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0070 WILTON DRIVE - Health
70 Wilton Drive Centerville . - I -M A = 208 052 o UPC 12534 ' No.2_ HASTINGS,MN TOWN OF BARNSTABLE LACTATION 7 o Last h k) DR, yC SEWAGE# 2GO I -1 1 3 L; V1Lt:AGE Caw f"C--2Vi 16- ASSESSOR'S MAP &LOT DID82 Q572- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 15 O a LEACHING FACILITY: (type) 2 D R c' t 1 S (size) 1,;;z X oR A S S NO.OF BEDROOMS 3 BUILDER OR OWNER C v CCO(b PERMIT DATE: f -l O ( COMPLIANCE DATE: /6-a Separation Distance Between the: II M Adjd Groundwater Table and Bottom of Leaching Facility Feet ftw y0y Well and Leaching Facility (If any wells exist on,*'o,qr withi 2OO f hing' ) _Feet F e of *land and JiaAty'(If4vy%"Uandstxist within 3OO4eet4limdhingfacility) Feet Furnished by . _ _ �; ��,,� O� 1.1�Js�l `' , r V w 1"L ���� �. r r 1► .9 1 � ' .•t �0. l fi �, r i �. __� � w � �'�✓� Gtf,fie e L0CAT ON SEWAGE PERMIT NO. AIA YI'LLACE INSTA LLER'S NAME � � ;A.DPRESS e U`I L D E R '- OR OWN ER wt DATE PERMIT ,*IS=SU, ED DATE COMPLIANCE ISSUED aAll r' SENDER: COMPLETE THIS SECTION 0 ■ Complete item-1 2,and 3.Also complete 7S'qnaure item 4if Restnc ed Delivery is desired. j /" 3 Agent■ Print your name and address on the reverse ' O Addresseeso that we can return the card to ou.Y . ,led Name) C. Date of D livery i ■ Attach this card to the back of.the mailpiece, � 3 � I or on the front if space permits. V ' D. Is delivery address different from item.j? ❑Yes 1. Article Addressed to: If YES,enter deliveryaddress belo,w: ❑No I 1 'U L- I fjq,C 13A (LA ice► 1 PA2L.,— AVM. I I if A V I t- 3. Service Type I ertified Mail ❑Express Mall i ❑Registered ❑Return Receipt.for Merchandise ❑Insured Mail ❑C.O.D. ` I i 4. Restricted Deliverv?fF -G-'- - +' ❑Yes _ I 2. Article Number ?pp7 3020 0001�3429 7915 (Transfer from service/abeQ -•------- y PS Form'3811i,February 2004 1 Domestio.Return Receipt f 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Maid ��gg r I / USP'S`e&Fees Paid -'I Permit No.G-10 4 • SenclOr. Please print your name, address, and ZIP+4 in this box• Y• t. I J � Town of Barnstable (r Health Division 1 \ 200 Main Street I ► '. i Hyannis,MA 02601 w I IM1111`iTiIiTi P,ly,1'.19%11111111111li:if11111111111111ItIII Irr � E i li .. ,. � Certified Mail#7006 2150 0002 1041 9808 Town-of Barnstable �r.(BAR � c Regulatory Services Approved: NSTABLE, MLD Ceft:_t`col MASS. `��* j Thomas F. Geiler, Director 3.639 ArFa MAC a. Public Health Division - Thomas McKean, Director 200 Main Street, Hyannis,,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 CERTIFIED MAIL 7007 3020 0001 3429 7915 March 9, 2009 Barbara Hill 105 Park Avenue Centerville, MA 02632 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 70 Wilton Drive,.Centerville, was inspected on March 4, 2009-by Jaime Cabot, R.S. Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.503 (A) —Protective Railings and Walls Spiral stairway needs railing on the outside radius. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by installing a railing to the outside radius of the stairway. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. . Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak'with the inspector who performed the inspection. PER ORDER F THE BOARD OF HEALTH T omas A. McKean, R.S., CHO Director of Public Health .Town of Barnstable Cc: Health Inspector Q:\Order letters\Housing violations\Rental ordinance\70 Wilton Drive.doc , I ill . i t R ck ` Aj �l�d�2 � �.S � I c i uY`-e. � ! /� e �Ot r 11�✓9 o Dtl �c1t,�`�J r��q l7, .S + -L ou �. �e- Qtj 4 (teZ7��,�s IJCL it ail : If �+ 1 ' E s.� '.S ,} r �I� _ . I{I If ` I I yy� �I ,. 4 i��� �I � y I� '� ♦ ' { � � - _ ;� . �� �� i' - �, �� ,� l i, ,. - �. II i� �1 e (� 1 a II �.� J SECTIONSENDER: COMPLETE THIS .MPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and&.Also coniiplete A. SismatLite Item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse In Addressee so that we can return the card to you. B R cetved by(P ted e) C;Date/of Delivery ■ Attach this card to the back of the mailpiece, 6�(C� or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No / �� 3. Service Type ` � ►`~' �1 IU I T[/ ' v ❑Certified Mail ❑Express Mail O Registered ❑Return Receipt for Merchandise lJ ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extrafee) ❑Yes 2. Article Number — — I (Transfer from service label] f R 7 00 6 215 0 0 0 0 2g 10 41 9 8 04 a PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED �L...: :.!n..:..�;:.c;..\.:s::/l:'•.�`;v ':.t"':.t.'i :L.� ..:.. :.�y�n t ��:.Efi�lo.�ms'.:�o • Sender: Please print your name, address, and ZIP+4 in this box • I I Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 I I itl�itii'ifi�!ltllttlilt�141it��11191t1!llilll�ItEt�1t33t1i111 k.i. S Postal S6 rviceTM4"�p'tfs+ CERTIFIED MAILTM RECEIlp,M, ■ (Domestic MaU;only,No"insurance Cov_erage,Pioy�ded)� ;�'�f ?�a For,del ivery,fnformationvisitour.webstteat"www.usps:com® fFarm,, IN III SL�;•A� - f?S_Form 3800 August 2006 See'.Reverse for Instructions Certified Mail Provides: ® A mailing receipt o A unique identifier for your niailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. ■ 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. o 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. n 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". in 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 Certified Mail#7006 2150 0002 1041 9808 Town of Barnstable . � �. Regulatory Services • BARNS`rABLE, 9� MASS. � Thomas F. Geiler, Director 0 . pjfDMA'la Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 10, 2008 Barbara Hill 105 Park Avenue Centerville, MA 02632 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 70 Wilton Drive, Centerville, was inspected on.Tune 6, 2008 by Jaime Cabot, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.503 (A)—Protective Railings and Walls Spiral stairway needs railing on the outside radius. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by installing a railing to the outside radius of the stairway. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF T OARD OF HEALTH o as A. cKean, R.S., CHO Q:\Order letters\Housing violations\Rental ordinance\70 Wilton Drive.doc FORM30 C&W HoBRs&WARRENTM THE COMMONWEALTH OF MASSACHUSETTS •�i BOARD OF HEALTH CITY/TOW N WIj AC.? DEPARTMENT ° 2G - � ADDRESS/ GSM SVey`aW TELEPHONE o N a,4 • (tbyit.�G- Occupant Address -70 Floor Apartment No. No. of Occupants No. of Habitable Rooms Co No.Sleeping Rooms_-__ No. dwelling or rooming units No.Stories — Name and address of owner �4e 6A QA N i Lt, A K V4- (f 4^11LR V1 Ct�f— /4-^ Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: / Dampness: Stairs: Lighting: STRUCTURE INT* Hall,Stairway: plar 1. STAAA A,,X,tp& ,gtu" Obst'n.: ON TNL bu1C 2,c iv 4/0 -TO 3C4) Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central Y ElN Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ S ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 / D Bedroom 2 2 3 5 Bedroom 3 200 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flue , e eties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted -T I$tj FdW I 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 INSPEC ION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES 0 PERJURY." 1 ' INSPECTOR �' TITLE JHCAC.'iN S N8 p4c.-to2- DATE � �i0 O8 TIME ,'d0 ) A.M. THE NEXT SCHEDULED REINSPECTION -f ` 4 A A.M. 410.750: Conditions Deemed to Endanger or,lmpair 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,Jo 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. f Town of Barnstable BARNSTAIME s `9 m Regulatory Services Department #�b A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 / lJ (J/ J Thomas A.McKean,CHO APPLICATION FOR RENTAL R.lEGISTRATION Date: Fee:$90.00 Per Unit Plus$25 for each addt].Unit (2006 Partial Year Fee S40 plus$10 for each add't unit) Property Location: �0 /l4a✓1 ,��ja- �e.lr1 fe�1/i'/!� Number of Rental Units On This Property Assessor's Map and Parcel: 2 o f Owner's Name: — Telephone Numbers (Daytime) (Home Phone).fob'7 7 G ' G '/8 °l _ (Cellular) _o g -7 7P - Owner's Address: /oS Mailing Address: (if different than above) �7 1CD , 1. e), Address: - r' Telephone Number: r: Number of Bedrooms: Check One: Is this a single family dwelling nit? �(], an apartment building? [ ] -'or an accessory apartment? [ ] Do You Have Zoning/Building Division Approval for an accessory apartment? Will there be any children under the age of six who will be occupying the rental unit? (circle one) Yes No Was the dwelling constructed prior to 1979? Yes NO l' I certify that the information provided above is true: ppli 's Signature I r Town of Barnstable Geographic Information System June 5,2008 © o v� 0p`p,� M O ca LU FP� CJ 3 a cC]0 a � W CA V aQ 4yb �' a 3 D b Q P C3 \0� 5201 Feet �`� DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:208 Parcel:052 Selected Parcel ED ou ^(; bndary determination or regulatory interpretation. Enlargements beyond a scale of 1 € "=100'may not meet established map accuracy standards. The parcel lines on this map Owner:HILL,BARBARA J Total Assessed Value:$353700 are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.25 acres Abutters "f � y'� bndaries and do not represent accurate relationships to physical features on the map Location:70 WILTON DRIVE $y such as building locations. Buffer `!/% r i No. *P0 I - 713 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for 30igpogal bpgtem Congtruction 3permait Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 0 Wilton Dr. ,Centervi le John Ciccolo Assessor's Map/Parcel an oS.2- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service Daniel Johnson O Box 1089, . Centerville 804 Main St. , Osterville Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) r Other Type of BuildinfitPG i rlPnt i a 1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date 11 —8—01 Number of sheets 1 Revision Date Title subsurface sewage disposal system Size of Septic Tank Type of S.A.S. Description of Soil; gravely coarse sand- medium sand Nature of Repairs or Alterations(Answer when applicable) replace cesspool with a 1 , 500 gal, septic tank and 2 leaching drywells ( 25 'L X 12 'W 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 B2prd o,pKealth. Signed Date 11/JT Application Approved by PA4 4). Date /I -�S--o I Application Disapproved for the following reasons Permit No. r?PU I - -7I 3 Date Issued 11#5770 -------- _--------------- No. Fee (t n _ I- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _. Yes PUBLIC HEALTA'D"IVISION -TOWN OF BARNSTABLE, MASSACHUSETTS;,- ZippYication for �Digpo%al *p!tem Congtructfon 'Permit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 0 Wilton Dr. ,Centerville John Ciccolo Assessor's Map/Parcel ;0 0S2 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service Daniel Johnson O Box 1089, Centerville 804 Main St. , Osterville Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building.tes i_dentia 1_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date 11 —8—01 Number of sheets 1 Revision Date Title subsurface sewage disposal system Size of Septic Tank Type of S.A.S. Description of Soil: gravely coarse sand- medium sand Nature of Repairs or Alterations(Answer when applicable) eeplace cesspool with a 1 , 500 gal. septic tank and 2 leaching drywells ( 25 'L X 12'W 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 Bo ,d o ealth. Signed Date 1/ Y O ` Application Approved by 04 - Date N '�57-01 Application Disapproved for the following reasons Permit No. 00 I ' -71 3 Date Issued N E o l -------------------------- THE COMMONWEALTH OF MASSACHUSETTS P , BARNSTABLE, MASSACHUSETTS Viccolo ' Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( X)Upgraded( ) I.Wbitndoned( )by Wm. E. Robinson Septic Service a'\70 Wilton Dr. , Centerville has been constructed in accordance �iAhe provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Wm. E. Robinson Sr_ . Designer Dan Johnson 714issuance o thisf permit shall not be construed as a guarantee that the syst�n will �nction as designed. Date C1 1 j 1 l2 w), InspectorJVt ----------- No C �.fJ(J 1 - �r3---------------------- Fee $50 s.+ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Ciccolo Migpoar *pgtem Construction Vermil Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 70 Wilton Dr. , Centerville x 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 thi ermit. 44 Date: I Ifs-1 G Approved by i TOWN OF BARNSTABLE LOCATION 70 Zai'160 D P2 i QC— SEWAGE # 2 oo 1 -7 13 VILLAGE �YV tE2V1 Ili ASSESSOR'S MAP&LOT 2t282Z o,s'2- INSTALLER'S NAME&PHONE NO. f,6 W^J!SQiN/ Sr=>D SEPTIC TANK CAPACITY 1 O LEACHING FACium (type) aZ D iZV OC U S (size) j a X 9 A a S NO.OF BEDROOMS 3 BUILDER OR OWNER C d r o(C> — PERMIT DATE: I I I o S l 0 ( COMPLIANCE DATE: ! I 41 ,a3a Separation Distance Between the: Maatm Add Groundwater Table and Bottom of Leaching Facility Feet .. Or 200 e o nd a n 300t Dili Feet Furnis d by �0. e _o �"""ems-�_^---�-•• Gtr.1�.e _r SM/01 NOTICE: This Form Is To Be Used'For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, 6h04lLt- 9- J o MAIJ°"J , hereby certify that the engineered plan signed by me dated / 3 /a 1 , concerning the property located,at r 70. wr�Tt�.+e �R.!.tc CCW7--a A. ILL .. meets all of the " i following criteria: • This 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. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • 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 fourteen (14) feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface f-levation (using GIS information) S9 B) G.W. Elevation Al. +adjustment for high G.W. DIFFERENCE BETWEEN A and B SIGNED :- DATE: it NOTICE Based upon the above information, a repair permit will be issued for 'bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. _. q:health folder.percexmp Fss... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD9F HEALTH D ----.....OF...... ... . / ... � .......................... r Appliration for Dispoti al Works Tonstrn.rtion Prrutit , Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: , --.. ..1 ....... 6j&—-----. -------------------------------------------------------------------------------- -..---.Location-Address •:----••-•--•••.•••--•----------------'..•or Lot No. .._... ,� ............. ...---.............. .-.----------------...--..---......_......... Owner � - --.--Address �1t.......... �..... ..�-.... �...:�r...................................... ................_..._._._.............._... Installer Address Type of Building�� Size Lot............................Sq. feet U Dwelling- o. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q, Other fixtures ................................................. d .............................................................. 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. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... G 14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x = 0 Description of Soil.............. ... .. . .......•-• -••----••-----•• -•-------------------------------------••••-•........--•--•-•--••- W U ------------------- ..._..---------------------------------------- ----------------------------------------------------------------- ---------------------- ---------------------•-••-------- W •--•-••----------------------•-••-----•----•--•••••----•-•----•---•••-•-•---•---••••......-•--•-....---•...•---- . •• ----------------- U Nature of Repairs or Alterations—Answer when a licable_/=:i_.. _ 40D�''. ..••-- ••-•••••---•••••-•••--------------•-------•--------------------••...•••••••---•-•..........•--...---••••••••••--...-••...•-•••-••-•••............--------•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by t bo of health. Signed.••••• --- 01 :.. . •-••-' ------ r� � Da ApplicationApproved By........ ....... ................••----•---•----•--........-_. ................ Dat Application Disapproved for the following reasons-------------------------------------•----------------------....--------------------------------------•••••....-- ...........................................•••••••---•-••••.......-•--•-•--••-•-•---------...••-•--••----••-••••-•-••-•-••-•-•--•-•-------••----•••••-•-•••••••--••••-••-•----•-----••--•-••---••-•----- (� c� Date Permit No...X.J..3...` -------------------,( C� 2" ---.-. Issued--•---------------------------------------------------- --------- Date is` "■ i.• THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,a �t -r r r 1 ........................... ..............OF......r::,::.r -r� ---------------•••••----•----------- NpV ira ion for Disps al Works Tonstratrtion antic Application is hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal System at: ...........................` f.. ...•—..�sJ, s!? 1 ............................... r / Location-Address or Lot No. E. ....,i // 3 Owner Address Installer Address Type of Building�� Size Lot............................Sq. feet �--1 Dwelling-mo o. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------•••••-----•-••••--••......•-------------------..----------------••-•- W Design Flow............................................gallons per person per day. Total daily flow............................................ 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. I................minutes'per inch Depth of Test Pit.................... Depth to ground water........................ LX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9�/ 4. 7 W ..............................."7 ............................... Descriptionof Soil............. .:w :.------------------------------------------------------------------------------------------------•--------------------------- V .............................................. ...............................................................----•-......-••-••-------•---•••---••-----•-••••-••-•••••••.......---•---•••-----•-------- W x ---- - --•----------------- U Nature of Repairs or Alterations—Answer when applicable_--_ r %~r 'J ............ ----------------------------•-------•----------------------------------------------•-.....:--------------•-•---------------------------------------------------------------------------.......--••.--•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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. J, Signed / L '''`f '...... - --' x n --•• 4t Application Approved B ..... "'. :.:. ............................` . t PP PP Y .......... Date Application Disapproved for the following reasons:......................... V' -------------------------------------------•.-•••.:�..................................................................................... -------------------------------•--------------------•---•------- -• Date PermitNo.....t�S -•••••• --.................. Issued........................................................ Date — THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .' OF...... ...:.................. < .......................................... ...................... ......... CInr#ifirate of Tomplianrr THIS IS. TO CERTIFY, That the Individual•Sewage Disposal System constructed ( ) or Repaired Installer w 1 has been installed in accordance with the provisions of TITLE r of h Site Sanitary Code as described in the application for Disposal Works Construction Permit No.-___v3 "''__ _._..._. dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 5: DATE.................... .............................. ' Inspector........: ..... ..... . LQ1A ..&...................... a THE COMMONWEALTH OF MASSACHUSETTS . BOARDF HEAL-3M WIWI ...................OF.. No. ................ ... FEE...................... iayl o �onrton rr ' Permission is hereby granted... .._........� ✓ � _. _11! .__.. ..._.._ /�_ ` �� ✓�` � .�•�� .............. to Construe ) or R�epaEr4"7 an Ind>y,IIsevcra a Dispos cyst pp at No.--•• l ° `" 2' ..._....._ . . d! ' Street 'd%��"�-D �'1 ,�./� �.a as shown on the application for Disposal Works Construction Permit No.. ............... . ------------------ Board of Health DATEf ........................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS I c���,,- "',- �� -.-"' -,:'�-," -,-.-�' .I _',, �,v-,--, ---, - � � I I 11� I - ��-.1 I � I , �''' ",11�I � I� .� 1- � I 11 ",,� I 11 .1 I '_ ,'. ,-1--- ,�", I '_r'',_ . - I I , -,, I --- I - . I __� _ __ " -_ � ____ - -_�-_ I � . 74-1`7-�7,1777--.-_�'�",�--"'7``-7` 1'�,`7-",',-�,'�`-�'��,,','� . I I I , I . � � ", I ,. ; I , ., I ,- .., I,` � ,I� �, ":,," I �'. � I 11 -7 , I - 11 I---I 1, " , � .17 1 I _�I �, � I � I , � __ , . , ,, -- --- -_ -- - I I . I I I I I - I . I , ;, r, ". I . , I � . � , . . , . � , , . ,,,, , , I I � � I � ,'� I .I .., I ,- � �� I I � , 1. I I I : � I I , I I I I 1, I � ,�" ,� I . , I I I 1� I � I '', . I I I . � I� � I I. . I a . 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I�'' _.'��'L,- _�' 1� ; L- ..- , z z , I :_ fsf 4 . No chang I I I . I --- . -_ I . � � " . '10 r I I I I I I I __4 � r L .� . I I r 11 .. � 1W r -t LA . es � __ I r I L � . . � I I I I � �1�I ,.' :: a L � . I- I E,j IV . it fL1 ul 1. &III# . r � L r , . I . I 11 I . . . I '' : . r X .. Vt I ,� I I I I 1, �L �, I. to A A T#4( � I I . of the Boa �L I - . r I I I I I .I r r . .. I . . . . I . . - � 'I -4 � 'L:,1, 4 A .. 4D *4 r I . �L`fte$�. I . - .1 r I I I I � I L . , :11 ,It � I r'a'. r - � I I . . I . I I , - - I _ I;- #6, .1 4r - -0 I _ - I I— I - I . I L � r I L �Ll I � L . r I . I I i L . I . I r r I � r � I . . I i � L . . � I L . L I L -.11 '.1 I I I r I I . I I r I L I I . .I . 'r I I I . r or use with, I 1. 11 I . . I . I I I � L ! I . r I � . I I - i � r�' I L, . ,� r - I .11 I I . I I r r I � . I . i : ,, , 'L I I . I 1. I. L I P/?-0 0 L 6 Oic- 5;C?T1(_ , S 1 �TE/-I ' I L I L I r i r I r L I . t I r , I I , I � . � . L I I I I � I I . . -I . . . L I I 1. . I L I ! - � � .. I � i I I . IL I I I I � I � I I , . � I i I � �. r I I 1 51(-14 I-E .1 111� J4%." . r I r � 'r I . i I . : ''. � I . Ir. I I . I I . r r . . � � I . I � 6. ,. c I rL I . 11 . I . I I I . I I . I L r I I I I L 11 I � I I . I 1� I I .� rL L I � I I . . . . r . � r . , r I L . � c . . I ; I r I I O;L - . L I � L I L . I . I I . I I � I . I I i . I . I I L I L I . I . I r I . I L . � - . I , � . " r L I . . L r I . . . L I . I I I , I . . I r r L I � . I . r . I � L I I I I . I . � I I I ,�,_ I I to(, It - L I I L I . r I . � I . � I I � 7 . Property line information taken fi;om Tlan ofland in I I� I � ... r �_ 1CFE.: . I . r . I r . . . r . I I I � . � I I r, I ; - . _ � . r L r r r r I. r I . . I . I I . . � � � ! Barnstable , (Centerville) , prepared by Baxter & Nye � I �,L ,I � 'L I I ; . . . I . � . . I � I . I � I r L . I L r L , . I r . . I L � ! . RLS, dated March 19, 1990. Septic Plan not to be used as a I - .. � 11 1. . . I I � L I � . I . '1� I I � r I . . . ; r . i i r � I I r I . . I L . I I I I I r . I . . 11 , I L I I . . . � . . I . . I I I r Lr ,r- . I . L . r I r I e-,p;r,I,,q& &�4i)F I I I . r . I I . r � r property line survey. 11 I I I : 1� too - I I . ; I � I I I I I �: , I � I I � . �-b ILI r , . �j IL 6 1 I! � I L . . I I I r - - I I � I I . � . � . L I 1 L� I . . - I . I I I I I I L . I . L I . L . , I . I -_ I- - . . ------- ' L � I L I r r . � r L i CALCULATIONS , L I - .r . I I Ir - I . . r I . . L L i � . � L L I L I I I . L�, r r 'r . . I I . I r _____�_ . r L, I I . ; L ,� .. r I I I . I i I . I , I L I . I I., � I . I -L . I I r ,�, � I L I 11 I ; I . I . I r I I . �I . 1. :� " . L r , I L� . I . I I I I 1 . I� . I I . . 3 Bedro I I . I k I L I . . I I i I I .. r L I � I I , . . . ___**� L I I - I I I L � 11 I I I �I I . L Y.9f 0 1 : , I r L . . . . r ! I 1 4 �1 I L I - . � -, ,� ,". . I � �_ . r � I L � � . � I r m I r I I I . r I I r . 1 0 r I I - I I I I . I I . I I . . L. I j L . . I r � I I % %� r. r ,___� . I .1 . I . ; I . r I I. I I �,_. I _�. Y& .- - r 11 Ili .1 L I 4-,2 s . I ___�Ip_ I L . . r . I I . . r r . � I I r � r I I r � . ���1,1�31,_:, L' - I I L r ,. I 1. . 1 4 fol . 0 . ""�� r . I I . . . o s F I I I - r 0 1 1 . . r - r I I I .,0 . 1 16, r I � . . r . . L L . ; L I r I I L � I . I I I r I I ;I , .1 r � .. I I If 0 r I VA91 L I L I r I L . r . I . I I I I . . I � � . L I� I r I I I . .S,-. 01 67f r .� � I r r I . I I L : ,- . :L '�. r L 97�,'7 t , I I . I -1 .3 ------I � . . . . . . I r r . I i L L ; ,PROPOSED LEACHING AREA: L I I �, I. � I I I L � %,O I I . . . I . r I I .r I � I 1. . I I i . . I . L I I -I L . 'L I .- . I. I IF ILI J r/l/V I ,,,r...( _ I L . . . I r . L . � I 1 4 r L 1. I I I I I I � . L r � I ., � . L . I I I I � . . I . I . . I I - . . I I .� r L I , IL r �� I . r Ir - . P,5,0 L I . . r I r I i;,95 I � ",� � L I . I I I r I . . r I I r L � L . . i L Leac 2111 (Effect) I . . � . " r�� . JbL-, � . 11 I I . .. L _ . I I L L r . 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