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HomeMy WebLinkAbout0354 PINE STREET (HY - Health 354 Pine Street 228-036 Centerville 'PC 12543 Ho.53LOR :IASTINGS,MN ?Ob , P G J (� Ts6 icyC, Fr 4 e, C� i r '.; sLi MV cr .. x"••fir;- "�"�#t�e+�m. � '1:�-q•�^�' ffi�=r 6` in , c 1 SrWM M •,9 I w = Cl La I i at !_C _ G✓eX- x _ lk j♦ ti It r _ rfe/8 hC/A� iiz .rum. y` 4�c/h�. he�lti l )491 \., off.: _ �•C '�' *�i� ; ° I I a ooaP . z bit � 5 1£ he T7W�- swa 4 /h 4.4 • v� ..,, rl0 hH t Commonwealth of Massachusetts -U L W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 354 Pine Street s Property Address 14 Leonard Daccardi Owner Owner's Name M.- information is =* required for every Centerville I/ MA 02632 5-3-17 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information (� filling out forms U J.# on the computer, ZN OF use only the tab 1. Inspector: ........ key to move your cursor-do not James D.Sears __` JAMES ,m use the return Name of Inspector _ key. *: co Capewide Enterprises ; �,•. �,� o rQ Company Name Q 153 Commercial Street '���i�NS Company Address *rn►rrnrn rem Mashpee MA 02649 Citylrown State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority owlJ o 5-3-17 nspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection: If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 5 Commonwealth of Massachusetts . Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 354 Pine Street Property Address Leonard Daccardi Owner Owner's Name information is required for every Centerville MA 02632 5-3-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 1500 Gal. Tank D Box and two pit's. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 354 Pine Street Property Address Leonard Daccardi Owner Owner's Name information is required for every Centerville MA 02632 5-3-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 354 Pine Street Property Address Leonard Daccardi Owner Owner's Name information is required for every Centerville MA 02632 5-3-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in is less than 6" below invert or available volume is less than %day flow P/'TS t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 354 Pine Street Property Address Leonard Daccardi Owner Owner's Name information is required for every Centerville MA 02632 5-3-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 354 Pine Street Property Address Leonard Daccardi Owner Owner's Name information is required for every Centerville MA 02632 5-3-17 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 354 Pine Street Property Address Leonard Daccardi Owner Owner's Name information is required for every Centerville MA 02632 5-3-17 page. Citylrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. Tank D Box and two pits. Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2015-101,000Gal g ( y g (gp ))' 2016-100,000Gals Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203)'. Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 11�4 IN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 354 Pine Street Property Address Leonard Daccardi Owner Owner's Name information is required for every Centerville MA 02632 5-3-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 354 Pine Street Property Address Leonard Daccardi Owner Owner's Name information is required for every Centerville MA 02632 5-3-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1988 Permit # 88-767 / 5-2017 New D Box. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 44" feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: 32" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast H-10 Sludge depth: 1" t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 354 Pine Street Property Address Leonard Daccardi Owner Owner's Name information is required for every Centerville MA 02632 5-3-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-TapeSludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and outlet cover at 32" below grade. Inlet cover at 4". Inlet tee. Outlet baffle. No sign of leakage or over loading. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ,a 354 Pine Street Property Address Leonard Daccardi Owner Owner's Name information is required for every Centerville MA 02632 5-3-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 354 Pine Street Property Address Leonard Daccardi Owner Owner's Name information is required for every Centerville MA 02632 5-3-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 37" below grade w/two line's out. Box is new 5-2017 w/cover at 8". Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'M 354 Pine Street Property Address Leonard Daccardi Owner Owner's Name information is required for every Centerville MA 02632 5-3-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two precast pit's. Pit# 1 at 34" below grade w/cover at 8" 1'-6"water, no sign of over loading or solid carry over. Pit#2 at 3' below grade w/cover at 8". T water in pit. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 354 Pine Street Property Address p Y Leonard Daccardi Owner Owner's Name information is required for every Centerville MA 02632 5-3-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 354 Pine Street Property Address Leonard Daccardi Owner Owner's Name information is required for every Centerville MA 02632 5-3-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 e £tip" P � F-A ('c 13 73 13 Y ; q1 - 0 Commonwealth of Massachusetts IL - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 354 Pine Street Property Address Leonard Daccardi Owner Owner's Name information is Centerville MA 02632 5-3-17 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells /VO 12'+ Estimated depth toFigh ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 11-17-88 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: T.H. on Design plan 11-17-88. No G.W. at 12'+. Bottom of pit #2 9' below grade. Bottom of pit #2 3'+ above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 354 Pine Street Property Address Leonard Daccardi Owner Owner's Name information is required for every Centerville MA 02632 5-3-17 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 fm Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System �rIndividuai Components Location Address or Lot No.354 P106-S I C'VI LL Owner's Name,Address,an Tek.No. LEc�t/ak� DAC('e4 � Assessor's Map/Parcel 354 P l AJE Installer's Name,Address,and Tel.No. Sv 8- 4 771-gg?l Designer's Name,Address,and Tel.No. CAF��wanC Ex ►S&:,:, tj Ct2ti�cCtil�12�1/9-C_ STD Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building AJIPS I k�lTcd.Q-�No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Z k).T 71+{,4— tJ43LO -A b n—6®)e Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date i4 - ;L - AP Application Approved by Date !Vr-)L,111 Application Disapproved by Date for the following reasons Permit No Date Issued i � r � No. !J ✓ �.: �..:r iA.sN �.. ..� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ° a PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftPhLatlon for MIsposal 6pstem CDnstrUCtion permit Application for a Permit to Construct( ) Repair( Upgrade( ) .Abandon( ) ❑Complete System Individual Components Location Address or Lot No.3 5.4 p(u� 57 Cat/!((LC Owner's Name,Address,anc�Tek No. (,60A/AV-b DACG0.dA Assessor's Map/Parcelra.� :. Q�(p -� 3$4 r A)tr $"P GG1rJT� �f G.C�L� Installer's Name Address and Tel.No. $O Z.- 't77-'98?1 Designer's Name,Address,and Tel.No. !s covvcut �-c 5�- K%tf P Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building., \$I N9UT[`¢-C.,No.of Persons Showers( ) Cafeteria( ) Other Fixtures i Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: "Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of iy_-Compliance has been issued by this Board of Health. Signed , Date t r�7' Application Approved by l Date.Application Disapproved by Date for the following reasons s t F. Permit No Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS e yf• e n CertlflLate Of CDritpYlanLe THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(�) Upgraded( ) Abandoned( )by C R?GW p 6 at 3 5 //V,5: S` 4f; Zr CW7&&/u Chas been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.i�'�7 �7 dated Installer (±06 w c o C R17�QP2( L Designer 7T I t #bedrooms Approved design flow W gpd The issuance of this permit shlall not be construed as a guarantee that the system will ctio as°designed. Date J 7 / ? Inspector.. �..,1. .._.--..,�_�._..../ . --------------------------------'----------------------------------------- ''----------------------------------_ ,------------------ No. � ,�— 7 Fee 7 - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS j Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at 35-q P 1 t-.,4s cej,-w_yt(-Lc t r and as described in the above Application for Disposal System.Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must,be c6mplete with• three years of the date of this permi '— Date Approved by Town of Barnstable Barnstable Regulatory Services Department AR-Aroiii CRY + HAM SUABLE, • , I '®I MAC. ibsq• Public Health Division �0 AlfD MAC s 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO July 26, 2007 Leonard Daccardi 27 McGuerty Road Brewster, MA 02631 RE: 354 Pine Street, Hyannis Please be advised that this rental property is zoned for and therefore is to only be used as a Single-Family Home (i.e. all tenants must have full access to kitchen). Respectfully, Caitie Barrett Health Division Assistant Rental Program Coordinator u �OCDfl[ I a[ 0° . cLn ru 3caP LA ru `i L U t r►13Postage $ ^ by p Certified Fee d _ L4 C %mark p Return Receipt Fee g Here (Endorsement Required) ( - (U, co fA O Restricted Delivery-Fee rR (Endorsement Required)ca r W 1, Total Postage&Fees .0 _ C3 Sent To S`treet,JfptNo.; �� �/►� or PO Box No. 9 r --------- City State,ZIP+4 0 1631 631 13 Certified e Maii P (asianarovides: mailing P H)Z00a ounr'ooss uuod Sd 13 A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years 13 important Reminders. may ONLY bE;,combined�with First-Class Mail®or Priority Maile, o Certified Mail is not available for anOilass of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured of Registered Mail. ® For an additional fee,a Return Receipt may be requested tno 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 USPSe postmark on your Certified Mail receipt is required. .a For an additional fee, delivery may be restricted to the addressee or addressee's authorized aagqent.Advise the clerk or mark the maiipiece with the endorsement"Restricted eeiivery".-, - , a 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 in qu Internet access to delivery'information is not available on mail addressed to APOs and Ms. COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sig ure item 4 if Restricted Delivery is desired. 'gent ■ Print your name and address on the reverse Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, L� or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Art' le Addressed to: If YES,enter delivery address below ❑No 7 1�c 3. Se ice Type Certified Mail ❑Express Mail O et 6 3 I ❑Registered P Retum Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number c '� OO6 0810 2�00 3525 2650 ;r (Transfer from service label) t,7'' I- — TD PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 i } UNITED STATES l $Tl$k $ ylY fTAyi..,* �::: F�Fst='�:TaSS tVFm �. e Fe '�!,'o';?. pws: Y .IRYI ''�IHn • Sender. Please print your name, address, and2lP+4 in-this box• 4 ' t a� q Town of Barnstable + Health Division } 200 Main Street Hyannis,MA 02601 I I `�'r•'��•'?r= Fi�!!flllf�lllfflFIEl:fEillif?!�l�ldFt'ilfflf!!11!!?iilfffl?lI! I - - HOBBS&WARREN'm THE COMMONWEALTH OF MASSACHUSETTS FORM 30 Hx� BOARD OF EALTH t CITY/TOWN 9 W v DEPARTMENT 2s 4- a D�� o TELEPHONE ) Address Floor Apartment No._.-d_ __-No. of Occupants -- No.of Habitable Rooms No.Sleeping Rooms_ No. dwelling or rooming units N _No.Stories_ Name and address of owner ^^ _ Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: a' Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS LIST ❑ 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 x Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: %Acks, Flues,Vents,Safeties: Kitchen Facilities i (jrrV tove VEIL) . ® 6 l --- Bathing,Toilet Facil. ., 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 PSIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY.' INSPECTOR TITLE A DATE 3 TIME A.M. THE NEXT SCHEDULED REINSPECTION P.M. 44''%4 A #Ift4 if,f:�'ttA F"d IM._`y '��� '•zp,`...�., '�{'k'4�i'�iitF.�'. �hes "fir.. �.YX.lf :Y.•i .,AV' .t,ir�r1. .'e +c.n .;I t. f t 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. 1 FORM3O �i � HOBBS&WARREN'" THE COMMONWEALTH OF MASSACHUSETTS BO D OF H LTH CIl Y/ O w a � P R MENT� M -� -- c^ PA 00661 DRESS sn�A _ M 5ey`e �/� —� Ce TELEPHONE Addressj—l ._ _ __ Occupant_Floor Apartment N __ No. of OccuP ants II No. of Habitable Rooms L _No.Sleeping Rooms_0__.___ No. dwelling or rooming units_ �N�� ries Name and address of owner (>/ (iC/ �� . emarks Reg. Vio.�1 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.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vents 1 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,Ye ts,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 INS EC N PORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTI R Y. ' INSPECT R TITLE .M DATE TIME— _ P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in noway 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. Date / 07 I,/A G h/3GL PE/YI S i,` , voluntarily grant permission to the Town (Occupants name) of Barnstable Board of Health (Agent or Health Inspector) to inspect my dwelling unit located at 354 P,N E 5T AFJ- G R t1l LLC in accordance (House#, [Apt\Unit#if applicable],street,village) with the Town of Barnstable Code (Chapters 59 and 170) and the State Sanitary Code (105 CMR 410.000) on 20 0- I hereby authorize and name (Date o inspection) C4��� uoal-_,X� to be my tenant representative for the (Occupant representativ purpose of this inspectior� �� is an adult person (Occupant representative) designated and duly authorized to act on my behalf and will be accompanying the Town of Barnstable Board of Health for the inspection, granting access to any and all locations (including bedrooms, bathrooms, closets, etc.,) allowing the use of photographs and answering questions. This authorization is only valid for the inspection date specified above, and must be renewed for any future inspection(s.) \ Z_/ /A� Occ an s Signature \ Date Occupants Representative Signature \ Date Q:\Rental Ordinance\inspection permission 2.doc FORM30 HOBBSBWARREN'M THE COMMONWEALTH OF MASSACHUSETTS BO RD OF E LTH �►'� o CITY/TOWN DEPA ENT. Anpi C IVESS M SVo 0 �T�E,L��HONE Address 4' .A__1�'4 � occup_ /l� �_�`Pi_ t ` Floor Apartment No.. _ No. of Occupant No.of Habitable Rooms No.Sleeping Rooms _—_— No. dwelling or rooming units_ _ NO ories Name and address of owner _ (�cYjGl�(,�._j� _�j1�y-� - ��-�'�'""eI' l"L Remarks Reg. Vio. 00631 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.: l Hall, Floor,Wall, Ceiling: Hall Lighting: y Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 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 V ts,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 INSPECTlOhLREPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND EN LT M�: INSPECTOR TITLE ' M. DATEL41)� TIME- — P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and'therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to,meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. • ' rad (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. Certified Mail#7006 0810 0000 3525 2650 Town of Barnstable Regulatory Services IMIMS ASM Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 4, 2007 Leonard Daccardi 27 McGuerty Road Brewster, MA 02631 NOTICE TO ABATE VIOLATIONS OF 105. CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 354 Pine Street in Centerville, MA was inspected on March 29, 2007 and on April 2, 2007 by Timothy B. O'Connell and Meridith Morgan, Health Inspectors for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable code. The following violations of the State Sanitary Code were observed: 105 CMR 410.351: Owner's Installation and Maintenance Responsibilities: Observed GFCI outlets in kitchen area not working properly. (i.e. not tripping) Also observed fan in bathroom inoperable. 105 CMR 410.100: Kitchen Facilities: Observed that the second floor occupant's can not access kitchen facilities which is required in a single family home. This home must operate as single family home. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by pulling any required building permits (if applicable); by fixing or repairing GFCI outlets within kitchen, by fixing or replacing fan within bathroom,b_y____arranging single family home so that all occupants have access to all facilities within single family home. (i.e. kitchen, ect.) 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 letterMousing violations\Rental ordinance\1354 pine Street Drive.doc -7 �jnl� - v z63 I a � s I � vs 6 a C v-42!1, zl� NQ vo • � �o 0 h�L a /W F 9 , ;A&V�1 , • ___ �- r -- _. � -soa- ttv�. -YaUI � 1 I . , • • . t • , E�V01/2007 11:27 5084320826 UPS STORE #3978 PAGE 02 Leonard Daccardi 27 Mcguerty Rd Brewster, Mass. 02631 1-508-896-9241 To: Town of Barnstable: Regulatory Services Public Health Division: This letter is to inform you that the violations as per your notice have been corrected. 1. GFCI outlet in room D has been repaired, and the bathroom fan is now working. 2. 1 have arranged the tenancy of the house so that all tenants in the, second floor rooms have access to the kitchen on the first;floor, to comply with single family home status. Since your last inspection Andrew Cook [room B] is no longer a tenant and Michael Dempsky [ room C ] is will no longer be a tenant as of May 31 Thank you, Leonard Daccardi F05J0112007 11:27 5084320826 UPS STORE #3978 PAGE 03 Certified Mail#7006 0810 0000 3525 2650 Town of Barnstable Regulatory Services L 1AIiN3TAffiE M Thomas F. Geiler, Director a Public Health Division Thomas McKean., Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fah: 508-790-6304 April 4,2007 Leonard,Daccardi 27 McGuerty Road Brewster,MA 02631 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II — AUNIMUM STANDARS OF FITNESS FOR HUMAN RABTTATION AND T7IE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 354 Pine Street in Centerville, MA was inspected on March 29,2007 and on April 2, 2007 by Timothy B. O'Connell and Merid.ith Morgan, Health Inspectors for the Town of Barnstable. This inspection was conducted on the basis of the rental registration 1n accordance with Chapter. 170 of the Town of Barnstable code. The foi.lowing violations of the State Sanitary Code were observed: 105 CMR 410-351: Owner's Installation and Maintenance Responsibilities: Observed GFCI outlets in kitchen, area not working properly. (i.e. not tripping) Also obsmed .fan.in bathroom inoperable. 405 CMR 410.1.00: Kr1tchen Facilities: Observed that the second floor :occu:pant's can not access kitchen facilities which is required in a single family home. This home must operate as single family home. You are directed to correct the violations listed above within thirty(30) days of your receipt of this notice by pulling any required building hermits (if applicable): by fixing or repairing GFCI outlets within kitchen, by fixing or replacing tan within bathroom, by arranging single family home so that all occupants have access to all,facilities within single family home.(i.e. kitchen, ect.) 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 S.1.00.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. 0:`.Arder Iett,-rs�llousing violations\Rental ordinance\1354 pine sweet Drivc.doc 05./01/2007 11:27 5084320826 UPS STORE #3978 PAGE 04 PER ORDER OF JJE BOARD OF HEALTH Thomas A. McKean, B .S., CHO Director of Public Hca.lth Town of.Barnstable Cc: Frank D'Pietro Tenant Mike Sullivan Michael.Dempsky Andrew Cook Q:\Ordcrlciiers\lTokisingviciationsNRentaI ordinanecU354 pine Street Drive-doc In ov-6 w 4�Y o h e J''�re y� a-e. s(A hit/'-ze ck ajut--o Seta OPT OUT lip vA9-T-6-n ,�v, c.� 1h ec j ad- 1-�b��s O_A-Z -tom >9 m + r �'s haa,�. r'�G-6AI i>>acfD Have you contactpd another agency? Have you hired an attorney? sirs T& n V8 L) e LTA ` '° If yes, please give the name of the agency below. If yes, please give the name of the Attorney below. P duSiN� �y1gI AM-t lAl0Meh l Y) f'c-n 0 U S cyi—Se ASe.S Please sign the complaint form after briefly describing your consumer complaints. Try to explain your problem in chronological order, using dates, if possible. When you return the completed form, please enclose clear copies (keep origigal copies) of any bills, receipts, contracts, advertisements, repair orders or any other relevant documents. -�- _ E h v tYur Y VJ9� e C,TI 5Y1 °� un oN�YesSM�N��I � �v l State here what action, if any, you have taken to resolve this problem and what you would like as a remedy. Please print or type legibly in BLACK d O Z T T )1 s c nbi e s % hn w yko pets AloY b -�i' rt, cam' o?tlA f-a�'C fto m�}• 'JY-�l S 'i4 , ions I,. tok Ca.MR b»ct � Bu( RR- 's .Ah& ] 2-7Y a --ov S&A h/ 3 OhJw, I hw' Ate ho?1c.e& &t r 5 ui&ya .ciao -U ath' - T 1o/ck ;6� �oL�YI �ec��dL' �c{.�fs�,�,�A nuU C6MA r� + crvc k1 �oSe , ,� S Yaff I-rj A �IA S v e rCfS 4 _Xn 2,t. -n+sllc c. � b I ervv call T 07 Scwhi eS ACC R nl T.wxu Tlvea c� , 'lac Ski''.tJ III_Y_YA t T S t Ac1-� t o 6+ tit✓ -A 0 Kc- &Vy-J YhQ. t o 11 l-S e r'- S Co h Gy W e cp -t t" W 14 S Cj U e. .�o /��. j C0/-7 ' 14S -/-b To t rr tM U I t -} 1 b LAe ego la h-\-z wa0 I j j o So - Jul - -1 i 0 I d >u M s woo A Ye hn our �Yw ite m s 7o 6 cv- ¢ wm.c 1 d >k he_ Ay i s i J�Ilcd2 -;&W L7ul N 'i( Jk--Aye a)-A n rn -t!► C Lrri?}1'ac�' �i-zram' S �G Vt A copy of this complaint form may be sent to the merchant as part of the mediation process. Signature:��()Ad 4 J-M &VVL6 Date: _ ! / 7 / zoo 6U51UP, 1 co)rrz c� CONFIDENTIALITY 0 Your complaint form may be considered a public record,a copy of which is available to any member of the public upon request. In response to such requests,this Office generally will not be able to disclose your name,address,or phone number,or any other information on the form that identifies you,and will not disclose this form in response to any request for complaints submitted by you. Your record in its entirety may,however,be disclosed to state and federal authorities as required by law,and to law enforcement and regulatory agencies who may assist in resolving your complaint. 7o �cS ��61iC- H e"( �h 1 }� ovq )uT VSecQ /VlaVYeSS aj YC.WcuoY "V q 11 - I uCTi islry _ 4pr L Ir e— Yk c� I Da Q,U.e YY`e. C'- D /VD P(e o-p —FrV/o/NA-Vv A) t p EC� ME CONSUMER ICACConsumer Assistance Council, . , =E- - ASSISTANCE WORKING IN COOPERATION WITH THE ATTORNEY GENERAL OF MASSA HUSE COUNCIL A NON-PROFIT ORGANIZATION SERVING CAPE COD & THE ISLANDS , 149 MAIN STREET 0 E-MAIL:cac@capecod.net MASSACHUSETTS: 800-867-0701 HYANNIS, MA 02601 www.consumercouncil.com FAX: 508-771-3011 CONSUMER COMPLAINT FORM CONSUMER: Please supply information requested below: Name: hq Reh 0 1q,1*,1 S Address: 3 5 q P&yx 34 A o I IL 3 City/State/Zip: A a;h N G - P o 6 oX a 510 0 R16 b A/5 ,, /� o a (5 3 Tel: Home 50 ) -7 3 7 q 3 5 S Work: ) COMPLAINT IS AGAINST: Please supply information requested below: Name: 92,6n �� r��c c� 11 Address: Q I ck City/State/Zip: 1EYsw S i ey 1 MA o 2 (0 3 1 Tel: (J b� i5q ( `1 y Fax: ( � Product/Service involve • e T b - bO G 6i Birds Person dealt with: I Nl y Place of Tran action: n/ Date purchased: e17affi . C 3 Was deposit paid? Yes /No Amount $ 5 I-r-S Method of Payme Cash Loan Credit Card Other f Contract Signed: Yes No Name of W' ess(s): V 5 — �g How did you comp ain? By Phone By Letter V In Person To Whom: 7p 41' ->Lvl csZ When: IF AUTO COMPLAINT: MAKE/MODEL: ' VEHICLE I.D.# (on title registration): NEW/USED PURCHASE/LEASE Odometer reading (at purchase): Current mileage: Purchase price: $ Payments: $ Total number of times vehicle has been repaired for the same problem or defect: Total number of business days (Monday—Friday)vehicle has been in repair shop: (OVER) 3. cil 2 • , /l1 N �51 N LOT I 26.320tS.F. 4 se r :. �k W - o 0 O DECK DEC O A8O .r, O 0 33`t o N Z, 0354 55't N 85°56•40,p-yl FREE, ASSESSORS MAP 228 PARCEL 36 TOWN OF BARNSTABLE ZONING BY-LAW DATED MARCH 14. 1997 ZONE RD- l I CERTIFY THAT TO THE BEST OF MY PROFESSIONAL SETBACKS KNOWLEDGE. INFORMATION AND BELIEF THE DWELLING FRONT - 30 ' SHOWN HEREON CONFORMS TO THE HORIZONTAL SETBACKS SIDE - /0 ' OF .THE ZONING BY-LAW FOR THE RD-1 DISTRICT. REAR - l0' PROPERTY LINES SHOWN HEREON THE LOT SHOWN HEREON IS 1N FL00D HAZARD ZONE C WERE COMPILED FROM AVAILABLE AS SHOWN ON MAP 250001 0015 C. DATED AUG. 19. 1965. PLANS OF RECORD AND DO NOT REPRESENT AN ACTUAL SURVEY OFM4 ON THE GROUND. TERRY 9�yG __s? 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Y 1q , Co y n wca Ca C�Lr 0 s pe�t..,S_ C/ F -�y IOU j 0A �C-Ah bV S end jrbp :to e37)i,14>e. C Aye 4kis o u enr (,Aj _f fr- S 6-y-1 f T I Me To e C J o V f c e Ye l "VAN �� 7 3 - y 3 5 cif w "0 I► n _C�a .. _ -TO :I)iYeeITaY' OT B® orY-P CAq,'dq,, tvAyn-e- tn,,J1w no on came -"o p ir�-#b 3. 7 qaATb-�Q� wri-s e1�101Ydlld�ll111 no PVt� 6-h tvt4A To To: Karen Morris From: Thomas A. Mckean Date: 7/28/2004 Re: Complaint for 354 Pine Street ley CMR /0 - ?P( A) (1) ( Enclosed you will find the two reports of the Health Inspector's endings regarding your complaint' W iq rr7- o j3C J'V,5 .S e 4 L S Ph e ;were no insect infestations present. ..........- - S � .... ........... Uo Ileo _ �t)-Cues ct -�10 �4 Y� �^ Thomas A. McKean R.S. CHO .�Ltvojt ps-n. xf, L-�-rtj)�Tfc�-j ve � -E,' e 1 SLL,3 re s v 1 TS S,DIIPA/al 1 JlVI OV. Yr /Prj 0 �^ 9 9 6 - q A., 1 -- ---------'-------------_....._ _-1. --- --__----------_____.._.._.__----------------------------------_-------------------------------------_ _._ - ---- - _ Cc"ae ._.... �-_V-.- `/ K...../k'.Cam,/C ;,/[Jc..-_ �- �- � �!a.C�x, � ,6 _ C'�-- t ����G'rJv�rrr/irra�'✓a� l' Y. ( 1 j i i __ _ ---- -rceo - -- - ------- _. �OeCO a, 61 ' x�ZG --. _._.. -,u� 1 all lot A V / f I i i i 'Al ti • --�- 7 Jd a 04,1 -- per ; i 2% 3 -- — � �` - are ----- --- - __ _- ------__-_ -- _- - -_ Ze -o 00 i V/4- ..( fir -, ' -�./ - - - - -- - ---� - --- - aayz " Kav . l R __-�f _1_-. _ at k4.1 - - -- -- -----— —---- - ------ ------- - - --------- ------- - - , ----- _ r - u i --_-- -. ------------------- Itk V�t ------------ a -- -- - -- --- - - - -- ---- __---------- -_------------ - ------------- - - �'- 06 t ® U i a ------ -------_.---- . a� C4(C CONSUMER Consumer Assistance Council, Inc. ASSISTANCE WORKING IN COOPERATION WITH THE ATTORNEY GENERAL OF MASSACHUSETTS COUNCIL A NON-PROFIT ORGANIZATION SERVING CAPE COD & THE ISLANDS TELEPHONE: 508-771-0700 149 MAIN STREET E-MAIL: cac@capecod.net MASSACHUSETTS: 800-867-0701 HYANNIS, MA 02601 www.consumercouncil.com FAX: 508-771-3011 MERCHANT'S RESPONSE FORM Consumer Assistance Case: # 0704CCO410 14 Consumer's Name: Karen Morris A cony of this response will be sent to the consumer unless the merchant states otherwise on this form. Merchant's Name Z � Q� Contact Person: Business: Len Deccardi Phone: SI& - jzg�J Address: , 27 McGuerty Rd., Brewster, MA 02631 STATE BRIEFLY WHAT ATTEMPTS YOU HAVE MADE TO RESOLVE THIS DISPUTE. J fiX � I G &J Z& , HOW DO YOU FEEL THIS CAN BE RESOLVED? itGoccGC G�� to. al aij-24y 441-e-�&rv_ ��' DAAA �LCeLc Uzt GJ Signed: a Date: 2 Title: Please send your response back to:Consumer Assistance Council,Inc., 149 Main Street,Hyannis,MA 02601 Or FAX to : (508)771-3011 A MEMBER OF THE UNITED WAY BRIGHAM AND ffiffN HARVARD WOMEN'S HOSPITAL MEDICAL SCHOOL 75 Francis Street Infectious Disease Division Boston,Massachusetts 02115 Tel:617 732-5885,Fax:617 732-6829 July 1, 2004 Dear Sir or Madam, I am writing concerning Ms. Karen Morris who came to our-clihic at Brigham and Women's Hospital. Ms. Morris has had itchy skin papules off and on since May. These lesions have occurred when she has been in her apartment and are improved when she moved temporarily to another residence. Multiple treatments for various types of skin infestations have been unsuccessful. A biopsy of two of these lesions was consistent with an insect bite. She reports that efforts to fumigate the property have been made and have not been successful. On the basis if this history it is likely that these are insect bites and the apartment she is living in is the source of exposure. I have repeated prior recommendations from other physicians. She should seek another residence. I would be happy to discuss her presentation provided that she gives her permission. Sincerely, Cameron Ashbaugh, M.D. Brigham and Women's Hospital Tel 617-525-7363 PARTNE S_HealthCareSystemMember �N- BRIGHAM AND Co r� C.e v h j,",Al HARVARD WOMEN'S HOSPITAL MEDICAL SCHOOL 3 Sq 75 Francis Street r � Infectious Disease Division Boston,Massachusetts 02115 �" Tel:617 732-5885,Fax:617 732-6829 C July 8, 2004 ("u To whom it may concern, I am caring for Ms. Karen Morris at our Infectious Disease clinic here at Brigham and Women's Hospital. Ms. Morris been suffering from.bug bites to her arms and legs for several months. These are a particular concern because she previously had serious burns to her hands and the skin grafts in these areas are very sensitive. She has had an extensive evaluation including skin biopsies that all support that these are bug bites. The history is consistent with exposure in her current apartment. She says that some efforts have been made to exterminate the apartment, but that these have been limited and to date ineffective. A thorough attempt to clean and exterminate arthopods in this building is one necessary component of-this--woman--'s-care -- -- --.. -- - -- - ----- - - - - - Providing the patient gives her permission, I would be happy to discuss this matter at any time. Sincerely, Cameron Ashbaugh, M.D. Brigham and Women's Hospital Tel 617-525-7363 Beeper 33903 PARTNE16.HealthCare System Member L . BRIGHAM AND WOMEN'S HOSPITAL MEW HARVARD MEDICAL SCHOOL 75 Francis Street Boston,Massachusetts 02115 Infectious Disease Division Tel:617 732-5885,Fax:617 732-6829 July 1, 2004 Dear Sir or Madam, i am writing concerning Ms. Karen Morris who came to our clinic at Brigham and Women's Hospital. Ms. Morris has had itchy skin papules off and on since May. These lesions have occurred when she has been in her apartment and are improved when she moved temporarily to another residence. Multiple treatments for various types of skin infestations have been unsuccessful. A biopsy of two of these lesions was consistent with an insect bite. She reports that efforts to fumigate the property have been made and have not been successful. On the basis if this history it is likely that these are insect bites and the apartment she is living in is the source of exposure. I have repeated prior recommendations from other physicians. She should seek another residence. I would be happy to discuss her presentation provided that she gives her permission. Sincerely, Cameron Ashbaugh, M;:D. Brigham and Women's Hospital Tel 617-525-7363 PARTNERS.Healthcare System Member 07/08/2004 02:18 15087786322 FOWLER AND SONS PAGE 02 FOWLER & SONS, INC 358 WEST MAIN STREET HYANNIS, MA 02601 (508) 771-BUGS FAX (508) 778-6322 (508) 240-BUGS Hyannis Orleans July 6, 2004 RE: 354 Pine Street, Centerville To Whom It May Concern: I, Charles Fowler, Massachusetts pesticide license no. 17463, inspected apartment in question at 354 Pine Street, as well as the exterior perimeter of the whole building. During the course of my inspection today I found no evidence of any insect infestation. Furthermore, the glue boards that had been placed at the property to try to catch an insect to identify had no evidence of insects on them. r Sincerely, j' Charles A. F. . ler Inspector Fowler and Sons Termite and Pest Control, Inc. CC: Tom McKean, Barnstable Health Dept. .� 'bo) YYa- oT Hew If h e T(Dm ,,A (?, eo 6 - a t,,4 A -T M.6VEC� 42 Y1 N i n-T T, v 'StyAtc-lqb bumn aloric" v� 0 i J Tb o - Pe ' e coAo a g �l �,�� r� c,�.n P-ET- fJll4C o D.2Q��r�cJ2 �'YI`2 5w?uY4a " P ck t Ynshe s 1e O-LJ uh nu (� ��k s &a ( v soh 1Y111f.Y AY1�1 Y.e UTS + hakk 70 AM 7 C, c 13 11 � )4 5D'737 y355 o &r4t,�;c ,64rle,� 7-7 r . - - - - oe - v +6j�> n :Etv q nu. CA � e rR d Luu5 d f f'S mo S v S a C,o V r onw e ow s � t.1 S �b eY W%A C P J yx vredl SC)173 '�3 5 TOWN OF BARNSTABLE LOCATION J �-{ �rtiE S-r; SEWAGE # 78- VILLAGE- Cen(er_LL ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. Zahn A. as 1-/2R �S�S SEPTIC TANK CAPACITY j ��6C�_ ui LEACHING FACILITY:(tYPe) 6 `s G/ (size) _._ NO. OF BEDROOMS S PRIVATE WELL OR GEDWATER BUILDER OR OWIIER W, ��'�`` �rdone. _ DATE PERMIT ISSUED: y- DATE f COMPLIANCE ISSUED: VARIANCE GRANTED: \ r 1 \ - � � � .V No.. .76 2... Fms....._ 5 ^.• THE COMMONWEALTH OF MASSACHUSETTS c�' O BOAR® OF HEALTH ff ----- N Appftr�ation for Bispaa al Work, Towitrurtion Frrutit �v Application is hereby made for a Permit to Construct (/or Repair ( ) an Individual Sewage Disposal System at: ----. ....................................................... .. L ca'on- ress or Lot No. ......... � .L Add �l" ';jef�l Installer Address Type of Building llV// Size Lot_.;Kl_�_.�._.....--._Sq. feet Dwelling—No. of Bedrooms............. ...........................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Ga Other fixtures ...............••--•--•----••••. . w Design Flow................................���_.gallons per person per day. Total daily flow--- S_a.............................gallons. WSeptic Tank—Liquid*capacity/ ..gallons Length_/l1-4_"--- Widths.'A".___ Diameter__ --------- Depth.S.'_'e,.... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.--_--__---`�.,_..... Diameter.....A0......... Depth below inlet_.............. Total leaching area.,5. 4.....sq. ft. Z Other Distribution box (14 Dosing tank ( ) aPercolation Test Results Performed by, ......... Date..A�1�2-zF—.............. Test Pit No. I......�.......minutes per inch Depth of Test Pit.._.l.2'! .. Depth to ground water-------- ... GL, Test Pit No. 2.......Z......minutes per inch Depth of Test Pit.... ....... Depth to ground water--- _--_-___. Q+' _ ----------------------------------------•----------•---•---- --------------------------------------------------------------•--.------ 0 Description of Soil---•7;, :rp."s........ , � i.{� ., ,9A��� .................................................. x U ------ w V Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------•----....-----------------------------------------------...-----------------------------••--•---• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of f•7T�Y�• 'y t LL 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...... "459 •--- . _ ....--•--••---••- Date Application Approved BY...... "^� ca- -=�..... ----•-- Date Application Disapproved for the following reasons:................................................................................................................ .................•--•----.....--•--•---•--•--•-•-----•-•-•--•-----•----••-----•--........--•••--•--------I---•-•--------•--------------------•---•-----•----•--•-•-•-•••-•---•----------••-•------------- —7 Date Permit No......�-S---=------<-`r--'- ------------------- Issued-------------------------------------------------------- Daze .1... F>ts. ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------------..........-........ Allp irFaiion for Disposal Workii Tonitruriion V rranit Application is hereby made for a Permit to Construct ( ) or Repair { ) an Individual Sewage Disposal System at: ...................................... ...... •••-----------•-••---...--•---••-•--•• .....-•-•----------...............----...._. .......................................... ----------- ---- ---------- Location-Address or Lot No. ....................................................................._.._..............•...._.... ............._..._..............•.....••-•-...------.......---•--------.._........-•--•--•-------- Owner Address W Installer Address UType of Building r Size Lot_Zw;...�� Z- ........Sq. feet ►� Dwelling—No. of Bedrooms............:` __..........................Expansion Attic ( ) Garbage Grinder ( ) CLI Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures W Design Flow................................ per person per day. Total daily flow------S_r;l-------•----••__--------------gallons. W Septic Tank—Liquid capacity/S—_.gallons Length_Zn_�•_:'__ Width:a._'_.._...._ Diameter---'--------- Depth,'_:�.'.... x Disposal Trench—No..................... Width.............._..... Total Length.................... Total leaching area____-----_____.__---sq. ft. Seepage Pit No----------Z------ Diameter.....14...._...... Depth below inlet.' `............ Total leaching area ._.�......sq. ft. Z Other Distribution box (✓) Dosing tank ( ) '-' Percolation Test Results Performed b Z c Goa,', t= v�;'sc' ��if' //_ % WY --------------------- -----_ -----;•---------------- Date----•-.....�. ..---------•----' Test Pit No. 1.....Z�.......minutes per inch Depth of Test Pit.... Y?'_-. Depth to ground water_______ ____________ r=q Test Pit No. 2...... ...._minutes per inch Depth of Test Pit---- Z -------- Depth to ground water-------- ------------ 9 ----------------------------- •---•-•--•------------------------•-•------•......---------•----------.....---------••--•--------------------•---------------- O Description of Sollr--z C _.._..... . .�r:�. 1�.:> ..... ------------------------------------------------------- x W UNature 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'TT .;-. , p 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--- a1-- ,/ . ;:� Date Application Approved By........... Date Application Disapproved for the following reasons-................................................... ............................................................ -------------------------------------------------------------------------•...---------------------------'-------------•--------------------.........................................Date Permit No.----Z.C6: :----� .7-------------------- Issued....................................................... L:_:. THE COMMONWEALTH OF MASSACHUSETTS BOARD O�F,�/ HEALTH y} (//{y���� ..........f ..........OF...............'1..c1. :<..is'L:!!dRt°'�`.•.................................. Trrfif iratr of TontpfiFatta THIS I TO CERTIFY, That the Individual Sewage Disposal System constructed (x) or Repaired ( ) by................ ............--•----•----------------tall- Installer at----------------- �"�---------f--L'�- ......-�-[. ._...�Cz- f ='t,."-� .. ---------•-•-----------------------•-----------...--•---------•-- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.....!0-n..*7La.`7........ dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................... 7 7."...� �j-•--••----------------------- Inspector........------... ................................................... THE COMMONWEALTH OF MASSACHUSETTS G BOARD OF HEALTH ............... .OF...... _ FEE...f.� Disposal 10or.16.15 �Tonstrwtion unlit Permission is hereby granted--------- �., ^`'`� <:,��.e to Construct (,j>11) or Repair ( ) an I n-dividual Sewage Disposal System at No. a- p 3 S --�--------------- Street as shown on the application for Disposal Works Construction Permit No.(�e.-'1,..7._ Dated.......................................... ...................................... ----------------------------•-----•- Board of health DATE...... �.._-_. y FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS -, J t MI6 11 ._. 4 C - i4d..� ......, i 42.1 44 4 6.8 i 2-6 41k-.6-} J 26,320=5 9 lU/2 a:�a ►: ::_ mot ;1.: . s �')(p. F ;I'f-t10 J 4o.Si 1 14. Date 111-21-88 rp {r . ® 118J �,. i. (P/2 atone q 4` 1,.S311 ai, PRO Po5ED � D- -�-. �-.:J-4-f-;-, - .l 093 gpd rJ S-e.R. 40,9 Ndi ;..:. o, 44 t.. i t �- 4. An 150a lu Ind. 43.0 ;: M So.0 4 o i ;..+.. :��-i.ze S eP.t •q 8.4 ,� 1 41.�' . .. . } - J% 0 wide, 1 . �ndi tt/Cape £,u Sepfii c De,,;i yn r_, L19 /'f")o-t; r,�o,ad A'o. lJan.Zi�., /!�a, bedf,.00nra.- y 02601 g�l°w •.... ;SSO�yid. ;:. : .. r.y b area ;S30.`� I Capacity . .19d-# j 5/zetch plat o f Xand a n Corte�w i l.Ce llla -'- 14 �02 (Ui.Gli c<rt Naulone } ,..;.1_r. ..1... shown on.a p aecozded I in book- 2/2 pacfe 137. ri i } cute •an aysunred. i Date: Ac�e�►.t: Sze r�oa2c� �.. o� Seat pit ,#P-7129 No. wate t ertcou;&tp_4,a petit. 2 r4L)PPet p I' I p 24 ' 4- 42 ! - . top c E: -top A,A4LW 4i.3 rr.ecticrnc J �A�ua I ,►�IN�f A1q '�+. E 9:•• ESN F-4f, 02 EoWAtt i KEAQ o ,\� \YNILNE 32490 s Q it �a�fF „re ZA EC151ERE� 30.4. 3o•9 '. SSl ��`' BHA( LAND So