HomeMy WebLinkAbout0107 CHASE STREET - Health 107 Chase Street Sewer Acct# 3641
Hyannis
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Purchaser
Premises Inspection Date
Name _BOB GONN I I A _ Name ROB G3QNNFl I A
Address 300 DUCK ISLAND Rf7 APT 7C Address _ 107 CHASE ST
City —ItVF.�LYABM.QUTH City HYANNIS
State MA Zip __42.f 7 _ State MA Zip 02601
Phone(Horne)_ (Work) Phone(Home)_(508)280-5387` (Work)
Basic Coverage-Treatment or Inspection for: .
A merican Roaches moLy Brown Roaches U__ ouse Ants(Excludes Fire, Pharaoh and Carpenter Ants)
i3 r wn Ranci_r._d Ro�achcs 1064ice ty Centipedes Z11"'Miliipedes
C Aerman.Ro 1 � is
—Z-- �`� 4:J�'aper Wasps C611ouse Crickets
d Urtental Roaches rt3 Silverfish c�Earwigs 3 Insiders
Expanded Coverage-Infestation Treated Upon Request at No Additional Charge
d'Ex[erior Ants(Excludes Fire, andoor Tick Control if�'s e
arpent I�
er and Pharaoh Ants) U Indoor Flea Control a& .
0`.8ees(Excludes Honey Bees) Black Widow Spiders _
Yellow Jackets/Hornets Q"B ' Recluse Spiders
lti'Clothes Moths y',�'ther:
This(tome qualifies for a free termite inspection and preferred customer discount. Yes [ No 4
Service Frequency Exterior Service /Ins tion Special Instructions
Monthly Feh ar ril � ��
lye_I '. .
LI Stlmmar� of,.Charges77.
_.
I-Service Charges
Initial Service Charge(xi) $ — 275 00 _ INI Service Charge
Regular Service Charge Ni 550.00
j @. g 11 $ Anwum CK Number Cash 5 CC 5
Sub-Total Annual Amount $ 825-00 Received at Start
Sales Tax . • . , , • , • • , , $ Amount I CK Number Cash S CC 5
! Other Discounts Mission Cust.Number
i s --- 9114 2 31/12 8 8 415 l
I Total Annual Amount • . • . $ 825.00
*Payment is due at time of Service.
Njethod of Payme it
j Method: ❑ Easy Pay ❑ Cash ❑ Check 1 Credit Card ❑ Charge CC for INI service ON-LY
I Type: ❑ MasterCard-4 ❑ VISAb ❑ Discover* 0 AMF,X°C ❑ Sears
Credit Card# X X X X - X X X X - X X X X __ Expiration Date (mmlyy)
Name as it appears on card _
j Signature(required) _
Easy Pay Feature; Signature required -- --
I understand that by enrolling my account for Easy Pay. all future invoices sent to me by Terminix for services performed pursuant to my contract will
automatically he paid by a deduction from my checking,savings or credit card account as indicated. /
❑ Credit Card# (if different from above) CxP iration Date —— __ (mm/yy)
---- ---- ---- ----
❑ Checking Account*(Voided Check Anached) (If Easy Pay is selected-copy of agreement must be sent to Corporate to
see terms and conditions for details 800 Ridge Lake Blvd.,Memphis,TN 38120 Mailstop C24092)
This aereemenr is for an initial period of twelve(12)months from the date of first service and,unless canceled by the purchaser,will automatically continue on a
quarterly or monthly basis until canceled by either party upon thirty days notice.
YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER
THE.DATE OF THIS TRANSACTION.SEE TIIE ATTACHED NOTICE OF CANCELLATION FOR AN EXPLANATION OF THIS RIGHT.
The Terms and Conditions on the reverse side including the mandatory arbitration agreement, are part of this agreement.
The initial service %Sill occur within 30 [lays oi' the date of the contract and be completed as set forth herein.
in the event you have any questions or complaints,you may contact a Terminix representative by calling 1-800-TP:RMINIX(1-800-837-6464).
Terminix 0lTice__..____S01fJ_ffEAS i-ERN NE VV ENG(ANa_2041@Ihone (5 0 8> 8 3 3-94 0 0
Address 24 A JONATHAN BOURNE DRIVE BOURNE MA 02559
3 LkhlflviX RL•4RESEPI'I'ATNL'iptini twntj DATE.
1 UNDERSTAND THAT THIS AGREEMENT IS FUR AN INITIAL PERIOD OF TWELVE MONTHS.
TERMININ REPRESENi A,rivE SIGNATURF.
PURCHASER DATE
KEY.433235 REV.9108 DOD 8108
C2008 The Terminix infern;onnal Cmmnanv I initpri Partnpr hin
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SOUTHEASTERN NEW ENGLAND
® � (508)775-54 24 A JONATHAN BOURNE DRIVE Residential General Pest Control
BOUFghRNE,MA 5499 oz559
Master Agreement#:56381-0115928
Work Order#:12158695145
Customer Name:BOB GONNELLA Home Phone: (508)280-5387 service Technician: WARNER,CRAIG Date/Time In: 03/22/2013 3:41PM
Contact Name: Work Phone: Employee Number: 56381 Date/Time Out 03/22/2013 4:25PM
Customer#: 9114231 Cell Phone: License/Cent#: 39619 Page: 1
Sales Agrmt#: 12884151 E-mail Address: robert.gonnella@comhasL
net Supervisor Name: WINSLOW,ROBERT 1.
Service Address: 107 CHASE ST Frequency: Supv.Lkense/Cert#: 23396
HYANNIS,MA 02601 Last Svc Date: servke Type: Initial
Billing Address: 300 BUCK ISLAND RD APT 7C Customer Since: 3/22/13
WEST YARMOUTH,MA 02673
General Information:
Anus Inspected:Inside
Comments
Thank you for choosing Terming.Your business is appreciated.
Material Usage:
Malfforae FC Magnum Roach Areas Inspected/Treated Pests Targeted Post Treatment Precautions
Active Chemical: FIPRONIL 0.05% GARAGE German Roaches-Activity
EPA Reg#: 432-1460 KITCHEN Noticed
Treatment Bait Placement MASTER BATHROOM
Applied Amount 37.000 Gram
Equipment Bait Gun
Maxfoi ce FC SM Roach Stations Areas Inspecbed/Treated Pests Targeted Post Treatment Precautions
Active Chemical: FIPRONiL.05% BASEMENT-RESIDENTIAL German Roaches-Activity
EPA Reg#: 432-1257 KITCHEN Noticed
Treatment: Bart Placement MASTER BATHROOM
Applied Amount 6.0D0 Each(9 gm)
Equipment- Insect Bait Station
Summary Of Charges:
Previous Balance $0.00
Current Charges: 275.00
SubTotal: $275.00
Tape $0.00
Total: $275.00
Customer Name: Customer Signature: Unavailable Date:
Service Technician: CRAIG WARNER Service Technician
Signature:
Date: 3/22/2013
Customer payments can be made either at www.termin/x.com or by mailing payments to:Term/n/x Processing Center,PO Box 742592,Cincinnati,OH 45274-2592.Please
include your customer number,noted above.Call 1-800-TERMINI(with questions or to find out about our Easy Pay options
Call 1.800.TERMINIX or visit Terminix.com
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FORM3O C&W HOBBS&WARREN'" THE COMMONWEALTH OF MASSACHUSETTS
BOARD OFFHH LTH
CITY/TOWN
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DEPARTMENT
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'o ADDRESS
G,,M 5 0y`oW
TELEPHONE
Address �b _ Occupant_
Floor Apartment Nyp. No. of Occupants
No. of Habitable Rooms No.Sleeping Rooms__
No. dwelling or rooming units_ N .Ston s
Name a adcess of _ er
v A
emarks Reg. Vio.
YARD Out Id 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: Ail 1
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 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), A
{
Bedroom 2 2 d-'
Bedroom 31.
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.:
S -cks, Flues,Vent afeties:
Kitchen Facilities 6inkG
e
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:
I
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 r)
"THIS INSPECTION REPORT I NED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OF PER.WA
'k
INSPECTOR TITLE
DATE (/ - 7 d 7- TIME P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
i
410.750: Conditions Deemed to Endanger or Impair Health cr 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 persDns 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 410.1DO 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.
I
(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 Co-itrol, 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, burn3,shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation cr 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.
LOCATION SEWAGE PERMIT NO.
f}L737^4 P,OBE 6144/
VILLAGE
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INSTA LLER'S NAME i ADDRESS
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BUILDER OR OWNER
DA T E P ERMIT ISS.0 E D
DATE COMPLIANCE ISSUEDy_ g-
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
T.................
own...-...-.O F............Barnstable
App iratiou for Bhipviial MirkB Tomitrnrtiun amit
Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal
System at:
.1Ya rLLS,...Mtn.....026.01............... ..................................................•............•..................................
Location-Address or Lot No.
Alt ....o1_?bl,r -------------------------------------------------------------- .....a26a1..................
Owner Address
a -A-..&---.....Ce..
.....- •.
Installer Address
Type of Building Size Lot............................Sq. feet
v Dwelling—No. of Bedrooms................ .........._..._...._._...Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons........... __.-___-__-__-_ Showers ( ) — Cafeteria ( )
a' Other fixtures ..................................
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No._-_--__-__-____-- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
0.4 Percolation Test Results Performed by.......................................................................... Date.......................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water________-_______---_-.-.
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
1:4 ---•--••••••--------------•••••••••••••--•-••-----•-••••-••-•--•--............•---•------...............................................................
0 Description of Soil---•••••Sand---------------------------------------------------•---•---------------------------------------•-----------------------------------•••-•-----.•----
x
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W --------------------------------------•--------------------------------------- -------------------------------------------------------------------------- o......--- --•-•-
VNature of Repairs or Alterations—Answer w en applicable.____installation of a Tom-- gallon, pre-cast,
stone packed leach pit (overflow ...
-•--------------------------•---------------------------._...------------------. .
Agreement:
. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
_ the provisions of'T I y g g p y
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 o d al1health.
;g... L S�
���c � ' 51..1/81............Sign ------ --- - ---- ------ }.:.---•---------------•--•------------•-----•--
D to
Application Approved By------------- � ' ---- ------------------------ -----------5 :81.--•-•------
Date
Application Disapproved for the following reasons:--••----••--•--•-•......----•------------.-------------•---••---•-••-•--•-•----------•--•---•-•--- ......
------------------•••-••--•-.........•••-•••.....•-•....-•--•.....--•------•-••---••-•----••-•---•••••-•-
Date
Permit No.81...............................=--••-•--------.... Issued_...............5/-..Val
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No.81-,7-1 .-- Fin$...$...5..0 ..........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.....................Town F............Ea.rnstable
Appliration for Biopos al Works Tonitrurtion amit
Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
System at:
..... ....Z2601............... ..•--•--•---._..--..----•--.._----------••---•-----•-•------..----.------•------------•----•-•----
Location-Address or Lot No.
Alton------Robbr}s �.R7. �..S .,e..... �1! ta ..... ....4z.6.Q1................
----
v Ownez Address
WA & B Cesspol_Sergice 12€ __Bshop..........
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Installer Address
UType of Building Size Lot................. .........Sq. feet
Dwelling—No. of Bedrooms...............4......................---Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ______________-_--___-___. No. of persons..........4.........._---- Showers ( ) — Cafeteria ( )
a Other fixtures ........---•-••--•-------------- ...
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length________________ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
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. I................minutes per inch Depth of Test Pit.................... Depth to ground water----------.------_-____.
rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--------------_.........
-•-----•---------------.....................................................................................................................................
O Description of Soil..........__and
---------------------------------------------------------•-----------------------------------------------------------------------..............•---
x
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W
--------------------------------------------------------------------------------------------------------------------------- -------------------- ----- -
installation of a ,060 gallon, pre-cast,
U Nat re of Re firs o- Alt rations Answ r w en applicable-----------------------------------------------------------------------------------------------
stone pa�.ced each pit ToverrT ow) .
•-----------------------------------------•-----•----------•---------------------------•---------------------•--....------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the rovisions of'TTL
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 l o d of-health.
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� �APPlication Approved BY --•-------•-••----- .V4--•-•--•-•-
.
Application Disapproved for the following reasons-----------------------------•----------------------------------------------------•--•--.._..----••--------......
...........................................•-•----•-••-•-------------------------•••------
/ Date
Permit No.81-..................•---..........------------_... Issued...----.----•-5......1/.81
Date
THE COMMONWEALTH OF MASSACHUSETTS I.r
BOARD OF HEALTH
.............Tow,n..................OF...............1 arnstable............................................
Trrtifirtttr of Tontplianrr
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed (- ) or Re aired ( X)
by. A & B Cesspool service, 128 Bishops Terrace] 1�y.pnise MA 02 i01 77 -6264
Installer
at.. 107 Chase St., Hyannis, MA 02601 _ Alton Robbins
- -------------------------------- -------- -------- ----------------------
has been installed in accordance with the provisions of TITL_: j of The State Sanitary CofOe ap described in the �..
application for Disposal Works Construction Permit No -
da.ted__-.-5f_. 181
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....'-......5�. �81.................................................... Inspector.... �,.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1- Town......OF.......Barnstable..................... ...... . .......I ..
No.. ..... L / FEE.........riOQ.......
."�- �io�oo�al orko �on��rttr�ion rrnat�
Permission is hereby granted.....A & B Cesspool SeryiCe, 128 Bishops Ter, Hyannis, i?A 02601
to Construct r, or Repair (X ) an Individual Sewage Disposal System
at No....... 107 Chase St._, Hyannis, FIA 02601 Alton Robbins
----------------•---------•-•------.----------••......---•••------------ ..............................................
Street
as shown on the application for Disposal Works Construction Permit No.._81-....____._. Wed........... 81
----....
5/ 1/81 B ' ;dF AfHeailh
DATE............... --------------------------------•-----._.......-•--•--•-..------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -