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Home My WebLink About1052 OLD STAGE ROAD - Health 1052 OLD STAGE ROAD ` Centerville A = 173 — 025 S M EAD No.2-153LOR UPC 12534 amaad.com • Mado in USA 40). OI�iIK�MiH{POOOUCTIlE IFI MMYK OHM PGDWM WWXW Y. TOWN OF BARNSTABLE LOCATION IU SEWAGE #� VILLAGE��> .;y y SAL ASSESSOR'S MAP & LOT /73- INSTALLER'S NAME & PHONE NO.Joke A Aq SEPTIC TANK CAPACITY /000, Cr, LEACHING FACILITY:(type) ��' �� (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER)OW BUILDER OR OWNER G `_'Aw 1 f DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No / / !� r� r , ` Ij f f� �/� t. �. .. �� i rr�� .` �� c� � , %//l / � / / / ` / 7' /� �! .�:. H. �, '�,:�,; ,n�c l G to�/� ' /Tii'a�' P�.J No..231:.� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH F f!1................OF.... �fit..S/�.�!.•C Apptiraiion for Disposal Works Tontrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (PJ an Individual Sewage Disposal . System at e ocati99�-Addre � or t No. --- - d .f_lt.�;?,l� -'-�.................. s�....` .-S7'ryifl� Owner /� A(ddrrees a ..................... �ly-�;t•••• �v E ..... Y !�i!�!�"3. ...s2��_....!!(�----- -- Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............... No. of ersons...._....................... Showers a YP g ------------- P ( ) — Cafeteria ( ) 0 Other fixtures W Design Flow............................................gallons per person per day. Total daily flow....................... ......................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.................................................••-••-•----••-----•-•---- Date........................................ Test Pit No. 1-__-____---___minutes per inch Depth of Test Pit.................... Depth to ground water........................ rs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Descriptionof Soil `'i 7----------------------------------------------------------------------------------------------------------------------- V ........••-•--••......------•----••--•-•----•-••-•-••---•--•--•---------•-•--------------------•-•--•-•--•-----•••----------••--•------•-••---••••--•--•---•--•--•-••-••------•-•--...---••---•--------•. W UNature of Reps or Alterations—Answer when applicable.._.....��.9 J-S- , l_� ..____ Agreement: / F2.ou 1 1,,Oz The undersigned agrees to install the aforedescribed Individual Sewage Dispo al System in accordance with the provisions of'T'�L p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be 'ssu by the board of health Signed-----•-• --•- s Application Approved B ............... ��[ ..... L-Ce PP PP Y - Date Application Disapproved for the following reasons:------•-------------••-----•--------•------------------•---------------------------------------------•••......•. .------••-•-•--.-•---••------------------•-••--•-••------••••-----••-••----.....•-------•-•-----•-----•-•--.....-•-•------••......------•-•--•......--..................................................... Date Permit No...... Issued_........................................................ t,,,p, Date No :.�..:. 2 ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH J f .Al_...--- .....OF... .... Apptiratiuu for Dispnual Works Tanotrurtiou rprmit Application"is hereby made for a Permit to Construct ( ) or Repair (V an Individual Sewage Disposal System at: - �IP " � ... . . --------------- ---------------------••- -------- ---------•--••-------..._----....-------••-•-- 4 jLoca4' n-Address or No. - 1�.� '_ :l. L) � `� 5�"'�t�p° a'r. �1.. .. `e Vie' t✓O��w Owner - Adddrre J�y Lf a .................. ._...--•-------- �?.f ------/ -r--. a ------------------------------ ----�`.. _ " '.f.? !. _-- --F---..!�44.... Installer Address UType of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms............. ..........................Expansion Attic ( ) Garbage Grinder ( ) atOther—Type of. Building ............................ No. of persons...._................_______ Showers ( ) CafeteriaOther fixures -- ------------------........................................................................•----------•------------.......-----------.......---•-- WDesign Flow............................................gallons per person per day. Total daily flow----:_......................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter-_-_-__--_____ Depth................ xDisposal Trench—No..................... Width.................... Total Length.................... Total leaching area.........._---------sq. ft. Seepage Pit No--------------------- Diameter..............-..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution'box ( ) Dosing tank ( ) Percolation Test Results Performed bY...................:........................•-•--------------•----•-•---- Date........................................ a Test Pit No. 1_................minutes per inch Depth of Test Pit..................... Depth to ground water___________-_••_---_•__. r3 Test Pit No. 2................minutes per inch Depth of Test Pit.....................Depth to ground water........................ --------------- ---------------•--------------....------------...........-=............................................................... O Description of Soil___________________________vf ! .------••._-__._ x V x Nature of Repairs or Alterations—Answer when applicable...... ___._.-_0Y`_._ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iT'�'Li:p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b iss d by the board of healt . Signed......_ , la- .............................. •-- "-. "� ". �•7 . Application Approved By....._r` _;; -" f- �� --•--- 1 a��` 7- _� Date Application Disapproved for the following reasons:--------•---------•--------------------•--•------•-------•----•---------------•-----------...._••-----......---- •- •------•--•-•------------------•-------- Date Permit No..__..�.=�"°rz_ _-�.`.._.:_l__rC....`��-;- Issued.. ---•--••----- --------- ---------- -- -------------- ----- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... .................OF.... .................................:...... Trrtif iratr of ToutpliFaurr THIS IS TO CERTIF That th In•Jvi�1 Sewage Disposal System constructed ( ) or Repaired ( } by . -------------•-•••... / ' .....-•---------------------------------------------------•----•--_..._ I ter has been installed in accordance win the provisions of TTTIE 5 of The State Sanitary Coe as described in the application for Disposal Works Construction Permit No... dated.... ...................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO TRU A GUARANTEE THAT YHE SYSTEM WILL FUN TIO A FACTORY. /� l DATE--•--•••--•-••- •.. ...................................... .. Inspector_....__ t.r= . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �f�Z ... . .. p DisposFa arks Tuuu ativit rrutit Permission is hereby granted .__ l �C+ -••-------•-------•-------••--------------------••--------.......--••---..._.. to Construct ( ) or Repair (t/) an Indivi ual Sewn.,e Disposal�� System at i�i0................ }0. « Old.. pfiC ....... >r—IF t!C . .`� ./ .............................. Street ,;;� - ? u� '7 -S. as shown on the application for Disposal Works Construction Permit No------------- ----- Dated_____ _.._...`..__...........__..... 2 � C, Board of Health DATE ------� - ••-- ......••- �-------------------•--- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r TOWN OF BARNSTABLE d LOCATION S' 01,D 5 :-1D SEWAGE # 95'' J ' 1. VILLAGE 6fxT 2v)GUE. ASSESSOR'S MAP & LOT Z7g INSTALLER'S NAME & PHONE NO._Jo Aa;l{p AW-2-52S ' SEPTIC TANK CAPACITY 1000 6PLC. c ' LEACHING FACILITY:(type) FUWDA-Fd0 S (sizeO) NtOF:BEDROOMS 3 PRIVATE WELL OR UBLIC WATER BUILDER OR OWNER ZRENE G.1H00 DATE PERMIT ISSUED: �- ' ATE COMPLIANCE ISSUED: ARIANCE GRANTED: Yes No �/ �' � 2��`��: + � B s 1 �s� 3s� c 2` �9� 4c�` �. 0 3 2�� 39� o 0 ASSMSORS MAP Nk 1 MCELNo: FF....... ...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Diin.pn!ul Wor1w Tnntrnr#inn Urrmit, Application is hereby made for a Permit to Construct ( ) or Repair (e-Iran Individual Sewage Disposal System at: A /{?S 2 '14------------ C . --- r osat' n-. ddress or t o. i /t�•�� r. �� ,Qs� dl�P S7� t Co o`�i/l v ......................_._.. --._.... -•------------•-•------•------••-•--•----• -- ---------- ------------......•....... --------------------------------- owner W JTv4r r ) �-.(),p..................... �.......................................� .. Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms--------:9--------------------------------Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures -----------------------_....... _ W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length----------- Width-----.---------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No---------------------- Diameter---..-------..------ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY-----------............................................................... Date........................................ Test Pit No. I----------------minutes per inch Depth of.Test Pit-.------___-_-_--- Depth to ground water........................ G% Test Pit No. 2................minutes per inch Depth of Test Pit.---__.._.__-___-_- Depth to ground water........................ Descriptionof Soil c`.....�P•-------••--••-----------•--------------- --------------------- ----------------- --------- ----------•---------- V ......................•-••-------------------••--------•--•••••---••----------•-•...--------..........---------.........----.._...-----------•---•------.....---•---••-•---•-••----------•-----•------•-- ••---•-------------------------------•--•--•-------•---•-•----------------------....---•---------------•- tt U Nature of e airs or Alterations—Answer when a icable.-.__e [u�t..__�--S_S�J. vvl..._...'��o-`^ �i .�,i. ,� no._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has n. ' sue.d� th. board f health. .. ........... ..............Signed 2................................QiS� Date Application,Approved B --- PP PP Y - +-� -x--` Dare Application Disapproved for the following reasons: .................. .... .. --- ........_........... .. _............ ......--------------------- . ............... ..... .......-.... _........_-- ------------..._._-.._..-------------- ---- ------------------ ------------- ........................................ Permit No. ..-----?j -- Issued Dare 1 7_3 r No.--..1:.�?I:_ .� Fizs..... --mod.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Allpfiratintt for Diti-pntiu1 Workii Tott9trnr#inn Frrinit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: w^• Location-l�dd,ess �� vs old Sf-�� _... ...................................................... - --------------------- Owner � • Ad r ss.........................�_..._...._...._. ---------------- --•............ ....... ............................... Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.........---------------------------------._Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons.-.._-___--_-_----_-_----.-. Showers ( ) — Cafeteria ( ) Otherfixtures .---_--------_--------- -------------------------------------------- Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width----..---------- Diameter- ........ Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area_.___...............sq. ft. Seepage Pit No.......-.--_---_-_- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by_------------------ .................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water-_----.-__--_-__----_.-. (.Tq Test Pit No. 2................minutes per inch Depth of Test Pit_................. Depth to ground water........................ Ix ---------• --------------- ............................................................................................................................ Descriptionof Soil s4 ��---------------------------------------------------------------------------------------------------------------••-------- U •--------•-------------------------------------------------------------------------------•--------------------------------------------------------------------------------....-•--•...............•..... W --- ---------------------- ------------------------------------------ --- ---------------------------------- k U Nature of.Rey�airs or Alterations—Answer whenn apL)Iicable._-..-./Rt ct.-__cas� v_s--.--- �-- /� �.., S"'_l_/...__.../00a .S - 94.9 ...-!'_..!../O �. 1t ¢N SUNS ........................ .. .--..-----_.__._....... --•--------.-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has e n i sued by the board f health. Signed ----------------- ...6 �.......... - ---------------- --- 2 /. `g 5� ----- _..... ..-..An lication,Approved BY Date ....1�'�:. Application Disapproved for the following reasons- ----------------------------------------- ---------------------------------------------------------------------------------------- ---- ---- --- Da ce Permit No. .. ?J�-------- '_'zI- ..--------- Issued Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Prtifirate of 01-1IIrajiliance THIS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( >') by ------------------ ---------- --- G--- ` �'......__-----------------------------.....-............... atL.iS..-,J o�.. �'� .........u� `? - - ----- �.P .. ......... ... ---------------------------------------------- has been installed in accordance with the uvtstons of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...---- .-_J/.Q......... dated ---------------------- ----------------_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE .. ......... .... ................_...------------------------------------------ Inspector ....---------- ------------------------- -------------------- --- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q I TOWN OF BARNSTABLE _ Dinpnm nr�kn Tnr _ �r#inn "rrmit Permission is hereby granted----------- 7vidual � '-- - ----------- ---------------------------.-------------------------•-----to Construct ) or Repair (�an In Sewage Disposal System at No. T ..5� --�0- I :----:� `�'- &=tlf.:.....U....----------C-0..:�I.A. .----- r2-A -'........... .................................... Street as shown on the application for Disposal Works Construction Permit Na..l>{-��a-�---_�Dated----- ....... _.s.- .....................................•. �,.. - ' / ________________ oard of Health DATE. FORM 36508 HOBBS&WARREN.INC..PUBLISHERS 5 Certified Mail#7006 08100000 3524 5126 �t tti Town of Barnstable Regulatory Services ACMsnRNsra $ Thomas F. Geiler, Director 16j Public Health Division Thomas McKean, Director 200 Main Street, Hy , MA 02601 Office: 508-862-4644 Fax: 508-790-6304 October 24, 2011 Clifford Lihou 1052 Old Stage Road Centerville, MA 02632 _[6— 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 1052 Old Stage Road Centerville, Ma was inspected on October 21, 2011 by Timothy O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received .at Barnstable Health Division. The following violations of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. The living room, hallway and kitchen ceilings are in the need of repair due to leaking roof. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by repairing or replacing the leaking roof; by repairing the said ceilings after leaking roof has been corrected; by removing all mold like growth and sources of chronic dampness. 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. O ER OF THE BOARD OF HEALTH mas A. McKean, R.S., CHO Director of Public Health Town of Barnstable QAOrder letters\Housing violations\Rental ordinance\1052 old stage 10-24-11.doc I FORM`30 CI_W HOBBS&WARREN'M THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH 3Are+► cI,b� CITY/TOWN DEPARTMENT ADDRESS �y soy`0 _ n o TELEPHONE Address fV�X"'�'/l` _Occupant_. Floor Apartment No. No. of Occupants �— No.of Habitable Rooms No.Sleeping Rooms No. dwelling or rooming units_ No.St rie Name and address of owner_ ' 6 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: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: n Hall, Floor,Wall,Ceiling: .s.i Hall Lighting: 67) Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: A I IV_ ❑ 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 INSPECTOR TITLE TIME A.M. ' TIME l�`� � P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. c; 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), 410,251 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, includinggarbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. 9 9 9 9 (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 her and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do,not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. FORM 30 Caw HOBBS a WARREN TM THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH CITYITOWN W tsvo DEPARTMENT } ADDRESS 1 V 5 1 TELEPHONE 7 ) Address Occupant_! Floor Apartment No. No. of Occupants Ila No. of Habitable Rooms No.Sleeping Rooms i No.dwelling or rooming units_ No.Stories Name and address of owner Remarks Reg. Vio. YARDS <.. . Out Bld s.: Fences: j Garbage and Rubbish1 Containers: A Drainagej C Infestation Rats or other: s f , STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof V Gutters, Drains: Walls: J Foundation: _ Chimney: BASEMENT Gen.Sanitation: aDam ness: f + " - XStairs: i Li htin : 1 STRUCTURE INT. Hall,Stairway: t Obst'n.: �i Hall, Floor,Wall,Ceilin .ti Hall Lighting: .. p tcru Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair sic TYPE: Stacks, Flues,Vents: q� -� �r PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: v 16- H.W.Tanks Safety and Vents v 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-_-_ r Pant r = -f. ......�..� Living Room Bedroom 1 Bedroom 2 Bedroom 3 w` t Bedroom 4 «, Hot Water Facil: Stacks, Flues,Vents,Safeties:-1 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) j ` "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES 0 INSPECTOR "TITLE DATE f Q}•• �. ...' 1 TIME ( ` f✓ P.M. i 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 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. M FORM 30 CHI&w HOBBS&WARREN THE COMMONWEALTH OF MASSACHUSETTS r ' BOARD OF HEALTH " CITY/TOWN DEPARTMENT 'o ADDRESS r �� TELEPHONE Address i _ Occupants:" Floor.Apartment No. No. of Occupants I ti No. of Habitable Rooms No.Sleeping Rooms ; No. dwelling or rooming units--No.Stories !I Name and address of r owner _ e� Remarks Reg.f rf a- 1 YARD u,,„.., Out Bld s.: Fences: i Garbage and Rubbish Containers: i .� Drainage ,..� r• w E` `1 ! Infestation Rats or other: , R STRUCTURE EXT. Steps,Stairs, Porches: "" Dual Egress:and Obst'n.: ❑ B OF ❑ M ) Doors,Windows: j Roof Gutters, Drains: E Walls:t Foundation: ( r t Chimne ' _ 1 BASEMENT Gen/Sanitation: ADar ness: j �`_-- 'Stairs: 1 Li htin : s ) -- STRUCTURE INT. Hall,Stairway: i Obst'n.: Hall, Floor,Wall,Ceiling: }�-►�'`�- ,,,d Hall Lighting: _ I� r �... `110 . tlZ,) Hall Windows: 1 �'�`" i► b' y HEATING Chimneys: �t Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: " A).c r PLUMBING: Supply Line: — Po ❑ MS ElST El :P Waste Line , °i J 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 k Hot WaterfaciL _ � Su—Ten:,Gras, Oil{Elecf`: .�, _..� 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 PERJbRY." INSPECTOR ��-'1- ��- \ TITLE tJ A.M. DATE "" , ' TIME �° � � P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 1 410.750: 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. i TOWN OF BARNSTABLE LOCATION 1G1 S C)lA S q P . l /J- SEWAGE #0 q5d VILLAGE C2!'�t 5 c> (�<' ASSESSOR'S MAP & LOT 7 3' J INSTALLER'S NAME & PHONE NO. �hn A. A,,,I SEPTIC TANK CAPACITY /0bO/ - LEACHING FACILITY:(type) �� `' �' �� (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER+��L� c BUILDER OR OWNERS DATE PERMIT ISSUED: - o� - � DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No I f / tA r/, i