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Home My WebLink About0450 SKUNKNET ROAD - Health 450 SKUNKNET RD. CENTERVILLE A = �lllll �� • UPC 12534 ' 0.2-153LOR HAITINoi,UN g 7 , S §Cp R x . NOV.14.2008 0-:39AM BARNSTABLE BOARD OF HEALTH NO.571 P.2i4 Town of Barnstable Health Inspector Office Hours Regulatory Services 9;30-9;30 Thomas F.Geiler,Director 3:30—4:30 ' MASS. , Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PRQGRAM APPLICANT - SEPTIC QUESTIONNAIRE Datc; 11/6/08 1. General Information; Size of Property: .34 acres Address:450 Skunlmet Rd Centerville,MA 02632 Map 170 Parcel 018-001 Name:Elizabeth Keen Phonc#; 508-775-4056 2a. How many bedrooms exist at your property now? 4 r 2b. Are you planning to add any bedrooms? 0 If yes,how many? 0 �`- LL �"A 2c. How many bedrooms total are proposed at this property(including the amnesty unit)?4 ,° n 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. ow all 4ting rooms in the home and the proposed amnesty apartment. Provide width measurements of any o en doordys. Please label each room clearly. .. eu c.n r- %D rn 3, Is the dwelling connected to public sewer? N0 If the dwelling is connected to public sewer,skip SLuestions#4 through#9 below, 4. Location of dwelling is INSIDE or OUTSIDE a Saltwater Estuary Protection Zone? I 5 . Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wella", r,_ 6. Is the dwelling connected to an ONSITH WELL or to PUBLIC WATER? 7. Is a disposal works construction permit on file? YESa or 8. If yes,how many bedrooms were approved according to this permit? edroomt 9. Were any building permits obtained for construction of additional bedrooms? YES or NO P�' 10. Is there an engineered septic system plan on file at the Health Division? YFS or NO 11, Has the septic system boon inspected by a DEP certified inspector within the last two years? YES or NO ----------------------—................................ -------------- .............................. FOR OFFICE USE ONLY The Public Health Division has no objection to_ bedrooms at this property. Special Conditions: m Signed: Date: Q;Ili ealth/wpfiaes/ana nesryapp THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) M A DATA I MASONRY SERVICES ,lilt(Y 1�-1 V n PROPOSAL NO `f SHEET NO. SPECIALIZIN INS ESTORATIONS • Free Estimates ` � d V '� DATE /a • Fireplaces /i ✓ ! • Steps VV WORK TO BE PER ORMED AT: • Stone Walls Masonry Repairs p ADDRESS (508)9004 6- Guy V.Nelson-Mason Contractor A9 s ,,. DATE OF.-PLANS' A- - PHONE NO. ARCHITECT :: ...:N a We hereby propose to flirn h the materials and perform the labor necessary for the completion of A` "4 S C�l eArr �H�,, C C C-v `.. �l!'I.IV 0 Lf/ 1 t WtrvlSpr�J ` Tp QC` 3T V '^ 35, ': "icl C' k' t.0 I T s s Q O�jtj /LJ .1 C NC r �� Iv 4 r t t� PL AJL Aj�i S U'� E W A✓D O W P � r w ti o w t TO rg e ^n - 0 O u s ,v ra 0 0 e, Sp e All material is guaranteed to be as specified, and the above work to be performed in accordan e.with the drawings and specifications submitted for above work, and completed in a substantial workmanlike manner for the sum ofF4 7 06 FO P-r Y Sle-v c N H ury o rt L 0 Dollars ($ y 7 D cl ) with payments to be made as follows: C7Qd (J O I -7 0 0 W 12 L L -t UJ t hJ tOO LJ I1v S C I 000 V.Polu Gd p,�GLL"1 16KJ Respectfully,submitted " Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge Per G. V, hJ. 1M q y U N n over and above the estimate. All agreements contingent upon strikes, ac cidents ays bey dour ontrol. Note - This proposal may be withdrawn by us if not accepted within 10 days. ', r ,,r � aye'" YY" ;t: ACCEPTANCE OF PROPOSAL The above prlces,apecrflcatlons Arid conditions are satisfactory and are hereby accepted You are authorized to do the work as sped ied.`Payments will'be`made as outlined above Signature Date Signature MADE M IN USA ad— MADE PROPOSAL w G tv tt)0 u! 7z I I �\ fl4)C wi.(J#Lf _ I , 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS THE MASSACHUSETTS STATE BUILDING CODE a maximum of six inches-(152 mm) into the shall be provided at the normal level of required dimensions of the window well. entry/exit. In addition,all other floors within 5310.2.1 udder and Steps.Window wells with a dwelling unit Shall have at least one means a vertical depth greater than 44 inches(1118 mm) by which a continuous and unobstructed path shall be equipped with a permanently affixed leads to the exit doors: Such contfnrious and ladder or steps usable with the window in the fully unobstructed paths shall be by means of open position. .Ladders or steps required by stairways, corridors, hallways or 780 CMR 5310.2.1 shall not be required to combinations thereof. comply with 780 CMR 5311.5 and 5311.6. Lad- Exception 1:In split-level and raisedranch dens or rungs shall have an inside width of at least style layouts, the two separate exit doors 12 inches (305 mm), shall project at least three required by 780 CMR 5311 areperenittedto inches(76 mm)from the wall and shall be spaced be located on different levels•. not more than 18 inches (457 mm) on center Exception 2: Where site topography- vertically for the full height of the window well. prevents direct access at two remote locations to grade from the normal level of 5310.3 Bulkhead Enclosures.Bulkhead enclosures entry/exit, the two separate exit doors shall provide direct access to the basement. The required by 780. CMR 5311.4.1 are bulkhead enclosure with the door panels in the fully permitted to be.located on different levels. open position shall provide the minimum net clear 53I1.4.2 Exit Door Types and Sizes. The opening required by 780 CMR 5310.1.1. Bulkhead minimum nominal width of atleast one of the enclosures shall also. comply with 780 CMR exit doors required by 780 CMR 53I7.4sltaCl 5311.5.8,2, not be less than 36 inches(914 min)in'width 5310.4 Bars, Grills, Covers and Screens. Bars, and the minimum nominal height shall be 6 grills, covers, screens or similar devices are feet, eight-Inches (2032 nun). The 36-inch permitted to be placed over emergency escape and (914 Mm)exit door shall be side-hinged. All rescue openings, bulkhead enclosures, or window other required exit doors and doors leading to wells that serve such openings, provided the or front enclosed stairways, or to interior minimum net.clear opening size complies with vestibules shall not be less than 32 inches 780 CMR 5310.1.1 through 5310.1:3; and such (8I3 ruin)in nominal width or less than six devices shall be releasable or removable from the feet, eight inches (2032 ntm) in. nominal. inside without the use of a key,tool or force greater height and maybe of the.sliding or side- than that which is required for normal operation of hinged type. The 36-inch(914 mm).required the escape and rescue opening. Also see S27 CAIR exit door shall provide for direct access from as referenced in Appendix A. the habitable portions of the dwelling to the exterior without requiring travel through a 780 CMR 5311 MEANS.01EGI2C+SS garage, 27he32-inch(813 rnm)secondary exit door mayprovide egress through an attached 5311.1 General. Stairways, ramps, exterior exit garage,provided that the attached garage is balconies, hallways and doors shall comply with also.provided with a 32-inch (8I3 min)exit 780 CMR 5311. door rfteetipg the requirements of 780 CMR 5311, Side-hingedsrvingingdoorsprovidedio 5311.2 Construction. meet these requirements are.'permitted to 5311.2.1 Attachment. Required exterior exit swing Inward. : balconies,stairs and similar exit facilities shall be Other exterior doors, in excess of the two positively anchored to the primary structure to required exit doors, whetherside-hinged or resist both vertical and lateral forces. Such sliding-type doors, shall not be required to attachment shall.not bp accomplished by use of comply with these minimum dimensions. toenails or nails subject to withdrawal. 5311.4.2.1 Interior Doors. All doors 5311.2.2 Under Stair Protection. Enclosed providing access to habitable rooms shall accessible space under stairs shall have walls, have a minimum nominal width of 30 under stair-surface and any soffits protected on the inches(762 rum)and a minimum nominal enclosed side with Vi-inch (12.7 mm) gypsum height of six feet,six inches(1981 mitt). board. Exceptions: 5311.3 Hallways. The minimum width of.a I.' Doors providing access to bath- hallway shall be.not less than three feet(914 mm). rooms are permitted to be 28 inches 5311.4 Doors. (71I mm)in nominal width. 53I1.4.1 Exit Doors Required. Egress fron r D t oors providing access bath- [ rooms in existing buildings are all dwelling units shall be by means of two permitted to be 24 itches(610 ntm)in exit doors,remote as possible from each other norninal'width. and,heading directly to.grade., Such doors 556 780 CMR-Seventh Edition t/11/08 (Effective 1/l/08)-corrected 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS BUILDING PLANNING FOR SINGLE-.AND TWO-FAMILY DWELLINGS Self-closing devices andfire-resistive-rated door 780 CMR 5310 EMERGENCY ESCAPE frames are not required, All door openings between the garage floor and the dwelling shall AND RESCUE OPENINGS 5310.1 Lmer y p q be provided with a raised sill with a minimum ' gene Esca a and Rescue Required. height of four inches(102 mm). Basements with habitable space and every sleeping 5309.1.1 Duct Penetration, Ducts in the garage room shall have at least one openable emergency and ducts penetrating the walls or ceilings escape and rescue opening. Where basements separating the dwelling from the garage shall be contain one or more sleeping rooms,.emergency constructed of a minimum No. 26 gage (0.48. egress and rescue openings shall be required in each mrri) sheet steel or other approved material and sleepingroom,but shall not be required in adjoining shall have no openings into the garage. areas of the basement: Where emergency escape and rescue openings are provided they shall have a sill 5309.2 Separation Required, The garage shall be height of not more than 44 inches(I 118 mm)above separated from the residence and its attic area by not the floor. Where a door opening having a threshold less than 9 inch. 1pe X gypsum board or below the ld adjacent ground elevation serves as equivalent(15.9 mm)gypsum board applied to the emergency escape and rescue opening and is garage side. Garages beneath habitable rooms shall . .provided with a bulkhead enclosure, the bulkhead be separated from all habitable rooms above by not enclosure shall comply with 780 CMR 5310.3, The less than%-inch(15.9 mm)Type X gypsum board net clear opening dimensions required by 780 CMR or equivalent, Where the separation is a floor- 5310 shall be obtained by the normal operation of ceiling asseinbly, the 'structure supporting the .the emergency escape and rescue opening from the separation shall also be protected by not less than inside, Emergency escape and rescue openings with Winch(15,9 nzm)gypsum board or equivalent. a finished sill height below the adjacent ground 5309.3 Floor Surface..Garage.floor surfaces shall elevation shall be provided with a window well in be of approved noncombustible material. accordance with 780 CMR 5310.2. The area of floor used for parking of automobiles 5310.1.1 Minimum Opening Area. All or other vehicles shall be sloped to facilitate the emergency escape and rescue openings shall have movement of liquids to a drain or toward the main a minimum net clear opening of 5,7 square feet ( vehicle entry doorway. Concrete floors shall be (0.530 m2). \. installed as required by 780 CMR 5506, Exceptions., 5309.4 Carports. Carports shall be open on at least I. Grade floor openings shall have a two sides. •Carport floor surfaces shall be of minimum net clear opening of five square approved noncombustible material. Caiports not feet(0.465 m'), open on at least two sides shall be considered a 2• Double hung windows used for -- garage and shall comply with the provisions of emergency escape shall be permitted to 780 CMR 5309 for garages. have a net clear opening of 3.3 square feet Exception:Asphalt surfaces shall bepermitted at (0.31 in') provided that at least one ground level in carports. operable sash meets the minimum height The area of floor..used for parking of and width required by 760 CAI R 5310.1.2 automobiles or other vehicles shall be sloped to and.5310.1,3'and operational constraints facilitate the movement of liquids to a drain or defined by 780 CMR.5310.1.4. toward the main vehicle entry doorway. 5310.1.2 Minimum Opening Height.. The minimum net clear opening height shall be 24 . 5309.5 Flood Hazard Areas, Forbuildings located inches(610 mm). in flood hazard areas as established. by the applicable FENIA flood Insurance Rate Maps} 5310.1.3 Minimum Opening Width. The garage floors shall be: minimum net clear opening width shall be 20 inches(508 min), L Elevated to or above the design flood. elevation as determined in 780 CMR 5323;or 5310.1.4 Operational Constraints. Emergency escape and rescue openings shall be operational 2. Located below the design flood elevation from the inside of the room without the use of provided they are at or above grade on all sides, keys or tools. are used solely for parking, building access, or storage,rneetthe requirements of 780 CMR 5323, 5310.2 Window Wells. The minimum horizontal and are otherwise constructed in accordance with area of the window well shall be nine square feet 780 CMR 51,00 through 99,00. (0.84m2),witha minimum horizontal projection and , width of 36 inches (914 mm)• The area of the 5309.E Automatic Garage door Openers, window well shall allow the emergency escape and Automatic garage door openers,ifprovidtd,shall be rescue opening to be fully opened. listed in accordance with UL 325. Exception The ladder or steps required by 780 CMR 5310.2.1 shaifbe permitted to encroach 1/11/08 (Effective 1/l/08)-r-nrrrr.trri 7Rn rnm vo•,e_.4 ,:.: _ MASONRY SERVICE SPECIALIZING IN RESTORATIONS - :'. .::... Free Estimates • Fireplaces • Steps • Stone Walls Masonry Repai (508)280 3066 Guy V. Nelson-Mason Contracts 10 wr�c�a�S _..: ... to 00 P ITT Li OU pot10 Ou1�51DC wIAj 50Lo vGtw \`r J�.fl ,ot(s !J� / N ", �aWS l . - .. j, t) First Floor Second Floor 1� Z&YDDM r�ecLvbonl Basement Apartment vo I1 X 12-- NOV 2008 8:38AN BARNSTABLE BOARD OF HEALTH NO.571 P.1i4 y�pZHEIq� Town of Barnstable HAMSTA9LE. Regulatory Services MASS. LGROWTH Thomas F. Geiler, Director Public Health Division. NAGEMEN,I Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 am", 01"a"01 � 5y •.Ja,:teF .na; ...- r3. r7.1 ! JaT _.�i DATE: 11/14/08 NUMBER OF PAGES TO FOLLOW;. j TO: FROM: GROWTH MANAGEMENT TOM MCKEAN p�TONE; PHONE; (508)862-4644 FAX PRONE: FAX PHONE: (508)790-6304 • cc; NOTES/COMMENTS: RE: 450 Skunknet FLOOR PLANS ARE DEFICIENT: . UNMARKED 'UNLABELED ROOMS PLEASE, USE A RULER OR STAIGHT EDGE Q TAX Form.doc o A �^ m m p co l 1 D Z U7 D w r m 0 0 D t� 0 ' r- D r Z o A end -�lovY' . z 0 c A N m m c0 cu D 3 f i t D 0 co co E m W O 70 _ C7 rrl D -I Z O Ul m � A A C� 1"ET°w Town of Barnstable BARNSTABLE. " Regulatory Services �$ MASS.: Thomas F. Geiler, Director ArFD MAC A Public Health. Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 DATE: 11/14/08 NUMBER OF PAGES TO FOLLOW-: TO: FROM: GROWTH MANAGEMENT TMM MCKEAN PHONE: PHONE: (508)862-4644 FAX PHONE: FAX PHONE: (508)790-6304 cc: u �• T+�or xou�-�2ev�ie�w�� 1 � 1�P � � Ple'aC-�ir�t nt`� NOTES/COMMENTS: RE: 450 Skunknet FLOOR PLANS ARE DEFICIENT: . UNMARKED UNLABELED ROOMS PLEASE :?•USE A RULER OR SMIGHT EDGE QAFax Form.doc Town of Barnstable Health Inspector Office Hours �FTNE '1% Regulatory Services 8:30—9:30 II ; Thomas F.Geiler,Director 3:30—4:30 • BAMSrABLE, '" MASS. Public Health Division At f p H►e't°i Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT - SEPTIC QUESTIONNAIRE Date: 11/6/08 1. General Information: Size of Property: .34 acres Address:450 Skunknet Rd Centerville,MA 02632 Map 170 Parcel 018-001 f Name: Elizabeth Koen Phone#: 508-775-4056 2a. How many bedrooms exist at your property now? 4 2b. Are you planning to add any bedrooms? 0 If yes,how many? 0 2c. How many bedrooms total are proposed at this property(including the amnesty unit)?4 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label each room clearly. 3. Is the dwelling connected to public sewer? NO If the dwelling is connected to.public sewer,skip questions#4 through#9 below. 4. Location of dwelling is INSIDE or OUTSIDE a Saltwater Estuary Protection Zone? 5 . Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells`? Jj z 6. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 7. Is a disposal works construction permit on file? YES? or NO 8. If yes,how many bedrooms were approved according to this permit? edrooms ; 9. Were any building permits obtained for construction of additional bedrooms? YES or NO 10. Is there an engineered septic system plan on file at the Health Division? YES or NO 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------------------------------------------------------------------------------------------------------------------- T+ FOR OFFICE USE ONLY The Public Health Division has no objection to bedrooms at this property. Special Conditions: Signed: Date: n) Q;/health/wpfiles/amnestyapp N V PS+cwr � �JS} k\o0� end fi«or Parcel Detail Page 1 of 3 Q. .� ; t."{ i• - # - V �!..I'4G.r w.rMw.wa.y+.�•`*-yam „�.dL�«.._ i�tA S Logged In As: Parcel Detail Tuesday, Novem Parcel Lookup Parcel Info Par"cel ID 170-018-001 Developer LOT 22 Lo Location 1450 SKUNKNET ROAD Pri Frontage 1137Sec 1 - Sec Road JAMES WAY Frontage 128 Village ICENTERVILLE Fire District C-O-MM Sewer Acct I Road Index 1494 ^rry Asbuilt Septic Scan: Interactive 170018001_1 Map Owner Info_ Owner I DONOVAN, ELIZABETH^M _ I Co-owner %KOEN, ELIZABETH ry _ Streets 1450 SKUNKNET RD ! Street2 city CENTERVILLE I State MA Zip 102632 country US Land Info _ Acres 10.34 Use Single Fam MDL-01 I Zoning I RC Nghbd 0106 Topography Level I Road Paved Utilities I Public Water,Gas,Septic Location f ---' Construction Info Building 1 of 1 Year 1981 —� Roof Gambrel Ext Clapboard Built Struct Wall Effect 1618 I Roof Asph/F GIs/Cmp c None Area gg cover Type Style Colonial 1 wnt Bed ail Drywall I Rooms 3 Bedrooms Model Residential Int Bath Floor[---. - - -----.--I Rooms 2 Full Grade(Average I Heat Hot Water I Total 6 Rooms Type Rooms . http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=l 1231 11/4/2008 n U 09/IB/2008 09:14 5082247580 ARCADIA PAGE 01/14 May 28 08 12: 33p Marjorie Ho%R 978- 38-0189 P-2 i STAI ARCADIA HEALTH CARE S �„nu COFd PXQTJEST FOR:m Arcadia Health Care has been certified by the Crirninal History Systems Board for access to conviction and pending criminal case data.. As an applicantlemployee for A�C_`'d9C1 %A _, I understand that a'crizninal record check will be conducted for conviction and pending criminal case information only and that it will not necessarily disqualify me. The information below is correct to the best of my knowledge. Al?PLI AJ%T EMPLOYEE SIGNATURE "nlcss otherwise p e -n ted by Aaw) APPLICANIVE fPLOYEE TNFORNIATION (PLEASE PRINT) z LAST NAME FIRST NAME MIDDLE NAME MAIDEN NAME OR ALIAS(IP'APPLICABLE) PLACE OF BIRT14 ' (if applicablejable MOTHER'S MAIDEN NAME �C, CURRENT AND FQF-IviER ADDRESSES: 190a� SEX; HEIGHT: ft.D in. WEIGHT: / 5�EYE COLOR: --- ***THE,ABOVE INFORIV ATION1 WAS VERIFIED BY,REVIEWING THE FOLLOWING FO \1I OF GOVERNMENT ISSUED PHOTOGRAPHIC IDENTIFICATION: REQUESTED BY; 5IGNATUR-E OF CORI AUTHOWZED EMPLOYEE * The CJJ3B Identify Theft Index PIN Number is to be completed by those applicants that have be?ri issued an Identity Theft Index PIN Number by the CHSI3. Certified agencies are required to provide all pplieants the opportunity to include this information to ensure the accuracy of the CORI request process. All CORI request forms that include this field are required to be submitted to the CHSR vi r snail or by fax to 617-660-4614. �I T - Certified Mail#7006 2150 6002 1041 9228 oF-(VIE)1, Town of Barnstable Regulatory Services �nARNSTABLE�j � ��"Ass m Thomas F. Geiler, Director � t6 Q OAS F°Mai_ Public Health ]Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 28, 2008 Elizabeth Koen 4707 Eagle Drive Fort Pierce, FL 34951 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 450 Skunknet Road, Centerville, was inspected on April 22, 2008 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of complaint. The following violations of the State Sanitary Code were observed: 105 CMR 410.500— Owner's Responsibility to Maintain Structural Elements At the time of inspection, the Health Inspector observed that the kitchen ceiling has a damp area with chipping paint and holes in the bathroom sink from leaking. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by repairing the kitchen ceiling and the bathroom sink. 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. Q:\Order letterMousing violations\Rental ordinance\450 Skunknet Road.doc a .Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH Tho �ean, R.S., CHO Director of Public Health Town of Barnstable Cc: Health Inspector David Corshia Q:\Order letterMousing violations\Rental ordinance\450 Skunknet Road.doc J FORM30 C&W HOBBS WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE H CIT Y/TOWN z 1 � DEPARTMENT Ltqi�� ,A`'\ ADDRESS TELEPHONE t Address _ Occupant_ Floor Apartment No. No.of Occupants No.of Habitable Rooms__No.Sleeping Rooms No.dwelling or rooming units_ No. tories w Name and address of owner _ O 11 �� Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT.. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: 42 PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: 11110 ❑ 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 T IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJ INSPECTOR TITLE DATE TIME A.M. THE NEXT SCHEDULED REINSPECTION P.M. TOWN OF BARNSTTABLE LOCATION US; R C' SEWAGE # VILLAGE ASSESSOR'S MAP & LOT —o U INSTALLER'S NAME&PHONE NO. 0I0 C,11 e e,-14/C' 7 SEPTIC TANK CAPACITY 400 LEACHING FA4(,ype �i/rA 7a 2 S (size) NO. OF BEDRO / BUILDER OR 0PERMITDATE: COMPLIANCE DATE: q11M� 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 lk IT- h Zr f/ Lf I 77 / 11 z c C9 {/ TOWN OF BARNSTABLE +C LOCATION Cls�`l��r��7" � � SEWAGE # qq VILLAGE� /v/,�/ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Aft Lt ��s :7 SEPTIC TANK CAPACITY /®a LEACHING FACILITY: (type 4A11Wr,4 To/L S (size) Y 11 A-1-X NO.OF BEDROOMS BUILDER OR O PERMTTDATE: qh LIM 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) W Feet Edge of Wetland and Leaching Facility(If any wetlands exist-- ' within 300 feet of leaching facility) Feet Furnished by + F4 _ , A7 as /3y 7 t No. 2;?, Fee �J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for MiopofW *potem Comaruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System kjndividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel h` �` (f0��'�� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 16AI p—cA"(e-S�e p, r 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 j q 0 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 S i��Fkti-�- CCrr, Type of S.A.S. S`l Cq ho� �/"moo L- Description of Soil Ajk_,osQ Sv4o't/ Nature of Re airs or Alterations(Answer when applicable) o c t S`C" ' dLt-- 0-%t- 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 ental Code and not to place the system in operation until a Certifi- cate of Compliance ssue y lth. Signed Date Application Approved by - Date 9-0/- Application Disapproved for the following reasons Permit No. Date Issuedn t 'No. ww G7!A Fees E! THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: axI PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Migpogaf *pgtem Congtruction Permit Applic4.tion fora Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System �<Individual'Components Location Address or Lot No. "1 Owner's Name,Address and Tel.No. Assessor's Map/Parcel '`7 01 '` Cow eo j Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ytn`t p-CAa Pam-S-e Type of Building: Dwelling No.of Bedrooms_ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures c r ~� Design Flow Y `f o gallons per day. Calculated daily flow `i / gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank �: 5-T", Type of S.A.S. 14. �A Cr, A�l �— FR Description of Soil lA.AeC -Sv4d Nature of Repairs or Alterations(Answer when applicable) t c.v f/3 (GQCt c c-'Z t�-i c,. w L1 t 0L, Iva 4, 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 Envitonmental Code and not'to place the system in operation until a Certifi- Cate of Compliance - ue y lth. Signed 1 Date ` Application Approved by Date l7 V Application Disapproved for the following reasons Permit No. Date Issued 910 `"kzt R 19 --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CER that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded+ Abandoned( )by at L ��.,u t has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. date' P r e7 1, 4 ` Installer Designer r n The issuance of this permit shall no a onstluo�s a guarantee that the sy m i function as de ig,ed v n J Date Inspector A/ A I ' rv. No. �— --------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwigpogal *pgtem Congtrurtton Permit Permission is hereby granted to Construct( )Repair( )jUpgrade Abandon( ) System located at 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:Construction must be completed within three years of the date of this PC 't. Date: Approved by r 'ti, =� 116/99 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) I, e� hereby certify that the application for disposal works construction permit signed by me dated 0= concerning the property located at q� "A'J"'Vvest— ec C e=r� 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. c/• 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 ere 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 ma.�dmum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] _11�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) B) G.W. Elevation (;)06"+the MAX. High G.W. Adjustment .3,( _ DIFFERENCE BETWEEN A and B SIGNED : DATE: [Sketch propose lan of system on back]. q:health folder:cent � r, � `� ��, _ D Certified Mail#7006 2150 0002 1041 9228 r4,E'l ETown of Barnstable /' ° Regulatory Services r kBUARNSTABLE, Thomas F. Geiler, Director tbgq�� Alf°MAYa. Public Health ]Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 28, 2008 Elizabeth Koen 4707 Eagle.Drive Fort Pierce FL 34951 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170 The property owned by you located at 450 Skunknet Road, Centerville, was inspected UU on April 22, 2008 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis off-a complaint. The following violations of the State Sanitary Code were observed: 105 CMR 410.500— Owner's Responsibility to Maintain Structural Elements At the time of inspection, the Health Inspector observed that the kitchen ceiling has a damp area with chipping paint and holes in the bathroom sink from leaking. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by repairing the kitchen ceiling and the bathroom sink. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. QAOrder letters\Housing violations\Rental ordinance\450 Skunknet Road.doc Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH Tho �ean, R.S., CHO Director of Public Health Town of Barnstable Cc: Health Inspector David Corshia QAOrder letters\Housing violations\Rental ordinance\450 Skunkoet Road.doc ¢ Y FORM30 C&w HOBBS&WARREN rM THE COMMONWEALTH,OF MASSACHUSETTS BOARD OF HE H CITY/TOWN W ( r _j�I DEPARTMENT ,w 'o ADDRESS G,1M SV9 y`0W TELEPHONE. �I c P Address — Occupant_l """� Floor Apartment No. No.of Occupants No.of Habitable Rooms_No.Sleeping Rooms No.dwelling or rooming units No.9toriesif Name and address of owner Remarks Reg. Vio. YARD Out Bid s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches.- Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls.- Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: 17 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 Lim 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 T IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJ INSPECTOR TITLE DATE � TIME A.M. THE NEXT SCHEDULED REINSPECTION 7 P.M. i J 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 4.10.830 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 onto 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) � 3�� 1 i ---- � � Citizen Web Request Page 1 of 3 s• � a mp J s A4. ,araiet a4 ¢ 't ( tyz 'c .,1 C t i .C..Fff``'^^��¢g a$$p'�°,'..-, '�9qp'' a n a °{y $ =t J ..R t 1 t e. ._S... ;..r_ Ae3 Y rs.;"?h.c'. Lt. �sti::_. ._ ,. �,.;: F.c:..2...:..>...: =._,:1.;., .. iZYL:ad Request Information Request ID: 21754 Created: 4/17/2008 10:25:24 AM E Status: Assigned To Staff Assigned To: O'Connell, Timothy ! Health Office Anonymous: No Request Category: Chapter II : Housing i Substandard edit Estimated 4/22/2008 Change EstimatedMar April 2008 [ Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 122 23 24 IZ51 26 27 28 29 30 1 1213 4 5 6 7 8 9 10 .... . ........................_........_................._..... --- ...__...._._.....__......._.........._.._...........__.......-.............._.................._...._......._..._.__._........................._ -—..........._...._...._._....._...... _....__._..... Created By: Shea, Sally Priority: Medium _edit Building Dept Citation Numbers: � edit f jj Requester Information 3 Requestor Request Parcel Number Map: 170 Block 018 Lot: ;001 i ( , CALLER IS GETTING EVICTED FOR I BEING BEHIND IN THE RENT, HE Parcel._Lookup WAS OUT SICK FROM WORK HE THINKS BECAUSE OF THE MOLD IN THE HOUSE (HE THINKS). THE MOLD IS REPORTED TO BE IN THE HOUSE http://issgl2/IntemalWRS/WRequest.aspx?ID=21754 4/17/2008 Citizen Web Request Page 2 of 3 1 I FROM THE LEAK IN THE UPSTAIRS BATHROOM TO THE DOWNSTAIRS. THERE ARE CHILDREN IN THE HOUSE AND EVERYONE IN THE I HOUSE HAS BEEN SICK ACCORDING TO THE CALLER. MAY 8TH IS THE COURT DATE. Email: i Edit_Re._uestor Information Track Request Progress —Request Work History: Internal Note History: ._............_........_ ....._--.................._..........._.._..._.._..............------._.......-..................... ----._................ .._......_ _ _ __ System y entry on 4/17/2008 10:48:20 AM. _ Assigned to O'Connell, Timothy Entered on 4/17/2008 10:48:50 AM { by Barrett, Caitlin i Melissa will send letter to owner to register I System entry on 4/17/2008 11:25:07 AM: I -Please Review- email sent to O'Connell, { Timothy E Enter work progress: Enter internal note: E (Viewed by everybody) (Viewed ed internally only) ` I i E � SpellrCheck Spell G:heck_ , I Add document or image link: . ., Browse... i er �l^� ^a¢^ ^aSso folder Y!q �y Cry e eve r,1t t Y } _ eh # http://issgl2/Intema]WRS/WRequest.aspx?ID=21754 4/17/2008 Citizen Web Request Page 3 of 3 Current Links: ...... ... ........................................._._............................. . Time worked on request M Response time FO re in hours, Exaniples of time entries: j,2 0,75, 1 3 f 0,215, Resporise Measured from the creation date to your tint aCti tc €fin the request, ;< D � ci d3 z nights, � r s � � response � r � dens' " t i ��mltLit #tj €.i s� v�r�? £��' c;Cii3 1�11it�s2`V'.i ,(� €L�.i€, i�I:E'. ;.ii�1�� (Y?';�� E:�C;�a. I C Save changes Check to notify town employee below to review this request. C Save changes and notify citizen* Health Office _ m. Barrett Caitlin (7. Close request l C Close request and notify citizen* Brief message to reviewer: �•n: dfy works if email address was given d- z �U date ° Spel, Check Ofl p ..........................._......... _......._..._............................__...__........._.._...._.___._..._._.__...._ ...................._......_._......_........ 1 Public_Use:._Printer Friendly._Vers.. 3 i Internal Use: Printer Friendly Version http://issgl2/lntemalWRS/WRequest.aspx?ID=21754 4/17/2008 03nSsi I3NSI1dIN03 31110 03ASS1 IINNId 31V0 U NMO V0 V 3 011 n 0 SS3N00M 1/3 IN V Of SA311 WISNI 35V111A 'ON II1MN3d 39SM3S N01IrV#<:1 I . � «'j i ... - - sP,4 +-+� ,.. ' P �1 � � ►�� . � - � r.h � �� V '��. h y �,,� __ I No.... l:�.7%. . ~� Fims......3 . ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OF.......1 AA..5. ... -----._._........_........ Appliration for MipatiFal Morks Tomitrurtinaa ramit Application is hereby made for a Permit to Construct (--*") or Repair ( ) an Individual Sewage Disposal System at: p ..... n.K!�e:. ......... v ...... '--------------••--........._ .....L Lk ion-Add ss or Lot No. ............................................... .. ..... .... �_f 1'1► , R®v�C C .\a..A (kn(k .------ . ..._--- ...... --.....- -•---•-. .......... ner Address an ------................................................ .................................................n ... Installer Address Type of Building Size Lot.... O- 73.....Sq. feet Dwelling—No. of Bedrooms...............3_........................Expansion Attic ( ) Garbage Grinder (po a Other—Type of Building .....X_' No. of persons............................ Showers ( ) — Cafeteria ( ) __________________ dOther fixtures .••••••-•-----•..............••--••---••--•-----••••-.....•---- W Design Flow..................1\d.................gallons per person per day. Total daily flow___........_3.��....._....__......gallons. WSeptic Tank—Liquid capacity_ 90.Qgallons 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--- --_eJ-1-----k..... .�.................... Date...SP7. ............. Test Pit No. I................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........................ -------------------------------------------------------------------•-------••.......__..._......---......................................................... 0 Description of Soil... ........ .............*............. -------------------- Vlp-..�►a'.........Mc_,&.............4-ca�,A.................................................................................---------- W x -------•-•-•-••-•----•-------•--------------•-••-••••-•••-••---•---•-••••-•--•---------•---•-•--•-------••------•---•---•---------------•-•••--•---•-••----•----•••--•-••••-••----•-••----••--•-•••..... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---------•-......-----•----------------------------•------•------------.......-----•----...-------------------------------------------------•--------------------.............----. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TAITf,% 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.............. _ ............ Application Approved By.. !/...! �,f� 2 --$��-.-�------. Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------•----- .............................•--------------•---•--•--------...-------•--•-----------------•---------•----------•---•-••--••--------•-•••---•----------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Other fixtures Z Other Distribution box ( ) Dosing tank ( ) ~� Percolation Test Results PerformedPerformed '� �J Date...�2............................... � TestPit No. l-'--.._-noinutcsper� Depth�pt6 of Test PiL..--~---.-' Depth to 87000d water........................ c� Test Pit No. 3................minutes per inch Depth of Test Pit.................... Depth to ground water........................ o« ` ---_—._---.—.----__.-'--' 0 -------------------------------------------------------------------------------------------- -----_--__'-----'-----_—_---_—.---_—'—'—.—_'_------'_--__.__-_------_-----'-'----- U Nature of or ��o�—�o�� o | ^ -,�----'---'---'—'------'------'-----'-'—'—''------- | '---'----'---'---''---'—'-----'---------'—'------------------'--''---''-----'-'----- ^^u^^^~e~^' The undersigned agrees to install the oforedescribed. Individual Sewage Disposal System in accordance with the provisions of TIT LE 5 of the State Sanitary Code The undersigned further agrees not to place the system in �,dt t_�{ 1`l.Ava/ � I t0 ,c � + ��p G.F'•D r , �• , ; �'`�. lr c ;: • i5 6.PD;'. USE ! l 000 r A6.L- SPCK et t�iT I�SE (00o Gam_, `2 t \�, ./Jq •I � !1 /�cGN � : !. �Ll TOTAL„ -0 ESl&Q s -425 G.RD. .ToTA L �M,dt t_�f Fc.ow � 330 6.P.D. . .: : •.: ' ; � ... -�: �°j'' : _:� � �' �aAAc: Gl✓2GDL&TlQQ O&Te : t4.S SmitJ•OQ LESS.: 64 i i Y7 Z, . i .�F.R; :77i c.++2`}` 4 3� ," t 5 rie ..i. •yL ��f7Co'O•� ,�,� - i. � ; 4 cq r �i it i \r 'f. .1 .i � _. ,.. +•. .._ y , i,. l -JT /C. � I _ ... ` .. . 4;"= / / Tor F►10 a 1oo.e - I. ISJV _____ - -- __.. . - -- •- --------- w� InnFT . _ , . � .. Lea � 94,Z.-: � , , , 1 ' { :', � •�► � •_. ' ..i r-. WAIWED pt_oT PL.QVj4 �.� t I1 1jA.TC I,l-ZD-�I i �d GGCZ-rtt=,4 T14AT TNT F�'',VN�aTlpi.� SUcr�tJ 4�LAQ �t:l=EV-IE ca Iti . - ur.�LatJ Cc�trlPt-`!S W iTIA TPZ-% Awt> Sa-MAC-4 Vc-, 'CGkt'c-wT'S, -To w U or- R12�.1�iTQa3 c b Au'lb s 0 0 �?r.A rJ ForZ ! .1z oG:✓Z L-oGATEtb• Wrrl-AlQ T JS�)(.TCtiZ 4ZCGIS rttZED 1�wc.) iUCV�.Y�25 _ 05, TcevtLLc o M� LlOT L'A5�Ct7 0►4 AN lWS(Ctl/vlC_t•l; �ivt,./�-YTtiL:. c+��C,i_j"�. �itlDwt]D ANPt_1GA.t-,1T �•k>r CI- 'ro t-)ereCM6►4E= LOT Ltwa'5