HomeMy WebLinkAbout0033 HIRAMAR ROAD - Health 33 - 35 FRESH HOLES ROAD, HYANNIS
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P TOWN O BARNSTABLE
LOCA-,ION 33-v�S �/�tSp�j O Odd SEWAGE #�-
VIL.LAGE ASSESS R'S MAP&LOB
AME&PHONE NO�. 7' k a 0n6
SEPTIC TANK CAPACITY /6706 Q4A1) ��� �,,�is�•
LEACHING FACILITY: (type) �i �3 I(�J (size)
NO.OF BEDROOM 4
BUILDER R OWNER �i
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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 t of I achin far,),2)j
ce Feet
Furnished by, Or tr/�% i 7`/Ge -Zzoc
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Fowler & Sons. Inc. Invoice
Termite, Pest Control, and Turf Management
358 West Main Street DATE INVOICE NO.
Hyannis, MA 02601 12/28/2011 417772
508-771-BUGS (2847) 508-771-TURF
Service Date: 1212712011
BILL TO Address Serviced.
ERIC WINER ERIC WINER
144 BARTON RD 331ANET`35`17F ESH'+f&ESS `
HODGDON, ME 04730 HYANNIS, MA'02601
TERMS: Net 30 Days
DESCRIPTION AMOUNT
Initial - Bed Bugs $300.00
TOTAL $300.00
ER
- --__._.
..............................................................................................................................................................................................................................................................................
Please Return This Portion With Your Payment
From: ERIC WINER Invoice Number: 417772
144 BARTON RD Customer ID: 126507
HODGDON, ME 04730
Prior Balance: $0.00
Invoice Total: $300.00
To: Fowler& Sons, Inc. Amount Due: $300.00
358 West Main Street
Hyannis, MA 02601 Payment Amount:
Check Number:
*Please include the Invoice Number with your payment
BORTOLOTTI CONSTRUCTION, INC.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
Address Prop 3 3- 35-
Date of Inspec Map Parcel Owner
PART A — CHECKLIST
CHECK IF THE FOLLOWING HAVE BEEN DONE:
PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH.
--NONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN
RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO
THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION.
i/
AS-BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WITH N/A.
THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK-UP.
y THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT.
,--ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE.
THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC T.ANK WAS INSPECTED
FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE,
DEPTH OF SCUM.
THE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR
APPROXIMATED BY NON-INTRUSIVE METHODS..
✓THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER
MAINTENANCE OF SSDS.
PART B — SYSTEM INFORMATION
RESIDENTIAL FLOW CONDITIONS
No of Bedrooms V No of Current Residents Garbage Grinder
Yes Laundry Connected to System Seasonal Use
NON RESIDENTIAL:
Calculated flow
WATER METER READINGS,IF AVAILABLE:
GALLONS
Pumping Records and Source of Information:
SYSTEM PUMPED AS PART OF INSPECTION? /Y v IF YES,VOLUME PUMPED = GALS
Reason for Pumping:
TYPE OF SY EM:
Septic tank/distribution box/soil absorption system
Single Cesspool Overflow Cesspool Privy
Shared system (if yes, attach previous inspection records, if any)
Other(explain)
Approximate age of all components. Date installed,9 known. Source of information.
SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE?IVO
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B — SYSTEM INFORMATION (Continued)
SEPTIC TANK:
Depth below grade:/ ,/i� Dimensions: `+A.5-X
Material of construction: 1CConcrete Metal FRP Other}
Sludge Depth / Distance from top of sludge to bottom of outlet tee or baffle
Scum Thickness �// Distance from Top of Scum to top of outlet tee or baffle
Distance from bottom of Scum to bottom of outlet tee or baffle
Comments: (
��5 �' /6 0U u �Da7 /`F- C�Jal C a G G��"l Geu/l �D �•�' /�z mod
/��al-) 2�2 17Z 0 e-;Z s ►� had ''
Q /' �3 /rJ /I'I P_ /�Jcr _ d77, �L<' Cii� - .
DISTRI UTION BO . i72C. DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT
Comments:
PUMP ZH—AM BER: Pumps in working order?
Comments:
SOIL ABSORPTION SYSTEM (SAS):IF NOT PRESENT,EXPLAIN: _
TYPE: ' —/ D //7 plc
c� �a c . /
Comm nts:
i JL b`�JCc P� Vi
/� ►/—042
CESSPOOLS: 5 Number and configuration
Depth—top of liquid to inlet Invert Depth of solids layer Depth of scum layer
Dimension of cesspool Materials of construction
Indication of groundwater inflow(cesspool must be pumped)
Comments:
PRIVY:
Materials of construction
Dimensions Depth of solids
Comments:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B - SYSTEM INFORMATION (Continued
SKETCH OF SEWAGE DISPOSAL SYSTEM:
INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES,LANDMARKS OR BENCHMARKS.
LOCATE ALL WELLS WITHIN 100'
o
(�1
� m
DEPTH M GROUNDWATER: DEPTH TO GROUNDWATER
METHOD OF DETERMINATION OR APPROXIMATION: /
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART.C — FAILURE CRITERIA
(Indicate Y—yes N—no ND—not determined.Describe basis of determination.If"not determined",explain why not.)
Backup of Sewage into Facility?
Discharge or ponding of effluent to the surface of the ground or surface waters?
Static liquid level in the districution box above outlet invert?
Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow?
Al Required pumping 4 times or more in the last year? Number of times pumped
Septic tank is metal?crackedl structurally unsound?substantial infiltration?substantial exfiltration?
tank failure imminent?
N Is any portion of the SAS,cesspool or privy, below the high groundwater elevation?
IV Within 50 feet of a surface water?
Within 100 feet of a surface water supply or tributary to a surface water supply?
Al Within a Zone I of a public well?
IV Within 50 feet of a private water supply well?
Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)?
Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water
quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for
col'rform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen.
PART D — CERTIFICATION
INSPECTOR: ROBERT J. BORTOLOTTI, ADDRESS: 765 WAKEBY ROAD, MARSTONS MILLS
COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508)771-9399
CERTIFICATION STATEMENT
I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION
REPORTED IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY
RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE
IN THE PROPER FUNCTION AND MAINTENANCE OF ON-SITE SEWAGE DISPOSAL SYSTEMS.
CHECK ONE:
I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THEF SYSTEM E FAILS TO ADEQUATELY PROTECT PUBLIC
HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303, ANY FAILURE CRITERIA NOT EVALUATED ARE AS
STATED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM.
I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN
310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS
FORM.
INSPECTOR'S SIGNATURE:
DATE:
ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(if applicable),APPROVING AUTHORITY
r
Auguste TO,. •X984,.
Dolben, ..Inc."iAg,ents
Quaker-9iaage Ae9ociatoa.
40 Court Street."
Boston,,'Ma. 02108
NOTICB,TQ;"ABATE: VIOLATIONS .OB`,105 CMR:410000, MINIMUMSTANDARDS�OF FITNBSS'.
'FOR;HUMAN. HABITATION '
The property.,owned by. you, at 334resh Holes Road, Hyennis, .was inspected on .'
August 101 1984, .,by,Janet Gribko,.-Realth Inspector 'for ,the Town of Barnstable,'
because pf a complaint-;by.'the tedant•,'Debara kalbes'. The following .violations ,
of State Sanitary . .• II. ,10 -tMR 410.090 'Standards of Ftt-C n
tress for Wumen `Habitation;-were:observed
RHGULATION410300i Large. ,area in laving room ceiling and wall bq front
',door water. stained. . -Water 'lcaka in men it' rains. ` ✓
$`eVezial ceramic wall tiles. missing from tub. aref_wal l+ Wa11- adjacent,..to
front,of tub water:soaked.,-mildewed,
'REGULATION- 410.351c Water' leaks fiom ebower head aad `'tub faucets: Leak
at .%rater drain connection ?in :kitCheri`sink,'..
,- REGULATION 410.3511 Gas 64e6-door` does not close tightly,., :,Left ;front burner
ori' -stove-loose from fitting'.- gus1•odor. detected.( Iir:; Potter. of Col n al
Gas Company .aotiffed ,by •the Board of Hearth on QugueE 100. `1984).
Vbu are=:dirdcted to tcorrect �theee ,violations: within seven_ (7) ` ay$ :orow ipt
of this notice.
You may request a hearing before `ihe•Board',df. Rea lth_ It..written petition,.;re
,questing same is -received within-seven (7)�days aher.the date order served. '
Non-con lianee:eoula result-.'in a fine
' up to.'.$500. Bach day's failure to,
comply with An order -shall constitute a. separate violation.
fBR,ORDBR OF.THE BOARD.OF HEALTH
John*.,.Ully
Director. of: Public Realtti
JMR/mm
cc= Debars`-'RalWe-
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BOARD OF HEALTH
Town of Barnstable
P.O. Box 534
Hyannis, Massachusetts 02601
This is an important legal document. It may affect your rights.
You may obtain a translation of this form at the Town Office.
ARTICLE II
STATE SANITARY CODE
Address: . ., .. . . . . . . . � ,h. . .A1. ./u . . . . . . . L ,"/_ . . . . . . .1.,�'J.�/�. . . . No. Occupants . . .1?1..,. . . . . .
,/
Occupant: �. . �! . . . . 6. v '. . . . . . . . . . . . . . . . Floor: . . . .. . . . Apt. No. . . . . . . . .
No. Dwelling Units: . . . . . . . . .?. . . . . . . . . . . . . . . . . . . . . . . . . . No. Rooming Units: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No. Stories: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Basement: . . . . .0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Type Structure: . . . . . . . . . . . . Frame: . . .e/. . . . . . . Brick: . . . . . . . . . . . . Semidetached: . . .i,.�.. . . . . Detached: . . . . . . . . . . . .
No. of Habitable Rooms: . . . . . . . . . .a. . . . . . . . . . . . . . . . . . . No. of Sleeping Rooms: . . . �. . . . . . . . . . . . . . . . . . . . . . . . . .
t �f
Owner: � �!+? . . . . s��v�_^. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
X=VIOLATIONS
REGULATION LIVING ROOM YES NO
7.1(a) Is there sufficient natural light?
7.1(b) Are there two separate electrical outlets'in good repair?
7.1(b) Is there one outlet and one light fixture.in,good repair?
8.1A,8.1B(e) Is there proper ventilation?
13.1A Are the windows in good repair, weathertight and fit for the use intended?
13.1 Are the walls in good repair and fit for the use intended? Elt/in�t /✓ C t/�
13.1 Are the ceilings in good repair and fit for the use intended?%,,_
13.1 Are the floors in good repair and fit for the use intended? "_-
14.5 Are the exterior openings screened?
REGULATION SLEEPING ROOM #1 (identify)
7.1(a) Is there sufficient natural light?
7.1(b) Are there two separate electrical outlets in good repair?
7.1(b) Is there one outlet and one light fixture in good repair?
8.1 A,8.1B(e) Is there proper ventilation?
13.1A Are the windows in good repair, weathertight and fit for the use intended?
13.1 Are the walls in good repair and fit for the use intended?
13.1 Are the ceilings in good repair and fit for the use intended?
13.,1 Are the floors in good repair and fit for the use intended?
14.5 Are all exterior openings screened?
11 Is there adequate space for the number of occupants?
REGULATION SLEEPING ROOM #2 (identify)
7.1 (a) Is there sufficient natural light?
7.1 (b) Are there two separate electrical outlets in good repair? i
7.1 (b) Is there one outlet and one light fixture in good repair?
8.1 A, 8.1 B(e) Is there proper ventilation?
13.1 A Are the windows in good repair, weathertight and fit for the use intended?
13.1 Are the walls in good repair and fit for the use intended? _
13.1 Are the ceilings in good repair and fit for the use intended?
13.1 Are the floors in good repair and fit for the use intended?
14.5 Are all exterior openings screened?
11 Is there adequate space for the number of occupants?
REGULATION BATHROOM
3.1A(a)3.113(a) Is-toilet with seat available?
3.1AN 3.1B(b) Is washbasin available?
3.1A(c)3.10(c) Is shower or bathtub available?
3.1D 3.2 Are the facilities in a clean, smooth, impervious and sanitary condition?
4.1 (9.1 &9.2). Is cold water for facilities available (with sufficient quantity)? _
5.1 (9.1 &9.2) Is hot water for.facilities available (120 F- 140 F)? �T 9
9.1 &9.2 Are the facilities properly connected to drain line?
7.3&9.3 Is there at least one light fixture in good repair? v
7.4.& 9.3 Is there an electrical outlet in good repair at washbasin?
13.1 & 13.1A Are the windows in good repair, weathertight and fit for the use intended?
13.1 Are the doors in good repair and fit for the use intended?
13.1.& 13.6 Are the walls in good repair and fit for the use intended?/ ,I J"'C�--�:1.644 1/i
13.1 & 13.6 Are the floors in good repair and fit for the use intended?"'��;rj�
8.1A&8.18 Is there proper ventilation? �'rr ryif t�
13.6 Are the floors and walls of nonabsorbent material?
14.5 Are the exterior openings-properly screened?
' X-VIOLATIONS
s� -'REGULATION KITCHEN YES NO
2.1 Is the room suitable? _
2.1(a ." Is the sink available and of sufficient size and capacity?
4.1(9.1 &9.2) Is cold water for the sink available (with sufficient quantity and pressure)?
5.1(9.1 &9.2) Is hot water for sink available (120 F- 140 F)?
9.1 &9.2 Is sink properly connected to drain lines.
2.1(b) Is there a,working stove and oven?
9.3 Is the stove and oven properly connected and vented? rf,/y
2.2 Are the facilities clean, smooth, impervious, nonabsorbent?
7.2(a) Is there one light fixture in good repair?
7.2(b) Are there two electrical outlets in good repair?
7.2(c) Are the windows(if kitchen exceeds 70 sq.ft.)equal to at least 10% of the floor area?
13.1 & 13.1A Are the windows in good repair, weathertight and fit for the use intended?
14.5 Are the exterior openings properly screened?
13.1 Are the doors in good repair and fit for the use intended?
13.1 Are the walls in good repair and fit for the use intended?
13.1 Are the ceilings in good repair and fit for the use intended?
13.1 Are the floors in good repair and fit for the use intended?
13.6 Is the floor impervious and easily cleanable?
2.1(c) Is there adequate space and facilities for installing of Refrigerator?
8.1A,8.1B(o) Is there sufficient ventilation?
9.3(a)9.3(b) Are all owner installed appliances properly installed?
9.4 Are all occupant installed appliances properly installed?
REGULATIONS COMMON AREA AND EXITS
7.5 Are interior common areas properly illuminated at all times?
7.7 Are there operational and sufficient and properly located light switches and fixtures?
13.1A Are the windows in good repair, weathertight and fit for the use intended?
13.1 B Are the doors in good repair, weathertight and fit for the use intended?
14.5 Are all doors screened as required?
13.1 Are the ceilings in good repair and fit for the use intended?
13.1 Are the walls in good repair and fit for the use intended?
13.1 Are the floors in good repair and fit for the use intended?
15.8& 15.9 Are all common areas clean?
13.1 Are the stairways in good repair and fit for the use intended?
13.3& 13.4 Are handrails in good repair and fit for the use intended?
13.5 Are all required balusters or other devices in place?
18.4 Is every entry door of a dwelling unit fitted with a proper lock?
18.3 Does the main entry door of a dwelling close and lock automatically?
18.6 Is the building properly posted with the name of owner?
3.2 _ Are the common bathroom facilities clean?
12.1 & 12.2 Are there sufficient and properly maintained exits?
REGULATIONS EXTERIOR
Are light fixtures and switches properly located?
13.1 Is the chimney in good repair?
13.1 Are the porches in good repair?
13.1 Is the foundation in good repair?
13.1 Are the stairs in good repair?
13.1 Are the structural elements in good repair?
13.3, 13.4& 13.5 Are all required hand railings and balusters in place and in good repair?
13.4 Are there walls or protective railings as required?
15.4 Is the storage of rubbish and garbage proper (occupants)?
15.3 Are there sufficient and properly located receptacles?
15.10 Are the private passageways or rights of way clean and sanitary?
13.1 Are the gutters and down spouts .in good repair and fit for the use intended?
REGULATIONS GENERAL
10.1 Are all required services available and working?
6.1 Are the heating facilities in good repair?
6.2 Is heat being supplied at proper temperatures. (68 F-78 F)?
5.1 Are hot water heating facilities in good repair?
9.3(a) Are all required facilities properly installed and vented?
6.5 All space heaters in use meet the proper requirements?
7.9 Is there no temporary wiring in use? Location?
7.8 Is the electrical service safe and adequate?
14.1, 14.2 & 14.3 The dwelling is free of insect rodent presence?
15.7 Is the dwelling unit maintained in a clean and sanitary condition by the occupants?
REGULATION OTHER
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 av�de�t�ermined by Regulation 29.2 of the code or the Authorized Inspector. _ /A.M�
INSPECTOR / c� TITLE A.M.
DATE TIME
THE NEXT SCHEDULED REINSPECTION IS: DATE TIME
LOCATION SEWAGE EIT NO.
(J, RM`7�i
VILLAGE I
t-- (- L
INSTA E R'S NAM E & ADD�- 1 ovv 1 .
�%-�-
e UIIDE OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUEDp,r
A- 3.7 f
A - 0 pjT- 2 43r
52 To Pi T- 1 3 o r
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...... Fxs....U.j....................... ..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Of HEALTH
..OF.......... — ..
Apptiration for Bii#oiial Works Tonitrnrtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair { ) an Individual Sewage Disposal
System at:
..•••• -------•••............................•..... -- ---•...----•-••-•---••..............---•--
Location-Address or Lot No.
......................-.......................................................................... .. ! ............................................-•-•----
Owner Address
------------------------------------------------ ------------1, .........
Installer Address
Type of Building Size Lot............................Sq. feet
,.-., Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons____________________________ Showers — Cafeteria
Q' Other fixtures ------------------------- ...................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
W' Septic Tank—Liquid capacity------------gallons Length---------------- Width---------------- Diameter--------------.. Depth-------------
'
W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
x Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date.................................
. _.
aTest Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water-___-._ ;......._....__.
Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.____ _-____-_-____.
------•------------------------------•---•-------------------•--•-......----..._......------------......................................` :
ODescription of Soil......................................................................................................................... r
x
U ............................---------•-••-•-------------•-••••-•-••-•---•--•--•-•-••---•------•----••...••-----------•-•-------•••-•-------••-••-•......------------•-••--•--•........--•---•-----•----
W -•-•--•---••----•--------------------------•--•--••----•-----------•--•-------......•-•••••------•••----•••--•••--------•--- ---------------------- ------- -----
VNature of Repairs or Alterations—Ansyer when applicable.-------12rO° ._T %v' � a ---- lZ-17------ '�Q�E-.._-sY -------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'TILE of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Date
Application Approved B _
------------------•-----------------------•-----............................_.Date------..._---
Application Disapproved for the following reasons:............
-•----•--------------------------•----------------•-----------------------------------•-•--•---------------------------------------------------------------------------------...... -----•-•-•--------.
Date
PermitNo......................................................... Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE TH
OFF,, ,
�p gf irate of. Tautpfionrr �
THIS T CER Y, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
b ....... � •........... --•-----------------••----.......•---._...--•---------•--
Y ...
at...... .Jj?7- .,?X........�;�-W.���� �S . --" ------------------------------------------------------------- --- - .
aller
has been (stalled in accordance with the provisions of j.of»»-.The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. _ ..... dated_ _L__.____________-
THE ISSUANCE OF THIS CERTIFICATE SHALL NOY<BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. r
---41i�•
DATE................•---......-----•------....---•---••-------••-••••--•-••........_ Inspector-- =............
Y .
.........��'....... J'° Fps.............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
--. r ' Y.... -OF.......... ... .. ,,,,,,
Applirttffun for Bftiputitt1 Works Tuutitru.rtiuu ranfit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
......................--........................................................................ ... ..__....
Owner Address
Installer Address
dType of Building Size Lot............................Sq. feet
V DwellingNo. of,Bedrooms...............................................Expansion Attic ( ) Garbage Grinder ( )
.-�
Other—T e of Building ____________ ____ No. of persons Showers — Cafeteria
a YP g - P ,..
Otherfixtures ----------------------------------• •-• ------ ---- ---------•••. ----- ••.....-•---=
W Design-Flow'::__ ____ ___ gallons per person per day. Total daily flow____________________ gallons.
W Septic Tank—Liquid capacity_.,._.......gallons Length................ Width................ Diameter__..__................ Depth................
11
xDisposal Trench—No. .......... >._____ Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank.( )
Percolation Test Results ..Performed-by.......................................................................... Date........................................
Test Pit No. 1............._::minutes per inch Depth of Test Pit.................... Depth to ground water_-___-.-________-____-..
fs, Test Pit No. 2___._____.:,____niinutes per inch Depth of Test Pit____________________ Depth to ground water------------------------
W -------•-------------------------------••------------...__._.......----....._.....---•-•---•-------.........................................................
0 Description of Soil...................................................................................................................................................................
.._
x
W ---------------------------------------------•-•--------••-----------..._.......-•----•------•---------•---•••• . - --
Uy�sNature of Repairs or Alterations—Ansyer whenapplicable.-__,_a� � _: r- �?__._ � w
l- ?S' ex-r?° Y ""�• °' " ---------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TT T LE
p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health
Igne :.-r+ t ;�Y° �`�!... 4 t
Date
Application Approved By-- .E' •-----
Date
Application Disapproved for the following reasons:
•-•--••--•----•-----...•--•---------•--•----------••--------••---.-•-•--•---------•--------•••--•--••-----------••-•-------------------------- ...................-.............................
Date „
Permit No. • ----- .
Issued
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........... :......OF...................:...... %..:7.......__`............._...
�rr�ifirtt� of f�,a�t�rlitt�trr
THI. IS T CER Y, That the'Individual Sewage Disposal System constructed ( -) or Repaired
••---- ---------------•-- -:_._.:_..____.•-•-----..__..._._.._••
Id Ai Ins tiller
at6/, - �
has been installed in accordance with the provisions of.1 I j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No- --- --------7Y................. dated_...- __" `..4PI.................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEWWILL FUNCTION SATISFACTORY.
DATE............................................................................. Inspector.... / -•-- L, - -
,y.J
�FTHE Tp TOWN OF BARNSTABLE
OFFICE OF Capy
2 BaaNAB& Al= BOARD OF HEALTH
1M �
YpY O 367 MAIN STREET
'E k'
HYANNIS, MASS. 02601
:July 101 1981
Elizabeth C. Jones, Trustee
Quaker Village Assn.
c/o Dolben, Inc.
40 Court Street
Boston, Ma. 02108
NOTICE TO CORRECT .A VIOLATION- OF. .S,TATE.SANI.TARY ..CODE , CHAPTER II
MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
The property owned by you at 32 Fresh Holes Road, Hyannis, was in-
spected on July 9, -1981, by Ronald Gifford, Health Inspector for
the Town of Barnstable, because of a complaint by the tenant,
Kim Delancey. The following violations of State Sanitary Code,
Chapter II 105 CMR 410.000 were found:
REGULATION 410.500: Wallpaper peeling; sheetrock wall
under bathroom basin crumbling; wooden baseboard under
bathroom basin rotten, Loose wall tiles in bathtub area.
Rear d000r stick's, making locking difficult.
REGULATION 410.551 : No screen provided - rear bedroom window.
Screens in front bedroom and living room windows not tight
fitting - screens fall out of window frame.
REGULATION 410.552 : Broken latch mechanism on rear screen
door ,prev.ents tight closure.
You are directed to correct all violations within ten (10) days of
receipt of this notice.
You may request a hearing before the Board of Health if written
petition requesting same is received within seven (7) days after
the date order served.
. Non-compliance could result in a fine of up to $500. Each day' s
failure to comply with an order shall constitute -a separate violation.
PER ORDER OF THE BOARD OF HEALTH
n M. Kelly
irector of Publ c Health
JMK/mm
cc: Mr. Grover Martin
Ms. Kim Delancey
� BOARD OF HEALTH
imp
Town of Barnstable
P.O. Box 534
Hyannis, Massachusetts 02601
This is on important legal document. It may affect your rights.
You may obtain a translation of this form at the Town Office.
ARTICLE II
STATE SANITARY CODE
Address: . . . . . . f,..f i,C1. . . ..!,S ae Ze r. . . . .R.2,N A/ !ill. . . . . . . . . . . . . . . . No. Occupants . . . . . . . . . . . .
Occupant: . . . .k./ . . . . . . . . ANC f->. . . . . . : . ... . . . . . Floor: . . . . . . . . Apt. No. . . . . . . . .
s No. Dwelling Units: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. Rooming Units: . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . .
No. Stories: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Basement: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \. . . . . . . . . .
Type Structure: . . . . . . . . . . . . Frame: . . . . . . . . . . . . Brick: . . . . . . . . . . . . Semidetached: . . . . . . . . . . . . Detached: . . . . . . . . . . . .
No. of Habitable Rooms: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. of Sleeping Rooms: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Owner: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
t
i X=VIOLATIONS
REGULATION LIVING ROOM YES NO
7.1(o) Is there sufficient natural light?
7.1(b) Are there two separate electrical outlets in good repair?
7.1(b) Is there one outlet and one light fixture in good repair?
8.11A,8.1B(e) Is there proper ventilation?
13.1A Are the windows in good repair, weathertight and fit for the use intended?
13.1 Are the walls in good repair and fit for the use intended?
13.1 Are the ceilings in good repair and fit for the use intended?
13.1 Are the floors in good repair and fit for the use intended?
14.5 Are the exterior openings screened?
REGULATION SLEEPING ROOM #1 (identify)
7.1(a) Is there sufficient natural light? 1
7.1(b) Are there two separate electrical outlets inff'good repair?
7.1(b Is there one outlet and one light fixture in good repair?
8.1 A,8.1 B(e) Is there proper ventilation?
13.1A Are the windows in good repair, weathertight and fit for the use intended?
13.1 Are the walls in good repair and fit for the use intended?
13.1 Are the ceilings in good repair and.fit for the use intended?
13.1 Are the floors in good repair and fit for the use intended?
14.5 Are all exterior openings screened?
11 Is there adequate space for the number of occupants?
REGULATION SLEEPING ROOM #2 (identify) n 0-RA
7.1 (a) Is there sufficient natural light?
7.1 (b) Are there two separate electrical outlets in good repair?
7.1 (b) Is there one outlet and one light fixture in good repair?
8.1 A, 8.1 B(e) Is there proper ventilation?
13.1 A Are the windows in good repair, weathertight and fit for the use intended?
13.1 Are the walls in good repair and fit for the use intended? _
13.1 Are the ceilings in good repair and fit for the use intended?
13.1 Are the floors in good repair and fit for the use intended?
14.5 Are all exterior openings screened? ��,,
11 Is there adequate space for the number of occupants?
REGULATION BATHROOM
3.1A(a)3.1B(a) Is toilet with seat available?
3.1A(b)3.113(b) Is washbasin available?
3.1A(c)3.1B(c) Is shower or bathtub available?
3.1D 3.2 Are the facilities.in a clean, smooth, impervious and sanitary condition?
4.1 (9.1 &9.2). Is cold water for facilities available (with sufficient quantity)?
5.1 (9.1 &9.2) Is hot water for.facilities available (120 F- 140 F)?
9.1 &9.2 Are the facilities properly connected to drain line?
7.3&9.3 Is there at least one light fixture in good repair?
7.4& 9.3 Is there an electrical outlet in good repair at washbasin?
13.1 &13.1A Are the windows in good repair, weathertight and fit for the use intended?
13.1 Are the doors in good repair and fit for the. use intended?
13.1 &13.6 Are the walls in good repair and fit for the use intended?
13.1 & 13.6 Are the floors in good repair and fit for the use intended? �
8.1 A&8.1 B % Is there proper ventilation?
13.6 Are the floors and walls of nonabsorbent material? 7�
14.5 Are the exterior openings properly screened? �
X=VIOLATIONS
,.REGULATION KITCHEN YES NO
cs 2.1 Is the room suitable? _
2.1(a) Is the sink available and of sufficient size and capacity?
_
4.1(9.1 &9.2) Is cold water for the sink available (with sufficient quantity and pressure)?
5.1(9.1 &9.2) Is hot water for sink available (120 F- 140 F)?
9.1 &9.2 Is sink properly connected to drain lines?
2.1(b) Is there a working stove and oven?
9.3 Is the stove and oven properly connected and vented?
2.2 Are the facilities clean, smooth, impervious, nonabsorbent?
7.2(a) Is there one light fixture in good repair?
7.2(b) Are there two electrical outlets in good repair?
7.2(c) Are the windows(if kitchen exceeds 70 sq.ft.)equal to at least 10% of the floor area?
_13.1 & 13.1A Are the windows in good repair, weathertight and fit for the use intended?
14.5 Are the exterior openings properly screened?
13.1 Are the doors in good repair and fit for the use intended?
13.1 Are the walls in good repair and fit for the use intended?
13.1 Are the ceilings in good repair and fit for the use intended?
13.1 Are the floors in good repair and fit for the use intended?
13.6 Is the floor impervious and easily cleanable?
2.1(c) Is there adequate space and facilities for installing of Refrigerator?
8.1A,8.1B(a) Is there sufficient ventilation?
9.3(a)9.3(b) Are all owner installed appliances properly installed?
9.4 Are all occupant installed appliances properly installed?
REGULATIONS COMMON AREA AND EXITS
7.5 Are interior common areas properly illuminated at all times?
7.7 Are there operational and sufficient and properly located light switches and fixtures?
13.1A Are the windows in good repair, weathertight and fit for the use intended?
13.1E Are the doors in good repair, weathertight and fit for the use intended?
14.5 Are all doors screened as required? -h � Av.,s._raI. V
13.1 Are the ceilings in good repair and fit for the use intended? r �
13.1 Are the walls in good repair and'fit for the use intended? '
13.1 Are the floors in good repair and fit for the use intended?
15.8& 15.9 Are all common areas clean?
13.1 Are the stairways in good repair and fit for the use intended?
13.3& 13.4 Are handrails in good repair and fit for the use intended?
13.5 Are all required balusters or other devices in place?
18.4 Is every entry door of a dwelling unit fitted with a proper lock? (S TiC�<f�,
18.3 Does the main entry door of a dwelling close and lock automatically? A o_14A
18.6 Is the building properly posted with the name of owner? 2z
3.2 _ Are the common bathroom facilities clean? -
12.1 & 12.2 Are there sufficient and properly maintained exits?
REGULATIONS EXTERIOR
Are light fixtures and switches properly located?
13.1 Is the chimney in good repair?
13.1 Are the porches in good repair?
13.1 Is the foundation in good repair?
13.1 Are the stairs in good repair?
13.1 Are the structural elements in good repair?
13.3, 13.4& 13.5 Are all required hand railings and balusters in place and in good repair?
13.4 Are there walls or protective railings as required?
15.4 Is the storage of rubbish and garbage proper (occupants)?
15.3 Are there, sufficient and properly located receptacles?
15.10 Are the private passageways or rights of way clean and sanitary?
13.1 Are the gutters and down spouts in good repair and fit for the use intended?
REGULATIONS GENERAL
10.1 Are all required services available and working?
6.1 Are the heating facilities in good repair?
6.2 Is heat being supplied at proper temperatures. (68 F-78 F)?
5.1 Are hot water heating facilities in good repair?
9.3(a) Are all required facilities properly installed and vented?
6.5 All space heaters in use meet the proper requirements?
7.9 Is there no temporary wiring in use? Location?
7.8 Is the electrical service safe and adequate?
14.1, 14.2 & 14.3 The dwelling is free of insect rodent presence?
15.7 Is the dwelling unit maintained in a clean and sanitary condition by the occupants?
REGULATION OTHER
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 RReejguulatidnn 29.2 of the code or the Authorized Inspector. �� A.M.
C_,�, �i rn�Jl>rAs� P.M.
INSPECTOR c TITLE
i A.M.
10 , y S (--P.M)
DATE �/ 'J TIME
THE NEXT SCHEDULED REINSPECTION IS: DATE TIME