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HomeMy WebLinkAbout0141 ESTEY AVENUE - Health 141 ESTEY AVE. , HYANNIS A=306-198 1 s y � r ' - �� t°�ti Town of Barnstable o� Department of Health, Safety, and Environmental Services ■ARNnABM 9� � Public Health Division �fOMA'�A P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Thomas A McKean,RS,CHO FAX: 508-790-6304 Director of Public Health March 1, 2000 Michael B. Guarco 7 Bayberry Drive. East Granby, CT 06026 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE H, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE, ARTICLE 51 The property owned by you located at 141 Estey Avenue, Hyanis, was inspected on February 17, 2000 by Glen Harrington, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code H, Minimum Standards of Fitness for Human Habitation were observed: 410.350 A : The hot water to the first floor bathroom was inoperable. 410.353: Approximately 40 feet of confirmed asbestos containing material (thermal system insulation)was observed to be damaged in basement. Asbestos containing material must be removed by a licensed asbestos abatement company. (pictures taken) 410.500: The basement ceiling was observed to be water-stained and damaged (picture). You are directed to correct the above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. guarco3/wp/q/ls r Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER O THE BOARD OF HEALTH Thomas A. McKean Director of Public Health cc: David Hausch guarcoNwp/q/ls -c� oFtTti Town of Barnstable * snuNsrast.E, Department of Health, Safety, and Environmental Services MASS. i639. Public Health Division 9�A `�� rfD"A0�A P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health '7 /Y 077 G.e-r y prc 6-z oL,s� o��y> GT o6oZ(, NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at , was inspected on 2'!7 Ze-cv by Glen Harrington, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II, Minimum Standards of Fitness for Human Habitation were observed: 3 OA 410.E: rL h 0-�-VCDIS � V4k 4,:j d -'f„ tau- -- a I woIxt , a-, 3 S'3 . 410. : 1Pbatio rG �{ d7 11, e,.. Q� lxs o 6, u.e v.,t wia w C`E'19.r�.a l di) A ( 1 da z c lF, V/Q3 6_) A ,, a to,A w-r 4va ) 1'UA za 410 W-g2�4 1., ) csw�a.•-S .j �R.t 4 0. 82: 41 410 1: 41 51: L4504: pires/wp/q/Is You are directed to correct the Faeairj4 above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health cj GrY 4-7 c O SpeCA or OLP C— IyS�pe�f4S /dj.�a�1'!-e� �Ju c-Fs cc Abf otiG�a F pires/wp/q/Is FORM30 Caw HOBBsBWARREN n THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN o DEPARTMENT ADDRESS TELEPHONE ��s�•, 1_r,5�1✓' Address 1 heyti i Occupant—. fre."c11'a.v�l Floor Apartment No. No. of Occupants 7— '1 1 1",t' ?q 9 No. of Habitable Rooms___No.Sleeping Rooms Z Q 71-96.3-7"f 72 P1'JSJ- 65 No. dwelling or rooming units_ No.Stories_ - Name and address of owner A:4 i IGf— 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:k 14 U S'vs ck-s6eoks 3,9-3 Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: 331-tx;l Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: �1✓v�� "-' 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 S k"o Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks •FS Kitchen ®lam Bathroom .Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties.- Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: 4✓n 4 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 PENALTIES F PERJU Y.- INSPECTOR s` t �f TITLE A.M. DATE TIME_ I'IV Q� A.M. THE NEXT SCHEDULED REINSPECTION4 ("Q GPit P.M. 0r „i`.r�'”" .-r.•yM�Ci�',ra+ryiyy�L.�,r,':S';'.L,tM'.�h�+.�..h"`. £ ;�;::'i�R;r•+,�.;�;rir•- v1. .»w.w,;•ntf...-�C.;� -�.:,aa,�M'�;:14._^s�r�':;e"'F�T_-kstA:tw,�F�,*ar,,..,,-::u»^+�r..,�v ,s'.ti: s�•, .,. . t 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 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 nof�ir cluded•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 i6 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 o`r otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0) shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. Department of-Labor and Workforce Development Division of Occupational Safety ANGELO BUONOPANE ROBERT J. PREZIOSO Director Deputy Director February 22, 2000 OOA-4147 Glen Harrington R.S. Town of Barnstable Department of Health and the Environment 367 Main Street P.O. Box 534 Hyannis, MA 02601 Dear Mr. Hamngton: As you requested the bulk samples sent to this office from 141 Estey Ave. Hyannis, MA have been examined for asbestos content. These samples were analyzed using the EPA approved method of polarized fight microscopy with dispersion staining. The analytical results are as follows: Sample Number Location/Description Result Percent OOB-0265 Sample#1 TSI Chrysotile 60 asbestos Non fibrous 40 OOB-0266 Sample#2 pipe Chrysotile 70 lagging asbestos Non fibrous 30 OOB-0267 Sample#3 TSI Chrysotile 60 pipe covering asbestos Non fibrous 40 If you have any questions concerning this report or related matters, feel free to contact me at this office. Sincerely, CaKramarz Asbestos/Lead Supervisor 1001 Watertown Street • W. Newton, Massachusetts 02465 • Tel: (617)969-7177 Fax: (617)727-4581 D� .11bosarbus0t3 IItYiTttDri�F�II� DEPARTMENT OF LABOR AND INDUSTRIES 3 DIVISION OF OCCUPATIONAL HYGIENE 1001 WATERTOWN STREET WEST NEWTON, MASSACHUSETTS 02165 f6171 969.7177 PAUL Ae000r CHAIN OF CUSTODY RECORD Director 1. SAMPLE COLLECTION I �,/��, ' (�. �. collected samples ��� k t veS ; phut'Dame marked Sa (•es Z t 3 aamp Irc Oca Dum n from 14 ! ES4eY /q,,v e_ u u%g namc or ou on 0?-6 0 - fCaS:DO.,a , OWn,Lp C C samples were taken from TAt-ina1 escnp OD Of ump a ow on on Fe41rvary I7, Z000 at q,6d -- e Signature of person collecting sample signa re V 4e /,vk AUSEF. . S o T= 76 2 — L(6Y q_ 1. SAMPLE TRANSPORTATION I transported and delivered DD. pnn Damn samples marked camp c i co ica an Dum rs collected from buiJdmg Dame or ou an on to a ME DO., n,up c C at um Signature of person transporting and delivering sample: algna fC ,gmcy f (� >~ C�ommo�tfn�tt�th of c assiachugetts - DEPARTMENT OF LABOR AND INDUSTRIES DIVISION OF OCCUPATIONAL HYGIENE 1001 WATERTOWN STREET WEST NEWTON, MASSACHUSETTS 02165 (617)969-7177 PAUL AsooDr CHAIN OF CUSTODY RECORD Duector 1. SAMPLE COLLECTION I �+,/��r . �. llected 3 samples �(e �► � w, co -�.�►r— PTBem- ' marked Sa jfS z f 3 ,.mp ice Bum n from 14 1 ES40Y Ave VLv e. U usg Bemc or oce on i� Y aiL�Js /t/l r4 O Z-6 0 1 . - a rus:Bo.,s own,up c c SY She�-, l i�J�1.,.�►cK--, samples were taken from 7Zit M�a P on 01 saBrpc Toubon on �e (o ��cL�y / 7, z-cco at 5� 60 Signature of person collecting sample .00..h,,4,16'4e x IleR !ate a-" S o 7= 762 - 46, gN. 1. SAMPLE TRANSPORTATION I transported and delivered Bo pnB Bemc samples marked setup c i Ica oo Bum rs collected from buddrBg Bemc or ou on on to a rras:Bo., B,zrp c e at LLM Signature of person transporting and delivering sample: 2 DA re e9cBcy r Town of Barnstable Department of Health, Safety, and Environmental Services . s63q. Public Health Division 9� ,�� P.O. Box 534, Hyannis MA 02601 Office: 508-8624644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health January 21, 2000 Michael B. Guarco 7 Bayberry Drive East Granby, CT 06026 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 141 R Estey Ave., Hyannis was inspected on January 6, 2000 by Glen Harrington, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code U, Minimum Standards of Fitness for Human Habitation were observed: 410.100: The right front burner of the stove was observed to be inoperable. 410.351: The faucet at the kitchen sink was observed to be leaking at the base. 410.351: The light over the kitchen window was observed to be loose and inoperable. Electrical wiring is suspect. 410351: The toilet was observed to be leaking at the base. 410.452: The rear exterior egress from kitchen is unsafe. Concrete slab was cracked and subsided. 410.481: No posting of owner's name, address and telephone number in dwelling. 410.500: The living room floor was observed to be warped and loose due to insufficient support. 410.500/551: The master bedroom window was observed to have a rotted sill. All windows were observed to have chipped and peeling paint and glazing. guarco/wp/q/ls 410.502: Lead paint was used on painted surface in dwelling. Lead determination form and Order to Correct letter enclosed. You are directed to correct these violations within seven (7) days of receipt of this notice. (except 410.502) You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health gu—o/wp/q/Is r oFt ' � Town of Barnstable Department of Health, Safety, and Environmental Services • BARNSPARI.F'w .039 Public Health Division 9� i63q ,0� AlFDN10�A P.O. Box 534, Hyannis MA 02601 Office: 508-8624644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health J�r Y Z VA tG(-a IT, 6.0L C,0 -7 (sal�-cV,rY -DV-i V-0 ,e4-s4 6►-(>.by , (-i 6607-6 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE, ARTICLE 51 l y I (2 F S4-e-Y v-,�o The property owned by you located at , was inspected on -"J by Glen Harrington, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary ZdvO Code II, Minimum Standards of Fitness for Human Habitation were observed: 160 410 �� ar�,.� 6�� t dZ dv 12.0 410.351: 'f�-e - ec.. l,� fr��^ S c.c�G� wa) d(o J Q,-�e d1 dd ot.- U-c (00-� 410.351: � `� l�y(ti{ try--•`�- tt� F c(.Q„„ e,. ��.t�rw e�a� e ire�{� dv la.e l ooze 410. . � l� u W U+ C�CU S-2r v e_d 'Z 410.4A �}/ ey4,.IWe.-7 e5) I t E rea k1'-(-,(., ' 1^I-) Cc c c.�cR d� �. S hS 410.4 £ •--� A/o PC S ><I't-3 r1 rL-tv,_ n ow,..,e 410.500: � l �l VV-,-_ cvt'"'S ✓P-in,-, („C- 410.E— I G u� c�-e � c �s(/9-C�A ,,.'r S L-r'C-1+ `r2e- �r� csr�- -•-ter% e a,:.,. pires/wp/q/Is -/�try O�z. L�%w a� �}v C w✓�Ci� V i d P �t7n�) q 10 , l Q o a -d t{/O 3 s` �✓��"� +- `!'�^�-'^ 4-w f y �,.- L z S G..v.., ! 61 r e c x p f- cat I j (..0 a4 Ge. You are directed to correct the remaining above listed violations within seven (7) days of receipt of this notice.C 2 "W k L?l O .Sv Z) You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health pires/wp/q/Is 1. 7� a-l7-zoo W PSTE.YAvf-. NYAAvaLS SUSpfGT.4CAA REM ov8D 8Y#0"80CVASQo ,s Pe Q TRNA Ao-r, s*AAt pj s o sy-Alvep. GLFw f/ARRh/cToAo A--r. C: I. r� � i� ram. -I C!: G: ', i � i l y ��� r I z C C ._�-h =J 1 � t 1- r ' a A,, Z-l?-z000 IYI ESTEY AvE.� NYI;�vihtS $A.r��+�T Gfl�tn/6•y 6v.4T6lZ r TA(AM P Cr LF4/ W R OVAL ' WO" �`1—— - ---�-- °" `'- r a R. ��. " s , . 1 i i II C C i cC �. C i fl t z-rl-zoo i�rr ES�r��By Kr�va�S SvtPEcTktM L�46.�.t�V(• � PtP� LowBit tA/b . SA^P it atrAdVAD �t6�✓ 1lARRlNb��B-t• 'r--- - - ' { c�. �' 4.. G f�. �w u: k i I � i � � i y i 1 I C t � C �; (. G n TH E TOWN OF BARNSTABLE CF j�4 OFFICE OF = e raAse E& BOARD OF HEALTH � � °°ems i639' 367 MAIN STREET HYANNIS, MASS.02601 LEAD DETERMINATION REPORT FORM Date of Determination: J v(L-1 Y / 9 1 Z OG Inspector: G, 1 e -, C • N a r,-, �„5 >✓t,., , . S License #: D -3 3 9-5'-- Method Used: ✓Sodium Sulfide Expiration date: Z J Z /Z 000 X-Ray Fluorescence Model: Serial#: Property Address: _ ly) /Z FS-fe-y 4ve Apt. # Description of Property: Single family ✓ Multi-family # units Z Garage Fence Other structures Age of Property: Pre-1978 _ Post-1978 Occupant: SC,rC,L-, S'ieLJCt"+ C S-fC K IE y a c' tole-Ea r 0 Occupants under six years of age: DOB: V1`f1g6 DOB: DOB: Occupant's Telephone: Property Owner(s): + E l a i k e G u a.,c o Owner's Address: 7 3 eL v y pD— Ectsf- -r-aM6 y r T O (ocz Owner's Telephone: , 960-673— 320 0 —(S 3--779 F cr -7ZY1 Lead Hazards found? Yes V/ No An X-ray fluorescence reading greater than 1.2 mg/cm2 or a gray or black reaction to sodium sulfide indicates a dangerous level of lead and constitutes a positive determination. Deleading of lead painted surfaces as a result of this report or subsequent inspection must be performed by a licensed deleading contractor and/or by an owner/agent who is trained to perform specific work as required under the Lead Law. Contact the Childhood Poisoning Prevention Program for additional information regarding deleading and training. CAW P50\LEAD1995\GEN ERA L\NOLTRHEAD\LEA DREPT.DOC 12/96 LOCATION SOURCE Pb 1. Child's bedroom Z`Vd 1 13 s & Window parting bead/exterior sill area vs r e 0 ,v. 2. Child's bedroom Window sill 3. Living room Window parting bead/exterior sill area 4. Kitchen Window parting bead/exterior sill area 5. Interior Flaking paint e— s d s�/ (� 2 1�`�' ��• 2R`! 'SII1 CSidz 6. Exterior Flaking paint 7. Exterior Cellar window units 8. Exterior Window sills below 5' S du fi Pis 9. Exterior Main entry door casing 10. Interior Outside corner of baseboard 11. Kitchen or Bathroom Chair rail 12. Bathroom 1A1"jj.4^­ gilt to r c 1 a,4-e,, 13. Exterior Threshold 14. Interiorh lway (common area)' rbo 0s Z�,.d w S i' v z t. 15. Interior hallway (common area) Balusters 16. Interior hallway (common area) Door casing 17. Porch Stair tread or riser 18. Porch Railing cap 19. Porch Balusters 20. Porch Support columns(<6" diameter or square) 21. Porch Staircase stringer 22. Exterior Bulkhead 23. Garage/Outbuilding Door casing or jamb 24. Interior Closet door or baseboard (uncapped) 25. Interior Cabinet door, shelf, or wall V1 -C 2 T XV C, CIS h ew lam- r fyy Al C:\wP50\LEAD1995\CENERAUNOLTRHEAD\LEADREPT.DOC 12/96 FORM 30 CAW HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY�/TOp,W�N DEPARTMENT ADDRESS t,+ v TEL HONE 7 Address / R FS�e_I VC "W Y-46�-S Occupant_� ?C ��ra`'� Floor �_Apartment No. LTS d- No.of Occupants T No.of Habitable Rooms S No.Sleeping Rooms _ No.dwelling or rooming units_— No. pries__Z_ Name and address of owner 6-vcu c Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: S wd-} S > 8 N tv-w k rw- wlf Wo i(-T Z_ Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: G✓ S /c' Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: ;f'I Stairs: Li htin : STRUCTURE IN Hall,Stairway: y etwS ®I aj,c 14/o Obst'n.: zye 000 w Z-x a.fd G�~� Hall, Floor,Wall,Ceiling: ooi— r v _d+ kjDwl-cy wv— © 5-00 Hall Lighting: Hall Windows: HEATING Oc Chimneys: Central �L Y N Equip. Repair TYPE: t W- Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: dLt i' t Co � e_ ,Y- e� 3-3-1H.W.Tanks afet and Vent(s) ELECTRICAL Panels, Meters,Cir.: i 0vL-- r (a/ivp y 4%,-k 410 ' ❑ 110 ❑ 220 Fusing,Grnd.: is toot Rke4-1w 1 AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT vker Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom(1). Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Su .Ten.,Gas, , Elect.: T1010F Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink ff-.,I 4/4, -W Stove AL-O Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other.- Egress Dual and Obst'n: General Buildin 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 PENALTIE OF PERJU Y " INSPECTO �J• TITLE Ay'f^� A.M. DATE — _ z4yy TIME Z i 3 0 A.M. THE NEXT SCHEDULED REINSPECTION 3 C) /QCG�' M. y 'K t 4 F el. �y .,1: . y ;�{ , .J�.''���F ifX' nSra' y-1 . - ..y.x ♦-. .... 1 1 1 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items,which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found,to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. � T♦ ti (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 orA10.602 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. r (M) Any defect in asbestos material used as insulation or covering.on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) _Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. I TOWN OF BARNSTABLE ®F HE T� �'�Q ♦� OFFICE OF Y • Besa9TSBL BOARD OF HEALTH NAG& 00 1639. `em 367 MAIN STREET 'EO M11Y k' HYANNIS, MASS. 02601 t LEAD DETERMINATION REPORT FORM Date of Determination: a�w V(&,y 191 ZOO O Inspector: & 1 f" E . 14& rr, ".3 t ", , "a . S , License#: J> 33 9s-- Method Used: podium Sulfide Expiration date: Zj z /Z ®tam �- X-Ray Fluorescence Model: Serial#: Property Address: ) fZ IFK-4r y 4v6 Apt. # Description of Property: Single family ✓ Multi-family # units Garage Fence Other structures Age of Property: 1�— Pre-1978 Post-1978 , Occupant: ,x - - S0_ Occupants under six years of age: Soar- . reet..ct r DOB: 9�iy�96 DOB: DOB: Occupant's Telephone: 5-0 7- 111-O39 1 Property Owner(s): Aj i okct e( + 6[a l k Q Cs ua r"c c Owner's Address: 7 13 oLl hg, bv- F-a-3 f- r-a/v,b O(0 0 z Owner's Telephone: 160-45,3- 320 f GU) S6 O -6 5-3•-'7 7 y F o-,- `7 2 y, Lead Hazards found? Yes No An X-ray fluorescence reading greater than 1.2 mg/cm2 or a gray or black reaction to sodium sulfide indicates a dangerous level of lead and constitutes a positive determination. Deleading of lead painted surfaces as a result of this report or subsequent inspection must be performed by a licensed deleading contractor and/or by an owner/agent who is trained to perform specific work as required under the Lead Law. Contact the Childhood Poisoning Prevention Program for additional information regarding deleading and training. C:\WPSO\LEAD19951GENERAL\NOLTRHEAD\LEADREPT.DOC 12196 f A/ JZ s -e7 � , f-( -a_h17 4S ///9/Z0 0 LOCATION SOURCE Pb 1. Child's Lbedroom Z'^d�I G Window parting bead/exterior sill area oS 2. Child's bedroom Window sill 3. Living room Window parting bead/exterior sill area 4. Kitchen Window parting bead/exterior sill area 5. Interior Flaking paint C s1 de, -44 0-s41- - (S 2. 1C* ;P 1• ex+-sc 1 I e s 14t 6. Exterior Flaking paint 7. Exterior Cellar window units 8. Exterior Windowsills below 5' ,q SWd� PAS 9. Exterior Main entry door casing �$ 10. Interior Outside corner of baseboard 11. Kitchen or Bathroom Chair rail 12. Bathroom wifidev.,Sill- 13. Exterior Threshold _e��+r;r,r.nr iwr LK V� 14. Interior Tway (common area) �'taj tranA dvw �Sr� 15. Interior hallway (common area) Balusters 16. Interior hallway (common area) Door casing 17. Porch Stair tread or riser 18. Porch Railing cap 19. Porch Balusters 20. Porch Support columns(<6" diameter or square) 21. Porch Staircase stringer 22. Exterior Bulkhead 23. Garage/Outbuilding Door casing or jamb 24. Interior Closet door or baseboard (uncapped) 25. Interior Cabinet door, shelf, or wall "4-11- am 11 2 -4/eA In-e.-,cN 1✓(Z Ids aa,,J evr `1 ea 4-e rA edicx ky `2 t.d. L2 . fftca, L11 ;!Iclew SG�i L, Si /Q C:\WP50\LEAD1995\GENERAUNOLTRHEAD\LEADREPT.DOC 12196 °fs"ET° The Town of Barnstable i 33UNSTAM s Department of Health, Safety and Environmental Services r�ss ,639. 9 a,� Public Health Division 367 Main Street,Hyannis,MA 02601 Office 508-790-6265 Thomas A.McKean FAX 508-775-3344 Director of Public Health DATE: January 20, 2000 ORDER TO CORRECT VIOLATIONS) Michael R_ Guarcn 7 Bayberry Drive East Granby, CT 06026 Owner or agent of the property located at 141 R Estey Avenue, Hyannis Be advised that an agent of the Board of Health has determined certain portions of the aforementioned residential property to be in violation of the State Sanitary Code Chapter II, "Minimum Standards of Fitness for Human Habitation," 105 Code of Massachusetts Regulations (CMR) 410.750(J). This violation also constitutes a violation of the Lead Law, Massachusetts General Laws (MGL), Chapter 111, Section 197, and the Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. Conditions exist in this residence which may endanger and/or materially impair the health of the occupants of these premises. DECLARATION OF EMERGENCY The Director of the Childhood Lead Poisoning Prevention Program and the Board of Health declare that the presence of the aforementioned violation of the Lead Law and the Regulations for Lead Poisoning Prevention and Control constitutes an emergency pursuant to the Lead Law, MGL Chapter 1 11, Section 198 and within the meaning of the Sanitary Code, Chapter 1, 105 CMR 400.200(B). CORRECTION OF LEAD VIOLATIONS) The Lead Law, MGL c. 111, ss. 189A-199B, and the Department of Public Health's Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000, require that residential premises or dwelling units built before 1978 have lead paint violations either abated and contained for full compliance or brought under interim control when a child under the age of six lives in the residential premises or dwelling unit. If you are interested in interim control, then you must hire a licensed private risk assessor to perform a risk assessment and issue a "Lead Inspection/Risk Assessment Report" before you proceed. If you are interested in deleading for full compliance, then you must hire a licensed private lead inspector to perform a lead inspection and issue a "Lead Inspection/Surface Assessment Report" before you proceed. C:\wPSO\LEAD1995\GENERAL\GENERAL.DOC\I311OTC39A.DOC RED'. 10/97 L. The Lead Law, the Department of Labor and Workforce Development's Deleading Regulations, 454 CMR 22.00, as well as the Regulations for Lead Poisoning Prevention and Control require that any high- risk residential lead abatement and containment activities, including making loose paint, plaster or putty intact, be performed by licensed deleading contractors—whether in the context of achieving interim control or full compliance. An owner or owner's agent, after meeting the training requirements of 105 CMR 460.175, may perform certain low-risk abatement and containment activities in accordance with these regulations without a deleader's license—again, whether in the context of achieving interim control or full compliance. These specific low-risk abatement and containment activities are the following: applying encapsulants; applying such coverings as carpet, vinyl, aluminum, plywood, plexiglass, and acrylic, to surfaces, including siding of exterior surfaces; removing doors, cabinet doors and shutters; and capping baseboards. In addition, an owner or owner's agent may perform structural repairs, as defined in 105 CMR 460.020, and cleaning of leaded dust, as may be required for interim control, except that the final clean-up required after the completion of high-risk abatement and containment work by a licensed deleader must be performed by a licensed deleader. Violations of these requirements shall be punished by a fine of not less than $500 nor more than $1,500 for each offense. ORDER You are hereby ordered to remedy all violations of MGL c. 111, s. 197 and 105 C*AR-460.000; as---� identified by a licensed private lead inspector or, if you wish to pursue interim control, you must remedy all urgent lead hazards identified by a licensed private risk assessor. Whether you pursue full compliance or interim control, you must correct the relevant violations in accordance with the following schedule: Within sixty (60) days of your receipt of this Order, you must provide to this agency a copy of a signed contract with a licensed deleader, if any high-risk abatement and containment work, including making leaded paint, putty or plaster intact, is required. If you or your agent is doing owner/agent low-risk abatement and containment and/or interim control work, you must also provide within sixty (60) days a signed and completed CLPPP form entitled "Documentation of Training to Perform Owner/Agent Low-Risk Abatement and Containment and Deadlines by Which Owner/Agent Low-Risk Work and/or Interim Control Work Will Be Completed." The contract must specify, and if you or your agent will be performing low-risk abatement and containment work or interim control work, then you or your agent will attest in the CLPPP form described above, that the work will be completed according to the following schedule: (a) Violations of the interior of the dwelling unit and interior common areas must be abated or contained for full compliance, or as required for interim control, within ninety (90) days of your receipt of this Order. However, you have a total of one hundred and twenty (120) days from receiving the Order to complete the following activities: (1) any low-risk abatement and containment work you or your agent perform, as long as all dust-generating abatement or containment work, including surface preparation, required to be done by a licensed deleader, has been completed, and any doors removed have been replaced, within ninety (90) days of your receipt of this Order; (ii) application of encapsulants by licensed Level 11 deleaders, as long as all dust- generating abatement or containment work, including surface preparation required to be done by a licensed deleader, has been completed within ninety (90) days of your receipt of this Order; (iii) installation of replacement windows, as long as you can demonstrate that new windows have been ordered within ninety(90) days of your receipt this Order. C:\wP50\LEAD1995\GENERAL\GENERAL/DOC\BHOTC39A.DOC REV 10/97 (b) Violations on the exterior of the residential premises and exterior common areas must be abated and/or contained for full compliance or as required for interim control, within one hundred and twenty(120) days of your receipt of this Order. Any contract with a deleading contractor must also specify that the unit will meet acceptable lead dust levels, as determined by the results of sampling done by the licensed private lead inspector or risk assessor at the time of the reoccupancy reinspection, if one is necessary. Should any of the dust samples fail to meet acceptable standards, the contractor will be required to reclean the entire unit until all dust samples meet acceptable levels. In interim control cases in which no reoccupancy reinspection is necessary and no deleading contractor involved because no high-risk abatement and containment activities, including making leaded paint, plaster or putty intact, were necessary, then you or your agent who performed required work will be responsible for cleaning the unit to meet acceptable dust levels. In these cases, dust levels will be determined by the results of sampling done by the licensed private risk assessor at the time of the risk assessment reinspection. Any room or interior area in which one or more surfaces does not meet acceptable dust levels must be recleaned by you or your agent in its entirety. You must comply with all of the deadlines stipulated above, and with all applicable sections af—I05 CN 460.000. Compliance with this Order will be determined by this agency's receipt of the appropriate documentation within the specified deadlines. The documentation consists of the following: a) if any high-risk abatement and containment work is necessary, including making lead-painted surfaces intact, a copy of a signed and dated deleading contract with a licensed deleader; b) if you or your agent will be doing low-risk deleading work or such other work as may be required for interim control, such as structural repairs and lead-dust cleaning for interim control, a completed and signed copy of the CLPPP form, "Documentation of Training to Perform Owner/Agent Low-Risk Abatement and Containment and Deadlines by Which Owner/Agent Low-Risk Work and/or Interim Control Work Will be Completed," c) a Letter of Lead Paint (Re)occupancy (Re)inspection Certification issued by a licensed private lead inspector or risk assessor, in cases in which interior high-risk abatement and containment work, such as making loose lead paint, plaster or putty intact, is necessary, thus requiring occupants to be relocated from the unit for the duration of the work; d) copies of results of all dust samples taken by the licensed private lead inspector or risk assessor; e) a Letter of Full Deleading Compliance issued by a licensed private lead inspector or a Letter of Interim Control issued by a licensed private risk assessor. In addition, a copy of the deleading notification must be received by this agency at least ten (10) days prior to any commencement of deleading, whether performed by a deleader or you or your agent, and whether in the context of full compliance or interim control.. PENALTIES Failure to comply with this order will result in criminal prosecution. The law provides penalties of up to $500 for each day of non-compliance. In addition, you may become liable for civil punitive damages equal to three times any actual damages for failure to comply with this order if a child becomes poisoned. C:\wP.0\I.F..kD1995\C,ENER:11.\GFNER:kt..DO('\RIIO'rC39:k.DOC REN' 10/97 CORRECTION OF VIOLATION BY CODE ENFORCEMENT AGENCY If within the time periods stipulated above the aforementioned residential property is not brought into full compliance or interim control, this agency may contract with a licensed deleader to correct the violation(s) and obtain a Letter of Full Deleading Compliance or a Letter of Interim Control, and bill the owner, or initiate court action to reimburse itself. RIGHT TO A HEARING You may request a hearing pursuant to 105 CMR 460.900 of the Regulations for a Lead Poisoning Prevention and Control, in conjunction with the procedures of 105 CMR 400.200(B), the Sanitary Code provision for hearings in emergency public health matters. As already noted, the aforementioned violation constitutes an emergency. (See "Declaration of Emergency" section.) As such, you may request a hearing only if you have complied with this Order. The hearing will be provided within ten days of your request. This agency shall issue a written decision within seven days after the hearing. Q Inspector Director Certified Mail No. Z203499184 C:\WP50\LEAD1995\GENERAL\GEN ERA L.D00131-10TC39A.DOC REV 10/97 r i r � 1 � e r i I� NO;.fit.. ..jl........ Fus.............................. THE COMMONWEALTH , MASSACHU'SETTS ll (� BOARD O HEALTH Z: OF.......:... _..lss ..:.............. .. . . ........... Applir a#tnn for 11"uiiFat Workii Tiamitrnrttnn Punift Application is hereby made for,a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......................................... ---- ion•Address 1 o of No ' _ l - ----------------- - ------------------------------ --- � .._ �. .............................. Owner . Address a -� �'-----------•-•- - Z-_._.. ... 1. staller Address UTye of Buildi g ,.,.,Size Lot............................Sq. feet Dwelling— . o. of"Bedrooms___________________________________---------Expansion Attic ( ;.) ': Garbage Grinder ( ) pa, Other—Type of Building -------•.................... No: of persons---------------------------- Showers ( ) Cafeteria ( ) Other fixtures WDesign Flow_________________________________•_._____._gallons per. person per day. Total daily flow.._.._._____..__.._._.___________.._.....,gallons. Gt Septic 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. it. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------_---- ---------------------------------------------------- Date--------------------------------------- Test .Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water..-------.__-_._-_.-__-- (_ Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water._._----___..__.-----_- �+ ------------------- ---------------•--------------------•---•----____-___-_-•--------------------------------•-•----------------------------------------•---- ODescription of Soil------------------------------------------------•------•--------------------------------------------------------------------------------------------------------------- x W U Nature of Repairs or Alterations—Answer when applicable_(--,--`,,- ____ __ ----- __V____¢ __IV__________________ Agreemen` : , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the-provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. igned- ------ ' r� b Date Application Approved By------- -- ------ Application Disapproved for the following reasons:--•------------------------------• ---•------------------- ---------•-----------------------•---------------------------•••------------------------------------•--------------------------------------------------------.___---:---------------=---•--------_----- Date PermitNo......................................................... Issued........................................................ Date ........ F.E ................ nas �om�omxvs�,r* orw�ss�cxuasrrs ~� _ ' . / ������ ��K� A��������� ' � BOARD . .~-. .~- . . . ' --- ��F---�&���............. .............................------............... v � Applirxtmoo� -for Di �wl��� � Morkii Touwuor4mwxv Prrulit � Application is hereby made for u Permit to Coox�nc¢ ( ) or Rc�u� ( ) uo Iud��b^a 6rnagr Disposal System ' ' ����/ --_-'-------_-----__--___-_'-____--_____ ion-Address 'o . --- _----'-_-------_--_-'_-------_'_'- ...... ................................ 0 Address ---- -____-------'-'-- .........~--- ---------- � �*a� ��== Ty�� o{ 8o�d � ^ Size l-ot---�w�.__--'SY. {�t Dwelling-���o. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other--IypcofBuJding -------_-- No. of persons............................ Showers ( ) -- Cafetcriu ( ) ^L4 Other fixtures --------------------------------------------------------------------------------------------------------------------------------------------------- Design Flow............................................gallons per person per day. Total daily flow--------------------------------------- gallons. Septic Tank—Liquid ............gallons Length................ Width....... ...... Diameter------ Depth------ Disoosa Trench—No --------------------- Total Length-__--' Total area-------sq. f t. Seepage Pit Nu—.--___ .. Depth below inlet.................... Total leucbi4guzea------- .......'sg. h. Other Distribution box ( ) Dosing tank ( ) ~~ Percolation Test Results Performed 6v-------------------------------------------------------------------------- Date--.--.-.---.---' Tes Pit No. l................ninotcspezinc6 Depth of Test Pit.................... Depth to ground water--------------- ........ �14 Test Pit No per inch Depth of Test Pit-------------------- Depth to ground watcr'----.--- _ ---------------------------------------------------- -------------- --- ---.---.--_--_-' 0 Description ofSoil...---_-.---_-'_'-'--''___---_-_-''--'----._.__----------.----.--- � ---'----'-----------' '----------------'-''r--- ------------- ----------------------- ...... -------------------------------------------------------------------- ------------ ----._'.----------.-.-.-__� U Nature of Repairs or Alterations—Answer when applicable- [�' -------'' ' -----''---------'' --'----'-----------'=r'---� ''"'--.---. ~~ The undersigned agrees to install the ufozcdeocribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in | operation until a Certificate of Compliance has been issued by the board of health. ___---- .V -'------- u*" Application Approved By-.. � ����*�" -_-----'_----_.. ~ _- »*" _ Application Disapproved for the following reasons:----------------------------------- .............................................................. ......................................................................................................................................................................................................... l Date ' Permit No--..-.------'_�-'�---_----'-'.� Issued........................................................ � ""= . THE COMMONWEALTH oF MxosAc*ussrrs � BOARD OF EALTH | - ---' ............... AT ~~n~~-~~~~~r ~-- ~~`---~n--~~~-~-~ or Repaired AS ISAO CERTI That e In4ividual Sewage Disposal System constructed 00, k ~- ���beco ' "* ns of Article XI of The State SanitarvCo�e/ degribed in the #osal Works Construction Permit No- THE4S,SjJANCE OF THIS,CERTIFICATE SHALL NOT BE CONSTRUED AS GUARANTEE THAT THE SYSTEM VOLL, . Y. 7 ' r*c oOwmomvvsALrH or mAsamc*ussrrs BOARD O"HEA.LTH . ��- . .. ' ` N - ^ � R-rivogat rkii. QlanB tainFumit . ^ - _---_-- is hereby granted_ to / ' at ^" _ as shown vu the application fvcu Construction c ` ............. . - Boardof. Health '` / " ^ �ARR ponM /os5 xooasacw. INC.. puac'o"sns . No........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TdwG.......OF....... ..................................... 1phratiott -fur Difipgiiat Workii C omitrurtion Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. ................... ----•-....................•-•••-..--•-- W G .OwnerC/ic -----•---••--------------•----•--------- Address Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms-----3-----------------------------------Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) aOther fixtyxgs ------------------------------------------------------ W Design Flow...................._....................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/000-_gallons Length................ Width...:_......._.. Diameter_-_--_-..-_-__ Depth.__.--_-__.._. x Disposal Trench—No. ............... Width_ _ ___.___.._____. Total Length.................... Total leaching area....................sq. ft. /d �� _ S.e G.�• � Seepage Pit No..... .Ud._ _.. )dame er.................... Depth below inlet.................... Total leaclttttg ttre�t.._____._____.____sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.... -------------------------------------------------------------------- Date--------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water...---------.--.--.-.._. G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_._.----__----.-----._. W -------------------------------------------•----------•••--••--•----------------•----------------------------------------------------------------•------------ 0 Description of Soil--- -----------------------------------•------------------•-----•----------------•-----------------------------•-------------------------------------------------------- x U ---------------------------•--------------•----------_-----•-•--------------------•-•-----------•-- --.....---•-----------•-------•-----......-----•---.._..--••----•---•--•-----.................----- W ----------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable........�..................................................................................... ------. ----------C—;(141TI<. .......----YETk -------------------------------------------- --------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—Th n ne urther agrees not to place the system in operation until a Certificate of Compliance has been issu o ea . Signed . r •-------- --- Date ApplicationApproved By------------------------- -------- •----------- -------------- -------------- Date Application Disapproved for the following reasons:-----•-----•--•-•---------------•--•----•--•---•....-•--•--••------•-•-•-----•---------------••--•-•---•----•--- ---------------------------------------------------------------------------------------------------------------------- ..............................................----------------------------------- Permit No. Date ---------------•-•---••-•---...... Issued----•----------------- ................................. Date NO.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :/.4 ''r�....OF...... d <e........... ..................... Applirtt#iun -for Bitipoiial Works Tomitrur#ion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual S'ewaa��-Disposal System at: E% Location Address ¢ ^= or Lot No. J ys A ................ _ ..- .. .................. ..... �.4.�.Ksav` _ ..__________________-___-___.__..._.._...____........_.._____............................._. S.. Owner Address a ------------------------ L '"Ei " - ;'� ` ---------------• ........... Address QType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms__.,,3_...................................Expansion Attic ( ) Garbage Grinder ( )a Other gpe of Building ;r__________________________ No. of persons..--____-_: Showers ( ) — Cafeteria ( ) ;Other fi xt jigs . f _--------------------•. .......... ------------------- ------------------------•---- --- --- .......................... W Design,Fwlo ; . , f :� ._._ gallons per person per day. Total daily flow--------------------------------------------gallons. P; Septic T trait .,Liquid capacity gallons Length----------------- Width---------------- Diameter---------------- Depth _--- .. - Disposal Trenchi' No �" tiV3tdt1 ____: Total Length.................... Total leaching area....... __ .. .._._.sq. ft. r lame er ________ ______ 'Depth below inlet_________....._..... Total leaching area------._--_-___-sc tt. Seepage Pit No ..fir.. V_ _ b• e eg< 1 Z Other Distribution box ) Dosing tank ( ) ~" Percolation Test Results �'� Performed by.__,__--_-_-_------.--•_.-.._-----_ a - ---------------------------------- Date---------------------------------------- Test Pit No. 1------------n---minutes per inch Depth of "lest Pit____________________ Depth to ground water---__--.._.__----------- LL, Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water---------------------- ----------- .. O Description of Soil------- ............................................................................................... -----------------..... . .............. .. x • Rr ,�:�.w:�e - - �;yf ------------ i ............... ..---- -._...._ ___ ________ ___.__...._._......_ _ _._.________.__________.._._........._....._.__..___..._.____._____..______._.___.___________.. V }, Nature of Repairs or Alterations—Answer when applicable ---------------------------------------- - - ----- - - -- --_-____--- . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article lI of the State.Sanitary Code— The un i ed further agrees not to place the system in operation until a Certificate of Compliance has been issub e h. Signed,_.— �' v � - ----- -------------------- ........•....................... Date F APplic tion;,APProved By F `i = ' •, j" - : --- ....... ---- % Date Application Disapproved for the following reasons....................... ------------­---- ................................................... • . ........................................................................................:....................___.__._.__._.________._.______.........--...............__._...-.__-__--____-___•._-_.-_.- '' Date 7 - Permit No.... .....---=---- • ..... Issued------------------------------------•--•--• -•--------- Date THE COMMONWEALTH'OF MASSACHUSETTS BOARD OF HEALTH x ® .. "..........OF.... ................................. � k Qwr#ifirate of to"IIF i�nrr THIS IS TO CEh'1'IF,Y,,That the Individual Sewage-Disposal System constructed ( '') or Repaired ( ) by - ................... at. w,� _a I C: ^* alter s y- *'4Yf 4 .............. Y L -------------------------- a lbeen n for Disposal W an-Fe with the'provisions of Article of The State Sanrtary Conde 4 described in the ,12 �Co struction Perin-it No •j dated.-.-_ _'_ �.?:4 ias been costa e mb�accor a PP P r � 10 N- { THE ISSUANCE OF'`TW9 CERTIFICATE SkA"LL N T BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ..._ �., � -----• Inspector... ... e� ----- ----------------------------------•------------ - -- THE/COMMONWEALTH OF MASSACHUSETTS BOARD OF.. j .�j t FEE..;. .... -: frkii CIT,�a #r r i it rr ti# Permission is'Hereby.granted "' d6'' '/ `-- S6---- �i .._------- --•-----•- to Construct . or'Repair an Individual Sewage Disposal System r. (. ) P ( )- g P Y j at No.`. ................ Ae/� --- -- -- ----- . 1 t t Street `• i t as shgwn on the applica'rion for Drspo"saysWorks'fy95iStruetontlexmitNo '��� ...____ Dated__'. _y 7„ .•.-_-____.... .r. i �� .!tr Y'b{"w �';,•w" #�..,. 1 a ?Y -----------•--•-•--•-•--••----- - a-- eat - - .....---• - ` * . DATE i _� .. , B �- --f H- I FORM 1255• HOBBS & WARRENNC ,.PU�LISIi IRS. -'�{ _ 4•x 4. .fit 'Q �� e� ��•5.� ;,.�v p it M P'.�> t�•, ", f Y,: r��`m'Y' �'