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HomeMy WebLinkAbout0056 BISHOPS TERRACE - Health 56 BISHOPS TER. , HYANNIS A = 251 213 J ti �' i TOWN OF BARNSTABLE LOCATION �JIo 1147NO j aeA SEWAGE # NCO VII.I.AGE ")yr P%fCIT i`$ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ^� LEACHING FACILITY: (type) 1'i-7— (size) NO.OF BEDROOMS BUILDER OR OWNER '�"�_ R�A�1� PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facili ) Feet Furnished by =7r 5�D 0 1�0)6 .j,-Q �.s►� W w r � oo•oo� •��- __ J (ITOWN OF BARNSTABLE LOC TION !5li nia S _ Leg AGE #�•O 0O -- 30-� VIE AGE is - �GA�n/7iA SESSOR'S MAP& LOTJ ' INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /' v LEACHING FACILrrY: (type) (size)/G A' .J,� X NO.OF BEDROOMS -� BUILDER OR OWNER SA, PERMTT DATE:.J 1,Z �.- COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any.wetlands exist Y within 300 feet of leaching facility) ✓ '�_� Feet Furnished by 00 �, 70 l No.2Q' y h Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS Y t// Zipprtratton for Mtgogaf *p5tem Comarurtton Verrutt Application for a Permit to Construct( )Repair( )Upgrade( • )Abandon( ) ❑Complete System ❑Individual Components Loca%j AddreV,r Lqt No. ner's Name,Ad and Tel.No. -7 7 7—.2 7 3Y` Assessor's Map/Parcel Installer's Name Addres$,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil G� Nature of Repairs or Alterations(Answer when applicable) irtQlt� /� v g bate last inspected: Agreement: The undersigned agrees to en the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions f Tit 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu by t is oard eg4 _ Signed ��GG '1 Date Application Approved by Date Application Disapproved for the following reasons Permit No. ®Ls� _' 6 Date Issued .L �;77Z�! _. 0 No.�j �Vl� Fee 4�� i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y / PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS V/ Rpp[tcatton for MiOpogar *pOtem Congtructton Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components i Locati! �Qedrelor Lot Pfo. Owner's Nye,A�and Tel.No. -77 7 rj-a ] 3 F Assessor's Map/Parcel Installers Name-Address,and Tel.No. Designer's Name,Address and Tel.No. 7U 1&,?1 AV /J� � 7 . Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets^ f Revision Date Title Size of Septic Tarikvl-te Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) l'+t���a� / _� /d k -31 'Zl/ s Date last inspected: 4 Agreement: The undersigned agrees to ens the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Tit 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu by t is oard 6�i Ie� Signed �'"�` Date Application Approved by Date Application Disapproved,for the following reasons - Permit No. Date Issued -- � —————— — ————————————————————————————— r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTI that the On-site Sewage Disposal System Constructed( )Repaired(k )Upgraded( ) Abandoned( )b -t, at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N7j:W — .�r dated ,.✓'-'sue Installer Designer The issuance of this p ' sail o}�bb construed as a guarantee that the s to llffuncc�tio i s d�si 'tied. Date /G/� Inspector �Q� ------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLES MASSACHUSETTS Mig;pogar *pztem Coriftrurtton Permit Permission is hereby granted to Construct( )Repair(,c)Upgrade( )Abandon( ) �---- System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of t ' it. Date: ' Approved 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, do g-1 , hereby certify that the application for disposal works construction permit signed by me dated 37- 2-2-" �� , concerning the property located at meets all of the following criteria: 6--• 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. �• There are no wetlands within 100 feet of the proposed septic system (/• There are no private wells within 150 feet of the proposed septic system j.�• There is no increase in flow and/or change in use proposed �• There are no variances requested or needed. Ve The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] :�• If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 4/"� B) G.W.Elevation +the MAX.High G.W.Adjustment. _ ' DIFFER7WEEN A and B SIGNED : DATE: r- �Z^ [Please Sketch propo d plan of system on back]. 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:cert �� � ��; i �� -=-�1 l7' s� 1 i i I r TOWN OF BARNSTABLE � LOCATION SEWAGE # /" -�;,; /�iJ �r•� ASSESSOR'S MAP & LOTr VILLAGE ' INSTALLER'S NAME&PHONE NO. j SEPTIC TANK CAPACITY LEACHING FACILITY: (type) , /C r A�, (size) iC > > X r' NO.OF BEDROOMS C, BUILDER OR OWNER PERMTT DATE:��" -Z 2-`=�`J COMPLLA.NCE DATE: Separation Distance Between the: g Feet l -.:Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist I on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any.wetlands exist �- Feet within 300 feet of leaching facility) Furnished by � v i -..r .r• i -T' _- TOWN OF ,BARNSTABLE BAR-W 5974 4 Ordinance or Regulation WARNING,, NOTICE _ Name of Offender/Manage, HC Address of Offender MV/MB Reg.# Village/State/Zip Business -Name •fj am/ Business Address SignatureJof Enforcing Officer Village/State/Zip j Location of Offense � Enforcing Dept/Division Offense C [ H10, -7 'S0 � ! Facts ^01- l✓� Vtl- y r This will serve' only as a warning. At his time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and. warning notices are attempts to gain voluntary compliance..': Subsequent violations will result in appropriate legal action by the Sown. .WHITE-OFFENDER CANARY-ORD./REG:-PROG. 'PINK-ENFORCING OFFICER GOLD'-ENFORCING DEPT. f w� Yi `i:'c"'. fis..T''r y[y'�ew?'ii1't'n il'r�c. a-v ,'r•::Frtr-^rr+a-.�..y,�r..,,,,.'yln^P` T`.{�=ice -d.Yr<.'M r-�,•.+^.- Y' Yn'=,�±r.,.,�w.:.,,,,,�.r.-.�.__ _. ._. TOWN OF BARNSTABLE BAR—W 597 Ordinance or Regulation WARNING NOTICE ` Name of Offender/Manager " ,g�t -�`�fa `„ 4 � Address of Offender �..� MV/MB Reg.# � � r Village/State/Zip n R r, Business Name tf t` Lc�� C. �am/pm, on "t 20 Business Address 6�c� Signature,./of Enforcing Officer Village/State/Zip Location of Offense ��""""" 1J4 f . �� � � t �, � �� � � Enforcing Dept/Di�T on Offense I � ` Facts L4 h-o . --<� A.- 'V-4 This will servetonly as a warning. At"kthis time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. `14WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR_W 97 i Ordinance or Regulation WARNING NOTICE Name of Offender/Manager 1 'riru'�.' r, ' t "' ' Address of Offender MV/MB Reg.# Village/State/Zips'-`` , �, ' f ` " Business Name ' '' - _ _am/RD A M.- 20 Business Address ^""` Signature./of Enforcing Officer Village/State/Zip �. Location of Offense Enforcing Dept/Divis•ion Is 0 Offense r { a Facts l This will servelonly as a warning. .At' his time no legal action has been taken. ` . It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. `Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. �, FORM30 C&W HOBBs&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD O� T CITY OWN y� � 1IDEIYARTMENT o� ADDRESS M sey`0 "I e7 TELEPHONE Address — Occupant Floor Apartment No. No.of Occupants No.of Habitable Rooms No.Sleeping Rooms-- No.dwelling or rooming units_ No.St nes 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: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: i Hall, Floor,Wall,Ceilin : Hall Lighting: 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,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPOR SIGNED AND CERTIFIED UNDER TjEf AINS AND PENALTIES OF PER INSPECTOR TITLE— (45w— I r 3� DATE 07 TIME - A.M. THE NEXT SCHEDULED REINSPECTION �0 D 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 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 qja-)tity, 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 41C.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 4-0.600, 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 gcs-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, asfittin , or electrical wiring standards that do not create an immediate hazard. 9 Y P P 9 9 9 9 9 (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. FORM 30 &w •HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H LTH CITY b }' DEPARTMENT _ ►/{ c � 1 ADDRESS w GSM sey`0 r ter.. TELEPHONE �j� , Address 156 '' Occupant Floor Apartment No. No. of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units_ No.Stp ries Name and address of owner j 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: A J ,�- Li htin : STRUCTURE INT. Hall,Stairway: -..:.. Obst'n.: 4 ,c- ' Hall, Floor,Wall,Ceiling: ( Hall Lighting: Hall Windows: HEATING Chimneys: ir' ` ---'' Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: 11110 ❑ 220 Fusin ,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: T DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink , Stove Bathing,Toilet Facil. ;- Vent.,:Plumb..,Sanit'n,: , .. Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: -Egress - - - Dual and Obst'n: General Building Posted Locks on Doors: r 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.REPOR S SIGNED AND CERTIFIED UNDER THE PAINS AND ' PENALTIES OF PERJ,IJ f INSPECTOR v TITLE ± DATE 6— `i 07 -TIME l V A.M. l / A.M. } THE NEXT SCHEDULED REINSPECTION � P.M: t , � i I� f i � 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 endarger 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. Failu-e to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within tl-is 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 crder 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 dwel'ing unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Cont-ol, 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 ma ntain 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: I (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 i-ifestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerEted 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. FORM30 C&W HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS p BOARD OF HEA NTH 'S CITY/TOWN r W r M DE A TMENT o I ADDRESS © ' M •1'., TELEPHONE Address _ Occupant Floor Apartment No. No. of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units_ No.Stories o Name and address of owner L � �� 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: ► { ,., 1, r Dampness: Stairs: t �? STRUCTURE INT. Hall,Stairway: _•�.av __� „_ Hall, Floor,Wall,Ceiling: L4 I f t J l Hall Lighting: Hall Windows: A —P HEATING Chimneys: .., - �' _e._. . 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: i DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 � Bedroom 3 I( Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink _ Stove Bathing,ToilefFacil. - --Vent Plumb:,Sanit'n.: Wash Basin,Shower or Tub: Y Infestation Rats, Mice, Roaches or Other: Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS.:DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) THIS INSPECTION REPORT Is SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJ�I,AY." INSPECTOR TITLE �- �. A.M. V DATE 7 TIME _ A.M. THE NEXT SCHEDULED REINSPECTION P.M. f 1 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation,any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CIVIR 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 expcse the occupant or anyone else to fire, burns,shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. i