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Home My WebLink About0251 HINCKLEY ROAD - Health 251 HINCKLEY RD., HYANNIS A= f p I r °PINE Tpw� Town of Barnstable P Regulatory Services Department ' BARNS-TABLE,MASS. i639• Public Health Division �� AIFD M 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO March 9, 2007 RE: Certificate of Registration for 251 Hinckley Road, Hyannis To Whom It May Concern: Please be aware that the dwelling located at 251 Hinckley Road, Hyannis had an inspection of the State Sanitary Code 105 CMR 410.000 on March 5, 2007 by Town of Barnstable Health Inspector Timothy O'Connell. At the time of inspection, there were no violations of the state sanitary code; therefore a Certificate of Registration was issued for the property. Should you have any questions regarding this inspection, please do not hesitate to call the Town of Barnstable Health Department. pectfully, ait' Barrett Division Assistant NP�O�t"Erb~�s Town of Barnstable Regulatory Services miNsimLE, buss4; � Thomas F. Geiler,Director QED MAC A Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 �"'r�,"o�,".m�.�r z�-�ir'"�"�`",��„+s:�""'id ;}.,rs°+r '+C•Td �.s�a+[{�e�'.°ss�'sz� '�'. f s`�s�,�„r- v-:t ''o-�t"��",�a��'r� . �;��'�� .., .a kit � +'�' �'� �"�3' - ��a.� .;:� ^t�7. aaz�„�rxr�,:'�+�� ,.z»�..: �r'°'�'w ,'��. i''. a� �• ��'�m�-z�`` � DATE: NUMBER OF PAGES TO FOLLOW: TO: FROM: lJ e e �A `J ; PHONE: � uVO�,\ PHONE: (508)862-4644 FAX PHONE: ( 1 �v FAX PHONE: (508)790-6304 cc: 'J NOTES/COMMENTS: C QAFax Form.doc P. 1 COMMUNICATION RESULT REPORT ( MAR. 9.2007 11:42AM ) TTI BARNSTABLE BOARD OF HEALTH FILE MODE OPTION ADDRESS (GROUP) RESULT PAGE ---------------------------------------------------------------------------------------------------- 405 MEMORY TX 915087757434 OK P. 3/3 ---------------------------------------------------------------------------------------------------- REASON FOR ERROR E-1) HANG UP OR LINE FAIL E-2) BUSY E-3) NO ANSWER E-4) NO FACSIMILE CONNECTION oppiwo�xs,�:8 I n r l c r 1 c Certified Mail#7006 0810 0000 3524 8554 y�,pFT rp�~s Town of Barnstable Regulatory Services 1] BARN'FrABLE, MAC• Thomas F. Geiler, Director039. Arf0 MAC Public Health Division L Thomas McKean,Director ,,o "'-7 7� 200 Main Street, Hyannis, MA 02601 (`C Office: 508-862-4644 Fax: 508-790-6304 February 26, 2007 David Tegelaar 160 Boylston Street Shrewsbury, MA 01545 C> NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 251 Hinckley Road, Hyannis was inspected on February 22, 2007 by Timothy O'Connell &Meredith Morgan, Health Inspectors for .. the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.351 —Owner's Installation and Maintenance Responsibilities. Open grounds on all outlets throughout house except kitchen outlets. You are directed to correct the violations listed above within thirty(30) days of your receipt of this notice by either grounding all outlets or replacing three prong outlets with two prong outlets. 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. QAOrder letters\Housing violations\Rental ordinance\251 Hinckley Road.doc Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH homas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Madeline &Wayne Perry, Tenants Cc: Timothy O'Connell &Meredith Morgan, Health Inspectors QAOrder letters\Housing violations\Rental ordinance\251 Hinckley Road.doc f Certified Mail#0000 0000 0000 0000 0000 Town Of Barnstable #. Regulatory Services B�awsrast7s.: .. Thomas F. Geiler, Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 date name Ujaddress v15H5 city,state, p NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned b you located at 5 1 �� LX/-(Was`� y y inspected on!/ )-� ®7 b �(� M C#� Y o (Address),(date) (Inspecto Health Inspector for the Town 's nam of Barnstable, (Reason for inspection) The following violation(s) of the State Sanitary Code were observed: State code violation number-violation deqgription n 105 CMR 410. 35 1 105 CMR 410. 105 CMR 410. - 105 CMR 410. Q:\Order letters\Housing violations\Rental ordinance\temp late.doc 5 105 CMR 410. The following violation(s) of the Town of Barnstable Code were observed: (Town code violation number-violation description) §170-_ - §170-_- You are directed to correct the violations listed above within ( ) days. (written#) (#) of your receipt of this notice by c- �-- You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: (Name,tenant,owner,Fire Dept.,Building Dep ....) Cc: —TO � r (Health inspector's name) (Generic codes located at QAOrder letters\Housing violations\Rental Ordinance\GENERIC CODES.DOC) QAOrder letters\Housing violations\Rental ordinance\template.doc FTHET TOWN OF BARNSTABLE 6 ^ � OFFICE OF = Bea39Tesa MA6o. BOARD OF HEALTH .� � 00,e,1639. e0 367 MAIN STREET f�MAY k� Mardi 5 , 1990 HYANNIS, MASS.02601 Mr. & Mrs . David Tegelaar 20 Nauhaught Road South Yarmouth, MA 02664 NOTICE TO ABATE VIOLATIONS OF 105 QM 410, 000 STATE SANITARY CODE, MINIMUM STANDARDS O FITNESS EM HUMAN HABITATION The property owned by you located at 2.51 Hinckley Road Hyannis was inspected on March 2 , 1990 by Do a"M-iora-n-di , Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410 . 000 State Sanitary Code II Minimum Standards of Fitness for Human Habitation were observed: ARTICLE XXXIX. CONTROL U TOXIC ARD HAZARDOUS MATERIALS. Section .5� (c) . The Board of Health requires that containers of toxic or hazardous materials be stored on an impervious, chemical resistant surface compatible with the material being stored, and that provisions be made to contain the product in the case of accidental spillage . On your property are two cylinders of nitrous oxide and. used oil filters on the ground. There are also abandoned vehicles and engines . These conditions pose a threat to our groundwater supply and also to the health and safety of the public in the Town of Barnstable . REGULATION 105 M� R 410, 482: No smoke detectors in house. The owner of every dwelling is required by Massachusetts General Laws to be equipped with smoke detectors and shall provide and maintain all such required smoke detectors in compliance with the regulation of the State Fire Marshall . REGULATION 105 CMR 410,500: One-half inch gap in the threshold between bathroom and living room. Holes in living room ceiling, wall, and holes in bedroom ceiling . Every owner shall maintain the foundation, floors , walls , doors , windows , . . . and other structural elements of his dwelling so that the dwelling is in good repair and in every way fit for the use intended. REGULATION 105 CMR 410,252: Bathroom Liahtina "n Electrical Outlets. The owner shall provide in each room containing a toilet, bathtub, or shower one operable lighting fixture .. Lighting in bathroom is inoperable. 1' REGULATION 105 CMR 410.756 (F) : Conditions Deemed to Endanger ar Impair Health or Safety. The water from the tub and toilet in the bathroom is being discharged onto the ground under the house ( in the crawl space) . This is a failure to maintain a sewage disposal system in an operable �r condition. This is also a violation of 410 . 350 and 410 . 351 . You are directed to correct the above first listed violation within forty-eight (48) hours and the remaining violations within thirty (30) days of receipt of this notice. You are also directed to notify the Health Department of any seasonal rental and to inform the Department when the violations are corrected. 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 that $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 Commonwealth of Massachusetts DEPARTMENT OF HOUSING & COMMUNITY DEVELOPMENT Jane Swift, Governor ♦ Jane Wallis Gumble, Director October 15, 2001 Dear MRVP Participant, This is to confirm that DHCD is inspecting all units subsidized by the Massachusetts Rental Voucher Program(MRVP). Your apartment at 251 HINCKLEY RD,HYANNIS Is scheduled for inspection on Friday, October 26,2001 At 11:00 AM. Your inspector is Peter Gauvin. He will be carrying a photo i.d. An adult 18 years or older, or an authorized representative,must be present for the inspection and must be able to provide access.to the basement, common areas and utility spaces. The owner, manager or maintenance representative is also"encouraged to be present. Failure to comply with inspection requirements may jeopardize the rental subsidy. Your cooperation is appreciated. Sincerely, G Joseph A. Hart Inspection Coordinator DHCD Inspection Bureau 617-727-7130 x372 cc: landlord One Congress Street www.state.ma.us/dhcd Boston,Massachusetts 02114-2010 www.state.rna.us/dhcd te.rn Commonwealth of Massachusetts DEPARTMENT OF HOUSING & COMMUNITY--DEVELOPMENT , Jane Swift, Governor ♦ Jane Wallis Gumble, Director November 1, 2001 Lydia Tegelaar 20 Nauhaught Road South Yarmouth,MA 02664 Re: 251 Hinckley Road,Hyannis(Jenkins) Dear Ms. Tegelaar, The above unit failed a DHCD health and safety inspection on October 30, 2001. DHCD is aware that the tenant was not cooperating with the inspection process and her actions led to the conditions in the attached report. We will reinspect this unit in the near future. Thank you for your help with the MRVP inspection program. Sincerely, vV Joseph A. Hart Inspection Coordinator DHCD Bureau of Housing Inspections 617-727-7130 x372 Encl. cc: Robert Hooper,Barnstable Housing Authority(by fax) Donna Miorandi,Barnstable Public Health Dept. (by fax) Lt. Donald Chase, Jr.,Barnstable Fire Dept. (by fax) Paul Attea, Atty., Garnick& Scudder,Hyannis Tenant One Congress Street www.state.ma.us/dhcd Boston,Massachusetts 02114-2010 ' ' 617.727.7765 Page: 1 DHCD INSPECTION M.R.V.P 'ZvO� Property: 251 HINCKLEY ROAD Inspector: PEGA Inspection Date: October 25,04 Program: MRVP Address: 251 HINCKLEY RD. Reinspector: Reinspection Date: HYANNIS,MA 02601 Owner and Address: Tenant: JENKINS,SUSAN PASS: NO (ID#020PGO069) PRIORITY:HIGH Result: P=Pass, F= ai Code: 01 =Emergency Repair (24 Hours) Type: M=maintenance related EOCD monitoring priority(guidelines): I=Inconclusive 02=Repair within 30 days T=tenant related HIGH=at least 1 "01"or 6"02" R=Recommendation 03=Pass with Repairs blank=undetermined LOW =at least 4"02" ITEM# ITEM RESULT COMMENTS CODE TYPE BA 8 BATHROOM TOILET/PRIVACY F REPAIR OR REPLACE DAMAGED TOILET SEAT. 02 T G 1 ACCESS/EGRESS/SECURITY F REMOVE TENANT STORAGE AND DEBRIS BLOCKING EXTERIOR DOORS TO 02 T PROVIDE A SECOND MEANS OF EGRESS AS REQUIRED BY THE MASS FIRE PREVENTION REGULATIONS G 16 NO SHOW/LOCKED OUT F TENANT HAS PREVENTED ENTRY FOR INSPECTION ON NO LESS THAN SIX 02 T SCHEDULED INSPECTIONS,INCLUDING THIS ATTEMPT(Owner present to provide access).TENANT HAD ALL THREE ENTRY DOORS BARRICADED FROM THE INSIDE. OWNER'S NEW LOCKSET&KEY(recently changed at her expense) DID NOT UNLOCK DOOR(with evidence new lockset tampered with). G 3 GARBAGE/DEBRIS/CLEAN F EXESSESIVE CLUTTER AND TENANT STORAGE OBSTUCTING PASSAGE 02 T WAYS AND LEADING TO UNSANITARY AND UNSAFE CONDITIONS G 6 ELECTRICAL I MOST ELECTRICAL OUTLETS INACCESSABLE FOR INSPECTION(BURIED IN 02 T STORAGE AND DEBRIS) G 7 SMOKE DETECTORS F BATTERY REMOVED FROM UNIT SMOKE DETECTOR IN HALLWAY OUTSIDE 01 T BEDROOMS H 3 HVAC-CONDITION/SAFETY F REMOVE TENANT STORAGE AND DEBRIS WITH-IN 2-FEET OF FURNACE 02 T BLOCKING ACCESS FOR INSPECTION,REPAIR AND CREATING POTENTIAL FIRE HAZARDS K 8 KITCHEN SINK/PLUMBING I REMOVE DEBRIS STORED IN SINK(apparently not in use) 02 T K 9 STOVE/RANGE/OVEN F REMOVE FLAMMABLE MATERIALS STORED ON AND AROUND GAS STOVE 01 T L 7 LIVING ROOM WINDOW/SCREEN/LIGHT I ELIMINATE TENANT STORAGE AND DEBRIS.BLOCKING ACCESS TO 02 T WINDOWS FOR INSPECTION NOV 02 101 12:46PM COMM MASS—EXEC OFF COMM & DEV P,1 Commonwealth of Massachusetts DEPARTMENT OF HOUSING & COMMUNITY DEVELOPMENT Jane.Swift, Governor • Jane Wallis Gumble, Director November 1,.2001 Lydia Tegelaar - c 5 - 20 Nauhaught Road South Yarmouth,MA 02664 Re: 25.1 Hinckley Road,Hyannis(Deakins) Dear Ms. Tegelaar, •'The above unit failed a DHCD health and safety inspection on October 30,2001. DHCD is aware that the tenant was not cooperating with the inspection process and her actions led to the conditions in the attached report. We will reinspect this unit in the near future. Thank you for your help with the URVP inspection program. Sincerely, Joseph A. Hart Inspectign Coordinator WCD Bureau of Housing Inspections b17-727-7130 x372 Encl. cc:Robert Hooper,Barnstable Housing Authority(by fax) Dorma.Miorandi,Bamstable Public Health Dept. (by fax) Lt.Donald Chase,Jr.,Barnstable Fire Dept.(by fax) Paul Attea,Atty.; Carrick&.Scudder,Hyannis Tenant t$e raw=sired, www.statc.ma.us/dhcd Rbswn�Massachusetts 02114-2010 617.727.7765 Page: 1 DHCD INSPECTION M.R.V.P • qvo� Property: 261 HINC:KLEY ROAD Inspector: PEGA Inspection Date: Occobear 25,04 4 Program: MRVP N Address: 251 HINCKLEY RD. Reinspector. Reinspection Data: HYANNIS.MA 02001 Owner and Addr�ees: Tenant: JENKINS.SUSAN PASS: NO (IDS 020PGO069) PRIORITY:HIGH Result, P=Pass, F=Fall Code- 01=Emergency Repair (24 Hours) Type: M maintenance related EOCD moo torin 9 priority(guidelines) I c Inconclusive 02=Repair within 30 days T tenant related HIGH=at least 1"i01^or 6'W' R=Remamendatton 03=Pass witb Repairs blank=undetermined LOW -at least 4'W ITENOfI ITEM RESULT COMMENTS CODE TYPE BA B BATHROOM TOILETIPRIVACY F REPAIR OR REPLACE DAMAGED TOILET SEAT. 02 T G I ACCESSIEGRESS(SECURITY F REMOVE TENANT STORAGE AND DEBRIS BLOCKING EXTERIOR DOORS TO 02 T �j PROVIDE A SECOND NJEANS OF EGRESS AS REQUIRED BY THE MASS FIRE A PREVENTION REGULATIONS os G 16 NO SHOW&OCKED OUT F TENANT HAS PREVENTED ENTRY FOR INSPECTION ON NO LESS THAN SIX 02 T SCHEDULED INSPECTIONS,INCLUDING THIS AT rEMIPT(Owner present to p provide access).TENANT HAD ALL THREE ENTRY DOORS BARRICADED FROM THE INSIDE. OWNERS NEW LOC KSET&KEY(recently Banged at her expense) L_ DID NOT UNLOCK DOOR(wkh evidence new locksel tanp"d wi ft o G 3 GARBAGEfOEBIRISICLEAN F EXESSESIVE CLUTTER AND TENANT STORAGE OBSTUCTING PASSAGE 02 T L) WAYS AND LEADING TO UNSANITARY AND UNSAFE CONDITIONS �X G 6 ELECTRICAL. 1 MOST ELECTRICAL OUTLETS INACCESSABLE FOR INSPECTION(BURIED IN 02 T � STORAGE AND DEBRIS) (n G 7 SMOKE DETECTORS F BATTERY REMOVED FROM UNIT SMOKE DETECTOR IN HALLWAY OUTSIDE 01 T Q BEDROOMS H 3 HVAC-CONDITIONISAFETY F REMOVE TENANT STORAGE AND DEBRIS WITH4N 2-FEET OF FURNACE 02 T BLOCKING AdCESS FOR INSPE=ON,REPAIR AND CREATING POTENTIAL ' FIRE HAZARDS KS KITCHEN SINK/PLUMBING 1 REMOVE DEBRIS STORED IN SINK(apparenly not in use) 02 T a K 9 STOVEIRANGEIOVEN F REMOVE FLAMMABLE MATERIALS STORED ON AND AROUND GAS STOVE 01 T L 7 LIVING ROOM WMNDOWISCREEWLIGHT I ELIMINATE TENANT STORAGE AND DEBRIS.8L0;MNG ACCESS TO 02 T iv WINDOWS FOR INSPECTION m . N 0 LOCATION 5EW&C4E PERMIT MO. - . - - - - - - VILLAGE lW ST IQLLER 5 ►J N F- h.DDRES E - - - - - - BUILDER 5 Q / MF- ADDRESS DATE PER"VT ISSUED DATE COKAPLI W-ACE ISSUED : y_� ` ®�� i ., i ,� � � No.._. Fzs. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1.. ..(!l.V. . ......._.OF...P.... ............ ...... .........-......-_. Appliration -for M-4 osal Vorko Tons#rurtion Vrrutft Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: ,_25 .1------------------- �--- �'� ------ 1-••-- ---- ----- - ------------------------------------- L ion-Ads or Lot No. = -------------------- --•••-....---••-•••---------•••--•••-•••••....•---•-...---.------..-•-•••--••••••---•.........•--- wner Address ---------------•---• --••--••---••---•----------•-•---•--•--.......-•-•••------•••--•----•-•-•---••-••----------------- ------------------- Installer Address d Type of Building Size Lot____________________________Sq. feet V Dwelling—No. of Bedrooms_-.7<---------------------------------------Expansion Attic ( ) Garbage Grinder ( ) p4 Other—Type of Building ___________________________• No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------ W Design Flow............................................gallons per person per day. Total daily flow-----------------------------------------..-gallons. 04 Septic Tank—Liquid capacity.----------gallons Length................ Width................ Diameter-__---..---____ Depth.-.-_-__--_-_- W Disposal Trench—No- ____________________ Width-------------------- Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet-----------_-------- Total leaching area------.-----------sq. ft. Z Other Distribution box i ) Dosing tank ( ) ~" Percolation Test Results Performed by-------------------------------------------------------------------------- Date---_---_-_-_--____.--------------------- a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water---------------.__-__--- f14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water-_--_________-____-- P' .......... -------------------------------------------------- .......................................................................................... 0 Description of Soil.........................................................................................................................................................-------------- x c, VW ------------------------------------- ---------------------------------------------------------------------- ------------ -------------- --•---- --------------------- -- Nat e of Repairs or Alter tions—Answer when applicable.- __ -__/Q �.._ __---____-____-._-. _._._._-__ y!.. __ _.. ___ --- ------------------------------------------ ___________________________________ _ greement: , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article ?U of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issued the board of h Signed. - - ` ` I:- -� 7 Date ApplicationApproved By...................................................................................••-•--------- Date Application Disapproved for the following reasons-------------------------••-----•-•--•------•--•-•------•--------•-•-----.....-----._..........•--....-••-••-•••- ---•-•---•--...-------•--••----.............................................. Date Permit No.•==-9- d 2---------------•-•-•----•--•-------•.... Issued..... A o 7-1 `� ------------- Date � --------------------- -------� No. .. .... � Fz�x. ...........:......_ THE COMMONWEALTH OF MASSACHUSETTS .,, .... BOARD OF HEALTH _ .... ._......OF...Ile..... ......... GL. I/1.......................................Appliratinn -fear Uispoiial Works Tonstrnrtion Vrrmft Application is hereby made-for a Permit to Construct ( ) or Repair ( an ndividual Sewage Disposal System a��t: - •- - .p„, 3 L ron•Ad s or Lot No. •- .... . --------- ...... ..... .. .... ......................... canerAddress ---------•-••--•-------------•-•-------- a�j Installer Address U Type of Building r ';_ ----------------------------Sq. feet Size Lot_-•-------------•_-- Dwelling—No. of Bedrooms.-Y--------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d Other fixtures --------------------------------------------------- W Design Flow.............................________}:......gallons per person per day. Total daily flow---------------------------------------------gallons. WSeptic Tank—Liquid capacity ,t---gallori's z Length ?_____________ Width..... _. __.. Diameter---------------- Depth.'!::.:__-__.-. x Disposal Trench—No-___________ - _ Width___ ;`; Total Length____________________ Total leaching-area ft. Seepage Pit No--------------------- Diameter-_____-__.._.._.... Depth"below"'inlet.................... Total leacing area------------------sq. ft. z Other Distribution box ( ) Dosing.tank '-' Percolation Test Results Performed' by-.___---- :':_.`:,__._.._..,_ a --•-==------•-----------•--_..-------•--•---- Date--,-----------------------------•-•-•- Test Pit No. 1----------------minutes per in6 Depth of'Test Pit_"`_________________ Depth to ground water.._-_---__________---. 1:14 Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground•water__---------------------- x . Description of Soil_________________________•.. ------------------------------------------------------ ----------------------- U -------------------------------- ................................................................................----------------------••-•-•-•---------------------------------------------- = Ul"1 •-- ---------------- ------------------------------------------------------------------------------------- ------ ---•--•-----------_ -- Nat e of Repairs or Alter tions—Answer when applicable___ �__� Qt3 ____ ----------- ---------------•- -----------------------------•--- egreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issued y the board of�1 . h. Signed .....................' r� f •» Date ApplicationApproved By--------------••--.._.._.--•- ••--••-•.._..------•-•-•-•. -•• --•-- t ............................ ........... s NDate Application Disapproved for the following reasons:: 4,_ -----;••-•--•--•----------------•------ -.........................7................... Date Permit No. 0 7 ................. . °'Issued. ...... `.. Date �+ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T(idGcL OF. i 'W"rrtifirate of 10111ntpliatirr THIS IS TO CERTIFY That the Individual Sewage Disposal System constiuctgd a( ) or Repaired ( ) at......... ,* �� /AI- -I ' t ller.�J --• j•.••-•-• ___..------. _ ------- -. -•-•--- has been installed in accordance with the provisions of Article XI 'ofs Theta_U Sanitary Code as escri ed in the /7- application for Disposal Works Construction Permit NoT.__: ` ' dated_- - , THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED NS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SSATISFACTORY. r r DATE. C /P Inspector•••- •.....F�.)4; k s THE COMMONWEALTH OF MASSACHUSETTS BOARD F; ,HEALTH E j}i� ya wk- .... krrhb _,OF - L c' FEE... e ..... Dinpotial World Tunfrnrtioat prrntit „r Permission is hereby granted.......-4-A.&-'.....C ,S, 'a_d.LS--•.•------------------•-.....--•----•••-•----•--•----------------------....----• to Construct- ( ) or Repair (7() an Individual Se age Disposal S stem at No.......... .�'/---.. �/�..e.A4 /%y},tt.1f.�_ �''�i'' S - r f fl. '-Kt c wY a Sweet� r• --•--•------ as shown on,the application for Disposal'Works Construcfron Permit No-___:yq_.__.____,_.Dated------ � t•.... u _ DATE....... Board Ith of FORM 1255 H.OBBS &,WARREN,g41NC PUBLISHERS � ,`_,+�; ^ -,.�.,4, :iHe.•_Ftl 45 x,i -.�.L 1, 7r :�"� � f r��,� �':