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HomeMy WebLinkAbout0025 HIRAMAR ROAD - Health 25-27,-E�iramar`;Road ` i LLxk .Hyannis F/R A = 292 010 i t.- i i �I �i' TOWN OF BARNSTABLE LOCATION o�s �--1', r—,,,,^,A j_ PP.SEWAGE# VILLAGE ASSESSOR'S MAP&PARCELa � c—o NAME&PHONE SEPTIC TANK CAPACITY S®® LEACHING FACILITY.(type) 3' SaCD so c (size) 3 3 rX (3'K a NO.OF BEDROOMS OWNER T G PERMIT DATE:, k,Q 1 3©(Q_-� COMPLIANCE DATE: (O[3O JO a Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility , G 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 'C�-g��yloe� e �S•.nC. , � , � 3 . 3S ` S ' Commonwealth of Massachusetts Title 5 Official Inspection Form copy.; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25/27 Hiramar Road Property Address Ben Virga Owner Owner's Name infeouiredforration ls Hyannis MA 02601 March 26, 2011 9 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out / n forms the computer,use 1. Inspector: • IW/I � l/// only the tab key to move your Patrick T. Sullivan cursor-do not Name of Inspector use the return key. Ready Rooter, Inc. Company Name P.O. Box 371 Company Address Sandwich MA 02563 City/Town State Zip Code 508-888-6055 SI 12843 Telephone Number License Number B. Certification 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails-,"I ❑ Needs Further Evaluation by the Local Approving Authority J .ram J 9 � March 30, 2011 a Inspector's Signature Date 1 -- The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 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 DEP. The original should be sent to the system owner and copies-sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 11 t5ins_ 09/08 Title Official Inspection Form:Subsurface Sewage Disposal System-Page I of 1 J i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25/27 Hiramar Road Property Address Ben Virga Owner Owner's Name information is required for Hyannis MA 02601 March 26, 2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: I have not found an information which indicates that the r® y ca es ha any of a failure criteria described in 310 CMR 15.303 or in.310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Property is a duplex w/two (2) bedrooms on each side. Property has been vacant since 2008. 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 -f the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" , N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years of * or the septic tank(whether metal or not) is structurally unsound, exhibits substantial in tration or exfiitration or tank failure is imminent. System will pass inspection if the existing tank is placed with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspe ion if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tan is less than 20 years old is available. ❑ Y ❑ N ❑ D (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2 Commonwealth of Massachusetts W Title 5 Official Inspection Fora o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25/27 Hiramar Road M Property Address Ben Virga Owner Owner's Name information is required for Hyannis MA . 02601 March 26, 2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a bro en, settled or uneven distribution box. System will pass inspection if(with approval of Board o ealth): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y . ❑ N ❑ ND (Explain below): El distribution box is levele or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system requ' ed pumping more than 4 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): — j C) Further Evaluation is Requi/beBoard of Health: ❑ Conditions exist which requirluation by the Board of Health in order to determine if the system is failing to protecth, safety or the environment. 1. System will pass unlessealth determines in accordance with,310 CMR 15.303(1)(b)that the systemtioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 3 of 3 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25/27 Hiramar Road Property Address Ben Virga Owner Owner's Name information is required for Hyannis MA 02601 March 26, 2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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, safety and 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 a surface water supply. ❑ The system has a septic tank and SAS and a SAS is within a Zone 1 of a public water _ supply. ❑ The system has a septic tank and SA and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS an the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well wat analysis, performed at a DEP certified laboratory, for conform bacteria indicates absent and the p sence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no ther failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 4 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 25/27 Hiramar Road Property Address Ben ViMa Owner Owners Name information is required for Hyannis MA 02601 March 26, 2011 every page. City/Town state Zip Code Date of Inspection B. Certification (cont.) T Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ N Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 16.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 eet of a surface drinking water supply ❑ ❑ the system is within 0 feet of a tributary to a surface drinking water supply ❑ ❑ the system is loc ed in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) a mapped Zone II of a public water supply well If you have answered "yes"to an question in Section E the system is considered a significant threat, or answered"yes" in Section D ove the large system has failed. The owner or operator of any large system considered a significa threat under Section E or failed under Section D shall upgrade the system in accordance with 0 CMR 15.304. The system owner should contact the appropriate raninnal nffirP of tha nPnarimant t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25/27 Hiramar Road Property Address Ben Virga Owner Owner's Name information is required for Hyannis MA 02601 March 26, 2011 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 459.91 GPD t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 6 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 25/27 Hiramar Road Property Address Ben Virga Owner Owner's Name information is required for Hyannis . MA 02601 March 26, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last Z ears usage d No usage 9 ( Y 9 (gP ))� Detail: No water usage since 2008. Sump pump? ❑ Yes ® No Last date of occupancy: Sept. 2008Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203)- Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.)* Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to t Title 5 system? ❑ Yes ❑ No Water meter readings, if availa e: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 7 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25/27 Hiramar Road Property Address Ben Virga Owner Owner's Name information is required for Hyannis MA 02601 March 26, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: No records found Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® 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) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 8 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25/27 Hiramar Road Property Address Ben Virga Owner Owner's Name information is required for Hyannis MA 02601 March 26, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: System installed October 30, 2002. Certicicate of Compliance on file at Board of Health. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 31" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A . feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 23"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 11' X5'X4.5' Sludge depth: 1" t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 9 l_ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25/27 Hiramar Road Property Address Ben Virga Owner Owner's Name information is required for Hyannis MA 02601 March 26, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 39" Scum thickness 0 11 Distance from top of scum to top of outlet tee or baffle 2', tank not at operating level Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Tape measure and dip tube. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet PVC tees in place. Liquid level in tank is 2' below operating level. Property has been vacant for 2 years. No sign of leakage. Risers bring covers within 6" of grade. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal fiberglass El polyethylene ❑ other(explain): 1' Dimensions: Scum thickness Distance from top of scum/utlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 10 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 25/27 Hiramar Road Property Address Ben Virga Owner Owner's Name information is H annis required for y MA 02601 March 26, 2011 every page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal fiberglass ❑ polyethylene ❑ other(explain): i Dimensions: i 1 Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: / Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): I Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 11 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25/27 Hiramar Road Property Address Ben ViMa Owner Owner's Name information is Hyannis required for y MA 02601 March 26, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert On Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): One inlet, three outlets w/speed levelers in place. Equal flow. No solids carryover, no high water staining over outlet invert. Cover within 8" of grade. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump cham r, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 25/27 Hiramar Road Property Address Ben ViMa Owner Owner's Name information is required for Hyannis MA_ 02601_ March 26, 2011 _._ �. every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3- 500 gal ea. w/4' of stone. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Chambers dry at time of inspection. No sign of previous hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater infl w ❑ Yes ❑ No t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 13 a Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25/27 Hiramar Road Property Address Ben Virga Owner Owner's Name information is required for Hyannis MA 02601 March 26, 2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): r Privy (locate on site plan): / Materials of construction: Dimensions Depth of solids Comments(note conditio of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 14 Commonwealth of Massachusetts Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 25/27 Hiramar Road Property Address Ben Virga Owner Owner's Name information is March 26, 2011 Hyannis MA 02601 required for y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately O O ) 3Q J 1 b,3 - 3� t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25/27 Hiramar Road 'M Property Address Ben ViMa Owner Owner's Name information is required for Hyannis MA 02601 March 26, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Oct. 16, 2002 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: ma.water.usgs.gov terraserver-usa.com You must describe how you established the high ground water elevation: Test hole found no ground water at elv= 38.8. Base of SAS at elv= 45.17. Accessed local ground water countours and topo mapping. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25/27 Hiramar Road Property Address Ben Virga Owner Owners Name information is required for Hyannis MA 02601 March 26, 2011 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information —Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 ,. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE / LOCATIO S 7 h`/R f��'h A2 o/� SEWAGE:,#o'Z 2__ —�d VILLAGE ASSESSOR'S MAP & LOTZ5l2,—o/a INSTALLER'S NAME&PHONE NO ke"o 6",57 e;' SEPTIC TANK CAPACITY is D y ��/lid^ems LE4CHING FACILITY: (type,5 � O0 CAAA"-t g.i�2S (size)�KZX /.3 �X ;)-� NO.OF BEDROOMS BUILDER OR OWNEIiv" LUANCE_DA�TE �� 'J� PERMIT DATE: l� 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 �� I o _ C� o o n't 3 a q G q7— ri No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rip tic do igooal *proem �Comaruction Permit Application for a Pertruto ons c ) pair( Upgrade( )Abandon( ) CJ omplete System El Individual Components Location ddress Lot No. Owner's Name,A dress and Tel. o. A essor's Mp arse o`L — O/d Installer's Name,Address,and Tel.No. Des ner's Name,Addressel.No. 19/2 --.4/ �i 5 I �v ��/112 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building PAS No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flows . 5 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alte/ratiof s(Answ r when applicable) ( S G 5 / 13 O X S O?> C // fl3c2� f STOrvE' 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 Certifi- cate of Compliance has been issued ty this Board of Health. a Signed Date� � -)_ Application Approved by 0' DatqO' IF Application Disapproved fo the following reasons Permit No. Date Issued o:? k - _. �. Fee ) r THE COMMONWEALTH OF MASSACHUSETTS Enteredzit m�omputer. x PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yicatio " iigogarp�tetn Congtructionerm�it �� ,--' Application for a Permi4 t @ons ctA R pair( Upgrade( )Abandon( ) CCT omplete System ❑Individual Components Location ddress Lot No.1 , Owner's Name,A dress and Tel..bjo.) l A�sor's M pd/Pazcel�✓"'/►2 DA / y�qq�•c.i f oZ — OX6 Installer's Name,Address,and Tel.No. t Des;iggner's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size' sq.ft. Garbage Grinder( ) Other Type of Building A)6 S No.of Persons Showers( ') Cafeteria( ) Other Fixtures Design Flow f G� gallons per day. Calculated daily flower J . 5 gallons. Plan Date Number of sheets Revision Date � Title , j Size of Septic Tank Type of S.A.S. Description of Soil f Nature of Repairs or Alteratio s(Answ,er when applicable) 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 Certifi_ cate of Compliance has been issued by this Board of Health. f Signed G %' Date�•� /� ,Application Approved by Dat Application Disapproved for the following reasons ` ti x` r Permit No. ' Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired X Upgraded( ) Abandoned( )by — a i� C.z,-s T - at � 5'� 7 l��2 -^� 2 '.4 '0 has b - constructed in,accordance with the pro isions of Title 5 and the for Disposal System Construction Permi o. �U dated Installer 2 Designer l/ 7 t /�l• m C j The issuance of this /e srtl 11 o be coonstrued as a guarantee that the s s wil fun/ctioo as de`igne�� Date (J 1. Inspector �fi�� i w ���lf s '4 i9 ——— -- i+ No. t�. ��../�-il✓ ---------------------Feed. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS &.5po.5al 6potein offitruction Permit Permission is hereby granted to struct(Repair( )Upgrade( Abandon ) System located at Co o9 2 v<I %f) .L a- f ,� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions.. - Provided:Construction must be comAeted witlfin three years of the date of this p- it. ' X "5 !i6Q7) Date: Approved by 1 �'� -A►.cf.v�rociZ.ta.A-c.�� a.,,�oQ G�.a K-le_r G--�a,.•. �� �ffi�-C.�� � G.- ��� G �i-�.,� ac�v�° : �a v,.,� �✓� 17 w Cra m{ s Gum i u� /.��. a r,� d� �e-� (mac`a�J A ! S G2a wu�— wa-u A �.e. `��. (,�.�2 - ,� _ ;-l�� v�oC �:-�.;� , �c• ter' �;��,�-�- � ` �v-v-w, — `�'�.�- Co�. G�o� �-J Q-Gr�sP�b Gc OL �2a st k4 4:L,�-s o'e-<L ez woloe� elder 0.1� 4yf, A v it-k- CI s- - alei w2�64 ate. LAX z v` G--�� � �� � •� Cie f�2� ,�.�� w, �� � s ,� t � � �:� • � _ � �� � ; i� • 'F i ' r�� ' � f ( � j1j ti � i s� e i ,�` , ` � .., � 4 + Y � 4; � i ' t` �i'� k ' i. r • �'�, � � L � � r. 1 �' 11 {� ,/. i .� - � �. � Y '' ` f + to f 1 1 } e ' �� �{ � t � � e r � j � � .. .. . x � s -- - � � '�' r _ r �. s � �~ �+ , ~ ^ rr T � � 4 � L J w ii w � � � , r ' ' y � � � — 1 &0"- L h a d' CL&-� /O J { 7 o -�"�rl� o� � cv►- der. dv a^�.� •y %a� S fi�y �� d plc cede ov a � t a I t i • 1 j • i I I • ! 4 - ♦ �.f f E - � � , f I � � r f. ,;,_ 3 4. � ; � 4 z •• .,• r 7 � ' � Health Complaints 06-Apr-00 Time: 1:00:00 PM Date: 4/6/00 Complaint Number: 2301 Referred To: GLEN HARRINGTON Taken By: GLEN HARRINGTON Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 27 Street: HIRAMAR RD. Village: HYANNIS Assessors Map-Parcel: . Complaint Description: Unit reportedly filled with trash, animals, animal feces. Child observed in bare feet which were covered in trash, filth and feces. There was an over powering odor. Actions Taken/Results: Inspection set for 3:00 pm today to meet with HAC and DSS. Investigation Date: Investigation Time: 1 �1 PAGE NO. DATE: Oho O6 ASSESSOR'S.MAP&PARCEL: COM/P/LAINT LOCATION: Hyanni S, �•� COMPLAINT DESCRIPTION: CIO S fly, /`1/7i/+9rcl.�, P-/i?i/Y14.� �etiCS, cG,�/J vJ�rc�oat� i ✓1 %r'A-ski atiJ cdv���d w� �ti ii-�SL, .4rr/O �:/,�ti ORIGINATOR OF COMPLAINT(NAME)- ADDRESS: PHONE: yA DATE: INSPECTOR: INSPECTOR'S ACTIONS/COMMENTS: v -z'203 499 p33 'Ug Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for Intemational Mail See reverse Ist ZIP Code Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom&Date Delivered .a Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $Go Postmark or Date 0 U a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. It you do not want this receipt postmarked,stick the gummed stub to the right of the a�i return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article Q 0 RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. c0 5. Enter fees for the services requested in the appropriate spaces on the front of this ff receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3611. ; 0 6. Save this receipt and present it if you make an inquiry. 102595-97-8-01< a r FIIH*E Town of Barnstable do Department of Health, Safety, and Environmental Services "'"SS Public Health Division P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health July 20, 1999 Michael & Patricia Blank 8 Parmenter Road Framingham, MA 01701 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 27 Hiramar Road, Hyannis, was inspected on July 13, 1999 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: 410.280: Mechanical ventilation not operating in bathroom. 410.481: Building not posted with owner's name, address and telephone number. 410.482: Smoke detectors not operable. 410.500: Carpet stained/worn to an uncleanable/unsanitary condition. 410.501: Storm door to main entrance was observed to be broken and missing a screen. 410.504 C Seal around tub wall and floor was observed to be rotted. 410.550 B Infestation of cockroaches observed in kitchen cabinets, utility/furnace room and hallway closet. You are directed to correct the violation of 410.482 within twenty-four (24) hours of receipt of this notice by repairing or replacing the smoke detectors. You are also directed to correct the remaining above listed violations within five (5) days of receipt of this notice. blank/wp/q/Is 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 q02 A. McKean Director of Public Health cc: Department of Social Services Bruce Roberts Eric Winer I blank/wp/q/Is r J�o INC. The Town of Barnstable -_ Health Department } ""TrLn 367 Main Street, Hyannis, MA 02601 rua AY�' Office 508-790-6265 Thomas A. McKean FAX.50 344 `�9 Director of.Public Health NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at Z-7 a-.1 was inspected on fY t 3 , 1999 byx 6(eN l-(a rrthy�ov, 2.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: lNS'CstnlL qlo, 2 /Vt2`�eu,,,,caj vewfi y >�+ SZ S' L4.e &4�p,4-✓s 1AZ Y- o�A.t* `1 l S�Jt7 C ,f s-�a �eo� l wcnr ti -f f 0,Ll FZ G (6;(o�, . ( � 1 You are directed to correct violationxfjwithin tw�enty- V r✓ four (24) hours of receipt of this notice. ' 12 You are also directed to correct _c�e_wx .�u a ,3 L td(c.dti`�" within ��„-e a s - 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 ()(F pc� c o <<Ii n FJ R � b � � e I� Health Complaints 12-Jul-99 Time: 4:00:00 PM Date: 7/9/99 Complaint Number: 1952 Referred To: GLEN HARRINGTON Taken By: K.S. Complaint Type: CHAPTER II HOUSING Article X Detail: UNSANITARY CONDITIONS Business Name: Number: 27 Street: Hiramar Rd. Village: HYANNIS Assessors Map-Parcel: Complaint Description: DSS agent has reported a total mess in the house ( bed odor, combination of feaces and dead fish). There are two children living in unacceptable housing conditions. Actions Taken/Results: Investigation Date: Investigation Time: 1 r � FORM30 CAW HOBBSBWARRENrn THE COMMONWEALTH OF MASSACHUSETTS I� BOARD OF HEALTH 10 CITY/TOWN o DEPARTMENT Po. 6a x S"3q, 36 ? S* &4A I 'o ADDRESS d ci(g ys `t 6 ,e L( 4�M SVOy`0W -r `l TELEPHONE Address 21 �^ku-d Occupant Cc-`'c ( To�_ S Floor Apartment No. No.of Occupants CZ ad z cc,) -C/o ci1� ta�Yev, No. of Habitable Rooms No.Sleeping Rooms Z v ( _77i_ /6 4AYWea' No.dwelling or rooming units No.Stories_ / Name and address of owner c "� 3(O.-A GL_— 9-,ce A7,_A6-Q., & , .4 61 — 2-0O5YRemerks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish 1 Containers: „ 1 ; Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: 13w&L,^ S �"l S'r✓✓ ocR ❑ B ❑ F ❑ M Doors,Windows.- Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: 94ac io..t t- Woe h Lie � Obst'n.: L Hall, Floor,Wall,Ceiling: Kc4c 44.h Z Hall Lighting: GUi,&�zd pl uLo 1.44 ri s Hall Windows: a S[vc c HEATING Chimneys: Central ❑ Y El N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks &kc4y Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 S d Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten. Mil, Elect.: 4, 3 Stacks, Flu ents,Safeties: �. p.v, d��rR Kitchen Facilities Sink — a -� Stove Bathing,Toilet Facil. n , Plumb.,Sanit'n.: c`^� . veA i-I6•vUc,--.(vu w7K tr,. Z ash Basin,Shower or Tub: v]a Ccv ro&V Q Lve//* F100r- 3 Infestation Rats, Mice oaches r Other: d�v� �� It'. Cov(;rV�5 js Egress Dual and Obst n: -.d fry &Lcu v4 ,- General BuildingPosted os i oqo ;ru^5 k� a reJ)f 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 " i INSPECTOR TITLE � ZXw! 7/13/2 9 1. 3� DATE TIME THE NEXT SCHEDULED REINSPECTION y ,�` A.M.\'� S P.M. ,,. . a e,� ., ..t,, +.���:.:,,,e.n:.�: yd �y. :M4l�tia^Fdn�i.NlIK•..31�1i�)^',�'�A'' WYh�, 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 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 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 410.20.2. t (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. W 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. I ' (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. r (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. - 4ds�� dv2-Q J7 -- -- {: _ cl ,• (c�..,,, ,.id d7S�i Via-f i .w��...p',-q T° 'c °- _ - 4r-6 c! S Gar 1 d o416 r, G►.,..i e1d`in%��. tc✓a� e�G� � �- S�"l/ Co�.�l, ,y w� rza R � L•A Sfs 1.� sa15 J ti/e ✓tea 615 76 D_ az�� 3q�J��3�6 - 77/ g 13v w. S�per �c Ja4 .Ma�7jL h—s© (�oQ � t����.r�-2 a s��c� Sc�,,0� <E- ��;�C,•e� l�a.�.!��--��-°'^-, �Jt r�.�..�i,1"d�e �,atp- J-aL ,,e rk2 w a cr',,- S Y-L 1 VVt t,(R. $ V--15z_ S LP- cs�3 �(G—Q G�O�'i� 7- /�o 7��^e d�v l w+�J 7�✓S �i v� p�a�t.e wd J in s�_ _��fifi r� d-7 nee- efo0 -ri�yj Yf (e�2 S c `' _ 7�-�e o�„�h.e,-� C,�-..e liw % o� d� ✓r-c✓ G� � -J 8 oav _ k- Ile saZ �- t:_ r � � � f � _ - ., „ 4J+ o a � �` � ' � 4. ' `� � w 1 j �� � � . 1 S' 6' 6, T �. } � � 1 -� W ' �� 1 _ � � �� - ' ( � _ �' i 1 y .w .., r � _ ,� � � � � 1 r u„r �.� ' . } 4 Y. + 1 1` tw 1 � r' � i f ti - 4 .. !' f "' ^, I � : t.. I ¢. ,t � �.r' � i 1 . � / 1 � i � . 1 — .�.. � 1 _ � �. ` 1 + 1 1 � � � � r , FORM30 CIW HOBBS&WARREN'm THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 3 d*1AS-4-6 I-e CITY/TOWN a DEPARTMENT &,ilday s 3 ql 1 G 7 Al 4 .E /A 'o ADDRESS f TELEPHONE' Add Occupant C01-10 r Floor_ Apartment No. No.of Occupants No. of Habitable Rooms �,cf No.Sleeping Rooms —Z- No.dwelling or rooming units_ No.Stories_ Name and address of owner—A4 Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish &_Cc.. Containers: ai-c_a 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: g40J. 1,v'�{c lrti• ��, ��� CaucfCOZr Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusin ,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: ODoLd4,1 IN., �J De 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 PENAL TIE OF PERJUFI INSPECTO o- TITLE M DATE Fill 10 4 TIME 1 P.M. C A.M. THE NEXT SCHEDULED REINSPECTION 7 / P.M. ' 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or impair the heaith, or safety and Well-being of 5 person or persons occupying the p�ernises.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||. 105CIVIR41O.1OO through 41O.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 thore(ue'io not included ih this listing. Failure to include shall in nu way beconstrued aaa determination that other violations orconditions may not be found VutuU'within this category. Nor shall failure to include affect the duty ofthe|oou| health official to order repair orcorrection of such violation(s) pursuant to 105 CMR 410830thmugh 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. � (\) Failure 10 provide a supply of water sufficient in quantity, pmaourb and temperature, bothhotundoo|d. tume$theordinary needs of the occupant in accordance with 105CIVIR410.18U and 41O.190 for a period of24 hours orlonger. (B) Failure to provide heat asoeqoimd,.by105-CMR41O.2O1mimproper venting muse ofa space heater mwater heater as prohibited by 105CIVIR410.20O(B)and 41O.202. . ' . . ` � (C) Shutoff and/or failure 10 restore electricity orgas. (D) Failure to provide the electrical facilities required by1O5CMR410250(B). 410.251(A). 410253 and the lighting in com- mon areurequied by 105CMR410.254. � � (B Failure Vo provide a safe supply of water. (F), Failure to provide a toilet and maintain a sewage disposal system in operable condition aarequired by 105CIVIR 41O.150(A)(V and 410.3O0. (3) Failure to provide adequate exits, or the obstruction of any exit, passageway mcommon area caused by any object, including garbage ortrash, which prevents egress in case ofan emergency 105 CIVIR 410.450. 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CIVIR 410.480(D). (|)` ` |u'vaVouomp|ywith'anypmviaiono'of 105CWR410.000. 410.801 6r�4106O2which results in any accumulation ofgar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests orothomwioo contribute to accidents ortp the creation or spread nfdisease. (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, 105CIVIR480.000. (See M.Gl. o. 111 @)@ 190through 199j. (K) Roof, foundation, mother structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers m impairment Vu health msafety. (L) Failure to install eleotriva|, p|umbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure Vn maintain such faoltioo as are required by 105 CIVIR 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 msafety. (M) Any defect in asbestos material used as insulation or covering on u pipe, boiler or furnace which may result in the m|euoa of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CIVIR 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 Voor knowledge of the owner of said condition mconditions: (1) Lack ofa kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack ofa stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub ao required in1O5CIVIR410.15O(A)(2) and 41O.150(A)(3)orany defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system many part thereof in violation of generally accepted plumbing, heaking, gmsfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing fui every stairway, porch balcony, roof or similar place aa required by 105CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, oouknxmhoo, insect infestations and other pests unrequired by 105CIVIR 410.550. (P) Any other violation of105CIVIR41O80O not enumerated in 105CIVIR41075O(A)through (0)shall bo deemed 1oboacon- dition., which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the I owner t6 mmedyoaid condition within th*time000rdered by the Board'of Health. . ' - - ` ` | __� f— 'M THE COMMONWEALTH OF MASSACHUSETTS FORM 30 FI6�W HOBBS&WARREN BOARD OF HEALTH 3 a i,&A s4e-6 IP I `t CITY/TOWN t �fQ A ��►'"1 5 DEPARTMENT ,/G/ ADDRESS M SVeye �6Z-46y� 1 TELEPHONE Address_-/_ rGv !M Occupant Floor Apartment No.___---_____ No. of Occupants , No.of Habitable Rooms__No.Sleeping Rooms_ No.dwelling or rooming units 1 No.Stories r Name and address of owners :t_5 C And k Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Rt 1 ov/l -.vo IRCA Containers: q" v 0-7 `F",a , 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: Lighting: STRUCTURE INT. Hall,Stairwa : p 1 w✓ LK kl IL. SGfo.i lwt,,,j OT 64 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: DWELLING UNIT 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. Sup. en., Gas, Oil, Elect.: ZO c 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: 2*&c,(*) 'r, 4C4 4.t,4 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 �,Q TITLE Ivan M. DATE 00, 11 07 TIME I I' V P.M. A.M. THE NEXT SCHEDULED REINSPECTION o1r� j„,S.".�„" "' '""`'T_.'T"'" "` P.M. n 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 included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and 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. .-ter 1 ,M THE COMMONWEALTH OF MASSACHUSETTS ` FORM 30 C&w HOBBS&WARREN BOARD OF HEALTH CITY/TOWN o DEPARTMENT ADDRESS TELEPHONE Address 2-7 Occupant Co-tv / �'► d Floor Apartment No. No. of Occupants 3 No. of Habitable Rooms '7-Y——No.Sleeping Rooms �- No.dwelling or rooming units No. ories l Name and address of owner 0u� tiC 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: Dam Hess: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: ' uSCu„¢rw ov,f ;.(G cf 1z lv az:e 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.: 13110 ❑ 220 Fusing,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Ufr1 (30 Stacks, Flues,Vents,Safeties.- Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: -V'eAA t- i Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: 4a- a6 g P49 i &P,&- °; /o 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 PENALTIE PERJURY " INSPECTOR c TITLE DA TIME P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. § r.r v.... r ....... ....... ....... _ y :-:f a., .,v_' w: 'V :,�. ."...:.• 'nvk.M-N•\.::..w,°aL+nv,fc' . «. 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 included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (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 Ieadbased 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. THE COMMONWEALTH OF MASSACHUSETTS 'M FORM 30 &w HOBBS&WARREN BOARD OF }HEALTH CITY/TOWN o DEPARTMENT i/�Z/ ADDRESS M G 7 - 4�1 IN 1# TELEPHONE Address 2 -7 0(r`/w"A r — -- --- - __-Occupant_C f ! c-�vi, Floor -Apartment No._ No. of Occupants No. of Habitable Rooms '___ No.Sleeping Rooms No. dwelling or rooming units_*_- _ No.S,ories t _— Name and address of owner `C_"-(_ 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: r Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: (i % f, r%,`I,r� s (r r :c j i5 rz f/a 60'rff 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: DWELLING UNIT Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks F Kitchen f Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: - Gv A A" cr, f C u Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: V CA c Wash Basin,Shower or Tub.- Infestation Rats, Mice, Roaches or Other: VGC< 0( l'i t4 ou 3� E ress 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 1C ltt', ��`-' TITLE `lyel '`'ld�a%�t ? r DATE / TIME y �� P.M A.M. THE NEXT SCHEDULED REINSPECTION P.M. 4 e.. y 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 not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (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. i (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and 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. TOWN OF BARNSTABLE LOCATIO 7�(�A�?A2 D SEWAGE VILLAGE-- h`y'��Od S ASSESSOR'S MAP & LOTa-22 --o/a INSTALLER'S NAME&PHONE NO'Ikt-H �""�� ell SEPTIC TANK CAPACITY //1��'°�S 3)s O!� rAA c2S (size)!Fi /3 X LEACHING FACILITY: (type NO.OF BEDROOMS BUILDER,0 R OWNE) PERMITDATE: 0 COMPLIANCE DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the$ottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) g Furnished by c �saos 3 4' c ,SooG�y�d!FnS 3,5 ell— ' i L0CA'&�TION SEWAGE PERMIT NO. �a 7 g VILLAGE. I N S T A LLER'S NAME & ADDRESS e U I L D E R OR OWNER Q U_cL9z.ei1 l��c,Q..Q ac,.P DATE PERMIT ISSUED DATE COMPLIANCE ISSUED g� a v da No.. ............._............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® E HEALTH OF...................... .. . .. .. .......... ApplirFatian for Disposal Works Tonstrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair (✓) an Individual Sewage Disposal System at: ............. r ------................ ..... ......... . . ............ ..- -- -t--- `Address —O o. ............. ................ .... ...... .................... .....,..: ................................. a ��._.99wn-e �cC C_ s Wa .--- . .............................. -C/ �j(.. ...--- ........................ ........lo:.. ........................................................ Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) PL,a Other—T e of Building No. of.persons............................ Showers — Cafeteria Q' Other fixtures -----------------------••-------------------------•••-. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter-_______-___-- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) r•" Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ••••••-•••----•-----------•-••-••-••••-••••-••-••-•--•......-•--•-•......--•---•-•-•-•---•----------......................................................... ODescription of Soil....................................................•-•-•--•-----------•---••-------------------------•-------------•--------------------------------•---------•••.----- x W U Nature of Repairs or Alterations—Answer when applicable__�W...!7_...�.�' ... ____ � _ 'c' C�. Ulf f r✓cT)f ? ' S'PD�e Lee�..e72 Agree t: h undersigned agrees to install the aforedes ri ed Individual ewage Disposal System in accordance with th pr j ions of L LE 5 of e State Sanitary Co —The unders' n further a rees not to place the system in per n u i1 er ' e ompliance has been 's ued by e lth Si ed-.. --••.•••-- •....-•••-•-•----------------------•--••--•••••••-• ................................ ----- -- ---- - Date APpl* i n pproved By................•. .... •.....•.-- •••...._. . --•-• ............................ - - ------ Date - Ap cation Disapproved for the fol ing reasons:................... .........-•---------------------------------------------------•--•--••----------.....---•-----...------..._...---------------------------------- ----------- ........................................... Date PermitNo......................................................... Issued-........ ....._.. .:. Date No.Z=.11_-.. FRs..........................._. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......- ..... Appliration for Disposal Works Tonstrudion rnmi# Application is hereby made for a Permit to Construct ( ) or Repair (v ) an Individual Sewage Disposal System at: ,/ / --Address.................................. ....�...._%� ........................ .o �N£0�.. _........................_.. CD ............ .................................. ....................................... ......................................................... Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a YP g ---••-•------------------------------------ .... ( ) — Cafeteria ( ) dOther fixtures ....................••-•••••...... ....•--••••---•-•-•-••-••--•-•---•-•-••••--•....•-•-•............. ........... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. ap W Septic Tank—Liquid cacity........_...gallons Length................ Width................ Diameter................ Dept h................ x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area...................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by..............................................__........_..__............. Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.................... LL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ......• -----------------------••--------•-•------•-----............-•-•-•------.........•---•--'••-•-•••................•--•- .....--••--'--_...-- 0 Description of Soil........................................................................................................................................................................ U --•----------------•••---••••------•-----_--••----•-•-------•----_••••- -----•---_-_______-----•----------•------•-•-------•----------•-•-•--•----___-•--------•---•-••----------_----- W ..• -•---------------•--•---•-••--......•••...........••-•••• •......•--•---•-•._..........----•--•••-•-•-••-••----•••-••••-•...••----•-•-•-...._____... .... U Nature of Repairs or Alterations—Answer when applicable.. �!�_.!a___. '_e,77,UC— � --------------•-••••............•...... -•- •-•-• Agree t �fT undersigned agrees to install the aforede arid Individual gewage Disposal System in accordance with the pr lions of 1 5 of e State Sanitary Co' The underslgned°further agrees not to place the system in .oper on u slued it ert' t Compliance has been be lacaard�af�lt�l �Z�/ . Signed• ... j 5 --•-•••-•-••--- •.......... .......................... J f / �,7 Date .APP 1 Approved By••••--••-•-•-_... ._ ,�1... ......l !....1............................ —f Date Ap iea.tion Disapproved for the f of ing reasons:--•-•---------•.....................................•___--------------•----••--•-------------......••---•-•--'- .....................•--......-------------•---.......---•--•--•--........._..----•-----•------...-•-•---._.............:......._......_............------•••--•-•-•••-•••••••--•----•---•--•-----_--•-- Date Permit No....... S 1 •�...................... Issued..:................ ......... ......... ate THE COMMONWEALTH OF MASSACHUSETTS + BOARD PF HEALTH c °e.................................................. (In#ifiratr of f ompliane THIS IS TO CERTIFY, Tlya the Individual Sewage Disposal System constructed ( ) or Repaired by...................0--___,`�....._G-c4-••---G- ...:�'�'.C----•---••-•------- ---------•-----------•------------ �3 at...............CS S ! -7 /lIk'/,G.v- /,' l'-1<.9 r ? 4-a f �_ ..---......-•--•-....------•.....................•-•-•-•----•---••----••••• ••--••-••----••--••---••--•-•-•••••-•-••••....••••.._....................-•-•-•-----•••-••-•- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUE® AS A GUARANTEE THAT THE SYSTEM WILL.FUNCTION SATISFACTORY. DATE.......... ........................................... Inspector-_••-'•. --- - --•-• -.............. THE COMMONWEALTH OF MASSACHUSETTS _ - BOARD OF HEALTH ............. :�.... L OF.......................... '�tare' z: .. .................................................... No......... .IFEE..................... Disposal Works Tilitstrudion Prrutit Permission is hereby granted = fe -•------.....---•-- to Construct ( ) or}Re�air (u')'.an Individual Sewage Disposal System at No..... `l 7 7 . Street as shown on the application for Disposal Works Construction Permit o��............... Dated... +a' _. ............. b-Nara of Health DATE.......2_*.A-.,a)-.`-9.�?__....---•-•................................. FORM 1255 A. M. SULKIN'INC., BOSTON qL ---- -- --- ASSESSORS MAP : 12' NOTES: TEST HOLE LOGS PARCEL : _ b� 1►�= (. SO IEVALUATOR : �/R sae M • M�=- �.S 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH FLOOD ZONE : L _ P f' Y � THIS PLAN, 95 MASSACHUSETTS TITLE V & TOWN OF WITNESS : A C - (�.rj 5 A } 5T)iA BOARD OF HEALTH REGULATIONS. > i Cv REFERENCE: (2,I07 DATE:_(_)C.To_gER IU12=2 2) THE INSTALLER S ALLER SHALL VERIFY TH E LOCATION OF AT� UTILITIES PERCOLATION RATE I- Alw '/NG+� SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO d�t� INSTALLATION. TH- I eL,6-0, TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION q�, n f U�M\l I / ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE r ft I. I IOC (Z3 DETERMINATION. 4) ALL PIPING TO BE 4" SCHEDULE 40 @ I/8 "/ FOOT. (UNLESS LOAMY �Q 1 P�S�j SPECIFIED OTHERWISE) LOCATION MAP N -T.S` SA n� ' v 1 A 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A �- ,r 4� ,13 20 GARBAGE DISPOSAL. Al Dr V PC 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) T(Y / MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON 2,S\I � r" A BASE OF 6"OF CRUSHED STONE. -7) C-ESSPCOt4; 7D 56 FVIUe��, A) 1�� yr 5 a v v �" V. SEPT I C SYSTEM DES I C N .� FLOW ESTIMATE //,, �J--/��--✓_Ai2l ANC �� T 2E �/ o� ..tQ 11 4 BEDROOMS' AT j�0 GAL/DAY/BEDROOM - 4` O GAL/DAY C r . SEPTIC TANK 'i Z440GAL/DAY x 2 DAYS - �a GAL \ USE lam ? GALLON SEPTIC TANK —/,/ BEN CH r PT I..ON SYSTEMMA-R< Ta7 or- (Ace \ \ ' PRECA--s 04 Ceti s _ U ,5 BTU M ASSUME v ( X L x r> w t� 35 '� x2 a� �0 �F SIDE,,AREA: 33.5 Z +- 13 �, k 2. k C>;7y = /37 (O� BOTTOM AREA. . `> I k O, UfB F� 7 .� �. � IN O C7 O SEPT IC .. .-..SYSTEM SECT l ONeA, � / �� , 1� � ue�,, sa �,�,� � �NG�}/t���-Q,K..- 7U'• = �L �uW 8U (�t-��vntis�Y� �'� j ovT Cvvets \� \ � •� o � � � / 1 5�� lo30 " 14" w`u•� �nisL �i�udP � �„M�7 .._.. __._M_�,.. _.._._. ��_ ___ A5 r� 1 � �� � ` � _. ..- 6 b� ' �v �•; 6''5S z,he use c DSB OX 7, SLAP, �f�w / GAL �- G 1 > t SEPTIC 7 vu, rs t \ // p-� >�___ TANK `� 7/7 -- oF- OAP A OF tf4 c - �o �A S I TE AND SEWAGE PLAN o. Sao LOCATION : 7 SgNI TAR�PN -02.,' 2� PREPARED FOR O O c. .. �� ARGP/ C.Dit/,.S%�`2UL 77 0 SCALE : DARREN M. MEYER, R.S. Z • 43 VINE STREET DATE: /y-2.3-os-- J z D UXB U RY, VIA 02332 " DATE HEALTH AGENT (731) 585-0293 Z u ,