO. — SEPTIC TANK CAPACITY LEACHING FACILITY: ( !1A QS (size)v?`J�t�. NO. OF BEDROOMS BUILDER OF t f R QZex) PERMTTDATE: COMPLIANCE DATE: Separation Distince 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 i per• �t � a .. �l t !� % r 4e-�,, Logged In As: Parcel Thursday, March 22 2007 Parcel Lookup Parcel Info Parcel ID 210-194 __:� Lot Developer Lot _.__-_----------- Location '15 GINA COURT Pri Frontage 107 Sec Sec Road ' ; ... Frontage _.. village ICENTERVILLE Fire District jC-O-MM ............ _. ......... SewerAcct Road Index j0602 _ w � .. ff Interactivea�� Map Owner Info _ __ ........ Owner I FILHO, IVO DOS SANTOS & Co-owner DOSSANTOS, JOSSANAN P streets E15 GINA CT street2 __... ............�,�__..,, ..�._......_ _____......_�.......�......._... City CENTERVILLE state;MA zip'02632 Country Land Info Acres 10.34 Use iSingle Fam MDL-01 zoning RC Nghbd 0106 Topography?Level Road ["Paved ..........._.. .......................................... ............... Utilities Public Water Gas Septic Location Construction Info ........... . _...._.._. Building f Year Roof " " � Ext . .......�_. .._�... Bunt 1.981 _.___.... struct,Gable/Hip Wall Mood Shingle Effect,1571.__ Roof l . .................... ACNone P-- Type' Style!Ranch Drywall roo Wall Int D wall Bed`3 Bedms — l_.. Rooms - _ s Model ;Residential Int i Bath Rooms€2 Full yv Floor. Grade ;Average j Heat Hot Water Total ?6 Rooms s _. Type;. _ Rooms .,.,.. ........... �,... ,.....- Heat �� Found-I Stories 1 Story Gas Typical —.... Fuel __.____. ____._ ation=_ YP _. Permit ..., History,....... ..._..............._........... i IIS-sue Date I Purpose I Permit# I Amount I Insp Date I Comments Visit History Date Who Purpose 4/9/2003 12:00:00 AM John Greene Data Mailer 3/7/2003 12:00:00 AM Paul Talbot Meas/Listed 2/6/2003 12:00:00 AM Paul Talbot Meas/Est 18/15/2001 12:00:00 AM Paul Talbot Meas/Listed Sales History Line Sale Date OwnerBook/Page Sale Price 1 12/23/2002 FILHO, IVO DOS SANTOS & 16135/093 $269,000 2 5/2/2002 DASILVA, SERGIO T& EVA O & 15120/187 $215,000 3 4/25/2000 SISK, OLEN D &WINNIFRED B 12967/003 $129,000 4 9/7/1999 U S MARSHALS SERVICE 12668/245 $0 5 8/15/1982 EVANS, MAURICE J JR 3538/314 $58,000 6 6/15/1981 SMITH, JAMES K TR $6,750 7 HRICKO, $55,800 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2007 $148,900 $16,100 $0 $133,500 $298,500 2 2006 $136,200 $16,100 $0 $135,500 $287,800 3 2005 $127,300 $15,800 $0 $135,100 $278,200 4 2004 $103,400 $15,800 $0 $135,100 $254,300 5 2003 $93,600 $2,600 $0 $44,600 $140,800 6 2002 $93,600 $2,600 $0 $44,600 $140,800 7 2001 $91,900 $2,600 $0 $44,600 $139,100 8 2000 $70,200 $2,500 $0 $26,800 $99,500 9 1999 $70,200 $2,500 $0 $26,800 $99,500 10 1998 $70,200 $2,500 $0 $26,800 $99,500 11 1997 $76,600 $0 $0 $20,100 $96,700 12 1996 $76,600 $0 $0 $20,100 $96,700 13 1995 $76,600 $0 $0 $20,100 $96,700 14 1994 $74,300 $0 $0 $24,100 $98,400 15 1993 $74,300 $0 $0 $24,100 $98,400 16 1992 $84,700 $0 $0 $26,800 $111,500 17 1991 $88,800 $0 $0 $46,900 $135,700 18 1990 $88,800 $0 $0 $46,900 $135,700 19 1989 $88,800 $0 $0 $46,900 $135,700 20 1988 $60,800 $0 $0 $19,200 $80,000 21 1987 $60,800 $0 $0 $19,200 $80,000 22 1986 $60,800 $0 $0 $19,200 $80,000 Photos µ ........... , ram_, rF saw' i Town of Barnstable Geographic Information System March 22,2007 i 210191 w , OR # Y 210192 # 20 lot iuuN 1 !+ I r ♦ r 210195 Y 210194 „ 210193 III 209014 209095 i" {Y • # 1600 ' #1A .* 209015 1550 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:210 Parcel:194 - boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:FILHO,IVO DOS SANTOS& Total Assessed Value:$298500 Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map ;E are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner:DOSSANTOS,JOSSANAN P Acreage:0.34 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:15 GINA COURT such as building locations. •Buffer i 7 A F \ �� \ ^ y°% .��«y. . ����� � ! � 2 \ . . \ { � �\/�« � � � � � , r±«� < : � ` \ � �\ < \. . ���� w � \� ^ � % � �ƒ� ^� � � ! � a � . - . ��.�, \ y � � d�/ , . \ � »�d ?� . � � > SC«« � . �22«�? » 2«©2 . » . : .�> �«2 f \ . . 2� < : °& � � � ` �<. , < »� � ���` � : . 2 � «� .©. ? 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W .4} 574.�. ...........................................................S. ............ C .. ... ar s ...................................... a � Installer Address i b q. Type of Building Size Lot....`_______________________•S feet U�--+ Dwelling—No. of Bedrooms............... ------------------.....Expansion Attic (piq Garbage Grinder (1JO aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------•--------------•-----------•-•-•-•-•.••-----•••-•----------------•-------•------•--••--••-••-•-•--••-••---••----.........-••-•-•.... W Design Flow.........._1.N ........................gallons per person per day. Total daily flow............. ..................gallons. WSeptic Tank—Liquid capacitykgPogallons Length................ Width................ Diameter.-.-----.-----.- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.........Zck �_!tA.....�A... ......... Date..... 3' Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..--.................--. 0-4 44 Test Pit No. 2................minutes per inch Depth of Test Pit---................. Depth to ground water.---...............---.. P --•-- ----- ........................................ -- --...... .. O Description of Soil--------.�?-" ......a-'............ Sal .......... .............N \�........................................................ (xj ------------------------------------ --- .......A•---•-----•-----------c�g-� ------- C1S V:.SZ-V..-------------------•--•-----•-•-------------------------•----- ---\- ice'=------------------- ------------.. -----.--------------•----------------------•------............-- V Nature of Repairs or Alterations—Answer when applicable............................................................................................... ................•-••----•----•-•----------------•--•---•-•-------•-------------------------•--•--•.._.._......---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iiTLd2 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed------.%. t` �..... �...•.. .k ........... 8 ,,�� Application Approved By... ��y'--•.• .............•--•....... Date�l Date Application Disapproved for the following reasons:-----•-------------------------•----•------------------------------------------•---•----•---••--------........_ ......--•---------------•-•-••----------...---•----•----•••-•---..--•-----•-•---.....•--.......••---.....------•--•----••-•-----•••----•---------•••-•--•------........................................ Date PermitNo......................................................... Issued........................................................ Date ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7�J\'_Q.1r\............0F...........3 . .. .: ..c`: �,�-- Appliratinn for Disposal Vorkg Tnnitrurtiun Vrrutit Application is hereby made for a Permit to Construct (I✓) or Repair ( ) an Individual Sewage Disposal System at: r� ._..... L{1 ... .�.� 'n ...._._... ............................................................................. Location-Addres or t No. ` �.r�e.5........__ .......----•--•...... at:� ..........-- ,.cl �..< 4 ••••... .......................................... ........._ Owddr as --- .................................... .................. ....................................... Installer Address Type of Building Size Lot...V�2......Sq. feet a Dwelling—No. of Bedrooms....................-3 ........................ Attic 00) Garbage Grinder (1._j aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ,(` ) dOther fixtures ---------------------------•-----------•--------------•••-•--•-•---••••--•••••••----.....--•-...-•--•...••-•••......-••-•-...........-••-•-. W Design Flow...........V\.0............. .........gallons per person per day. Total daily flow..............33 ..................gallons. I:4 Septic Tank—Liquid capacitykggQgallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.............._..... Total Length.................... Total leaching area..----------_---__--sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by......... ?�: :.!C. __.-_` �...�U- -......... Date.....y..'�__?"_� . Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ............•--- ------••••-••••••-••••••••-•-•--••••-••••...........-•-._......••-••---•--•-----•.......---••••-•-•--•-•--•......••••.....-•-•-...--•- i O Description of Soil......... \ --........ s �..---..�c .. Oc.�... U ..= � ------ .5 _ __ _1.....--•--------------------------------------------------------- ---------�-- •-•-••.V;m .....••-•••-•---._.t`i L' '''`' ----------- ���r' ��-----------•----------------------------------------------------- Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions,of TITS.% 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. -•.Signed:•••. J '�.. �� Date Application Approved BY ��'r�......,.,r-!i�'!-. r "�/` r ',',✓_•-.-_---- Date Application Disapproved for the following reasons-.............................................................--------------------------- ------------...._.... ......----•-----------------••-------•--...-------•---------...------------------•-------...--------...---•••-••-•••--•.....-----••-----•••-••-•-••------••••••••••-•---••---•-•-•--••-•••••--•...•••--- Date PermitNo......................................................... Issued_...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........�.L.............................OF............ ?...ln.n.`.... .C:' ?\�.................................. (I-Errtifiratp of TunwliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( � or Repaired ( ) by V .: .t=`` `' .....c•'-)'s . -----------------------------------------------------------------------------------------------------------------•-•----...-•••-•.... J Installer \ at.............. �� - GL C rl�1�------ _.C�_!i_ _ \J �� has been installed in accordance with the provisions of TITL: 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....p......al-S.......... dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION $ATI FACTORY. DATE................................../J,/-� ................... Inspector....... --------------------------------------------_-------•--•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH N o.... !".�i 1$•.. FEE...... 6�•. Wopos al Iforks NTnnitrnrtion .eranit Permission is hereby granted----------V:e_ .S_ t ..__... i S. ................................. ............... to Construct (✓) or Repair ( ) an Individual Sewage Disposal System -a \ 1 Zi at No.........� >..: ............ ..- .......-•-•---- a_ _w...............--�� "----- �:...................................................C ...V. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... "'lN ...C.Y_�..•____._a.r! . . . ........................................ Bo o Aealth DATE.. r!�a ..................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 6r 1`IC7 �At"G7raf l_ r•�1:!1 t..I:..•t:.l;._ i .. �•- t MD< , 4 :: =a C (� F%�7. ._ ..__ _ - q ' !{-_'F'� (C• �1r� - jil�i I•�7�a j!• • ���,'7..<,ri.l'-.r7....._.................-..................,. ...-__ �� L�'j•OCR ��.�.� AL Slo '+ ToTt ,s LT7 IG►.l = -i'Lr� L .P.C.:. •N ---- e / 6.FD. q,.� q,•,s �� �EfZGDLAI"IDt.I QATE : (��tt.1 ��.�4ttbJ OfZ �LS�,. ' 117 T� • ! •A} /+ram• eo/ � 1 �`�• 4�"rrxt�a.�a�'�'• � .� �!�!��-.__ r /3oi38 --------w_._. , � _ ___ 7 i 9 • 1 i-'""OJT . .,-z• ,4 e, �'"G. 7 '��I �►1 ti c 1 U L7.t.�N 16-1 9-!. T > >`,. ... T.:cr,r '7liZ�.:..-Ti. 1 � � ._..,r .... :;� i�.l��• �7,o O ,SvgScaG. 4rP � bt'�7. �1�A'• 'GpiaL. qG Ar loo0 9�.o tNv. +►� rc�tr.H PLC,'1 j - ---- - ..�i.`�... L.o.CJ�T�..I.C.�I•�_ G�IJT�•a.�l,(.-C.Cy J tJ C> t do J o W T� c. �t._.�.l�t TZ►_I= r_t,v T t i= -{ T t--{A T T 1-1 CG UV NDATt o N 5 t!aN Q L7- —` t44.ic_�titrlLI(5 AWt7 ;C'i 1'.:�C1; �'CG}<.�t Irt ,tJT•;' Gt= '►'"e:s 'To WLi cr- 'g,A,RN 5T/\ '6 LC. PC. • �tL �� :� t�.. � t t • t QOT r_ U1::3 A" ?{ U i-fLL;VII.LG U $l�r�iLSy, r 7 , C-uJ /:JC��/1:.�. 1 �(t�L� 11Fl�j�_`'� )t•ZlieJ�n y u:. j�>c.c, f�, t,r t't c.n�►►��: ; 1 c;r _t w —�.-. _ J A � � - ��1 a �`t ` — L°O CAT ION ? v � SEWAGE P IT NO. VILLAGE �i CF&7— v�c,� I N S T A LLER'S NAME i ADDRESS 8 U I L D E R OR OWN ER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED f6 �� r ,F ►t l ► 171ad i 5 TOW19 OF BARNSTABLE LOCATION J� SEWAGE #AW VILLAGE e,'I leASSESSOR'S MAP & LOT ^ D- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY r LEACHING FACILITY: ( )o f/,�� C/lA JW' s, (size) NO. OF BEDROOMS BUILDER O OWNER fs�eA) 65'1sk PERMITDATE: COMPLIANCE DATE: Z i 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 I ® a �C, E , ' FORM3O HxW HOBBS&WARREN" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN w a DEPARTMENT ADDRESS GSM yv9"`ou �v4ELEPHONE1 -� Address _ Occupant ._ Floor Apartment No. No.of Occupants No.of Habitable Rooms - No.Sleeping Rooms___ \ No. dwelling or rooming units___— No.Stories.--- 1 �nL 1 Name and address of owner ,,- I I — ( I A Remarks Reg. Vio. YARD Out Bld s.: .Fences: Czk r - Garbage and Rubbish Containers: r0� Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress: and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: j we Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: I,, Stairs: Li htin STRUCTURE INT. Hall,Stairway: Obst'n.: c Hall, Floor,Wall,Ceiling: Hall Lighting: I 6,t.Q. Hall Windows: IJ ^ HEATING Chimneys: v r ,_,e Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: ly PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom —Pantry Den Living Room Bedroom(1), Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten., Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin, Shower or Tub: Infestation Rats, Mice, Roaches or Other.- Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR TITLE A.M. DATE TIME _ P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. s .Jnn v l�.-,M z �..�.,A`9 ^i� •^'1.�:X Fr-Yfs ..�'.f,t '..�?,M'fq'W.._'t1 q nti f� -fT", '°o`'' ,n7^` , _ .+lr�'•fly�5Z'� M 'r . 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 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. I - FORM 30 CI1&W> HOBBS&WARREN'"" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOW N i 4 w DEPARTMENT 0 'c, a ADDRESS GSM cyeyw CJ ELEPHON ti r f/ Address Occupant. Floor __ Apartment No. _. No. of Occupants No. of Habitable Rooms_ __ _ No.Sleeping Rooms No. dwelling or rooming units___ _- No.Stories Name and address of owner_______. - - - - Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: T P fr ' N a� Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: x V 1 ❑ 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: - r��✓ Hall Lighting: Hall Windows.- HEATING Chimneys: Dr % ' n of Central . ❑ Y ❑ N Equip. Repair ' .�o !"° " 1) TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: " ,UA( {C H.W.Tanks Safety and Vent(s)R ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: f 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 PENALTIES OF PERJURY." INSPECTOR TITLE A.M. DATE TIME _ P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. a` 3. 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 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 hdbitaUon,.any other violation has the potential to fall within this category in any given specific situation but may not do so in every case arfd'th`e eforn,is no-Fincluded in this listing. Failure to include shall in no way be construed as a determination that other,violations:orcora&ti'ons may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to.&cIer 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. y;. { I ! NAME OF OFFENDER k L< A`'�� � A%K G3 "f A A BAR 7 6 7 0 9 TOWN OF ADDRESS OF OFFENDER '` ,pr 0 Q IS ; x tad BARNSTABLE CITY,STATE,ZIPt ` y DATE O6�IRH 0 Ft10ER � a"tr �f0�- MV OPERATOR LICENSE NUMBER f - t "'"^�^�..- MV/MLB1"R1tEGISTRATION NUMBER � OFFENSI: l t6jq. �i ED MIS O TIME AND p TTE OF VIOLATION LO ATION OF VIO TION •( W .NOTICE OF 061, �� A. ./ P.M. O !r� � 20�S' 1 --,5 SIGNATU OF ENFORCING PERSON •f t 1 EN RING EPT. Ir� BA GE NO. /•�,,.w VIOLATION ' , t o OF TOWN I,14E//REBY ACKNOWLEDGE RECEIA , OF CITATION X \ �l ` a ORDINANCE unable to obtain signatyre of fender. Date mailed � , THE NONCRIMINAL FINE FOR T.HI O&E SE-IS"$/ 0 LU LU OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH,REGARD TO DISPOSITION OF THIS MATTER:EITHER OPTION OR OPTION(2)-WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECb D. Lu REGULATION 1 You ma elect to a the above fine,either b arin in person between 8:30 A.M.and 4:00 P.M.,Monday through Frida`I al holid excepted, Q O Y pay Y p? p Y 9 Y•`e9 P LU before:The Barnstable Clerk,200 Mein Street,Hyann s, 02601,of byy mailingg a check,money order or postal note to Barnstable Clerk,P. Box 2430, d Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OFTHIS'NOTICE. UNSTABLE you desire to contest this matter in a noncriminal proceeding,you may do so by making written,request to DISTRICT COURT DEPARTMENT,FIRST If DIVISION,COURT COMPOUND,MAIN STREET,YARNSYABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature - __. _._�.__.,._..__.___Y.�..�. ny, 3 I� —r f �., � i I ,. i � i �� �� "'�� I -- -. _... -� r.� _ _ =� `\9 ci �,,� v � � � � I o � � � ..�. � � [ �, '• � � � G �r � 1 �` 1� i � r i 1 �1 � � S � O �� � �� IN , — f ` i v / fi Ir is �j 5 H. j, dam. a k•s { t �' 3�1 �-,� •� tit Y`4.1 4 r ` s 5�e1 �� �b.9 .i�s�wy„°Lauiv.�n' e!:,...�ey^�•� __.._.. - -,fin My„ V1!'. :f �'�' x• .we.,,k_.,..,:,-y„,ate...._,._ - �j�. f r GP . 4ti V �S FF � tti� c