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HomeMy WebLinkAbout0026 BODFISH PLACE - Health '26 Bodfish Place - Sewer Acct# 3466 � _.. _ Hyannis .%A = 306 —233 v o � E a � � r � o p o _ —`, fir'•. � oFIKE'�w1 Town of Barnstable I U.S.POSTAGE>>PITNEY BOWES W° Public Health Division I t( I FIX., "'� 200 Main Street '`fFohv+ Hyannis,MA 02601 ZIP 02601 $ 005.59 02 1VV 0001361475 MAY .31 2011. °0.8 3230 0002 5178 0349 Tim Chapin P.O. Box 217 is, MA 02601 { ri do RETURN TO SENDER UNCLAIMED 1.,NIAMLE TO FORWARD 4 _- SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete ftems 1,2,and 3.Also complete A Signature item 4 if Restricted Delivery is desired. ❑Agent 1 E Print your name and address on the reverse X ❑Addressee i 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 maflpfece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1..Article Addressed to: If YES,enter delivery address below: ❑ No Tim Chapin R.O. Box 217 Hyais,MA 02601 +` 3. Service Type ' l , ffrartifled Mail ❑Express Mail b ❑Registered Xetum Receipt for Merchandise i. f - ❑Insured Mail ❑C.O.D. } 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7008 3230 0002 5178 0349 (( (transfer from service label) \ € (i Hil Domestic Return Receipt 102595-02-M-1540 j L PS Form 3811,February 2004 f P _�� Certified Mail#7008 3230 0002 5178 0349 Town of Barnstable Regulatory Services BAMWABLL MAS& $ Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 27, 2011 Tim Chapin P.O. Box 217 Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 26 Bodfish Place Hyannis, was inspected on May 25, 2011 by Timothy O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received at The Town of Barnstable Health Division. The following violations of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Water staining observed on both bedroom ceilings. 105 CMR 410.351 (B) — Owner's installation and maintenance responsibilities: Refrigerator leaks water. You are ordered to correct the violations listed above within thirty (30) days of your receipt of this notice by repairing both ceilings mentioned above and curtailing source of chronic dampness; by repairing or replacing refrigerator so it works as intended to. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. QAOrder letters\Housing violations\Rental ordinance\26 Bodfish Place.5-27-11 doc PER ORDE F T E BOARD OF HEALTH . ; Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Lori Labor, Tenant QAOrder letterMousing violations\Rental ordinance\26 Bodfish Place.5-27-11doc + ace I ;_0 Certified Mail#7008 3230 0002 5178 0349 Town of Barnstable �, Regulatory Services sa�uvsrns = � �MAS& $ (� Thomas F. Geiler, Director 5 �Fn lNx� '`16 0`® Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 \ Fax: 508-790-6304 r May 27, 2011 Tim Chapin � 5-® 3 6a 19 45ki P.O. Box 217 �I°�0 ^ I �L 6 Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR-410.000 STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 26 Bodfish P1ace.Hyannis, was inspected on May 25, 2011 by Timothy O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received at The Town of Barnstable Health Division. The following violations of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Water staining observed on both bedroom ceilings. 105 CMR 410.351 (B) — Owner's installation a d m intpnan a responsibilities: Refrigerator leaks water. _d I ( . You are ordered to corr ct the violations listed above within thirty (30) days of your receipt of this notice by repairing both ceilings mentioned above and curtailing source of chronic dampC ; by repairing or replacing refrigerator so it wo&s as intended to. I You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. QAOrder IetterMousing violations\Rental ordinance\26 Bodfish Pace.5-27-11 doe v PER ORDER F THE BOARD OF HEALTH T Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Lori Labor, Tenant QAOrder letters\Housing violations\Rental ordinance\26 Bodfish Place.5-27-11doc 17 V rM THE COMMONWEALTH OF MASSACHUSETTS FORM 30 &W HOBBS 8 WARREN BOARD-OF HEA lcfrY/TOWN f DEPARTMENT � ADDRESS M s�ys0 C T EPHONE Address ro Occupant Floor Apartment o. No.of Occupants No.of Habitable Rooms No.Sleeping Rooms No. dwelling or rooming units_ No.St is C Name and address of owner B^.� 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.: Hall, Floor,Wall,Ceiling: — Hall Lighting: c— _ � Hall Windows: r— 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. to . Outlet Walls C W' d. Door FjQors Locks Kitchen Bathroom r 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 INSPECTIO EPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES J INSPECTOR ..{ TITLE DATE I TIME d `� P• THE NEXT SCHEDULED REINSPECTION P.M. 4ff. 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 suffic'ent 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 -,05 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 ecress 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 s'ze 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.E03(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. '. "` Il.--+r--''�'q��C,►.»^^-+-r'5 f,..+ .,,,,,�tae"""Yr-•,...v��, � ;'Ssr....�..w ,,,,.,a,•a. ,t� �� rr M THE ETTS FORM COMMONWEALTH OF MA.SiSACHUS&W HOBBS&WARREN - -^-j,� V �{ J ...US + 30 B;O,A R D� F H Ei4` ' ~ / C TY/TOWN DEPARTMENT I ',^ ADDRESS gyp^ Y ti ;V&_ T L EPHONE /p' t Address ) _ Occupant_. Floor J Apartment No. No.of Occupants No.oft.Habitable Rooms - No.Sleeping Rooms No.dwelling or rooming units_ No.Sass Name and address of owner 01 , +� Remarks Reg. Vio. t YARD Out Bld s.: Fences: Garbage and Rubbish �k 1 } Containers: A t K� f Draina'e A 11nfestation Rats o'r'bther: STRUCTURE EXT. `Ste ys Stairs lPorches`,;,` n, I/ Dual Egress:and Obst n.: _ ❑ B ❑ F ❑ M Doors,Windows i1 4 } Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: _�,l Hall Lighting: iJ A " c )_�j 0CJ Hall Windows: i... / HEATING Chimneys: Central- E14-- ❑ N-- -.E Ui - TYPE: Stacks, Flues,Vents: V PLUMBING: Supply Line: ❑ MS ST ❑ P Waste Line: H.W.Tanks S:afef 'and ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond.+Distrib. Box: r Gen. Basement Wirin : r DWELLING UNIT '4 Ventil. > tr .,. Outlets , Walls ,1C ias. ; Wi d. Doors moors Locks Kitchen Bathroom V —Pantry Den `Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: t.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 INSPECTIO EPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND - PENALTIES F•P J Y." INSPECTOR TITLE DATE "' � TIME I d q� a ` ( 9�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 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(6), 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). ( ) PY tY q (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 o,)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 whicf 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. Fax Send Report JUL-01-201113:11 FRI Fax Number • 15087906304 Name BARNST HEALTH Name/Number 915083627687 Page 3 Start Time JUL-01-2011 13:11 FRI Elapsed Time 00'38" Mode STD ECM Results [0.K] Town of Barnstable s Regulatory Serviecs 6 � Thomas F.Gciler,Director Public Health .Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 DATE: NCTMBFR OF PACES TO FOLT.OViW: I 3b° ~ FROM:-- ire PHONE: PHONE: (508)862-4644 FAX PHO FAX 111IONE: (508)790-6304 cc: NUMS/C'OMMENTS: R\wux Fam.doc LOCATION : 5E & E PERMIT UO. IMSTALL.ER5 U&ME� N.DDRE - , WEI In BUILDER'S Q &MF- ADDRF-SS DATE PERNA T ISSUED :_ — _ D ATE COMPLI WaCE ISSUED ; f� ' '� { 1,.. C.�► �q r { j tt � 1�p�~� � �� ,n . ��� � � �� � '�'� . � � i Fms............._:............_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF - HEALTH ..... _Vt .�1"......OF........1 ,0.. Q' ! .... Appliration for Disposal arks Tonstrnr#iun Prruti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: / i��si.. ..a.:Fl. :._MMJE........ .................�:�`��!K�`�_ ................................................... •.............. .-.Loc iou-Address or Lot No. - •- ----• r •--.....•--•-- ...... lAddr W - ess Installer Address Type of Building Size Lot............................Sq. feet ►-� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building --_--_.--.-_-------------- No. of persons--...................--.---. Showers ( ) — Cafeteria ( ) d Other fixtures Design Flow.._::_..��.��.....................gallons per person per day. Total daily flow.._-....___: gallons. W P P P Y Y �( ---------- ----- WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------- _--- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter....---......-----.. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date....................................... Test Pit No. 1•...............minutes per inch Depth of Test Pit.................... Depth to ground water.....................--. G>~ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 a .-••--•------------------•--•-------------••-••----•-----------------••------..........--------•-•-.......................................................... Description of Soil..................................................................................---------------------------------•---------------- f�1 ......................@-------------------•----.......=-----.........-------------------------•----------------------------.......--•-- --------------------------- U Nature of Repairs or Alterations—Answer when applicable...---__- . ................................................. Agreement: The undersigned agrees io install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'1'U, 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 bo tgned...------... - 3 :7 "g7 -Date Application Approved By.. -- .. --•-----•-------------------•-----------• ---•---•••--•---- -- � Date Application Disapproved for the following reasons---------------------•--•-•-•---------------------...----------•------------------•----------------........-•••- ....................•--•--•-••------•---.........---•------•-•---•--•-----•-•----......_..-•--------••-----------------•---•••-- -------•--•-------.................................................... 4.�. ' .................... ssue ----•-----------------..............................---._.�... I d- Date Permit No......... .. Date Nm...... :......!..? Fitz... v:� ..... THE COMMONWEALTH OF MASSACHUSETTS F 4 BOARD OF. HEALTH ices c� _.................OF...... T v A Apphration for Vamit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System at: •--•--...._... _..ems..;-=- '�Y?-:F--�.5lt: P��`±�rF-----... ......................5a.! v�:_`.3. .---.......----.....--.................... __ Location-Address or Lot No -------------- ..`: .. .� G; A<f.-VL.. .4 v'G''!t �'A.'. S 4J C:_V'-b!�:c, u ?_'). .. ................................. .......d_.......'............. ......... _ .._._.:_......._.......... Ow•ne �Ad rJ e C Y dress W b t.. Installer Address Type of Building '' // Size Lot............................Sq. feet Dwelling—No. of Bedrooms.----!1--.-----.-.-_...................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building a Other—Type ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixturesii�. W Design Flow.......��`�ti�........................gallons per person per day. Total daily flow...---. � .....................gallons. WSeptic Tank—Liquid capacity............gallons Length...--- Width................ Diameter....-----------. Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.......-.---_------ Diameter...................... Depth below inlet...............:.::. Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.............................. .......................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.........:.............. f� Test Pit No. 2................minutes per inch Depth of Test Pit.............---.... Depth to ground water........................ ---------------•---------------- .... ....... ....... -------- .------ •----------- •----------------------- ------------ ••------•---•-----.... O Description of Soil........................................... x W U Nature of Repairs or Alterations—Answer when applicable .... -•�-�•�1.._..-•-_••-_: _-°• 7S-tv� b - .----- - Agreement: t The undersigned agrees-to-install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITi.% 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. • •---- -.s - - 4„•i.' '" Date• -r----- Application Approved By..........................r = �. �1_/L ._... ...---....-- - . v ` Date Application Disapproved for the following reasons:.................................. ........ r ................•-------......7.................................................................................................................................................... Date Permit No.........R.2 = Issued ..- Date ti\ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......oF...... ?.:>. ..b....... .n(? ............................ Trrtifiratr of Tompfiancr THIS_IS O CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ............... Installer at............. ---••-- ..14.._ -. ............. Ya.1 �1 - v ir'C.. " ¢= . .r.,; r.t ............................ has been installed in accordance with the provisions of TIT.IL 5 of T e.State Sanitary Code as/ described in the application for Disposal Works Construction Permit No.--....1.2-------------- ......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............ �'.. .: ..... � -f Inspector... �` .......................................................... THE COMMONWEALTH OF MASSACHUSETTS b BOARD OF HEALTH r ....................... � `��:. ..........O F.........:. L-:.r'. .J. :: .......................... �� No..�..................... FEE........................ Disps-l Works Tunotrnrtion 1prrmit Permission is hereby granted.......... ----- -=� -=�!C - - ` '..•.. to Construct ) or Rep:�Ir,.( f)-an^Individual Sewage Disposal System _ ... �� ---- V Street. st � �-, as shown on the application for Disposal Works Construction •Permit No.--- p: -. ... .:......... • `l.,- �� Board ut Llcallh DATE----------- >� / -.............................................. TOWN OF B.ARNSTABLEGG� LOCATION SEWAGE # �- t�►� VILLAGE f:si Ca v\,t0 <" ASSESSOR'S MAP & LOT�� , INSTALLER'S NAME & PHONE NO i A u hy tim SEPTIC TANK CAPACITY LEACHING FACILITY:(type) a (sue) -go Li-- NO. OF BEDROOMS PRIVATE WELL di5UBLIC W.A .BUILDER OR OWNER vk DATE PERMIT ISSUED: DATE .C011PLIANCE ISSUED: VARIANCE GRANTED: Yes No x n, n O N l7Ja � { L � � � 7C C_) (T^� �_. �� �; c �' �� nip^ X _' N .�� m � N. � z Y� �Y I ,� v� -�+', �� � 1 i No.............l....... Fn$.1..................... THE COMMONWEALTH OFUuMASSACHUS�EgTTS BOARD.7 Appliration for ffiopaoal Works T.omatrurtion ranfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: b ..-._Z.......!� l ....10 1-. 6/-Z-...1 11"ll`s•-----------------------•----.....----......----------•-----------------•------••. -•- -- Lygatygn-Address or Lot No. �Imta ----•-------------------------------•------.....-----------------------............--••----.. Address f Address Type of Building Size Lot./........................Sq. feet U Dwelling—No. of Bedrooms........ ..............................Expansion A tic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. Showers ( ) — Cafeteria ( ) p-' Other fixtures ------------------------------------------=------------------------------•-------------•---------------•-----------------•--•------•------•-•------ Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity/T!(.gallons Length.._Z O___-_-- Width._6..._...... Diameter................ D pth__....._.._..__. Disposal Trench No----------------•-__- Width_�1�....._. Total Length..___3...W... Total leaching area. q. ft. Seepage Pit No_................... Diameter.................... Depth below inlet................... Total leaching area..................sq. ft. Z Other Distribution box (/ ) Dosing tank ( ) ` ,/� ��/P17Y Percolation Test Results Performed by........................ ........................................ Date........................................ ,4 Test Pit No. 1.7.f !... inutes per inch Depth of Test Pit....__7.. m ........ Depth to ground water....................�_...Q (� Test Pit No. 2................minutes per inch Depth of Test Pit------ .......,Depth to gro yd er-_.. .... ��• 1. . .._ �g -- -- _ �. O . Description of Soil---------t7--�--�-- = V ........................................................... -.� ......... •-- -- ----- ..... .� - U Nature of Repairs or Alterations—Answer when applicable.......................................................................................•.._...._ ---------------------•--....------..........-•-----------------•------------------.............•-•-•----•-••••-•------•----------•------•-----------•----------•---•---•-------•------•--•-••-----.-•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI 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 ealth. igned•. -----•-- ........................ ----------• --------•-- ............ Dac............... Application Approved BY.......-'.�=- --•-----� -•-•-- -�.t�j --- --.............. - ��- -�`�----��- .. Application Disapproved for the following reasons------------------------- ......................•-------......------__....---....._._.......---........-•--•-....----...--------------------•----•-•------•-•-----•-•-----------------•-.......................................... .--••ate PermitNo......................................................... Issued.... �/ ....•..... Date No .... A!, ......: Fix ........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD H EA H A "". !7 of { �'iG . .................. Application for Dis v,sa1 Works Tomitru Finn Pumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ......r... .......... ..........�: , . ... ......................... ................................................----R........................................... => I Qcajdpn,Address or Lot No. .. - - -----• ------••--- •------------------------•-•--------------- ,... O er x Address .. _-------------_-------..... Installer Address d Type ding �~ Size Lot........._..................Sq. feet Dwelling-,No. of Bedrooms ..................................Expansr>, n_A tic ( ) Garbage Grinder ( ) pa,, < Other Type of Building ......___ ,' :�.No. of persons. . ____ +°':.... Showers ( ) — Cafeteria ( ) P-' `, Other fixtures .: WDesagn Flow.............................. gallons per person per day. Total dai�y flow.._.___...__._......_________...............gallons. WSeptic Tank—Liquid capacityy '.gallons Length...?r ------- Width.:?'?.----------- Diameter................ D pth................ x Disposal Trench—No............. ... Width....... Total Length... __�... Total leaching area. q. ft. 3 Seepage Pit No;........------ --- Diameter____________________ Depth below inlet::_:................. Total leaching area..................sq. ft. Z Other Distribution box Percola �Test Results .,,Performed Dosing tank ( ) � .r �9�7 f .) , owned by-------------------------,..,.,.......................................... Date.. " t•c�, Test P,it.No. 1. .............minutes Per inch Depth of Test Pit-----7........._. Depth to ground water......................... Gz, Test Pit-No. 2................minutes per inch Depth of T st Pit----- .......... Depth to gro d ter......... 3 , ----...... . Description of Soil .... '".---- -- ---- --- :. ' ....... ........ VNature of Repairs or Alterations—Answer when applicable.-_......................:.:.::..:....:.........................: r _ ---------------------•--••,---.----.-.-.------,••-------........._______............................................ Agreement'- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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 bo`rd of ealth. igned -----°- � �r . Dat -. Application Approved BY n = ate Application.Disapproved for the following reasons................................................;•-=--------••••--•-•••-_---•--•-•_.... .._..-----•----•----- --........-•••---------•...........................•----••--••---•----••••-••---•-_.•-•---•-••--------•-•------•.................................------------------------------------•-------•-------- i Date PermitNo........................................................ Issued------------------==......................................... Date i THE COMMONWEALTH OF.MASSACHUSETTS BOARD:e-OF HEALTH f THIS ;;TO CE IFY, Tl&he I2�lividual Sewag s osal Sfjtem cons ru e or Repaired ( ') b .... ................................ + ♦♦♦ at es ti +t --- -�-------.--•----•--•---------------- `'4 has been iusfa11 din accordan e;VvA the provision o�':f Article of The St to Sanitary Code s des ibed in, the application for Disposal=Works`Construction Permit Igo.____ I++'-- ... dated-__ ,f` =_ _ _. ter••-•- THE.ISSiIANCE 'OF THIS CERTIFICATE SHALL NOT BE CONSTRUEQ_AS A'G ARANTEE THAT THE SYSTEM .WILL FUNCTION SATISFACTORY. .T : u DATE' n Jf n$peCtOTt .......... 4 ......... �THE COMMONWEALTH OF MASSACHUSETTS f3OARD OF ' HEALTH. .... ...'�. .' '1,;.....0F.............. ..... .... . �......_.. ..�. No r tr Permission s h reby granted _ .� .., �_-----• to Construct or $fair f Ind' id Stew e Dmyoo System atNo... zA ... ..... -......... -•-- Street as shown on the application for Disposal Works Construction Pe PINo. __. .. ... d------ 71 oard of ea h 4 tsc DATE---- •a. ..................................... f. ` FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS If 5 t t Diagram of Lotxand, kilding with Dimensions Fee ............................. 1...... SUBJECT TO APPROVAL OF BOARD OF HEALTH } �� SCA/-CS '/y, i q f .DRAIrv�G �►E as'� .. �►�:, t ( Th I lr c� __ - - - — - - - 4 ---I 72. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..................................................................................