HomeMy WebLinkAbout0063 CHESTNUT STREET - Health 03 Chestnut Street
Hyannis
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TOWN OF BARNSTABLE
LOCATION G3 C&Ajoud -:;tr e-' _SEWAGEfat /1 '� 01Y/
VIIJJ-AGE j�o;5 ASSESSOR'S MAP&PARCELA55, 309 11,E'4A
INSTALLERS NAME&PHONE NO. I,rr W59411 s n k lF,4,
SEPTIC TANK CAPACITY a—A _
LEACHING FACILITY.(type) S-0 (size)
NO.OF BEDROOMS
OWNER �Z
i PERMIT DATE: Z I). . 6 COMPLIANCE DATE: , o
Separation Distance Between,the.
Maximum Adjusted Groundwater-Table to the Bottom of Leaching Facility' s�� °� 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 leachi cility) '` AV-14 Feet
FURNISHED BY
M 3
� V
TOWN OFBARNSTABLE
LOCATIONS C/heS-k) c
CA- J4— SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHO NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
4
NO. OF BEDROOMS
BUILDER OR OWNER y Vim- c:r 1
PERMUDATE: 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
within 300 feet of leaching facility) Feet
Furnished by
o C+
V7
No. 20 /0 �oYl Fee IDO
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:__Aet—�
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2ppfitation for Misposai Opstem Construttiou i9ermit
Application for a Permit to Construct( ) Repair(X) Upgrade( Abandon( ) ]Complete System ❑Individual Components
Location Address or Lot No. 6'5 eke S%^"_7 -S Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel
Irry�§taller's Name,A dress,and Tel o. Desiggner's Name,Address,and Tel.No.
XSo`-S�re.C•L :on.�i�i+-/ J2>v..c a D/3co-.s�enn.,���i/
136x�� 9 S41? 21-63 �� �� s-r S°.�r►d�•a�t, e3 3 z-/77
Type of Building: 41
• Dwelling No.of Bedrooms 7 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building x No.of Persons Showers( ) Cafeteria( )
Other Fixtures ,,//,,``
Design Flow(min.required) AAA gpd Design flow provided gpd
Plan Date r 21,0 ,2-.o e v Number of sheets Revision Date
Title
Size of Septic Tank 15 DO Type of S.A.S. el,'�4N+4-0,s
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) ke4h .2x
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 A ot Date 2—O—/6
Application Approved by .�. Date Z-/2 ^ /p
Application Disapproved by Date
for the following reasons
Permit No. Z d/d — py/ Date Issued 2 /2 20/p
-.-^r.�-�+�it*^�s:bo�;,i;�,x Lwu.�.'""r.*>-«•+g.�wwr»-.-.��..w.,...�:...+a„+-.. �.;+,*...._,-.,..-.,�,,.w�,.._, ;,�„r..:�,:r�.,'rts+^,�OPiKw+:a,,,H,y-_ .,,"r.-*on. V .. '
t _
No.` 6J /4 ( ( ;r Fee /e)0
Entered in computer: c,
THE COMMONWEALTH OF MASSACHUSETTS
r PUBLIC HEALThL-DIVISION -TOWN;OF BARNSTABLE, MASSACHUSETTS Yes
ftpYitation for Misposal*pstrut Construction permit
Application for a Permit to Construct( ) Repair V) Upgrade(ky Abandon( ) ®Complete System ❑Individual Components
Location Address or Lot No. b C' w;jn % S: Owner's Name,Address,and Tel.No. jot S o v 2FF
Assessor's Map/Parcel c3 f?
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
.L`-N G r e4'air•� �e
fit, 9 SA 62T63 ��cF 2�ru 7 'r,r/w.��r-t 'z 2 / 77
Type of Building:
PL
Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building &alely No.of Persons Showers,( ) Cafeteria( )
Other Fixtures //'
Design Flow(min.required) 41416 gpd Design flow provided gpd
y Plan Date ,r 2.o ,.._2-n r e_� Number of sheets l Revision Date A J C b
Title
Size of Septic Tank , A ll o,,s Type of S.A.S. C►lea.�,ti Pr 5 J e �o/,rr.•�
Description of Soil
6
Nature of Repairs or Alterations(Answer when applicable) is-e o/.4-r Q _4�?.x r s ,,, Cp�S/,bd /3
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 — LJ Date
Application Approved by /Z $ Date Z . 12 /(j
Application Disapproved by Date
for the following reasons s
Permit No. ��4 16 Date Issued 2 /2-�20/D
r
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(k Upgraded( )
Abandoned( )by 2�Sf /N i c/ L 0
ato j has been constructed in accordance /
with the provisions of Title 5 and the for Disposal System Construction Permit No.?',5 1 h /'t t t dated_- / -7 i
Installer 36U5r"/e/� J z r r tA.y )�s�h Designer ,�/i Lr.�ca✓r�E'9 i� /
#bedrooms Approved de sign flow! ,, Z � 4 gpd
The issuance of this permit shall not be construed as a guarantee that the system wilt fimction.as designed.
Date 3 + t 0 Inspector C/f
No. 2,0 )n —O q l Fee f C?
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS
Zisposal Opstem Construction i3ermit
Permission is hereby granted to Construct( ) Repair(k ) Upgrade Abandon
System located at �� e® a 7r7 7—
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 completed within three years of the date of this permit.
Date �' �f!� Approved by 12, > .
f � ,
G�
Certified Mail#7008 3230 0002 5178 0332
Town of Barnstable
Regulatory Services
MARNSUBIA
MAB& $ Thomas F. Geiler,Director
i 399-
°tAAyA Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
�f May 6, 2011
Robert C. Souza
24 Lambeth Circle
Sandwich, MA 02563
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION,
THE STATE ENVIRONMENTAL CODE,
The property owned by you located at 63 Chestnut Street, Hyannis MA was inspected on
5-26-11 by Timothy O'Connell, R.S. Health Inspector for the Town of Barnstable. This
inspection was conducted on the basis of a complaint. 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 kitchen ceiling in two different locations.
You are directed to correct the violations listed above within thirty (30) days of your
receipt of this notice by repairing water stains and stopping source of chronic
dampness.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten ( ) days after the date the order is served. Non-compliance will
result in a fine of$'. , per violation. Each day's failure to comply with an order shall
constitute a separate vio tion.
Thomas A. McKean, R.S., CHO
Director of Public Health
Barnstable Health Division
Town of Barnstable
QAOrder letters\Housing violations\Rental ordinance\63 chestnut HY 5-26-11.
a FORM30 � w HOBBS&WARREN'"
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF TH
CITY TOWN �
W I
TMENT
ADDRESS
1y SBy`0
P T ONE
Address dAJ — Occupant_(__ _
Floor Apartment No. No.of Occupants
No. of Habitable Rooms No.Sleeping Rooms _
No.dwelling or rooming units__ _Ns N .Stos
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: kA
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 ❑ 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:
DWELLIN UNIT
Ventil. L to . ,Outlets Walls Ceils Wind.. D rs FlQua Locks
Kitchen
Bathroom
Pantry
Den
Living Room
Bedroom 1
Bedroom 2
r 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: Y
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 IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OF PERJURY."
INSPECTOR TITLE
A.M.
DATE TIME P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
rt
J
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 tc 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 CPAR 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 GMR 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 showe-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, o-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 e-iumerated 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.
j►
FORM30 Caw HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS
ly J
BOARD O !H
A
f
CITY TOWN
W
e
DEPARTMENT.
'o^ ADDRESS
TELEPHONE
Address _ Occupant __:,
Floor Apartment No. No.of Occupants
No.of Habitable Rooms No.Sleeping Rooms
No.dwelling or rooming units_ No.Sto i s
Name and address of owner
y(y Remarks Reg. Vio.
YARD C.OutEBld" :`Fences:
Garbage and Rubbish `
Containers:
I; Drainage
Infestation Rats or other: An
{ STRUCTURE EXT. Steps,Stairs, Porches: , , A
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows: V `� ;✓
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney: �+
BASEMENT Gen.Sanitation:
Dampness:
Stairs: a
Lighting:
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N E u; . Repair
TYPE: Stacks, Flues,Vents: ' r
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line: r
H.W.Tanks Safety and Vent(s)`
y ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:_ ,
AMP: Gen.Cond. Distrib. Box: `� t
Gen. Basement Wiring:
. ► ../-.= ._. DWELLINja`UNIT.,,
1
�,,.,�..�,,....., ` /* Ventil. L to .�Ouflets Walls Ceils,/ Wind. Doors FloD,Q, Locks ,q/�
Kitchen ,. .......�.� �� )_ 00
Bathroom n Q 0 °
Pantry I
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
r Bathing,Toilet Facil. Vent, SaniVn.,
r r.
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 IS SIGNED AND CERTIFIED UNDER THE PAINS AND
V PENALTIES OF'PERJURY.'
INSPECTOR TITLE
A.M.
w DATE TIME P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION' f P.M.
A
r
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 includea 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 dwel,ing or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Preventicn 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 shaver 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.
+-..7
7,,-.,. ...•-.....r^±`+�r�s..��"..►-rj�=t�..^..•,^^v..--'..rtiry'r.'•a..�.�,-n.fue,,,<✓^-..J4l+.r*-+=Yi�M�+►L.,r^.r.""'..'a`.'ri7b•.�ti� 4� �F!'��it:!P�,i�' "il�'+f'�nlF"}ng....a;„,,n,...Hr,,,1,,�-tom
FORM 30 CAW HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS
T.. BOARD OF k°LEA&TH
Cl/YTY/TOWN
w
ADDRESS
M svoy`0 ,
f TELEPHONE
Address Occupant
Floor Apartment No. No.of Occupants
No. of Habitable Rooms No.Sleeping Rooms +; ,
No.dwelling or rooming %units No. Sto es
Name and address of owner
a-•S-((1 , a C.dw4 Remarks Reg. Vio.
YARD l.Out'Bld s`.:'Fences: ` G �
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other: ,q
STRUCTURE EXT. Steps,Stairs, Porches: /,j ;t'X )
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains: '' W " -
Walls:
Foundation:
Chimney: y t
BASEMENT Gen.Sanitation: ^-- "� fib ,
Dampness: S
Stairs:
Lighting:
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys: t
Central ❑ Y ❑ N E ui . Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line: {
❑ MS ❑ ST ❑ P Waste Line:H.W.Tanks Safet and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
# ❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen.Cond. Distrib. Box:
Gen Basement Wiring:
.-- � DWELLING UNIT
'j`r'Ventil. L to Outlets Walls Ceils Wind., Ds Flaors Locks
Kitchen " .j �j (�(J
Bathroom ok 140
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
4 °' ,Bgthing,,_Toilet.Faal.. ,_ Vent. Plum_.b.,Sanit n
_ v a + r
Wash Basin,Shower or Tub: s` . s
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 i
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 PERJURY." e
INSPECTOR TITLE
A.M.
DATE �. . .. TIME P.M.
, J
- �. A.M.
' THE,NEXT SCHEDULED REINSPECTION' P.M.
n
4�
4'
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 :o 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 cr 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. r^
f.
(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 AMR 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 c,eation or spread of disease.
(J) The presence of leadbased paint on a dwelli-)g 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 irsulation 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(3).
(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 orderec by the Board of Health.
dvcV,U-T coy
I
r
No. 20 l0 Fee
leo
-
it HE A OMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF.BARNSTABLE, MASSACHUSETTS Yes
ftplitation for MispoBal 6pstem Construction permit
Application for a Permit to Construct( ) Repair(X) Upgrade(e Abandon( ) f Complete System ❑Individual Components
Location Address or Lot No. (7 S Cie S7,47 S-7- . Owner's Name,Address,and Tel.No.
. Kv-grit.S
Assessor's Map/Parcel
S417C—l"w«44 * ti4
Igtaller's Name,A dress,and Tel. 4o. Designer's Name,Address,and Tel.No.
o�SFit.l �st J2.-C."C A,_ Dec E,V,-trca-~n..e<r�n/
LL—LL'go x 66 �Sa,�id���'2 AlQ a2 S'63 J�X- Zd/6 EAE S"�nel���, dr"3 3 Z./77
Type of Building:
• Dwelling No.of Bedrooms T Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers(
Cafeteria( )
Other Fixtures
Design Flow(min.required) L41U gpd Design flow provided 6'S5 gpd
Plan Date- 2-0 -?__o e v Number of sheets Revision Date
Title
Size of Septic Tank /5-220 4�llo.�t Type of S.A.S. C,04o,,62rS e
Description of Soil
Nature of Repairs or Alterations(Answer,when applicable) keah avt 4-�.4e�aAxr— x r,p
jive s /3?1a TA-n t iq�ncl Ar4w /e4 4
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
Application Approved by .► Date Z^/ /p
Application Disapproved by Date
for the following reasons
Permit No. 0,016 — oy/ Date Issued 2 /2 20/p
--- --
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(k Upgraded( )
Abandoned( )by
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. .5 I - %}c.I Ldated
Installer / t5�j11 F' �c� J w c�, ?�/.u� �i° /t e :jam,� Designer i; ,. /i,.�
#bedrooms `r/ Approved design,'
e sign,flow ! ' �l) gpd-
The
issuance of this perjnit shall not be construed as a guarantee that the system wil)ltfunct! n as designed yf 1
Date '; ;" /f.� Inspector 6-' G✓ 'lr�l �—���;��
No. i!a q/ Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
]Disposal OpStrm Construction permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( 4- , Abandon( )
System located at F/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 completed within three years of the date of this permit.
r / / °� .
Date Approved by �� ,t 1
L,
Town Of Barnstable
° Her Regulatory Services
x Thomas F.Geiler,Director
+ HA2tN.Q�'AiBf:E s
a Public Health DIVIS1011
r.Fp a Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office:.508-862-4644, Fax: 508-790-6304
Installer &Designer Certification Form
Bate: ( I I b
Desi er:---Pl� ,I -I � 1C
Installer.
Address: . 6 �`�� t Address:
On _ � was issued a permit to install a
(da ) (installer)
septic system at .G � � based on a design drawn by
��, ' (address)
►. o '�. 1�1 J dated r — ZO -Z,o 1c.
(designer)
1' . 3Y-certi tics stem reference
fY that the septic y d above was installed substantiall3�according'to
design, which may include minor approved changes such as lateral relocation T the
distribution box and/or septic tank. .
4.
I certify that the septic system:referenced above was installed v�nth :ma r changes'
.to.
greater thin 10' lateral relocati6n of the SAS or-any vertical reiooatton of any component
of the septicsystern)but in accordance with State&Local;Regulations. Plan revisiork or
certified as-I;id by designer to follow.
�AZH gF Mgs�y
.&wlo- yc
(Insta er's Signa re) sn
a IASON .y
116:M66 . .
_ SgAll TAR�P�
(D er s Signature) (p f x gner''s Stamp Here)
PLEASE RETURN TO 1BA tSTA.BT.E UBLIC-DEALTH DIVISION.LURTMC TE
OF C2nPLIANCE WI;LL`Nj ZE SSUED 'UNT-1 BOTIH:rMMS, FOIrr]VI AMWAS_
]BUILT LAB ARE RECEIVED]BY ]THE:BAR s STWA$LE PUBLIC, H1�;AL '$D} SIOI�d
THANK YOU.
Q:1-lealth/Septc,Desib er Certification'Fom`, - ,
i
EXCERPT FROM THE BOARD OF HEALTH MEETING MINUTES 9/08/09:
B. Robert Souza—663^_Chestnut Street,jjyann is —bedrooms and egress.
Robert Souza explained he was unaware of the tenants sleeping in the basement
and agreed that is dangerous with only the one egress. He has now explained.to
the tenants that they are not allowed to sleep in the basement.
Mr. Souza proposed that the Board consider the number of occupants in the house
versus the number of bedrooms for their regulation. He is interested in renting to
three individuals and stated that using three bedrooms with only three people is less
taxing on the septic than having four people in a two bedroom.
Mr. McKean noted that they are not in any specially zoned areas and, therefore, has
the option to increase the septic to allow more bedrooms.
Dr. Miller explained that the only enforceable way, at this time, is to evaluate the
number of bedrooms.
Upon a motion duly made by Mr. Sawayanagi, seconded by Ms. Rask, the Board
voted to uphold the findings of the Public Health Division.
I
Town of Barnstable
Department of Regulatory Services
BAMMAK frrABEz, Public Health Division Date P Lo 9
059.� h,6� 200 Main y
Street,Hyannis MA 02601
ti
`
Date Scheduled u Time- Fee
Pd.
Soil Suitability Assess ent for�`Sewab¢e is osal
Performed By:
Witnessed By: ,t
Location Address
LOCATION & GENERAL INFORMATION 4
7 �f
J IV&71S7 Owner's Name �jp s6q'Z.4
Address
Assessor's Map/Parcel: i t L U U / Engineer's Name Z�/j) /V-4,'v�
NEW CONSTRUCTION REPAIR V _ Y
Telephone# 3� 2 /7-'7
Land Use
Slopes(%) ! Surface Stones
_ Distances from: Open Water Body ft Possible Wet Area
11 I� ft Drinking Water Well ft
Drainage Way ft Property Line l v
-�_ft Othec�— ft
SKETCII:,(Street name,dimensions of lot,exact locations of test holes&Pere tests,]ovate wetlands in proximity to holes)
co
U.
6 —
� ( Z
� o
r
Parent material(geologic) Depth tq Bedrock
Depth to Groundwater. Standing Water in Hole: V Weeping Prom Pit Face__�i��nn d
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TA13LE
Method Used:
Depth Observed standing in obs.hole: in. Depth ro soil mottles:Depth to weeping from side of obs.hole: li DepthGroun to soil mo tles:- t In,
Index Well# Reading Date: index Well levelM Ad,factor 4
J Adj.Groundwater Level
I PE_jO ATION TEST bate Time
FDcpth
on �''
--7f Time at 9" -- -Perc
^� Time at G"
Start Pre-soak Time @ G, �,
AlTime(9"•6")
End Pre-soak �. A I�.
Rate Min./Inch —r"l
Site Suitability Assessment: 'Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back--- ------
***If percolation test is to be conducted within 100' of wetland,you must first notify the
Barnstable Conservation Division at least one (1) week prior to beginning.
Q:\SP-PTIC\PERCFORM.DOC
DEEP-OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Surface(in.) Soil Color Soil
Other
(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
on istency.%Or Lvel)
6
477C�Je9
DEEP OBSERVATION HOLE LOG
Depth from Soil Horizon Soil Texture Hole#
Surface(in.) Soil Color Soil Other
(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency. Grave._)_
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Oar
Surface(in.)-- (USDA] (Munsell) Mottling (Structure,Stones,Boulders.
� r ,
Co i to c ° Gravel)
i
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency, I
Flood Insurance Rate Map:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No_ZYes
Within 100 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervi u ma enal exist in all areas observed throu3hout the
area proposed for the soil absorption system?
If not,what is the depth of hatur Ilv occurring per sous material?
Certification D
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Envi onmental Protection and that the above analysis was performed by me consistent with .
the requir fining,exper' e an exp rie ce described in 310 CMR 15A17.7 /
Signat Date v�Zo/o
Q:\SEPTIC\PERCFORM.DOC
July 30,2009
Barnstable Health Dept
I am requesting a meeting with the Health Dept to discuss a letter that was sent to .
me from the Health Inspector regarding a home I own at 63 Chestnut street in
Hyannis.
F
Robert Souza c
24 Lambeth Circle
Sandwich,Ma 02563
508-888-7869
FORM30 C&W HOBBS WARREN " THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAIJH
CITY/TO N
_ o n�,� �✓'� � _` ('� .I,DEP RTMENT —
ADDRESS
g TELEPH
____
Address Occupant__.--
Floor Apartment No. No.of Occupants
No.of Habitable Rooms_ No.Sleeping Rooms___.-_—
No. dwelling or rooming units_____ o. torie 5eg00
—
Name and address of owner
Remarks YARD Out Bld s.: Fences: Reg. Vio.
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 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 11220 Fusing,Grnd.:
AMP: Gen. Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Kitchen Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Bathroom
Pantry
Den
Living Room
Bedroom 1 — 0
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Su .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 I41ESE
ORT IGN AND CERTIFIED UNDER THE PAINS AND
PENALT '
INSPECTOR TITLE
M.
DATE_ � TIME
1
A.M.
a
THE NEXT SCHEDULED REINSPECTION _ P.M.
COMMONWEALTH OF MASACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET BOSTON MA 02108(617)292-3500
TRUDY COXE
Secretary
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Govemor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .
PART A
CERTIFICATION
Property Address: 63 CHESTNUT ST HYANNIS, MA 02601
Name of Owner WATERS
Address of Owner: 40 GEORGE ST.HYANNIS MA.02601
Date of Inspection: 11/6/00
Name of Inspector: JOHN GRACI 1
1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) 6'
eo,
Company Name: SEPTIC INSPECTIONS Q
Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 ,
Telephone Number: 508-564-6813 FAX 508-564,7270
CERTIFICATION STATEMENT
I 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 inspection.The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems.The system:
X Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's.Signature: Date: 11/6/00
The System Inspector shall su it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of
completing this inspection.If the system is a shared system or 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 Department of Environmental Protection.The original should be sent to the
system owner and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND COMMENTS
'The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of,how the system is performing at the time of inspection.I
inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life."
THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING NOW AND EVERY ONE TO TW6 YEARS TO PROLONG THE SYSTEM'S
USEFULL LIFE.RECOMMEND RAISING COVER TO MAIN CESSPOOL AND ONE HI PIT.
n�rn� Pane 1 of 11
y
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 63 CHESTNUT ST HYANNIS, MA 02601
Name of Owner WATERS
Date of Inspection: 1116/00
INSPECTION SUMMARY: Check A, B,,C, or D:
A. SYSTEM PASSES:
X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not
evaluated are indicated below:"-
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 o
the replacement or.repair,as approved by the Board of Health,will pass.
Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not.
nla The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance attached)indicating that the tank was Installed within twenty(20)years prior to the date of the Inspection;or the
septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure
is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved
by the Board of Health..
nla Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)o
due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health).
broken pipe(s)are replaced
_obstruction is removed -
_distribution box is levelled or replaced
nta The system required pumping more than four 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
_obstruction is removed
revised 9/2/98 Paoe 2 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: . 63 CHESTNUT ST HYANNIS, MA 02601
Name of Owner WATERS
Date of Inspection: 1116/00
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 the public health,
safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM I:
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has.,a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well,
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm,Method used to determine distance nta (approximation not valid).
3) OTHER
nla
revised 9/2/98 Page 3 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 63 CHESTNUT ST HYANNIS, MA 02601
Name of Owner WATERS
Date of Inspection: 1116100
D. SYSTEM FAILS:
You must indicate either"Yes"or"No"to each of the following:
e I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is
identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
X Discharge or ponding of effluent to the surface of the ground or surface waters due.to an overloaded or clogged SAS or cesspool.
X Static.liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow,
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped n1a.
X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
_ X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool or privy is within a Zone I of a public well.
_ X Any portion of a cesspool or privy is within 50 feet of a private water supply well,
X 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic
compounds,ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must indicate either"Yes"or"No"to each of the following:
The following criteria apply to large systems in addition to the'criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health
and safety and the environment because one or more of the following conditions exist:
Yes No
_ X the system is within 400 feet of a surface.drinking water supply
_ X the system is within 200 feet of a tributary to a surface drinking water supply
X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply
well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of
the Department for further information.
revised 912198 Paoe 4 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 63 CHESTNUT ST HYANNIS, MA 02601
Name of Owner: WATERS
Date of Inspection: 1116100
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
Yes No
X _ Pumping information was provided by the owner;occupant,or Board of Health.
X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that
period.Large volumes of water have not been introduced.into the system recently or as part of this inspection.
X As built plans have been obWned and examined.Note if they are not available with N/A.
X _ The facility or dwelling was inspected for signs of sewage back-up.
X _ The system does not receive non-sanitary or industrial waste flow.
X _ The site was inspected for signs of breakout.
X _ All system components,excluding the,Soil Absorption System, have been located on the site.
X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material
of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site
has been determined based on:
X Existing information,For example,Plan at B4O,H.,.
X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)j
X _ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of SubSurface Disposa
Systems.
revised 9/2198 Paae 5 of 11
.SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 63 CHESTNUT ST HYANNIS, MA 02601
Name of Owner WATERS
Date of Inspection: 11/6100
FLOW CONDITIONS
R SID NTIA ;
Design flow: 110 g.p.d./bedroom
Number of bedrooms(design): 2 Number of bedrooms(actual):
Total DESIGN flow: 220 gpd
Number of current residents:2
Garbage grinder(yes or no):.NO
Laundry(separate system)(yes or no): NO If yes,separate inspection required
Laundry system inspected(yes or no): NO
Seasonal use(yes or no): NO
Water meter readings,if available(last two year's usage): n/a gpd
Sump Pump(yes of no): NO
Last date of occupancy: n/a
COMMERCIALIIND (STRIA
Type-of establishment: n/a
Design flow: n/a gpd(Based on 15,203)
Basis of design flow:n/a
.Grease trap present:(yes or no): NO
Industrial Waste Holding Tank present:(yes or no): NO
Non-sanitary waste discharged to the Title 5 system:(yes or no): NO
Water meter readings.if available: n/a
Last date of occupancy:n/a
OTHER: (Describe)
n/a
GENERAL INFORMATION
PUMPING RECORDS and source of information:
n/a
System pumped as part of inspection: (yes or no): NO
If yes,volume pumped n/a gallons
Reason for pumping:n/a
TYPE OF SYSTEM
X 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)
T i/A Technology etc."Attach copy of up to date operation and maintenance contract
_ Tight Tank Copy of DEP Approval
Other:n/a
APPROXIMATE AGE of all components,date installed(if known)and source of information:
THE SYSTEM IS 33 YEARS OLD.
Sewage odors detected when arriving at the site:(yes or no): NO
revised 912/98 Paoe 6 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 63 CHESTNUT ST HYANNIS, MA 02601
Name of Owner WATERS
Date of Inspection: 1116/00
BUILDING SEWER:X
(Locate on site plan)
Depth below grade: 36"
Material of construction: _ cast iron 40 Pvc X other(explain);
Distance from private water supply well or suction line: n/a
Diameter: n/a
Comments: (condition of joints,venting,evidence of leakage,etc.)
TOWN WATER
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 6"
Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other
explain: n/a
If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO
Age: n/a
Dimensions: V X 6'BLOCK CESSPOOL"
Sludge depth: 4"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 3"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
How dimensions were determined:• MEASURED
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of
leakage,etc.)
MAIN CESSPOOL AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING NOW AND EVERY ONE TO TWO YEARS 7
PROLONG THE SYSTEM'S USEFULL LIFE.RECOMMEND RAISING COVER-TO CESSPOOL.
GREASE TRAP: _
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other
Explain: n/a
Dimensions:n/a -
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle n/a
Date of last pumping: n/a
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of
leakage,etc.)
n/a
revised 9/2/98 Paae 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 63 CHESTNUT ST HYANNIS, MA 02601
Name of Owner WATERS
Date of Inspection: 11/6/00
TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspectiun)
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other _
Explain: n/a
Dimensions: n/a
Capacity: n/a gallons
Design.flow: n/a gallons/day
Alarm present: NO
Alarm level:N/A Alarm in working order:NO
Date of previous pumping: n/a
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
n/a
DISTRIBUTION BOX:_
(locate on site plan)
Depth of liquid level above outlet invert: n/a
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
n/a
PUMP CHAMBER: _
- (locate on site plan)
Pumps in working order:(Yes or No): NO
Alarms in working order(Yes or No): NO
Comments:
(note condition of pump chamber,condition of pumps and appurtenances.etc.)
n/a
revised 912/98 Paae 8 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 63 CHESTNUT ST HYANNIS, MA 02601
Name of Owner WATERS
Date of Inspection: 11/6100
SOIL ABSORPTION SYSTEM(SAS): X
(locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods)
If not located,explain:
n/a
Type.
leaching pits,number:(1) 1000 GAL 6'X 6'
leaching chambers, number: (n/a)n/a
leaching galleries,number: (n/a)n/a
leaching trenches,number, length: (n/a)n/a
leaching fields,number,dimensions: (n/a)n/a
overflow cesspool,number: (1)6'X 6' BLOCK CESSPOOL
Alternative system: n/a
' Name of Technology: n/a
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
THE LEACH PITS APPEARS TO BE FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE.THE BLOCK CESSPOOL WAS
EMPTY AT THE TIME OF THE INSPECTION.
CESSPOOLS: _
(locate on site plan)
Number and configuration: n/a
Depth-top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer. n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater: nla inflow(cesspool must be pumped as part of inspection)NO
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a
PRIVY:
(locate on site plan)
Materials of construction: n/a Dimensions: n/a
Depth of solids: n/a
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a
revised 9/2/98 Paoe 9 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 63 CHESTNUT ST HYANNIS, MA 02601
Name of Owner WATERS
Date of Inspection: 11/6/00
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
Rkc
IR
i
� B
Ac
VD �a
revised 912/98 Paoe 10 of 11
s -
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
i
PART C
SYSTEM INFORMATION(continued)
Property Address: 63 CHESTNUT ST HYANNIS, MA 02601
Name of Owner WATERS
Date of Inspection: 11/6100
NRCS Report name: n/a
Soil Type: n/a
Typical depth to groundwater: n/a
USGS Date website visited: n/a
Observation Wells checked: NO
Groundwater depth: Shallow_ Moderate_ Deep_
SITE EXAM, . _ Slope
_ Surface water
_ Check Cellar
_ Shallow wells
Estimated Depth to Groundwater 12 Feet+
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed Site(Abutting property,observation hole,basement sump etc.)
Determined from local conditions
Checked with local Board of health
_ Checked FEMA Maps
_ Checked pumping records
Checked local excavators, installers
X Used USGS Data
Describe how you established the High Groundwater Y g Elevation.(Must be completed)
USGS MAPS AND,CHARTS-12+FEET
i
revised 9l2/98 Paoe 11 of 11
J
Make application to local Fire Department.
Fire Department retains original application and issues duplicate as Permit.
N 1/8�` 22P/nC4�V"(/XP CJP//�11e,, — Ooa,4 O1V��P� �I�P/UP/JGCGdJL
I
APPLICATION and PERMIT Fee: `- .��
for storage tank removal and transportation to approved tank disposal yard.in accordance with the provisions
of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by:
Tank Owner Name(please print)
rgnarure r a/p prpermrt 6 �
�7 if inn '•
Address srre c� stare zip
I
II • a 1 *' '
Company Name� '` V/ Co. or Individual
�x Print
Address 7' " / � Address
Print � Print
Signature (if a i for rmit Signature (if applying for permit)
I
i
i ❑ IFCI Certified Other O IFCI Certified LSP # Other
Tank Location
Steel Address city
f Tank Capacity(gallons) 2- u t nce Last Stored
i
Tank Dimensions (diameter x length)
Remarks:
t �
i
Firm transporting waste �""rn� State Lic. # V
I
Hazardous waste manifest# E.P.A. #
and#
�!� ��r�
Approved tank disposal yard C.�-7;4snk Y
Type of inert gas _Tank yard address -
01719
7or � �//t1% 1 FDID#_l r Permit:
j Date of issue /7�7/O/- Date of expiration
?661 *16W#4V64REVILNTION It Toll Fre eh � ber- 8CO-322-4844 �
Dig safe approval number: MIA { PARTMI:L #
Signature/Title of Officer granting permit 95 HIGH SCHOOL_ RD. EXT i
A 601
After removal(s)send Form FP-29OR signed by Local Fire Dept. to UST Regulatory Compliance Unit, One Ashburton Place,
Room 1310, Boston, MA 02108-1618.
'-292(revised 9/96)
T ri ''r,:,y tt �
o
r �k p RECEIPT OF DI$POShL OF UNDERGROUND STEEL STORAGE TANK `
1, 32 s ,
Fatn FP 291 .x .t Sr '�. ,�.,,rsua v � •a�aa. ..ai NNW
F APP.:ROVED TANK YAR
APPRE)UED TANK YARD NO .rTank Ysrd t edger 502 CMR-03(4)Number
I cetUfy under p natty`of law I have personally examined the underground steel storage_tank delniered to this apprt�ed tank yard by4firm coryoration or
Qartijership G�1d1�°7T "'�J may. "; and accepted dame m conformance with tvla$sachusetts Fire Preuen6pn Regulation 502
CMR 3 00 Prov_Isions forA vMp
mg Underground Steel Stofage Tank dismantling yards A valid permitwas'issuedpy LOCAL Head of Fae Department.
FDID#E � to transport this tank to this yard ,- wY s
"�Nam and o�ffi�ral title of app � d t k yard owner or[owners authorized representative' � '` r
'tea � s�at. �•.� ��� -., w x^a�. s '�`� �3 y�� ".a �.,e #�'���`n .>�
" SIGNATURE? � E ': ,.TITTLE z DATE SIGNED
t 4 }.` u o 502.GMR 3.00.
This slgned�recelpt of disposal must�be returned to the Copt_head of;fhe fire department FDID#� ® P �
� Y Sµ•� t ! a a �. S �.* p'f" t 1 S .z.
41,
- TANK DATA x
TANK REMOVED FROM
�- y t -. �ial)onS �v G®5�_,��a�.�-.€-- �.,. _ �+ --•� ..'� w ..�^ ��ss.:.+. �� ^ -t k -� �ij� `.a Tt
(Na aed'Street) T a
.; - Prev>lous Contents
FL
D►atiteter Length 4 - �
r { ity or Tawrt)
Date Received
r - Fire Department Peruut# �
Serial#(it available)
-
Tank'I D.#(Form'FP 290)
. Owner/Operator td maid revised copy ofvNotification Ftijm P290,or FP290R)to UST Compliance,`
Office of W'State Fire Marsha�,`P.0 Bo ,1025 State R®ad,Stow; MA 01775:
i
TOWN OF BARNSTABLE - UNDERGROUND=FUEL QND CHEMICAL STORAGE REGISTRATION
r � OWNER AND INSTALLER INFORMATION
ADDRES5ey4 d�- t/p n n •� , h?� MAP NO. P RCEL ,NO.
d7 /je•d ITASE �" c
OWNER NAME:14 fl< V 5,*1 fe-0'2"' It1�L '4-OGA,MA (�jILLAGE:
INSTALLATION DATE: � — _ BY:
ADDRESS: CE T. NO. 5
i i 17 11,0 k& WTb 1 1 NK TNFORMAT I ON � �� � 1 � �' 3 +�' 93
#bb� � �!N l
LOCATION OF TANK:
CAPAC I TY TYE AGEUL/CHEM LAL
TESTING CERTIFICATION C ] PASS C ] FAIL DATE 0
LEAK DETECTION .: C CHECK IF N/A TYPE/BRAND ' 9A
ZONE OF CONTRIBUTION C ] YES ] NO ,DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED CY] YES C ] NO DATE
CUNSERVATION C ] CHECK` IF N/A DATE
1 �3
BOARD OF HEALTH TAG NO. 0 ]C ]C ]C ] DATE L�-
PLEASE PROVIDE A SKETCH SHOWING THE,TANK LOCATION ON THE BACK OF THIS CARD
HYANNIS FIRE DEPARTMENT APR 18 2003
95 HIGH SCHOOL ROAD EXTENSION
HYANNIS, MASS. 02601
Harold S. Brunelle CHIEF Sfndle Oetectvzd Save .eived BUSINESS: 775-1300
EMERGENCY: 911
FAX: 778-6448
To ;
Town of Barnstable, Board of Health - T. McKean
Town of Barnstable, Conservation Commission -
From ; Fire Prevention Bureau, Hyannis Fire Department
Subject The installation of above ground storage tanks.
Date
Persuant to the applicable sections of 527 CMR - Fire
Prevention Regulations, this Department has inspected the
following location for above ground storage.
ADDRESS
OWNER/OCCUPANT
PHONE
SIZE OF TANK(S) 4>2117
COMMODITY STORED -
BURPOSE FOR STORAGE grl
THIS INSTALLATION IS PRE-EXISTI A REPLACEMENT
NEW
This installation complies does not comply
with the required installation regulation listed below.
FIRE PREVENTION OFFICE
For: HAROLD S.BRUNELLE,CHIEF
HYANNIS FIRE DEPARTMENT
Certified Mail#7012 1010 0000 2843 2294
'IKE Town of Barnstable
o�
Regulatory Services
BARNSTAeLE.
v� Thomas F. Geiler,Director
039. 10
Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA�02601
Office: 508-862-4644 Fax: 508-790-6304
February 19, 2013
Robert C. Souza
24 Lambeth Circle
Sandwich, MA 02563
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE 11—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION,
THE STATE ENVIRONMENTAL CODE,
The property owned by you located at 63 Chestnut Street, Hyannis MA was inspected on
February 19, 2013 by Timothy O'Connell, R.S. Health Inspector for the Town of
Barnstable. This inspection was conducted on the basis of The Town of Barnstable
Rental ordinance. The following violations of the State Sanitary Code were observed.
105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements.
Interior trim to the main door missing. Storm doors to the front door on the left missing
glass.
105 CMR 410.253 - Light Fixtures Other than Habitable Rooms or Kitchens.
The front door missing exterior light.
You are directed to correct the violations listed above within thirty(30) days of your
receipt of this notice by correcting said violations.
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$100.00 per violation. Each day's failure to comply with an order shall
constitute a separate violation.
f ,
mas
McKean, , CHO ,
Director of Public Health
Barnstable Health Division
Town of Barnstable 7�
u
Q:\Oider letters\Housing violations\Rental ordinance\63 chestnut HY 2-19-13
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date Time: In Out
Owner Tenant 7��
Address Address 63
1 V�
Compliance Remarks or
Regulation# Yes O Recommendations
2. Kitchen Facilities '
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities N _
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
1.6. Sewage Disposal
17.Temporary Housing
18. Driveway Width F7 r
19. Number of Tenants Observed
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Number of Bedrooms 3 Number of Vehicles Allowed (max)
Number of Persons Allowed (max) —�
Person(s) Interviewed Inspector.
If Public Building such as Store or Hotel/Motel specify here
k TOWN OF BARNSTABLE
,
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS$FOR HUMAN HABITATION
Date .f +� _ ( � Time: In Out
Owner Tenant x.
Address Address 63
Compliance Remarks or
Regulation# Yes O Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply r )
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements 1
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17.Temporary Housing
18. Driveway Width 3 �'
19. Number of Tenants Observed
PART II )
37. Placardiag of C Yr�9 eelling w ;
Removal of Occupants; Demolition
--
Number of Bedrooms J Number of Vehicles Allowed (max)
Number of Persons Allowed (max) �_-
Person(s) Interviewed Inspector. �^
If Public Building such as Store or Hotel/Motel specify here
�5
Town of Barnstable Barnstable q
edcaCfty
t Regulatory Services Department ,
sAxNsrAIJIM c:
mass ,,
059.
Public Heal Division f; —2007
200 Main Street yannis MA 02601
r,
email: Barnstabl` Rent L _ egistration t bamstable.ma.us
OFFICE: 508-862-4644G:
° .. 7� L
FAX: 508-790-6304 i�' gam+ !� A. aan,CHOO7
eta,_�. _ ..��
r3PLICA ON RENTAL; IGIS TION
/ { Date: Z6 Z
Fee: $90.00 Per Unit- lus$2 for
q �� ] each addtl.unit on the same parcel
,( r f'� (,kroperty Location: l�3 l/ y�/� 8 44i-/ yny, S t
r2l,
UNIT# 1 If Applicable, BUILDING#
Assessor's Map and Parcel:
. Nf
' otal Number of Rental Units You Own At This Property (including this unit) j
' Owner's Name:
<
Telephone Numbers (Daytime) Cal JJ
ome Phone) SKI , ad 4,v..t- (Cellular)
O er's Address: Z lyw �it � S✓--�d ul� s,]�J —
r ailing Address: (if different than above)
mail:
wner's Representative's Name (if Applicable): _ r
ddress:
elephone Number: 51
-7
Occupant's Name: 63
Daytime Phone Number: 3-�:'l I Cellular 1 �D y 3 a
c
Number of Bedrooms: Check,One: Is this a single family dwelling unit?
an apartment building? [ ] or an accessory apartment? [ ]. /Private Drinking Well? [ ]
Do You Have Zoning%Building.Division Approval for an accessory apartment? f
jWill there be any children under the age of six who will be occupying_the rental unit?
t� (circle one) Yes
Was the dwelling constructed prior to 1979? es
I certify that the information provided above is true:
-. *Inspections Done Annually. Applicant's Signature
Q:\PROJECTS\HealthlRentalRenewalMailing\2013\Application for Rental Reg.Renewal 2013.doe
PAGE 1 OF 2
INSTRUCTIONS ON PAGE 2
i .
March 19,2013
Timothy O'Connell
Barnstable Health Division
200 Main Street
Hyannis, MA 02601
RE: 63 Chestnut St
Hyannis, MA 02601
Dear Mr. O'Connell,
I have the estimates for replacing/repairing the cited violations as listed below:
Interior trim to main entrance
Replace storm door glass
Missing exterior front light
Estimated repair cost $300 dollars.
Due to pending eviction as well as hearing on April 4th I have difficulty gaining access to the
property to make the repairs. I also do not want to have any confrontation with the tenants.
Sincerely,
� -
Robert C. Souza
:T7
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1
I fit rl
tvc-
► � Oe-2
5 roof
I/V
0 - Z - w04Y K
Lq
1 x E
Poo
flv
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LE
%�.` t ' _Kr, •i � ' •- �w / 5 � . -,i,4•`.�L.'.i:1v .. �`•` ' � ,L. /O/y/1C /c Vv
fu
Frl '' � y -` •♦•�. � ->. r!••.~'i �� G /'� �� K�itt•j,'•lRy�. .TY 4+�•�f+ •`y� _ - S�f>'L(:_
'ter .• �j/••'a'• .. ..�... .. !•. V
. •. ....r♦:• ',. .•lG•i, 1. �+�:
5 I
ASSESSOR
S* MAP:
TEST HOLE __0GS
PARCEL: _� NOTES:
FLOOD ZONE: LAPP-, SOIL EVALUATOV :
'DAVtf�5
WITNESS .
i 'rhe installation shall comply with Title V and Town of Barnstable Board of
DATE:
k5T
REFERENCE:
P44P f /37 0�71p 7,(1 E0b
- Health Regulations. in A an
PERCOL TION R;,.T E:'.we<' M IV4, I d septic
2) The installer shall verify the location of utilities, sewer ve s
77
components pri
A
not to be utilized for property line determination nor any other
Y �'7
B7 P,"e
V Et-"4 17 or to installation and setting base elevations.
7 11 gravity septic piping to be 4 inch Sch 40 PVC at 1/8"p
er foot. The first
2- two feet out of the d-box to
4) This plan is
the leaching shall be level.
purpose other than the
ptic components mus me ec
ifications.
se
6t Title V sp
_propose stern installation.
t
5) All
C Parking shall not be constructed over H 10 septic components.
is bounded by prop
10CATI'ON MAP:6b� d property lines.
7) The erty comers an
property
8) The property owner shall review design considerations to approve )f total
_f bedr6o t be considered for design. Receipt
F;
design flow and ro
nurribe Ins 0,
01
of payment for the plan and installation based on the plan shall be deemed
of the design fl
ow by the owner.
shall be pumped and filled with material
in the proposed SAS shall
nment proce ures.
d Those with
moved along -wit contaminated so an p
per Title Vabando
approval
9) The existing leaching or cesspools
be re s er
�A/
h il and replaced with cle
mponen obe I feet from water line. Sewer lines crossing the
73�
Title V
specs.
0
10)Sys'tem c6 ts t
th 4 inch SCH 40 PVC with en s grouted if
r -shall be sleeved wi
d
wate line'
M C applicable. The pro, ed S�S isbeing installed below the water service
os
leeved as mea in place.
line. The line is to be s aforementioned and mainta
ex rem
FLOC a garbii�e'
�Col oved and is the responsibility of the
grinder ' istsitistobe
owner to ensure such.
4
GAUDAY installer is to tak in excavation around the gas line if such
e caution
S �., OM '
exists.
M
12)The
i d n
-7 sewer
13)The
A A installer shall verify the location,quant ty an elevatio ofthe
ng the dwellin
r 7 lines exi'd prior to the installation.
77
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